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.