| Our group
practice of 27 internists began considering a hospitalist
division last year. Some of the senior members in our
group expressed desires to escape the obligations of
hospital rounds, while others saw opportunities to
simplify their lifestyles. We also knew of the
frustrations that physicians from outlying areas
experienced when they tried to refer patients who
required hospital care. We first attempted to recruit
from among our ranks. Though several expressed interest,
none were willing to rotate through hospital-only work,
and none were willing to give up their outpatient
practices. Our hospital partner expressed a willingness
to assist with the recruitment of new physicians for an
inpatient program. They see benefits with increased
admissions and the potential for more efficient use of
hospital services. Our group is finalizing plans for the
launch of a hospitalist division this fall.
The ability to accommodate outlying physicians and
their patients is seen as an advantage to the program. We
also hope to extend the careers of senior physicians who
want to confine their practices to outpatients. The
ability to ease the work of on-call physicians is also
appealing to some. Wachter has written that inpatient
specialists, whom he has labeled
“hospitalists,” have the ability to improve the
care of patients by coordinating inpatient care and
reacting to clinical data in real time (3).
Disadvantages are not unrecognized. Transfer of a
patient from his or her primary care physician to an
inpatient specialist further disrupts the
patient-physician relationship. Internal medicine
physicians have witnessed a steady erosion of our
involvement with patients as specialties develop tools
and techniques unique to their trade. Hospital
specialists will further encroach upon our relationship
with patients. To avoid forcing this disruption, we have
set policy to use hospitalists voluntarily; no physician
will be required to use them. Some in our group vow to
never use their services; others plan to give up
inpatient work. Most fall somewhere in between.
To cope with the communication issue, we plan regular
meetings between outpatient physicians and hospitalists.
These may have an added benefit of defining practice
patterns that can improve the management of patients,
reducing the severity of illness and subsequent need for
hospitalization. Participation by medical students,
interns, and residents may add to the education of the
housestaff.
Our chief of medicine has raised concerns regarding
the deterioration of internists' skills if they give up
work in the hospital. Enhancement of outpatient skills
may partially compensate for this loss, yet all admit
that the practice of internal medicine in this new
scenario will change. With smaller inpatient practices
today, hospital skills may already be eroding. At least
one physician has admitted to a loss of skills and
increasing discomfort in the treatment of sick patients
who require hospitalization (4).
A leader of our medical staff has stated that the role
of hospitalists in the practice of medicine is
inevitable. Given that premise, he recommends that we
work to make the best of this change for patients and
physicians alike.
Does a hospitalist program offer advantages for
patients? Does a hospitalist program offer disadvantages?
The answer to both questions is yes. We hope to create a
system that can improve care for patients, maximize
efficiencies, and offer options for physicians. Success
of the program will depend upon the collective wisdom and
energies of all.
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