Both Dr. RW and Medrants have posted recently on the evolution of the hospitalist movement. Although the number of hospitals implementing a hospitalist program is growing rapidly, a number of questions remained unanswered regarding outcome data and cost-effectiveness of hospitalist-led patient care and the best job description for a hospitalist physician.
Within these recent posts, Medrants raised an issue that hits close to home for me. Here he excerpts from his editorial in the Archives of Internal Medicine:
As I wrote in my original discussion, the phrase "hospitalist inpatient system" does not describe a homogeneous concept. Hospitalist groups vary in call structures and accessibility. Academic hospitalists often have very different responsibilities than community hospitalists. We need to understand the influence of these various systems on the measurement of hospitalist impact.
We also do not know how much the individual physicians affect patient care outcomes. I suspect that we all believe that some physicians consistently do a better job of patient care than do others.
As a family doctor providing rural hospitalist services, I appreciate Medrant's acknowledgement that hospitalist programs and hospitalist physicians are not uniform in composition or quality. Most of the emerging policy statements I've read tend to address the needs of the new profession as if all hospitalists were facing the same responsibilities and concerns. Many discussions on the future of hospitalist medicine also assume that training and certification of hospitalist physicians will fall under the umbrella of internal medicine, either as a subspeciality or a new specialty "spun-off" from internal medicine.
Being a selfish beast, I am alarmed at the absence of rural or family medicine perspectives in the debate about the future of hospitalist medicine. So I'm going to throw my hat into the ring. Over the next two weeks, I'm going to be posting on some topics specific to small-town hospitalist programs and the family doctor as hospitalist, including:
- Characteristics of rural hospitals and rural medical communities
- Three rural hospitalist program models
- The development and collapse of a locally-run hospitalist program
- My own professional dilemma as a hospitalist physician facing an imminent job change
By the time I get to the end of this brief series of posts, I hope I'll have made up my mind about my own hospitalist conundrum, and also made the point that hospitalists are not one type of service, nor one type of physician.