The Hospitalist Movement

The hospitalist movement continues to be a controversial aspect of health care in America's changing medical landscape. A fast-growing specialty, hospitalists are general physicians who are able to focus on educational outreach and administrative hospital duties more than traditional physicians. Hospitalists, however, do not leave the hospital and do not carry on the continuity of care after the patient leaves the hospital.

History

• In 1996, two doctors coined the term "hospitalist." Dr. Robert Wachter and Dr. Lee Goldman published an article in the New England Journal of Medicine in which they introduced the new idea. According to Dr. Wachter, as of 2007, the hospitalist field was 15,000 strong and one of the most rapidly growing medical specialties in the country. The hospitalist movement is based on the idea that doctors who devote their time and expertise to hospital patients can better serve the in-patient community through standardized in-patient care.

Hospitalists

• Hospitalists are doctors who only see people while they are in the hospital. These physicians do not have a database of private patients they see periodically; rather, hospitalists are constantly seeing new patients. According to the Annals of Internal Medicine, hospitalists are generalists who treat only in-patients.

Out-patient physicians

• Out-patient physicians are doctors who attend to patients both inside and out of the hospital. They are normally primary care physicians working in family general practice and internal medicine. Many out-patient physicians feel threatened by the hospitalist movement and are concerned they will be pushed out of the hospitals, thereby losing in-patient skills and educational opportunities.

Negatives

• Many experts fear the hospitalist movement will mean the loss of the primary physician relationship with the patient. If hospitalists do not communicate with the patient's out-patient physician during the entire course of the hospital stay, the patient may lose quality and consistency of treatment. Communication between physicians is critical to the health and welfare of a patient. According to the American Academy of Family Physicians, opponents of the hospitalist movement argue that the continuity of care will be lost when a patient's primary doctor is no longer allowed to treat them in a hospital setting.

Positives

• One positive aspect of the hospitalist movement is that physicians who spend most of their time in the hospital treating sick patients are more accessible for training purposes. They are able to spend more time educating staff and taking care of administrative duties. Increased availability for medical consultations is another positive of the hospitalist movement. Patients of hospitalists have the advantage of being treated by a physician who works with hospital patients exclusively, thereby receiving more standardized treatments. These strictly in-patient doctors may also charge health insurance providers less for the same services as out-patient doctors.