Is the hospitalist movement a product of intelligent design?

A letter to the Annals of Internal Medicine seems to suggest it is. Dr. Ashok Daftary writes “Academic medicine is the carpenter that fashioned the coffin of internal medicine. Instead of re-engineering internal medicine to accommodate change it cannibalized the discipline reducing its worth, creating the hospitalist and ambulatory care internist.”

Although Retired Doc, DB and Kevin have this issue well covered I’ll weigh in as a representative of the hospitalist movement. I have to agree with DB that the movement was nobody’s grand scheme—it arose out of economic pressure as I pointed out earlier this year:

"Finally, to remind readers of the historical perspective, the hospitalist movement is a bit like the blogosphere, arising not by anyone’s personal agenda but almost as if out of thin air. About a decade ago changing practice patterns in pockets of California with heavy managed care penetration captured the attention of Robert Wachter and Lee Goldman who published this prescient article in NEJM in which the term “hospitalist” was coined. Economic pressures were the initial driving force. As the movement gained momentum it came to be driven more and more by its original detractors, the family docs who, for a variety of reasons, chose to eliminate their hospital practices."

I’ll be the first to admit that the movement is too self promoting at times, but as DB aptly put it, it was “not a nefarious plan or conspiracy.”