Hospital medicine
Encyclopedia
Hospital medicine in the United States
is the discipline concerned with the medical
care of acutely ill
hospital
ized patients. Physician
s whose primary professional focus is hospital medicine are called hospitalists; this type of medical practice has extended beyond the US into Canada. The practical effect of the hospitalist is to act as transition coordinator and case manager, due to the tremendous growth in medical knowledge and resultant number of medical specialists.
The term hospitalist was first coined by Robert Wachter
and Lee Goldman in a 1996 New England Journal of Medicine
article. Hospitalist activities may include patient care, teaching, research, and leadership related to hospital care. Hospital medicine, like emergency medicine
, is a specialty organized around a site of care (the hospital), rather than an organ
(like cardiology
), a disease
(like oncology
), or a patient’s age (like pediatrics
).
(M.D.) or Doctor of Osteopathic Medicine
(D.O.) degree. While it was commonly believed that any residency program with a heavy inpatient component provided good hospitalist training, studies have found that general residency training is inadequate because common hospitalist problems like neurology, hospice and palliative care, consultative medicine, and quality assurance tend to be glossed over. To address this, residency programs are starting to develop hospitalist tracks with more tailored education. Several universities have also started fellowship programs specifically geared toward hospitalist medicine.
According to the State of Hospital Medicine Survey by the Medical Group Management Association and the Society of Hospital Medicine, 89.60% of hospitalists specialize in general internal medicine, 5.5% in a pediatrics subspecialty, 3.7% in family practice and 1.2% in internal medicine pediatrics. Data from the survey also reported that 53.5% of hospitalists are employed by hospitals/integrated delivery system and 25.3% are employed by independent hospitalists groups.
According to the recent data, there are more than 30,000 hospitalists practicing in 3,300 large hospitals and half of all community hospitals.
Hospitalists represent one of the most rapidly growing forms of medical practice in the US. Currently a large proportion of hospitalists are recently-graduated residents, who continue familiar duties for a few years. As residency programs are encouraged to limit inpatient duty hours and provide more outpatient education, this pattern may shift. If this specialty evolves as emergency and intensive care medicine did, it will become a formal specialty with its own residencies and board certification within a decade or two. A few distinct residency and fellowship training programs are currently operating at major universities .
In addition to patient care duties, hospitalists are often involved in developing and managing aspects of hospital operations such as inpatient flow and quality assurance. The formation of hospitalist training tracks in residency programs has been driven in part by the need to educate future hospitalists about business and operational aspects of medicine, as these topics are not covered in traditional residencies .
(ABPS), was founded in 2009. The ABHM was North America’s first board of certification devoted exclusively to hospital medicine. In September 2009, the American Board of Internal Medicine
(ABIM) created a program that provides general internists practicing in hospital settings the opportunity to maintain Internal Medicine Certification with a Focused Practice in Hospital Medicine (FPHM).
) are compensated higher than their day shift peers.
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
is the discipline concerned with the medical
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
care of acutely ill
High acuity medicine
' refers to medical interventions designed to treat seriously ill patients used in the hospital, emergency department, assisted care facilities, or other medically-staffed specialized settings...
hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
ized patients. Physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s whose primary professional focus is hospital medicine are called hospitalists; this type of medical practice has extended beyond the US into Canada. The practical effect of the hospitalist is to act as transition coordinator and case manager, due to the tremendous growth in medical knowledge and resultant number of medical specialists.
The term hospitalist was first coined by Robert Wachter
Robert M. Wachter
Robert M. Wachter is a prominent academic physician on the faculty of UCSF. He is generally regarded as the academic leader of the hospitalist movement, a rapidly growing medical field comprising internists and other physicians who specialize in the care of hospitalized patients...
and Lee Goldman in a 1996 New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
article. Hospitalist activities may include patient care, teaching, research, and leadership related to hospital care. Hospital medicine, like emergency medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
, is a specialty organized around a site of care (the hospital), rather than an organ
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...
(like cardiology
Cardiology
Cardiology is a medical specialty dealing with disorders of the heart . The field includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology...
), a disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
(like oncology
Oncology
Oncology is a branch of medicine that deals with cancer...
), or a patient’s age (like pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
).
Training
The majority of hospitalists are physicians with a Doctor of MedicineDoctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...
(M.D.) or Doctor of Osteopathic Medicine
Doctor of Osteopathic Medicine
Doctor of Osteopathic Medicine is a professional doctoral degree for physicians in the United States. Holders of the MD degree, Doctor of Medicine, have the same rights, privileges and responsibilities as osteopathic physicians in the United States.The American Osteopathic Association’s Commission...
(D.O.) degree. While it was commonly believed that any residency program with a heavy inpatient component provided good hospitalist training, studies have found that general residency training is inadequate because common hospitalist problems like neurology, hospice and palliative care, consultative medicine, and quality assurance tend to be glossed over. To address this, residency programs are starting to develop hospitalist tracks with more tailored education. Several universities have also started fellowship programs specifically geared toward hospitalist medicine.
