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Hospitalists

Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients and who provide continuity of hospital care from admission to discharge, often seeing patients in the emergency room and organizing post-acute care. The term hospitalists was first coined in 1996. The recent American hospitalist movement continues to grow at a rapid pace.

Background

Hospital-based physicians in Europe and a small number of integrated health delivery systems in the United States, such as Kaiser Permanente, preceded the more general introduction of hospitals to manage inpatient care across the nation. Traditionally, primary-care physicians supervise inpatient care. Recently, however, some primary-care physicians have begun to delegate the responsibility to a hospitalist, thus converging to European practice, where the general practitioner in the community refers the patient to a consultant for inpatient care.

Hospitalists were first introduced in the mid-1990s, and by 2005, survey data from the American Hospital Association (AHA) reported 16,000 hospitals in the nation. The association's survey indicates that 40% of short-term community hospitals have hospitalists on the staff. The Society of Hospital Medicine (SHM), the professional society for hospitals in the United States, estimates that in 2007 there were 20,000 hospitals in the nation. Most hospitalists are trained internists, family practitioners, and pediatricians.

The AHA survey also showed that larger hospitals were more likely to use hospitalists than smaller hospitals. General hospitals were more likely than specialty hospitals, and hospitals with at least 20 residents and those affiliated with a medical school were more than twice as likely as hospitals with less than 20 residents and those not affiliated with a medical school. Federal government and private nonprofit hospitals were more likely than local government and private for-profit hospitals to use hospitalists. Hospitalists tended to work in hospitals that also made available advanced diagnostic and therapeutic medical devices. Hospitals in urban and wealthier counties were more likely to use hospitalists. Hospitalist use was more prevalent in counties with higher managed-care penetration and greater competition among health maintenance organizations (HMOs). A higher average physician age, an older patient population, and a greater share of primary-care physicians in the county where the hospital was located were all associated with lower adoption rates.

Duties of Hospitalists

The emergence of hospital medicine as a new medical specialty adds a new dimension to the ongoing specialization process in healthcare along the geographic and institutional dimension, namely the site of care provision. Whereas existing medical specialties are largely defined by disease, organ system, patient age, or patient gender, hospitalists are defined by the setting where they provide care—the hospital. In this sense, hospitalists are akin to inten-sivists, whose focus of specialization is the intensive-care unit of hospitals. Hospitalists, typically trained as generalists, can be contrasted with the growing number of ever more narrowly defined specialists working within the hospital whose services can no longer be coordinated ad hoc.

Although hospitalists enhance coordination of care within the hospital, some believe that they do so at the cost of potentially worsening coordination between the referring physician's office and the hospital. For this reason, hospitalists can be viewed as offering different advantages to physician groups and to hospitals that are comparing the likely benefits and costs of employing hospitalists directly.

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