Tuesday, December 02, 2014

Where is the hospitalist movement heading?

An article in ACP Hospitalist looks at the future of hospital medicine under the changing economic and regulatory environment. The article contains comments from Dr. Robert Wachter and other leaders in the movement about “value.” We all like the general notion of value but when hospitalist leaders talk about it they're talking about something artificial. It becomes artificial when it is reduced to something that can be measured. The data thus derived, they argue, must be presented to hospital administrators as proof of a program's value if that program is to succeed economically. But despite the fact that hospitalist leaders have been beating this drum for over a decade the main driver of hospitalist compensation continues to be the fact that there are just not enough hospitalists to go around. According to the article there's no sign that's about to change. Saturation with hospitalist care is by no means complete. There remain many primary care physicians who round on their own patients. Specialists are increasingly asking hospitalists to admit or comanage. Finally, according to the article, 30% of hospitals still do not have hospitalists.

Should the hospitalist job market someday become saturated we may indeed reach a point where compensation is derived by some artificially determined value metric. What might that consist of? As a possible answer the article discusses what the leaders believe to be the core skills of the future hospitalist. Of the many attributes mentioned none of them, unfortunately, fall in the realm of clinical excellence. This article paints a guarded prognosis for professional satisfaction as a hospitalist if your passion is clinical medicine. I still entertain the hope that the field will change direction but I see no signs of it happening.

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