Family Medicine Job Description/Duties — Inpatient
Family Medicine Hospitalist Job Description (DW/NF/*Doc)
Family medicine inpatient services are covered by two Day Ward (DW) physicians from 8 a.m. – 6 p.m. and a single night float (NF) physician overnight from 6 p.m. – 8 a.m. The DW physicians also alternate daily as “back up night call” for the night float physician, carrying the daytime CODE beeper and backing up the ED as requested by the ED attending.
Family medicine hospitalists provide 24/7 inpatient services that include pediatric and adult admissions; OB and newborn care (*link to OB & Newborn Section); urgent and emergency radio medical traffic *link to urgent and emergency RMT* consultation for Health Aides and Subregional Clinic providers; going on Medevacs for pre-term labor (and rarely other severe situations); helping in the ER as able; activating village to Bethel Medevacs as needed, providing back up “call” for nights, and evening - weekend etc. call.
DW schedules are generally made up of seven 10-hour shifts Monday through Sunday with an additional Monday ‘admin’ (AD Ward) shift that overlaps with the two new oncoming DW physicians. This day is used to provide comprehensive transition of care for all patients remaining on service. This day is focused on completing discharges of appropriate patients, updating problem lists, finishing up all documentation, making referrals and ensuring all patients on service get excellent care and sign out to the oncoming DW docs. The AD Ward doc is also expected to help out in the afternoon with regular clinic RMT, the ER, clinic or wherever needed, as they are able and as directed by the chief-of-staff or their designee (CD on-call).
NF shifts are 14 hours and are usually scheduled 3-4 consecutive shifts at a time as they are long hard shifts.
Sign-out occurs, in person, between DW docs and the NF doc at 6 p.m. and 8 a.m. on the North Wing unit. The NF and DW physicians are responsible for having the OB/Inpatient Patient List (sign-out sheet) updated for each sign-out.
DW physicians (and Peds) are required to attend a multidisciplinary discharge planning meeting every when scheduled by the Inpatient Case Manager. Each inpatient physician presents their patients that have not been discharged that day, so it takes only 5-20 minutes depending on the complexity of the patients and the follow-up care and planning they need.
There are hospital meetings: throughout the week/month that DW physicians are encouraged, but not required to attend if patient care is pressing. *link to meeting schedule*. Grand Rounds on Tues from 8-9 a.m. and Hospital Clinical Rounds on Thursday from 8-9 a.m. are highly recommended. These meetings can be easier to attend even with a busy service if you plan and use them as a time to complete notes/orders on your RAVEN laptop.
Family Medicine Hospitalist Duties
Northwing Inpatients: admit and care for adults, non-chronic peds, and behavioral health patients.
OB/Newborn Unit: triage, admit, assess for induction and manage labor with vaginal deliveries and postpartum care for OB patients. Admit and manage care for uncomplicated babies delivered in OB unit. link to OB & Newborn Section
Urgent and Emergency Radio Medical Traffic (RMT): Consultation is done via EMR and telephone with village community health aides (CHAs) and SRC PA/NP providers for patients requiring urgent or emergent care and/or transport. Telemedicine patient pictures and EKGs are available on AFCHAN link to AFCHAN and AFCHAN billing procedure. There are also three video conferencing telephones, one each, located in FM, Peds and ER offices for evaluating patients real time with the health aides and SRC providers.
Responding to admission requests: from the ER, clinic, and at times direct admit requests as appropriate from ANMC, sub-regional clinics, and other entities.
Backing up the ER and clinic as appropriate: (see night float specific priorities and wards weekend duties)
Going on a medevac: (rarely) for evaluation of either preterm labor or complicated and emergent term labor link to Preterm Labor in the Village: FM Orientation and Delivery in the Village: Peds Orientation or other emergencies that medevac crew might need assistance with.
All other duties: as the chief-of-staff or designee (CD on-call) might request
Yukon and Kusko Service Division
Patient responsibilities for North Wing/Obstetric and RMT patients are generally divided up by village of origin (see below) with equal populations in each.
