Hospitalists are a growing trend

Filed in archive Opinion on July 14, 2005

In this article, a physician talks about hospital-based physicians being part of an evolution of primary care:

I think you have to see the hospitalist movement in the context of the evolution of primary care. Think back to the old general practitioners -- my grandfather was one -- who would deliver babies, do appendectomies, treat blood pressure and deliver palliative care, sometimes all on the same day. As American medicine matured over the 20th century, and hospitals became places of high technology and extensive knowledge, specialization became important. Medical and surgical sub-specialties were invented and became institutionalized: cardiology, Endocrinology, thoracic surgery, dermatology and so forth.

Primary care broke up into pediatrics (for kids), internal medicine (for adults) and family practice (for everybody) -- with family practice continuing most closely in the vein of the old general practitioner.

Primary care physicians have traditionally called on their own hospitalized patients, bringing in consults as necessary. This still happens often. But this brings some problems.

First, the primary physicians are only in the hospital a few hours a day, so cannot respond to emergencies quickly. Second, breaking up one's day between two settings like that -- the hospital and the office -- tends to eat up some time, and it costs money.

That last part rings true. Shuttling between the office and hospital is not conducive to the best patient care. While in the hospital, one is always rushing to get back to the clinic. Once in the clinic, there is constant interruption from hospital calls. More importantly, you are not in the hospital should an emergency happen.

Hospital medicine is appealing to many newly graduated internal medicine residents - as it is an extension to what they are used to doing in residency. Hospital medicine continues to be emphasized more in training, thus many IM residents will continue to feel more comfortable in a hospital rather than a clinic setting. (Merrill, "You Could Get a Hospital Doctor", RedNova, Jul.14)