According to the State of Hospital Medicine Survey by the Medical Group Management Association and the Society of Hospital Medicine, 89.60% of hospitalists specialize in general internal medicine, 5.5% in a pediatrics subspecialty, 3.7% in family practice and 1.2% in internal medicine pediatrics. Data from the survey also reported that 53.5% of hospitalists are employed by hospitals/integrated delivery system and 25.3% are employed by independent hospitalists groups.
According to the recent data, there are more than 30,000 hospitalists practicing in 3,300 large hospitals and half of all community hospitals.
History
Hospital medicine is a relatively new phenomenon in American medicine. Almost unheard of a generation ago, this type of practice arose from three powerful shifts in medical practice:- Nearly all states, as well as the national residency accreditation organizations, the Accreditation Council for Graduate Medical EducationAccreditation Council for Graduate Medical EducationThe Accreditation Council for Graduate Medical Education is the body responsible for the accreditation for graduate medical training programs for medical doctors in the United States. It is a non-profit private council that evaluates and accredits medical residency and internship programs...
(ACGME) and the American Osteopathic AssociationAmerican Osteopathic AssociationThe American Osteopathic Association is the representative member organization for the over 78,000 osteopathic medical physicians in the United States...
(AOA), have established limitations on house staff duty hours, the number of hours that internsMedical internA medical intern is a term used in the United States for a physician in training who has completed medical school. An intern has a medical degree, but does not have a full license to practice medicine unsupervised...
and residents can work. This effectively reduces by 10-25% the amount of inpatient coverage provided per . Many hospitalists are coming to perform the same tasks formerly performed by residents; although this is usually referred to as a House Officer rather than a Hospitalist . The fundamental difference between a Hospitalist and a House Officer is that the Hospitalist is the Attending Physician of a patient while that patient is hospitalized. The House Officer admits the patient for another Attending Physician and cares for that patient until the Attending Physician can see the patient. - Most primary care physicians are experiencing a shrinking role in hospital care. Many primary care physicians find they can generate more revenue in the office during the hour or more they would have spent on inpatient rounds, including traveling to and from the hospital .
Hospitalists represent one of the most rapidly growing forms of medical practice in the US. Currently a large proportion of hospitalists are recently-graduated residents, who continue familiar duties for a few years. As residency programs are encouraged to limit inpatient duty hours and provide more outpatient education, this pattern may shift. If this specialty evolves as emergency and intensive care medicine did, it will become a formal specialty with its own residencies and board certification within a decade or two. A few distinct residency and fellowship training programs are currently operating at major universities .
In addition to patient care duties, hospitalists are often involved in developing and managing aspects of hospital operations such as inpatient flow and quality assurance. The formation of hospitalist training tracks in residency programs has been driven in part by the need to educate future hospitalists about business and operational aspects of medicine, as these topics are not covered in traditional residencies .
Certification
As a relatively new specialty, only recently has certification for specialty experience and training for hospital medicine been offered. The American Board of Hospital Medicine (ABHM), a Member Board of the American Board of Physician SpecialtiesAmerican Board of Physician Specialties
The American Board of Physician Specialties , the official certifying body for the American Association of Physician Specialists is a non-profit umbrella organization for sixteen medical specialty boards that certifies and re-certifies physicians in fourteen medical specialties in the United...
(ABPS), was founded in 2009. The ABHM was North America’s first board of certification devoted exclusively to hospital medicine. In September 2009, the American Board of Internal Medicine
American Board of Internal Medicine
The American Board of Internal Medicine is a non-profit, independent physician evaluation organization committed to continuously improving the profession for the public good by certifying physicians who practice internal medicine and its sub-specialties...
(ABIM) created a program that provides general internists practicing in hospital settings the opportunity to maintain Internal Medicine Certification with a Focused Practice in Hospital Medicine (FPHM).
Quality initiatives
Research shows that hospitalists reduce the length of stay, treatment costs and improve the overall efficiency of care for hospitalized patients. Hospitalists are leaders on several quality improvement initiatives in key areas including transitions of care, co-management of patients, reducing hospital acquired diseases and optimizing the care of patients.Employment
The number of available hospitalists positions grew exponentially from 2006 to 2010 but has since then leveled off. However, the job market still remained very active with some hospitals maintaining permanent openings for capable hospitalists. Salaries are generally very competitive, ranging from $180,000 a year to $250,000 a year. Hospitalists who are willing to work night shifts only (NocturnistNocturnist
A Nocturnist is a specialist hospital-based doctor who only works overnight. Some nocturnists are trained in internal medicine, and have experience in hospital medicine. However, there are nocturnists trained in other specialties, such as psychiatry...
) are compensated higher than their day shift peers.
Additional resources
- The Hospitalist Movement — Time to Move On, New England Journal of Medicine
- Study ties hospitalist care to shorter patient stays, American Medical News by the American Medical Association