Hospitalists assimilate inpatient medicine, is resistance futile?

Hospitalists are here to stay, for good.

MedPage Today reports on a NEJM study, not surprisingly concluding that “hospitalists now account for nearly 40% of inpatient Medicare claims for general internist services, up from less than 10% in 1995.”

That’s a lot.

How will it affect primary care doctors, who increasingly are confined to the office? Well, it’s not a positive as you’d think.

“The well-intentioned efforts of many primary care physicians to make themselves more available to their outpatients and provide their inpatients with the benefit of doctors with expertise in hospital medicine may have reduced their own value in the eyes of their patients and, in some instances, decreased their job satisfaction,” writes the accompanying editorial.

I have gone full-hospitalist about 3 years ago, and lifestyle-wise, it’s made a huge difference. Yes, inpatient skills have been sacrificed, but in the midst of raising a family with two young kids, I don’t miss going to the hospital in the middle of the night and doing an admission.

As more doctors place a priority on lifestyle, I don’t think I’m alone in feeling this way.

Bob Wachter, the man who coined the term “hospitalist,” gives his take, and basically says, “I told you so.”

Furthermore, Dr. Wachter offers an interesting take on his vision of the specialty’s future, saying, “These data portend a future in which hospitalists (if enough can be found) will be involved in the care of virtually every sick patient ““ medical and surgical ““ in the building, something I’ve predicted for years. This has major implications for training. Future hospitalists need to be as comfortable helping to manage hip fracture or subarachnoid bleed patients as they are COPD patients. The old residency model of doing a couple of weeks on “med consult” (we come when you call us, we make a few recommendations, you may or may not listen, and we slink away) is increasingly out of sync with modern practice.”

With the hospitalist movement, we’re seeing traditional internal medicine turned upside-down before our eyes.

email

  • Anonymous

    Interesting that the trend was NOT observed with family physicians, only with internists. This mirrors my own community, where almost all of the internists utilize hospitalists, and almost none of the family physicians do. The difference is philosophical.

    It is also interesting that there is no mention in the post of hospitalists saving money and/or improving quality. Very few studies have shown this, and most show no significant difference at all. The true motivation behind the hospitalists movement was always the lifestyle of the physicians involved, so it is time to stop mixing the kool aid.

    A family practitioner

  • Bad Medicine, Good Solutions

    The hospitalist movement will last only as long as the government continues the status quo of procedural medicine. Hospitalists reduce length of stay. That’s it. They increase the rate of turnover which increases a hospitals ability to proceduralize patients, and as a result their salaries are subsidized. Once the procedural favorability is gone, or medicare simply goes bankrupt, hospitals will have no gravy train. They will start going bankrupt (as some are starting to do now). ERs will start testing what the true bare minimum of EMTALA really is that they can get away with. As hospitals once again are forced into a market that doesn’t have the means of cost shifting, subsidizing hospitalists will be a fools errand. IM/FP will flee the hospitals and function as traditional PCPs once again.

    Summary: Hospitalists exist because of the current payment model. When it ends, so will hospitalists.

  • The Happy Hospitalist
  • The Happy Hospitalist

    Or all specialty groups will move to the hospitalist model. It’s one or the other.

    The way I see it, the hospitalist model increases efficiency and decreases length of stay. If anything, that means hospitals will look to hospitalists to see ALL patients in the hospital, not fewer.

    If hospitalists go bankrupt, that means out patient docs will as well and the whole system will implode. It will not matter if you are an out patient doc or a hospitalist model doc. Unless, of course you see only cash paying “customers”

  • Anonymous

    “The way I see it, the hospitalist model increases efficiency and decreases length of stay.”

    Stop drinking the kool aid.
    This has not been shown to the be the case in major studies.
    Prove it.

  • Christian Molstrom

    I’ve always wondered about the economic feasibility of the hospitalist model. Most hospitalists do very few procedures, making relatively little money for the hospital. However, I would like to know if specialist/proceduralist referal rate is higher among hospitalists compared to GPs or FPs.

    Reading Dr. Wachter’s original comment in the post above makes me wonder if he did not envision a hospitalist that was really a jack of all trades only rarely utilizing the specialist.

Trending