The inpatient beds at hospitals across the U.S. are filling up and in many regions, the surge is not slowing down.
Adult inpatient discharges are expected to increase 10% through 2035, according to Sg2. By 2035, the U.S. could see 176 million inpatient days annually — a figure that would strain even well-resourced systems. Data from the University of California suggests more than 75% of inpatient beds are already occupied, a share projected to climb to around 85%.
Ebrahim Barkoudah, MD, the inaugural chief of the division of hospital medicine at UT Southwestern Medical Center in Dallas — a role that puts him at the intersection of academic medicine, safety-net care and community health. His division spans four sites: Clements University Hospital, the academic flagship; Parkland Memorial Hospital, one of the country’s largest safety-net systems; Texas Health Frisco, a community hospital; and the VA. Across that breadth, he watches the same pressure building.
“Our patients are waiting,” Dr. Barkoudah said in an interview with the “Becker’s Healthcare Podcast.” “We need to get our patients faster to the right bed, to the right physician or clinician, and to the right service.”
Growth in ambulatory surgeries, hospital-at-home models and post-acute care options addresses real gaps but does not offset the overall inpatient trajectory. Sg2 data suggests post-acute volume will increase and could shift to home settings; even that shift doesn’t change the fact that likely inpatient demand will continue to outpace beds available and strain hospitals as clinicians juggle patients with complex health conditions and emergencies.
Emergency department crowding has become severe enough that ambulances are sometimes unable to offload patients, which Dr. Barkoudah’s colleagues in emergency medicine call “holding the wall.”
Dr. Barkoudah’s response to the pressure is built around three priorities:
- Operational AI — not diagnostics-focused tools, but systems that improve triage, optimize throughput and give clinical teams real-time data on where strain is developing.
- Integration across care settings: pathways that move patients efficiently across hospital, community and home rather than treating each as a separate operation.
- Longer-horizon investment in physician leadership and clinical informatics essential for managing the volume surge intelligently rather than simply absorbing it.
“The era of single tower hospital, or single tower hospital medicine, is really ending faster,” Dr. Barkoudah said. “We’re seeing more of the integration of more adaptive design and newer talent, newer generation of skills that would lead us to better optimization.”
CMS access rules now coming into force add a regulatory dimension to the challenge, requiring systems to benchmark waiting times and demonstrate measurable improvement. That layer of accountability ensures safety is central to all the health system’s initiatives at the leadership level and the executive team can sustain the investment needed to address it.
What he is not prepared to accept is the premise that the inpatient surge is too large to plan for. The trajectory is knowable and the interventions exist, but health systems need to act on the data now instead of waiting until the volume arrives.
“The investment is not a one cycle, but we need to work harder and smarter,” Dr. Barkoudah said. Once the executive team has a defined plan, they need the right managers and leaders across the organization to execute it.
Integration at scale demands a different kind of physician leader than hospital medicine has historically produced. Burnout data has focused the field on retention for the past several years. His concern extends further: whether hospital medicine is producing the next generation of leaders equipped to work across institutional boundaries, manage data systems and operate in environments where the unit of accountability is a network rather than a department.
“We need to have workforce physicians,” he said. “We need to think about how we can develop the physician leadership track and really create, at least from my scope, the new generation of hospital medicine leaders who could lead us more into the future.”
The model he is building at UT Southwestern is designed to deliver high-quality inpatient care today across four sites with divergent operational demands, while developing the physicians and building the infrastructure needed when the projected volume arrives.
“The model that I always want to at least provide work in is really that mixed-site model where we have integration into the community,” he said. “We have the AMCs ready.”
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