(2012), "United States of America - Specialty hospitalists will revolutionize inpatient care", International Journal of Health Care Quality Assurance, Vol. 25 No. 2. https://doi.org/10.1108/ijhcqa.2012.06225baa.004Download as .RIS
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Copyright © 2012, Emerald Group Publishing Limited
United States of America - Specialty hospitalists will revolutionize inpatient care
Article Type: New and views From: International Journal of Health Care Quality Assurance, Volume 25, Issue 2
Keywords: Models of healthcare practice, Speciality hospitalists and inpatient care, Quality healthcare improvement
Fifteen years ago, hospitals and physicians began to warm to a revolutionary idea: hospital-based physicians could provide the same, or a better level of care to a patient in the hospital as a primary care physician. Today, hospitalists now work in every major hospital across the country.
Today, a similarly revolutionary idea is taking hold in hospitals, an idea that is changing the way hospital and healthcare leaders look at the caregivers that staff their hospitals. Doctors in nearly every specialty are choosing to adopt the hospitalist model of practice.
In addition to the “legacy” hospitalist fields of adult and pediatric medicine, specialties like neurology, general surgery, obstetrics, psychiatry, orthopedics, gastroenterology, cardiology, and others are, in some settings, choosing to organize themselves into a hospitalist model of practice.
There are even dermatology and ENT hospitalists. Look at recruitment advertisements in the back of medical publications and you’ll see pitches for some of these positions. There are no precise statistics available to document the number of doctors in each specialty currently practicing in the hospitalist model. But there is a lot of anecdotal and indirect evidence.
A web site devoted to obstetric hospitalists (“laborists”) currently lists 134 such practices. The Neurohospitalist Society already has an affiliated journal, The Neurohospitalist, entering its second year of publication.
While the current number of hospitalist practitioners in most fields is still a tiny fraction of all the doctors in each specialty, it appears almost certain to grow in coming years. While the majority of inpatient general medical and pediatric care in the United States is now provided by hospitalists, it is unclear whether other specialties will find themselves in the same place eventually.
In some locales most inpatient care in a particular specialty may continue to be provided by doctors in a traditional (inpatient and outpatient) practice model, while in others the hospitalist model will predominate in inpatient care.
Some of the forces behind this growth across specialties are the same as those that led adult and pediatric inpatient medicine to adopt the model. For example, practitioners in any specialty may have difficulty being reliably available to patients in both the inpatient and outpatient setting during a work day, and it can be challenging to keep up with the knowledge base and skill set in each setting.
Other drivers of adoption vary by locale and specialty. For example, unlike many specialties, mid- to late-career general surgeons seem most interested in work as a surgical hospitalist, rather than those early in their career. They often say that they have always enjoyed inpatient surgical care but found it to be an intrusion on their ability to maintain a robust referral stream of private patients.
By leaving their private office practice, and in many cases becoming employed by a hospital, they are relieved of the burden of operating a practice and are often provided with a better call schedule and work-life balance, which extends their careers.
Hospitals are typically supportive of developing a hospitalist model in many specialties even though it appears that all specialties require some funding from a hospital or other source. A common scenario is that a hospital has historically paid on-call stipends to doctors in a given specialty and gotten poor responsiveness and service in return.
By reallocating the dollars spent on call coverage to instead support a hospitalist practice in that specialty, and often adding some additional money, the hospital can support a hospitalist model that promises improved on-call service and potentially better engagement around quality of care goals and other initiatives.
Depending on the particular specialty and the hospital’s baseline performance, there may be an opportunity to improve the efficiency of care and market share/patient volume to yield a net positive return on the hospital’s financial investment in the program. But even if the program operates at a net financial loss, a hospital may find it a valuable way to respond to things like the needs of existing medical staff and address emergency department on-call problems.
The growth of hospital-focused practice in so many specialties raises a number of issues including the overall value of the care for patients under this model, malpractice liability, and physician training and career longevity. It is reasonable to be optimistic about these things, but important to measure them through future research and not take good results for granted.
Research shows quality of care under the medical hospitalist model generally compares favorably to or improves upon the traditional model. But an August 2011 study showed that reductions in inpatient cost of care resulting from the medical hospitalist model are more than offset by higher costs after discharge, so the net cost to the whole healthcare system is higher.
There are likely to be complex trade-offs and some unforeseen consequences in each specialty, but many hospitals will not be able to wait to adopt the model until robust data proves its value.
Like the original hospitalist specialties of adult general medicine and pediatrics, adoption of a hospital-focused model of practice by many specialties has the potential to change the way hospitals provide care.
Hospitals and healthcare leaders that begin that change today will be able to look back on 2011 as the year they improved care and efficiency at the same time.
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