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The emerging role of the hospitalist

By Christopher P. Noel

Efficient, streamlined, cost effective. These are a few words that have been used by supporters of medicine’s latest celebrities. Their style is fast paced, their work ethic intensely focused, and they can shave a day off your average hospital stay in a single shift. They are the hospitalists. This emerging specialty is currently sweeping the country faster than the Chicago Bulls swept the 1995 NBA season.

About 2000 physicians nationwide call themselves hospitalists. Specializing in the management of hospitalized patients, the hospital becomes their office. A hospitalist takes over for a primary care physician when it comes time to admit a patient. For your average primary care physician, this means fewer, or no, visits to the hospital at the end of their office hours for rounds. Usually working on flexible, yet intense shifts of eight to twelve hours, the hospitalist turns his or her pager off when the shift is over.

Physicians of various specialties have decided to make inpatient medicine their focus. Many of them have recently become members of the NAIP (National Association of Inpatient Physicians), the association of hospitalists nationwide. According to John R. Nelson, M.D., chief of staff at Columbia North Florida Regional Medical Center in Gainesville, Florida, and cofounder of the NAIP, approximately 80 percent of hospitalists in the organization are trained in internal medicine. The highest percent of the balance are trained in pulmonary/critical care, and some in pediatrics and family practice. Nelson points out two of his reasons for being a hospitalist for the last ten years: “Having the ability to work flexible schedules, and not having overhead concerns while trying to manage and operate an office.” In addition, taking time off requires fewer headaches for a hospitalist.

Despite all the recent attention given to hospitalists, the positions are far from glamorous. Due to the recent adoption of hospitalist programs at many facilities nationwide, some physicians find themselves being the only hospitalist supporting a large primary care network. Long, intense hours, burnout and sometimes admitting up to and above 30 patients per week, and constant coordination with office-based primary care physicians are a few of the challenges normally faced by a hospitalist.

The communication between an office-based primary care physician, the patient and the hospitalist is essential to help maintain continuity and quality of care. Helping make these transitions as smooth as possible is a major concern for hospital administrators as well. A well managed hospitalist program requires the support of the outlying primary care physicians. Many facilities have attempted to “jump on the band wagon” and start a hospitalist program without consulting the well established PCPs in the community.

The fact is that without that support, many programs are destined for trouble. As competition increases, politics play a large role in most areas, and professional turf battles occur. Although hospitalist programs are standard in some European countries, the idea continues to evolve here in the U.S. The programs are adopted by various delivery systems as cost saving arrangements. Most hospitalists are salaried similarly to physicians in traditional practice—somewhere between $130,000 and $200,000. Some work for hospitals, some contract with groups and some are employed through an HMO. Because the current demand is up, hospitalists are able to command higher starting salaries.

For years the focus in medicine has been on primary care; this maturing practice trend has shifted some of that focus back to the hospital. Hospitalists will lead the way in inpatient care as future technological advances are made. Not yet formally considered a specialty, the hospitalist movement continues to gain popularity. At one of the country’s largest physician recruitment firms, approximately 10 percent of a client base of over 2000 clients have inquired about recruiting a hospitalist.

Hospital administrators, HMOs and independent primary care groups view having hospitalists as a powerful recruiting tool. With lifestyle requirements becoming an increasing priority, more and more physicians are seeking more flexible schedules with less hospital work. The addition of hospitalists could revolutionize the way many physicians practice medicine.

Christopher P. Noel is vice president of primary care at Weatherby Health Care in Ft. Lauderdale, Florida.

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