How will the economy affect the hospitalist profession?

They’ll probably fare better than other fields, says hospital medicine el jefe Bob Wachter:

All in all, hospitalists remain in an enviable position to weather the budgetary storms. In many organizations (including mine), hospitalists now help care for over 50% of the inpatient census, and make up a wildly disproportionate fraction of leaders in quality, safety, IT, and medical education. The market for hospitalists remains uber-competitive ““ hospitals recognize that an unhappy hospitalist can leave work on Friday and have a new and desirable job across town on Monday”¦

Although physician payments will decrease, the number of patients losing jobs, and thus their health insurance, will increase. Without a regular doctor, they’ll find themselves more frequently in the hospital, assuring that hospitalists will always be employed.

There are several other factors contributing to the field continuing to thrive. One is the emphasis on hospital quality measures. With more primary care doctors divorced from hospital medicine, hospitals are more reliant than ever on inpatient physicians. If community primary care doctors were relied upon to care for hospitalized patients, quality scores would likely plummet.

The other concerns academic institutions. Dr. Wachter suspects that resident work-hour restrictions will be further tightened, which will force the hiring of more hospitalists to pick up the patient care slack.

And to those who think that mid-levels can supplant a hospital physician – which is an absurd suggestion – Dr. Wachter says bring it on, and we’ll see what happens:

If hospitals believe that other organizational models might be successful in performing certain functions at an acceptable quality at lower cost (such as using NPs or PAs instead of hospitalists on certain services), I urge them to give it a try . . .

. . . In my experience, in institutions with strong hospitalist programs, senior leaders recognize the model’s value and will be highly reluctant to muck with it. But there is nothing wrong with a little experimentation, as long as the results are measured and acted upon.

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