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Hospital patients are safe with surrogate doctors

(Reuters Health) – Survivorship rates for hospital patients do not suffer when substitute doctors replace regular doctors, suggests a US study. UU

Patients were no more likely to die within 30 days of their arrival at the hospital when they were treated by the so-called locum tenens doctors, who temporarily replaced the staff physicians, the researchers found.

The hospital dependence of locum tenens physicians has increased in recent years, driven in part by the shortage of regional doctors and by the increased demand for care by patients who recently obtained insurance.

Researchers examined data on more than 1.8 million Medicare beneficiaries hospitalized between 2009 and 2014 and found that 8.8 percent of patients treated by locum tenens doctors died within 30 days of admission In the hospital, as did 8.7 percent of patients who had doctors. The difference was too small to rule out the possibility that it was due to chance.

"Our work indicates that locum tenens doctors who treat hospitalized patients for the treatment of general medical conditions provide quality care equivalent to non-locum tenens doctors," said the study's lead author, Dr. Daniel Blumenthal, from Massachusetts General Hospital and Harvard Medical. School in Boston.

"While it is unlikely that patients will come to know whether or not their doctor was a substitute physician, our work indicates that patients should not worry about whether their doctor is a hidden doctor or not," Blumenthal said by email .

Locum tenens physicians generally have no prior relationship with their patients, are not familiar with the local community and may never have worked with the hospital's electronic health record system, hospital staff or the network Local facilities where patients can be discharged after hospitalization, the researchers said.

Overall, about 38,000 patients in the study, or approximately 2 percent, were treated by locum tenens doctors, researchers at JAMA report.

A little over 9 percent of all general internists in the study had a doctor's coverage of locum tenens for them at some point.

Patients were hospitalized for a variety of reasons usually handled by general internists in hospitals such as pneumonia, kidney infections, lung disease and gastrointestinal disorders.

There were no significant differences in patient characteristics, including the reason for admission or other medical conditions, among those attended by staff physicians and surrogate physicians.

However, there were some small but statistically significant differences in other measures. Patients treated by surrogate doctors had a somewhat higher expense and slightly longer hospitalizations.

Patients treated by locum tenens doctors had a total average cost of $ 1,836, compared to $ 1,712 for patients seen by staff physicians, the study found.

With the locum tenens physicians, the patients stayed in the hospital an average of 6.64 days, compared to 5.21 days for the plant doctors.

Re-admissions, or repeated hospitalizations, occurred for approximately 23 percent of patients with locum tenens physicians, compared with 24 percent for staff physicians.

The study was not a controlled experiment designed to test whether the working status of physicians could influence patient outcomes or how they would do so.

"I suspect that most would hypothesize that the results would be significantly worse for locum tenens physicians compared to on-site physicians, since the locum tenens documents are not as familiar with the hospital, local practices and policies, and how to do things locally, "said Dr. Karl Bilimoria, director of the Center for Surgical Outcomes and Quality Improvement at the Feinberg School of Medicine at Northwestern University in Chicago.

"Therefore, this study provides findings that may be contradictory for many people," Bilimoria said by email.

Because Medicare requires locum tenens doctors to provide at least 60 days of coverage, however, these doctors may be reasonably familiar with the practices and culture of the hospitals where they are completed, Bilimoria said. The results of this study do not offer an idea of ​​the results for doctors who only substitute one day or a week at a time, he noted.

It is also possible that there are subtle differences in the results that the study did not detect.

"But just because patients did not die more often under the care of locum tenens documents, does not mean that their specific results of the disease are the same," Bilimoria added. "There may be more nuanced results that could show a difference."

SOURCE: bit.ly/2Ax83MB JAMA, online on December 5, 2017.

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