Yukon Service
Atmautluak
Chefornak
Eek
Kasigluk
Kipnuk
Kongiganak
Kwigillingok
Marshall
Mekoryuk
Mountain Village
Napakiak
Napaskiak
Newtok
Nightmute
Nunapitchuk
Oscarville
Pilot Station
Pitka’s Point
Quinhagak
St. Marys*
Toksook Bay*
Tuntutuliak
Tununak
Kusko Service
Akiachak
Akiak
Alakanak
Aniak*
Anvik
Chevak
Chuathbaluk
Crooked Creek
Emmonak*
Grayling
Holy Cross
Hooper Bay*
Kotlik
Kwethluk
Lower Kalskag
Nunam Iqua
Red Devil
Russian Mission
Scammon Bay
Shageluk
Sleetmute
Stony River
Tuluksak
Upper Kalskag
*Sub-regional clinic
Bethel patients are generally proportioned out to the less busy service. When one service is extremely busy, it may be appropriate to pick up an occasional non-service patient in order to help out.
Emergency back-up call (star doc) is assigned to the Wards Doc every other night and is intended only for EXTREME situations. Only the Night Float, CD-on call or Chief-of-Staff can request that the Wards Doc come in to cover. The most typical situation for being called in would be when there is a laboring preterm patient in a village who requires a physician’s sterile vaginal exam (accompanied by the pediatrician on-call) to determine safety of air transport back to Bethel vs delivery in the village. Although it is customary for the star-doc to go on the medevac, either can go, but the star-doc gets the final say. Additionally, if there are no immediate hospital needs, the star-doc could opt to take emergency RMT from home while the Night Float goes on the medevac). Other appropriate reasons for being called in would be the inability of the ER attending to fulfill his/her duties or a mass casualty or other settings of multiple traumas /resuscitations.
Under no circumstances should the star-doc be used as a “convenience” for a backed up ER waiting room or to otherwise help move patients more quickly through the ER.
Pediatric Hospitalist Job Description (PEDS/CALL)
A hospitalist pediatrician is available on the inpatient unit or “in house” 8 a.m.–5 p.m. M-F. There is also an “on call” pediatrician after hours and on weekends that round on and take care of all “pediatric service patients.” The on call pediatrician is available for consultation or to come in as needed to the inpatient unit, OB, ER or to go on an OB medevac if needed. The pediatricians admit all Chronic Pediatric Patients (chronically ill or complex care patients-CPP) link to CPP Definition, do radio medical traffic for all CPP patients, attend C-sections/high risk deliveries, stabilize/transport out sick neonates and critical pediatric patients and they go with a family medicine physician on Medevacs for preterm/high risk village deliveries.
The pediatricians “on call” are available 24/7 for consultation for ER, urgent care, clinic, village, inpatient and OB providers.
Peds Hospitalist Duties
- Admit, discharge and care for all CPP and selected family medicine pediatric patients
- Cover RMT for all CPP patients (and emergency peds patients when requested by family medicine).
- Provide consultation for the ER/OB/FM providers link to pediatric consultations
- Obtain ANMC patient discharge information and specialty dictations from AFCHAN. Arrange needed f/u, update problem list and forward to appropriate CM and pediatrician/s needed patient information or requests.
- Assist the peds CM with urgent care management referrals and issues for inpatients and other CPP patients as needed.
- Provide CPP CM liaison between primary peds, YKHC pediatric CM and outside specialists for issues that arise or are picked up on RMT (as able).
- Resuscitate/stabilize /transfer sick newborns and pediatric patients and
- Provide village to Bethel medevac medical control assistance when the ER is too busy or not comfortable with the patient.
Link to Pediatric Consults: both formal consultation requests and “quick questions” occur throughout the day. When doing pediatric consults, please use and refer to the YKHC guidelines whenever availableand appropriate. It is important to be consistent in pediatric consult recommendations. If a patient is complex, not straight forward, or you are not sure what to do—check with a more experienced pediatrician. When an official consult is requested, talk with the provider requesting the consult and ascertain whether you are being asked to assume care of the patient or if they are truly asking for a consult only. The most common pediatric consult requests are for murmurs or congenital anomalies of the newborn. If there is a sick newborn in the nursery who will need care and transport, it can be done by the FM doc if they have time, are comfortable doing it and can get advice and direction from a pediatrician. BUT if the FM physician is uncomfortable caring for the baby and setting up the transport or if the baby is unstable then the pediatrician should assume care of the patient. If you are acting solely as the consulting physician, do not write orders on the patient unless specifically asked to do so by the primary provider. Be sure to make the patient/family aware that ‘their doctor is in charge’ and that you are their consultant only. Work to instill confidence in their Family Physician.
When performing any formal consult, make sure that an order is placed for this consultation (for billing purposes). Make sure and write a consult history and physical-type note (for communication and billing purposes) with your full assessment and recommendations.
