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what exactly is the subspecialty 'hospitalist'? i hear it classified under internal medicine. can anyone describe this field?
hospitalist?
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A hospitalist is a doctor, typically an internist, who specializes in the care of inpatients. They work with patients who are in the hospital, rather than those in the outpatient clinic. I have seen them employed by hospitals as well as by internal medicine/family practice private groups. In the latter case, the hospitalist is responsible for the care of the group's patients that are admitted, while the other doctors in the practice care for the regular outpatients.
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Internal medicine w/o the clinics / follow up
A "professional resident"
Pure inpatient medicine with an extra scoop of unit
A "professional resident"
Pure inpatient medicine with an extra scoop of unit
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Once upon a time, primary care physicians would take care of their patients at all times, in the hospital and without. However, with the increased pressure to see more and more patients in clinic, PCPs got less and less time to travel to the hospital and take care of the inpatient, who due to the acute nature of the illness that got him/her there, is very needy.
Thus, the hospitalist was born. Hospitalists provide a service in which a PCP can have a hospitalist cover their patients whenever they land in the hospital. During the time that the patient is in the hospital, the hospitalists will make all the medical decisions (in close contact with the PCP, who knows the patient the best). When the patient is discharged, the hospitalist "transfers care" back to the PCP, and is no longer involved.
There are pros and cons to the system. Pros: Hospitalists are trained to address inpatient problems since they see it all the time. On top of that, since they're always in the hospital (they don't have clinics), they're always available to see the patient immediately instead of having to travel across the city each time something comes up. It's also felt that in teaching hospitals, the hospitalists are in a better position to teach residents/students.
Cons: PCPs know their patients best, and the continuity of care is important. Hospitalists will never see their patients again once discharge occurs (unless there is a bounce back).
You'll find that older PCPs are very disdainful of the use of hospitalists because they strongly believe that no one can take better care of a patient than the PCP who knows the patient the best.
You'll also find that many residents like the hospitalist role because it's a familiar environment to them (they're still in the hospital all the time, taking care of inpatients).
Thus, the hospitalist was born. Hospitalists provide a service in which a PCP can have a hospitalist cover their patients whenever they land in the hospital. During the time that the patient is in the hospital, the hospitalists will make all the medical decisions (in close contact with the PCP, who knows the patient the best). When the patient is discharged, the hospitalist "transfers care" back to the PCP, and is no longer involved.
There are pros and cons to the system. Pros: Hospitalists are trained to address inpatient problems since they see it all the time. On top of that, since they're always in the hospital (they don't have clinics), they're always available to see the patient immediately instead of having to travel across the city each time something comes up. It's also felt that in teaching hospitals, the hospitalists are in a better position to teach residents/students.
Cons: PCPs know their patients best, and the continuity of care is important. Hospitalists will never see their patients again once discharge occurs (unless there is a bounce back).
You'll find that older PCPs are very disdainful of the use of hospitalists because they strongly believe that no one can take better care of a patient than the PCP who knows the patient the best.
You'll also find that many residents like the hospitalist role because it's a familiar environment to them (they're still in the hospital all the time, taking care of inpatients).
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Looking at the advent of the hospitalist from the outside (I'm EM not IM) I think that it is a good system and is here to stay. Most PMDs are overwhelmed in their clinics. They face ever decreasing reimbursement and a mandate to see and dispo a patient every 7 - 10 minutes. I don't see how they do it. With these pressures there is no way for them to effectively manage even semi complex inpatients from their clinics. The hospitalist model makes the best of a bad system.
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I work as a mid-level practitioner with 10 hospitalists and i will tell you that the in patients get outstanding care. There are problems with continuity in that no one can work x days is a row and see the same patients all the time. I think the pay is pretty good with incentive bonuses ( i never hear anyone complian about money ), and there is no call. When we reach a certain census an additional person gets called in if available. Also, we have a resident from the teaching hospital and a pre-cardiology fellow who fill in on the night shift and just do admissions so they in still in a great mode where the admissions get a good workup--(versus the near empty H&P's we see with other patients not on our service that belong to 'busy doctors who have an office to run'. )
I work as the 'house officer' and our group as a whole provides 24 hour coverage. My calls are inversely proportional to the number of patients on the hospitalist service. They are very through and I think the patients do well because someone from the group is in house 24 hours.
I work as the 'house officer' and our group as a whole provides 24 hour coverage. My calls are inversely proportional to the number of patients on the hospitalist service. They are very through and I think the patients do well because someone from the group is in house 24 hours.
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