Ten years ago this month, Dr. Lee Goldman and I coined the term “hospitalist” in The New England Journal of Medicine.[1] From a handful of hospitalists then, the field has grown to about 15,000 today, making it the fastest growing specialty in the United States – and perhaps in American medical history. Soon, there will be more hospitalists than cardiologists![2] This growth has been fueled by strong evidence that hospitalists improve efficiency without compromising quality.[3]
After substantial early pushback from primary care physicians and specialists, recent years have seen broad acceptance of the value of hospitalists. In addition to their clinical work, hospitalists have become key leaders in quality, patient safety, information technology, palliative care, medical education, and more. These roles have been welcome, and completely fitting with hospitalists' self-perceptions as system improvers.
Recent housestaff duty-hour limits have increased the need for nonteaching services in teaching hospitals. In many community settings, specialty and generalist physicians have withdrawn from caring for uninsured patients or providing night coverage. In both settings, surgeons are clamoring for hospitalists to help “comanage” their patients.
The hospitalist field was founded on the premise that inpatient generalists could improve the care of hospitalized patients and systems of inpatient care. In the early years, the challenge was to determine whether the field was indispensable. We now know that it is. The challenge now is that hospitalists are often seen as the solution to all sorts of knotty problems – virtually none of which are associated with significant professional fee reimbursement. Managing this demand will be the greatest challenge of the field's second decade.
That's my opinion. I'm Dr. Robert Wachter, Associate Chair of the Department of Medicine at the University of California, San Francisco.
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References
- 1.Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335:514–517. doi: 10.1056/NEJM199608153350713. [DOI] [PubMed] [Google Scholar]
- 2.Lurie JD, Miller DP, Lindenauer PK, Wachter RM, Sox HC. The potential size of the hospitalist workforce in the United States. Am J Med. 1999;106:441–445. doi: 10.1016/s0002-9343(99)00045-5. [DOI] [PubMed] [Google Scholar]
- 3.Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA. 2002;282:487–494. doi: 10.1001/jama.287.4.487. [DOI] [PubMed] [Google Scholar]