Is hospitalist care in your future?

by Debra Wood, RN

With more medical care provided outside the hospital, those admitted are sicker and require intense services. Inpatients are increasingly receiving care from a hospitalist—a doctor specializing in hospital care.

"Patients are giving up their familiar doctor, and in return getting a more available doctor. You get someone who has cared for hospital patients many, many times and is highly experienced at hospital care," said John Nelson, MD. The Bellevue, Washington internist became one of the country's first inpatient specialists in 1988. He co-founded the National Association of Inpatient Physicians (NAIP) nine years later.

"Dr. Nelson was personable and approachable. He was right there. I liked the availability," said Christy Hulin, one of Dr.Nelson's patients. "But the biggest selling point is my primary care [doctor] doesn't have to take time out of her day. She has more time to see patients in the office. I know I won't have to wait while she runs to the hospital."

Growing Trend

Hospitalists grew from about 50 in the 1980s to a few hundred in the mid-1990s. Today 5,000 hospitalists care for about 3 million of the 33 million patients admitted each year. Settings vary from small community hospitals to major medical centers.

"It's growing, because it appears to be a more logical, efficient, and higher quality way of organizing hospital care," said Robert Wachter, MD. He is associate chairman of the University of California-San Francisco (UCSF) department of medicine.

Dr. Wachter estimates the number will swell to 25,000 or more by 2010. His research shows that hospitalists cut the number of days patients spend in the hospital. In most cases, they also reduce the cost of care. Most hospitalists were trained as internists. UCSF offers one of the few programs with additional preparation in this specialty.

"Doctors come out of a good training program in internal medicine competent to be clinical hospitalists," Dr. Watcher said. "We believe someone who is going to become a hospitalist should also come out of their residency program with the skills they need to be a leader in improving patient safety and quality [of care]."

Growing Trend

Hospitalists grew from about 50 in the 1980s to a few hundred in the mid-1990s. Today 5,000 hospitalists care for about 3 million of the 33 million patients admitted each year. Settings vary from small community hospitals to major medical centers.

"It's growing, because it appears to be a more logical, efficient, and higher quality way of organizing hospital care," said Robert Wachter, MD. He is associate chairman of the University of California-San Francisco (UCSF) department of medicine.

Dr. Wachter estimates the number will swell to 25,000 or more by 2010. His research shows that hospitalists cut the number of days patients spend in the hospital. In most cases, they also reduce the cost of care. Most hospitalists were trained as internists. UCSF offers one of the few programs with additional preparation in this specialty.

"Doctors come out of a good training program in internal medicine competent to be clinical hospitalists," Dr. Watcher said. "We believe someone who is going to become a hospitalist should also come out of their residency program with the skills they need to be a leader in improving patient safety and quality [of care]."

Growing Trend

Hospitalists grew from about 50 in the 1980s to a few hundred in the mid-1990s. Today 5,000 hospitalists care for about 3 million of the 33 million patients admitted each year. Settings vary from small community hospitals to major medical centers.

"It's growing, because it appears to be a more logical, efficient, and higher quality way of organizing hospital care," said Robert Wachter, MD. He is associate chairman of the University of California-San Francisco (UCSF) department of medicine.

Dr. Wachter estimates the number will swell to 25,000 or more by 2010. His research shows that hospitalists cut the number of days patients spend in the hospital. In most cases, they also reduce the cost of care. Most hospitalists were trained as internists. UCSF offers one of the few programs with additional preparation in this specialty.

"Doctors come out of a good training program in internal medicine competent to be clinical hospitalists," Dr. Watcher said. "We believe someone who is going to become a hospitalist should also come out of their residency program with the skills they need to be a leader in improving patient safety and quality [of care]."

How does care differ?

Usually, the patient's primary doctor refers him or her to a hospitalist. Some patients arrive at the emergency room without a doctor. If admitted, they may be cared for by a hospitalist. Also, surgeons often ask hospitalists to manage patients' medical needs.

Hospitalists direct inpatient care. If the patient needs a cardiologist or a surgeon, the hospitalist asks for a consult and coordinates care. They order home health. They help patients and families with end-of-life decisions. Over time, they become more at ease with tough inpatient topics.

"With the shear magnitude and frequency by which you're facing end-of-life issues, you become more experienced," said Adam Singer, MD, founder of IPC-The Hospitalist Co. The California firm employs more than 150 hospitalists in six states. "An internist might only face this issue once every six months. Whereas, this is a daily issue for a busy hospitalist."

Ensuring quality care

Hospitalists call, fax, or email reports to patients' doctors. Dr. Singer developed a hand-held computer system to create a smooth daily dialog.

"Doctors must communicate in a timely way and in sufficient detail," Dr. Nelson said. "I need information from the primary-care doctor. And I need the primary-care doctor to get information about what I'm doing."

Dr. Nelson quickly completes and sends admission and discharge notes. He discusses complex cases and end-of-life issues with the primary doctor. He also encourages referring doctors to call or visit their patients. Patients who are unsure how their doctors share information should ask.

Before illness strikes

Discuss with your doctor what to expect if you need hospital care. "The single most important factor in patients finding the idea acceptable is having the hospitalist endorsed by the primary-care doctor," Dr. Nelson said.

In addition, Dr. Nelson suggests that patients do the following:

  • Stay involved in their care.
  • Maintain a personal medical record.
  • Ask for and keep copies of reports.
  • Keep accurate lists of medications.
  • Make a list of surgeries.
  • Take records to doctor's visits and to the hospital.

As more doctors opt for exclusively office-based practices, inpatients will trade a familiar face for a more accessible doctor with hospital expertise.

"Patients are recognizing the virtues of this," Dr. Wachter concluded. "When a patient is cared for by a good hospitalist working in a good system, they see this physician is there for them."