Thursday, December 18, 2008

Hospitalists as bed control officers?

Yes, at least at Johns Hopkins Bayview. Doctors there reported their experience recently in the Annals of Internal Medicine. ER wait times were shortened and everyone seemed happy. Bob Wachter, although circumspect (not every program should tackle this, he said) had a generally positive reaction:

The American Hospital Association just released its 2008 estimates, and the number of hospitalists is now pegged at 27,000, which makes the field larger than cardiology or emergency medicine – the largest non-primary care field in Internal Medicine, and the fastest growing field in the history of medicine. This is staggering (next time, please remind me to trademark a term when I coin it), and owes to the fact that when most docs are running in the other direction, hospitalists step up to the plate and fix problems that need fixin’.

So a shout out to Eric Howell and the Hopkins Bayview crew for adding one more arrow to the hospitalist Quiver of Indispensability.

According to a conversation between Bob and the leaders at Bayview hospitalists were considered dispensable before the start of the bed control initiative. Now they’re considered indispensable.

This system is working well at Hopkins Bayview and might be a good fit at a few other hospitals, but it represents another step in the wrong direction for the hospitalist movement in general. When I made the move from traditional internist to hospitalist in 1999 hospitalists were considered clinicians (usually internal medicine trained) who, because they spent all or nearly all their professional time caring for inpatients, could ascend to extraordinary heights on the learning curve of inpatient medicine. The special expertise thus provided, along with the flexibility it afforded primary care physicians who chose not to round in hospitals, was the basis for their value. Over time things changed as leaders in the field thought up increasingly diverse tasks (clinical, procedural and administrative) to add to the hospitalist’s repertoire. Increasingly the specialty of hospital medicine is being viewed as a cadre of providers whose primary role is to offer business and administrative solutions to hospitals, with clinical expertise diminishing in importance.

There is little or no evidence to back up my opinions as to what’s “right” or “wrong” for the hospitalist movement. This developing model of hospitalist as jack of all trades might appeal to short timers looking for a good paying job while they decide what they really want to do, or until they land a fellowship. But I would wager that it is not what most of us looking for hospital medicine as a rewarding clinical career signed up for.


Hospital medicine: A mile wide and an inch deep?

More on SHM and hospitalist career satisfaction.

No comments: