Thursday, September 08, 2005

Personal reflections on the hospitalist movement

Published in the July/August 2005 issue of The Hospitalist is an abstract from the 2005 Society of Hospital Medicine annual meeting research competition that has received considerable attention around the medical blogosphere. It reports a large study of various outcomes of care by hospitalists compared with non-hospitalists in academic medical centers. In this first ever multi-center study there was no significant difference between hospitalists and non-hospitalists in outcomes. This was somewhat unexpected, since some earlier smaller studies suggested improved outcomes with hospitalist care.

Rather than try to critique the study (that’s been nicely done by DB, California Medicine Man and Clinical Cases and Images) I’ll offer my purely personal views as a hospitalist. First I disagree somewhat with Clinical Cases and Images that a well designed trial would solve the question of whether hospitalists are useful. To me the success of the hospitalist movement is driven by the growing demands and complexities of hospital medicine and a growing niche created by ever increasing numbers of primary care doctors choosing to practice exclusively ambulatory medicine. Personally I’m happy to fill that niche as long as it’s there. Although I’ve experienced more professional satisfaction since becoming a hospitalist I have no desire for the movement to “take over” hospital care.

The results don’t particularly surprise me. In fact they somewhat mirror my personal experience as I compare my numbers with those of my excellent local non-hospitalist peers. Many doctors in traditional primary care maintain excellent hospital skills. Their patients can get quality hospital care and at the same time maintain a measure of continuity---the best of both worlds.

Meanwhile a growing knowledge base in hospital medicine is creating a steep learning curve, and I enjoy ascending that curve. Maintaining this blog disciplines me to stay more abreast of this growing literature. In future posts I hope to accumulate a collection of hospital medicine “bookmarks” which will be useful not only to myself but to other physicians, in practice or training, with an interest in hospital medicine.