Here’s my very biased take on where things stand at the close of 2008:
The never ending debate over the value of the hospitalist model is moot. Research on hospitaists’ impact on outcomes and efficiency has been inconclusive and is likely to remain so, given that large comparison groups against which to study the model are shrinking fast and will soon be nonexistent.
The security of our niche is based not on any measurable value, but on the mass exodus of traditional practitioners from the hospital. The resulting expansion in hospitalist jobs has outpaced growth in the work force. The trend shows no sign of abating. The current economic crisis will only serve to accelerate this exodus. The inflation of salaries may moderate, but hospitalists’ jobs should remain secure.
Larger threats to the hospitalist movement are turnover and burnout. Although we lack hard data on the magnitude of the problem it is widely apparent. This creates challenges for leaders in hospital medicine who are poised to define the ultimate direction of the movement. Hospitalists are increasingly being asked to go beyond the limits of their training by caring for all hospitalized patients regardless of illness. Moreover, their role as expert clinicians is increasingly threatened by pressure to become business and administrative solutions.
This emerging jack-of-all-trades model for hospitalists is a departure from the original notion of doctors devoting all their professional time caring for inpatients in the realm of their specialty (usually internal medicine) who, because they ascended a steep learning curve, developed unique expertise in hospital medicine. The old model attracted me to the field almost a decade ago because of its promise of professional satisfaction. The new model will be palatable for many of the short timers and moonlighters who increasingly make up the work force of hospital medicine but may not attract the career hospitalists needed to sustain and grow hospital medicine as a specialty.