Friday, December 28, 2007

Top ten issues in hospital medicine for 2007, issue 2: hospitalists and the interface with primary care

Two facets of this issue were on the radar screen this year. One concerns what may be the biggest downside to the hospitalist model: the information gap between the hospitalist and the primary physician. An important paper in JAMA this year which I linked and discussed a few months ago demonstrated poor communication between hospitalists and primary care physicians following hospital discharge. As I was finishing this post I found an excellent commentary by Bob Wachter. He believes every health care system need a transitions officer; I couldn’t agree more.

The other facet is the controversy over what effect the hospitalist movement is having on the primary care shortage. The primary care shortage is creating a larger and larger niche for hospitalists. On the other hand the hospitalist movement has created an attractive career choice for internists, thus perpetuating the shortage of primary care physicians. It’s a self reinforcing cycle. Internists who flock to the hospitalist career are looking for professional satisfaction. It’s not just about money. As I blogged before, General Internal Medicine has lost its identity thanks to economic forces and the American College of Physicians which merely defines internists as “doctors for adults.” About a year ago Retired Doc spoke volumes with the title to one of his posts: Is being a hospitalist the only way to still be an old time internist?

Bob Wachter summarized the issue nicely with posts here and here.

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