Thursday, May 04, 2006

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.”

1 comment:

Anonymous said...

agree with above. The downside to the hospitalist movement is in the data showing that the growth of hospitalists is coming from docs departing primary internal medicine

the above growth is contrasted with the steady incoming pool of internists

Its obvious that the large pool of new hospitalists is coming from local community office based practices. (In our 8 man hospitalist group, 6 of 8 physicians all did primary care for several years before making the change)

the primary care pool, is dismal as seen below

As Internists and many FP's travel in the same crowd its no surprise to hear resentment from a primary care internist seeing the melt down of primary care.