Family Physicians' Attitudes Toward Inpatient Care in North Carolina: 2001

Over the past several years, the number of physicians practicing as hospitalists or using hospitalists to care for their inpatients has grown. The use of hospitalists departs from a more traditional model of practice in the U.S. in which primary care doctors care for their patients in both the inpatient and outpatient settings. Hospitalists pose a special challenge for family physicians as the majority ofhospitalists are internists or subspecialists. Historically, the discipline of family practice in part grew out of a concern for maintaining hospital privileges, a tradition potentially threatened by the growth ofhospitalists. Prior research has shown that practice setting and personal characteristics influence whether or not physicians practice inpatient medicine. This paper begins to look at whether or not attitudes toward hospital care influence whether or not physicians practice inpatient medicine. Using 2001 survey data from a random sample of practicing family physicians in North Carolina, this paper describes current self-reported practice and personal characteristics of these physicians as well as examines their attitudes toward hospital care. In 2001, 66% of family practitioners in North Carolina provide inpatient care and 11% practice obstetrics. While 16% of family practitioners work as rotating hospitalists, only 1% work as full-time hospitalists. There are differences in attitudes toward hospital care between physicians who care for hospitalized patients and those who do not. There are some smaller differences in attitudes between physicians who care for their own patients in the hospital and those who work as rotating hospitalists. The results of bivariate analysis suggest that attitudes, the practice of obstetrics, hospital size and post-graduate year less than 25 are positively associated with providing hospital care. In multivariate logistic regression models, attitudes toward hospital care, hospital size and post-graduate year less than 25 are positively associated with providing inpatient care. The results of this study, other published literature, and the growth of the use ofhospitalists have potential effects on the role family physicians play in caring for hospitalized patients. In addition, there are implications for the future training of family physicians, care of their patients, and research in the discipline.Master of Public Healt