Hospitalists rising: a brief overview

Hospitalists are one of the fastest growing physician specialties in the medical field today, and the increase in the number of hospitalists attests to the value of their role in our changing healthcare landscape. In this entry, we’ll provide a general overview of hospitalists, and expand on the topic in our ongoing series about the hospitalist trend. The series will include entries on emerging hospitalist specialties, such as orthopedic hospitalists and neurology hospitalists, and discussion of the value hospitalists deliver, the hospitalist’s role in an ACO environment, and how healthcare reform may impact hospital medicine. Stay tuned!

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The term “hospitalist” was coined in the mid 1990s, and describes physicians who exclusively provide care for hospitalized patients. The hospitalist specialty is unique in that it is organized around a site of care (the hospital) rather than say, a particular organ (such as a cardiologist). A majority of hospitalists are trained in general internal medicine,¹ but specialized hospitalists are now becoming more common as well. Emerging hospitalist specialties include neurology hospitalists, oncology hospitalists, OB-GYN hospitalists and orthopedic hospitalists.

According to the Society of Hospital Medicine, 11,159 physicians identified themselves as a hospitalist in 2003.¹  As the graph below shows, this number has dramatically increased in less than ten years, to 34,799 hospitalists in the U.S in 20121, with a compound annual growth rate of 12.05% in this period.

(click for an enlarged version)

The rapid rise in the number of hospitalists is proof of the role’s increasing value to healthcare providers today. Hospitalists serve as important intermediaries in the continuum of care. Unlike hospital physicians who stay in a specific department, such as an emergency medicine physician, hospitalists manage and help care for patients throughout their hospital experience, following them from the ER into the critical care unit and arranging post-acute care.¹ They differ from primary care physicians because they do not have separate office-based practices where they see patients. Hospitalists work in shifts in the hospital, and often on block scheduling in which they work 5-7 consecutive days for 10-12 hour shifts, followed by 5-7 days off.²

This setup is valuable for a few key reasons. First, primary care physicians have less hospitalized patients than ever before, and it makes less sense for them to take valuable time to travel to the hospital and make rounds. With hospitalists overseeing care for hospitalized patients, primary care physicians can focus on caring for patients in the outpatient setting.

Secondly, hospitalists provide increase access to care in the hospital. As hospitalists are based in the hospital,  they are much more accessible to patients than their primary care physicians, especially when there are crises or changes in the patient’s condition.

Finally, hospitalists have expertise in providing and coordinating care in the inpatient setting.Their familiarity with the hospital environment, staff, protocols and resources allows them to efficiently coordinate and expedite patient care and most importantly, reduce the length of a patient’s stay.¹

This reduced length of stay and the corresponding reduction in hospital costs is the key incentive for hospitals to install hospitalist programs, and they’re doing so at a fast pace. A 2007 survey of 5,000 community hospitals by the American Hospital Association (AHA) showed that 83% of hospitals with 200 beds or more utilized hospitalists, and projected that about 58% of all US hospitalists have hospital medicine programs, with an average of 9.4 hospitalists per hospital.³

As the hospitalist concept gains ground in US hospitals, new specialized hospitalist groups are growing too. We’ll explore these emerging hospitalist specialties in our next blog entries.

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Sources

1. http://www.hospitalmedicine.org/

2. http://www.acponline.org/medical_students/career_paths/hospitalist/

3. http://www.todayshospitalist.com/?b=articles_read&cnt=762

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