Our future health depends on the success of hospital medicine

Over the past few years I have talked with many hospitalists.   I know many hospitalist leaders and have many hard working hospitalists.

Most classic general internists have viewed the hospitalist movement with skepticism.  Many outpatient internists express jealousy over the salaries and work hours of most hospitalists.

But here is what most non-hospitalists do not understand.  In most hospitals in this country hospitalists are treated as second class citizens by their fellow physicians.  Most other physicians have no respect for hospitalists.

They are happy to have hospitalists provide care for their patients.  After all, hospitalists dictate H&P’s and DC summaries.  Hospitalists become skilled at social work interaction.  Hospitalists take all the calls that other physicians dislike.

But too often subspecialists, surgeons and others view hospitalists as advanced residents – physicians they can abuse without recourse.  Too often they have no understanding of the hospitalist job.

So we have an interesting problem, hospitalists make a fair wage and have call responsibilities that make quality of life excellent.  Hospitalists improve patient care and the lives of other physicians, yet they get no respect.

I suspect that over time at many hospitals this respect problem will dissipate, but hospital medicine does suffer from serious growing pains.  The demand for hospitalists is so great that many hospitals are happy to hire less well trained physicians.

The hospitalist job is a difficult one.  They care for approximately 17 patients each day.  Their patients are complex and many have undesirable social situations.  Hopsitalists are doing important work on safety and quality, yet they too often get no respect.

I believe this is the hospitalist’s challenge this decade.  The field should consolidate and better define best practices.

Hospital medicine has an image problem with many patients and many physicians.  If hospitalists can gain respect from their physician peers, then patient respect will follow.

Whether you have favored the hospitalist movement or not, one should no longer lament its growth.  We must all join to make hospital medicine successful.  Our own future health care may depend on their success.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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