MidlevelWTF is a bit late to the party with this communiqué by Dwayne Gard, MD, the Sound Physicians Chief Hospitalist for the Adult Hospital Medicine program at Memorial Health University Medical Center in Savannah, Georgia, already circulating widely on social media. Nevertheless, the dire implications of the policy it describes (having midlevel non-physician providers such as nurse practitioners and physician assistants act as the primary provider for a subset of patients) must be publicized. For those not in the know, MUMC is a large 622-bed hospital and Level I trauma center in Savannah, Georgia, and serves as a major teaching affiliate of the Mercer University School of Medicine. It hosts a number of medical residency programs, including internal medicine, family medicine, pediatrics, radiology, surgery, and more.
Dr. Gard proclaims that this "restructuring" of the hospitalist practice model at MUMC is all about maintaining excellent care. But reading between the lines, it's clear that this new policy of letting midlevels run amok as the primary provider for certain patients is the very antithesis of maintaining excellent care, which, by definition, means physician-led and physician-supervised care. To frame things more concretely: can you imagine being admitted to the hospital, and never getting to see an actual physician during your stay? Because that is exactly what this new policy implies. Indeed, there's no mention at all that a hospitalist physician will be rounding on the midlevel patients. Instead, the midlevels will merely be "discussing" the patients with a physician. And don't let hipster terminology like "dyad" and the doublespeak of "a collaborative model of care" pull the wool over your eyes. When questions regarding these patients are to be directed to the midlevel PA or NP "rather than the physician", it's clear which group of people Sound Physicians wants to be running the show. Perhaps Sound Physicians should consider rebranding themselves as Sound Midlevels?