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.