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The Hospitalist Program in the Section of Hospital Medicine provides several clinical services. Faculty rotate on the services in 4 week blocks.


SENIOR MEDICINE ROTATION


The unique team structure is a streamlined unit, incorporating a hospitalist attending, 2 Sr. Med PA's, two third-year residents, and up to two fourth-year medical student sub-interns. A hospitalist psychiatry attending also works closely with resident teams either by joining daily rounds or by providing timely psychiatric consultations to those patients with psychiatric co-morbidities. There are no interns or third-year medical student clerks on the service, allowing the focus of teaching to remain at the senior resident level. Given the team structure and the nature of the hospitalists' role in the hospital, residents are afforded the opportunity to interact more closely with their supervising attendings than in traditional general medicine rotations. Without an intern, residents manage their patients more as a private attending would manage patients in an “off-service” setting. This is intended to provide a higher degree of ownership of the patients.

HOSPITALIST SERVICE


The “Hospitalist Service” or the "PA service" is the non-teaching service and comprises the core of the Hospitalist Program's clinical activity. Each team consists of an attending and a physician assistant. Assignment of attendings and PA's is on a rotational basis at the discretion of the Medical Director. Physician assistants are expected to assist the primary attending in almost all aspects of clinical care, including direct patient care, family interactions, interdisciplinary team mobilization, documentation, dictations, etc. The only aspect that PA's cannot assist in is physician billing. All notes and orders written by the PA's require an attending co-signature. Attendings are ultimately responsible for their patients' medical care and disposition, including documentation and billing. Each attending is also expected to take an active role in the clinical development of the PA's while working with them. When the pace of clinical activities allows, There is no predetermined service size cap. However, each team is expected to be able to manage a service of about 12 patients.

MEDICAL CONSULT ROTATION


A hospitalist attending teaches and supervises the medical consultation service. The attending also helps facilitate the transfer of patients from nonmedical services to medicine when appropriate. Four senior resident rotate on this service per block. Attending rounds occur daily - usually in the early afternoon. Senior residents perform general medical consults as well as comprehensive perioperative risk assessments. They are called upon to consult upon patients on a wide variety of services, orthopedics, neurosurgery, psychiatry, OBGYN, Rehabilitation medicine, etc. Residents learn how to interact with and effectively communicate with other clinical services. They also learn to provide outstanding and efficient care to medically ill patients on non- medical services.

GENERAL MEDICINE ROTATION


A Hospitalist Attending teaches and supervises on one of the traditional General Medicine housestaff teams throughout the year. Each team takes advantage of the "two-attending system" by pairing attendings from complimentary backgrounds. A generalist and a sub-specialist are usually paired together on the Gen Med service The Gen Med II service has the unique feature of having dedicated time during rounds with a "third" attending from the Hepatology/Liver Transplant service.