The hospitalist system is emerging as an alternative to cope with reduced working hours of medical residents and improving their training their environment after the government implemented the Special Law on Medical Residents. It has been 10 months since the government entered a pilot program, but the system is not in place yet because of the applicants’ concerns about their insecure status as contract workers.
Study after study indicates, however, the hospitalist system is making a great contribution to reducing hospitalization period and making up for the void of treatment resulting from the shortage of medical workforce, stressing the need to establish the system at an early date.
What is needed most to make the system take root in Korea as soon as possible then?
Lee Hyun-jung이현정, a hospitalist at Seoul National University Hospital (SNUH)서울대병원, cited her hospital’s provision of vision that guarantees the autonomy of work.
“The advantage of the hospitalist system as operated by SNUH is to ensure independence,” Lee said. “When patients are hospitalized, we don’t receive orders from other departments but take care of them at our risks as an independent department.”
If there are problems with patients requiring cooperation with other departments, the hospitalists ask for co-treatment on an equal footing, she added.
“There are negative views that regard hospitalists as just alternatives for labor force shortage, but SNUH has solved the problem by offering a vision based on occupational self-reliance,” Lee said. “What has made it possible were sufficient preparations and discussions within the hospital in advance.”
“It remains to be seen, but the most important thing to reinvigorate the hospitalist system is to secure autonomy and show visions,” Lee went on to say. “If such a vision remains at the level of substituting the job of medical residents, it will be hard to find many applicants no matter high the salaries may be.”
A professor at Seoul National University Bundang Hospital (SNUBH) stressed the importance of staff relationship.
“After all, it is people that are most important for revitalizing the hospitalist system,” the professor said. “It is crucial motivated people get together, form good teamwork and create an environment, in which they consider and cooperate with one another.”
“What’s needed is to apply new systems, examine their problems and improve them. By repeating this process endlessly, all constituents need to rack their brains together to attain their ultimate goal of ensuring patient safety and improving the quality of healthcare,” the professor said. “Hospitals, too, should not spare support toward that end.”
Professor Jang Sung-in장성인 at Yonsei University College of Medicine pointed to the need to provide additional insurance benefits to energize the hospitalist system.
Aside from the basic premise of expanding human resources pool for invigorating the hospitalist system, the issues of payment and delivery systems need to be solved, Professor Jang noted.
“Few doctors apply to work at provincial hospitals even though they can receive higher salaries there, forcing hospitals to raise their wages even further, risking greater financial burdens,” Jang said. “The government, however, should not let hospitals shoulder all these burdens. In the case of the United States, they set insurance benefits by taking regional labor costs into account. We need to consider following their example.”
Jang also asked hospitals to take part in the system more actively.
“The government is leaving the preparations for operating the hospitalist system to hospitals, resulting in wide gaps not only among hospitals but even within hospitals,” he said. “Some departments just end up placing wanted ads while there are those in which department heads and professor come forth to explain the system and check applicants. Results can vary widely depending on how actively people responsible for the system do their jobs.”
Yet others emphasize the need for conducting researches to establish a system that suits the nation’s healthcare reality.
“The U.S. has been implementing the hospitalist system for more than two decades, but hospitals show differences in their systems,” said You Chul-kyu유철규, head of the Korean Association of Internal Medicine(KAIM)대한내과학회, “We also need to conduct researches by improving problems and discussing future direction based on experiences of hospitalists. If we can develop a system that fits our reality, we will be able to invigorate and stabilize the system at an earlier date.”
Some hospitals are trying to revitalize the system by shifting the status of part-time workers to that of full-time workers.
SNUBH has guaranteed job security of hospitalists by recognizing them as the tenure track, while Chungbuk National University Hospital충북대병원 has decided to change a part of hospitalists to full-time workers.
KAIM is also seeking ways to invigorate the system.
The association unveiled its plan at the “First hospitalist workshop” held at Grand Hilton Hotel in Seoul Monday.
“We will discuss how to revitalize and institutionalize the hospitalist system by forming a consultative body with the Ministry of Health and Welfare (MOHW)보건복지부,” said Kang Hyun-jae 강현재, a director of the association. “We will make a standing committee and select the representative of the department of internal medicine to take part in the panel.”
The association plans to work out educational certification programs. It will also provide chances to make a necessary system and a team to take care of patients, and prepare for programs to get the latest medical knowledge and researches, providing a basis to grow into an independent field, Kang said.
Also, the association will promote the hospitalist system, operate education programs for medical residents, and support registration and management of the hospitalist system.
Dr. Ahn Soo-jong안수종 at AMC, a specialist elected as the representative of hospitalists at the internal medicine department, said he would reinvigorate the meetings of hospitalists to help improve the system.
“It is true many hospitalists have concerns about their status of contract workers being turned into long fellowship. To dispel such concerns, incumbent hospitalists will get together and discuss how to improve and develop the system,” Ahn said. “I will do whatever I can to help the system take root in stable ways.”
“Currently, insurance benefits concerning hospitalization are limited to those related to admission, but we need to introduce diverse benefits, including those related to supersonic diagnosis,” he said. “Only when there are more various benefits, hospitals will increase hospitalists, helping to stabilize the system at an early date. I will do my best together with the association.”
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