The decline of a venerable institution says a lot about the state of medicine.
A few years back, internist Eugene Ogrod was walking along the bridge that connected his office building to the hospital when he bumped into a surgeon to whom he regularly referred patients.
"We chatted and realized that we hadn't seen each other for more than three years," says Ogrod, who practiced at that time in Sacramento. "And our offices are in the same building."
There was a time when these two doctors probably would've crossed paths in the doctors' lounge of their hospital. But these days, all across America, sometimes the only people in this room are CNN newscasters on the overhead television set.
It's not surprising that physicians cite hectic schedules and the advent of the hospitalist-who eliminates the need for admitting clinicians to make rounds-as the major reasons for not spending more face time with their colleagues in the now-lonely lounge. Yet many other trends in healthcare conspire to weaken a symbol of a profession's collegiality and leave doctors more isolated.
"The empty lounge," says Eugene Ogrod, "is a sign of the times."
What does this mean to you-and, as just as importantly, to your patients? We surveyed your fellow physicians informally to find out.
No-shows, fly-throughs, and e-mail checkers
The phenomenon that has most directly depopulated the doctors' lounge is the growth of the hospitalist movement, which boasts an estimated 10,000 to 12,000 members, according to the Society of Hospital Medicine. "Now that I use a hospitalist, I almost never go to the hospital," says internist Howard Grayson Jr. in Southington, CT.
At Mercy Medical Group, owned by two St. Louis area hospitals that comprise St. John's Mercy Health Care, 90 percent of its 150 primary care doctors use hospitalists, says internist Paul Hintze, vice president of medical affairs for St. John's. As a result, these doctors tend not to visit the hospital. "Professional isolation is a problem for them," says Hintze.
Even when employed doctors do come to the hospital, they tend to steer clear of the lounge, notes FP Steve Kamajian in Montrose, CA. Because they're not self-employed entrepreneurs, they see no need to network, says Kamajian. "They want to get in and out fast."
Then again, in the managed care era, it's less important to network, notes retired Dallas radiation oncologist Dale Fuller. "There's been a change in the way doctors obtain referrals," he says. "Doctors once used the lounge as a place to schmooze and get known, especially when they were starting out. Not much of that is going on anymore. Referring doctors no longer have the latitude to pick from among the best and brightest of their colleagues. Now they must choose someone from the patient's managed care network."
The centrality of the hospital and its lounge has diminished in another important way-surgical specialists increasingly make their living elsewhere. "I perform most of my operations in a freestanding ambulatory surgical center where camaraderie has largely disappeared," says ophthalmologist Peter Menger in Glendale, NY.
In addition to decrying empty lounges, doctors speak of lounges that are occupied but less collegial. "The socialization has decreased," says physical medicine and rehabilitation specialist Rahma Mustapha in Valatie, NY. "Many of the doctors are glued to the computer. We didn't have computers in the lounge 10 years ago."