I have posted a number of previous notes about hospitalists, by which I mean any physician who works full-time in a hospital as a hospital employee. Physicians in training programs are not included. The larger category of hospitalists can be subdivided into subgroups based on work function and now includes at least the following types: intensivists, surgicalists, proceduralist, and laborists. As this growing list would suggest, hospitalists are on the rise but a recent blog note by KevinMD puts some numbers on this phenomenon for me (see: Hospitalists assimilate inpatient medicine, is resistance futile?). Below is an excerpt from it with boldface emphasis mine:
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."...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.... Bob Wachter, the man who coined the term "hospitalist," gives his take, and basically says, "I told you so."..."These data portend a future in which hospitalists...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” ... is increasingly out of sync with modern practice." With the hospitalist movement, we're seeing traditional internal medicine turned upside-down before our eyes.
We have all read about the shortage of primary care physicians and internists in favor of super-specialists such as cardiologists. This is commonly attributed to the debt-load of physicians from medical school who seek higher paying positions. This is a surely a factor but we must also consider the fact that the medical and surgical subspecialties may have more appeal on a scientific and technical basis to medical students choosing their future careers.
However, we also need to ask who is going to train the office-based primary care physicians of the future? Putting aside family practice training programs which I am sure will continue in this mode, the internal medicine programs in teaching hospitals will undoubtedly train more hospitalists. This is the only mode of practice that the faculty members know and there will also be an eager market for this type of practitioner in hospitals. For me, this is added impetus for the idea that the first tier of office medical practice should be delivered primarily by nurse clinicians and physician assistants (see: Disruptive Innovation and Reform of Our Healthcare System). However, this latter term may soon be outdated.
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