10 things to know about hospitalists

This year marks the 20th anniversary of the title "hospitalist," or physicians whose work centers around a location of care — the hospital — rather than a disease, patient type or organ. Here are 10 things to know about the role and how it has evolved over the past two decades.

1. The term "hospitalist" was coined in 1996 by Robert Wachter, MD, and Lee Goldman, MD, in an article for The New England Journal of Medicine, as the specialty was just beginning to emerge. The American Hospital Association did not begin tracking the field until 2003, however.

2. Today there are more than 50,000 hospitalists in the U.S., according to AHA data cited by Drs. Wachter and Goldman in a recent article published for NEJM. This means the specialty is now comparable in size to pediatrics, which has 55,000 physicians. Now about three in four hospitals have hospitalists on staff.

3. Drs. Wachter and Goldman attribute this marked growth to a combination of factors: "a viable financial framework, a pool of qualified physicians and enough force to overcome resistance to change." They also credit an increase in emergency admissions, low remuneration for nonprocedural inpatient care and the quality, patient-safety and value trends. These factors helped general internists find a place in salaried hospital positions and as staff for nonteaching services in academic medical centers.

4. The growing scope and impact of the profession paved the way for CMS to approve a billing code for hospitalists in May. Before this dedicated specialty billing code was created, hospitalists had to benchmark improvement efforts based on performance of internal medicine physicians or other related specialties.

5. Most of the profession is concentrated in internal medicine, but hospitalists also practice across a host of other specialties. According to Medscape, 39 percent of hospitalists specialize in internal medicine. Following that, hospitalists are predominant in pediatrics (11 percent), psychiatry (11 percent), family medicine (8 percent), obstetrics and gynecology (4 percent) and anesthesiology (4 percent). Smaller numbers practice in neurology, critical care and emergency medicine.  

6. Hospitalists on average make about $4,400 less than their non-hospitalist physician counterparts, according to Medscape data. However, this differential is largely due to disparities in pay amongst hospitalist and non-hospitalist providers in emergency medicine, anesthesiology and critical care. The most common type of hospitalist — internal medicine — makes an average of $243,000 annually, which is $32,000 more than their non-hospitalist physician counterparts.

7. Some studies show hospitalists can reduce costs and shorten lengths of stay while preserving or improving quality of care and patient satisfaction. In their August 10 perspective for NEJM, Drs. Wachter and Goldman point to two studies in particular that they helped author. The first, published by JAMA, showed "a reorganized academic medical service, led by faculty members who attended more often and became involved earlier and more intensively," helped AMCs cut costs without sacrificing clinical outcomes or patient, faculty and staff satisfaction. The second study, published by Annals of Internal Medicine, found that hospitalists reduced length of stay and costs after just two years at a community-based teaching hospital.

8. Despite these benefits, hospitalist medicine presents inherent challenges to the patient, according to a dissenting opinion also published by NEJM on August 10. In particular, adding another physician into the mix can complicate communication and coordination, and may not provide extra care where patients need it most — in preventive health, Richard Gunderman, MD, PhD, wrote. Hospitalists may also have difficulty connecting to patients because they work exclusively in the hospital. "From the patient's point of view, it can be highly disconcerting to discover that the physician who knows you best will not even see you at your moment of greatest need — when you are in the hospital, facing serious illness or injury," Dr. Gunderman wrote.

9. The architecture of the specialty also stunts physicians, according to Dr. Gunderman. It is a young profession, so many who choose to focus solely on inpatient medicine will not have the opportunity to understand patients' lives in their communities, he contends. This siloed approach also creates a communication barrier between physicians inside and outside of the hospital, and between the hospital and the community.

10. Good or bad, the growing field will continue to adjust to the changing needs of the healthcare system. Drs. Wachter and Goldman suggest this transformation is already happening. For example, some hospitalists are beginning to follow patients to post-acute care facilities, while others are creating subgroups called "comprehensivists" who attend to only the highest-risk patients both inside and outside of the hospital.


More articles on integration and physician issues:

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Alaska high school opens teen health clinic

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