Sunday, February 11, 2007

The hospitalist movement: where is it headed?

Niraj L. Sehgal, MD, MPH and Robert M. Wachter, MD reviewed the hospitalist field in the January 2007 issue of Resident and Staff Physician. It’s on a roll and there are plenty of opportunities. The authors offer tips for trainees considering a hospitalist career.

There is controversy over whether hospitalists improve outcomes. The authors briefly address that question by citing this review appearing in 2005 which concluded that “most evaluations” found hospitalist care to be associated with reduced charges and lengths of stay with no significant difference in quality of care or patient satisfaction. The analysis was compromised by lack of randomization in many of the cited studies. Sehgal and Wachter failed to cite this very large multicenter study presented the same year at the Society of Hospital Medicine which showed no difference in outcomes or utilization between hospitalists and non hospitalist peers. Do hospitalists provide better or more efficient care? Although we’d like to think they do we don’t have an evidence based answer.


Anonymous said...

As a apst hospitalists and current moonlighting hospitalist, I agree there is a place for GOOD, HOSPITAL BASED physicians that practice the latest of EBM, not community docs slow to adopt to change.

However, problem I see, and I'm at 4 hospitals now, 9 total in my 3 years as a hospitalists, very few community programs respect them and their value. Very few admisntrators cater to them the way they do referring PCPs and specialists. Hospitalists don't generate revenue for the hospital. Hence, they will remain forever dumping grounds for lazy docs and subspecialists who don't want to admit to their service.

For this to change, hospital admisntrators need to embra,ce protect, and nurture this group. Think less about new revenoue source, but think about how they can help reduce expenditures significantly by practicing EBM, and reducing risk of hospital acquired infections, etc.

Anonymous said...

a discussion of hospitalists perhaps has changed in the past 10 years.

In 1996 primary care Internists were plentiful and hospitalists were still a novelty. In 2007 primary care internists are rapidly vanishing (by way of quitting and becoming hospitalists, by way of early retirements and by way of many residency programs producing less than 20% internists who plan on primary care) Hospitalist's are no longer a novelty but now are needed to do the inpatient work that outpatient internist used to do. Internists are now becoming hospitalists and less likely to work in primary care. I doubt one can now do a study comparing hospitalist care versus primary care doc's doing hospital work. why not? it's hard to find people in the latter group!