Dealing with diversity in the hospitalist movement…

Robert Chang, MD writes…

A blank slate to write for a national hospitalist blog is slightly intimidating, but perhaps from a different sense than one might expect.  Hospitalists are an extremely heterogeneous group, originally brought together by manpower necessity, serendipity as well as hard work.   Looking at the cards I get everyday for hospitalist recruitment, offers still range from academic positions in institution A, opportunities for provision of rural care in Remote area B, to competitive private group X in Fantastic location Y.  Writing on topics that affect the majority of us in our daily practice, in all its truly remarkable diversity, is not simple.

This diversity is a difficulty for not just a writer but also for the leadership of the hospitalist movement.  Our movement has grown from infancy to healthy adolescence, from merely surviving to defining our profession and scope of practice.  We are no longer just a disparate group of physicians whose main commonality is the caring for patients on the inpatient setting.  Great leadership has positioned us well, moving from a tenuous “economic benefit” platform to that of “best care” by associating ourselves with the quality improvement movement.  The call to integrate ourselves in the life of the hospital, nursing and administration only strengthens our position from being important to necessary.  Quality improvement and integration into the hospital life serve as two key foundations of our growth into a mature field.

The early move to capture hospital-based topics such as DVT prophylaxis, consultative general medicine, and palliative care will help with identity issues.  Despite carving out these core topics of our field, however, I think significant work to create a comprehensive identity for a hospitalist remains.  The challenges of a location-defined specialty as opposed to a topic-defined specialty require our continued attention.

To this end, we need to continue to mark target areas that naturally belong to our role in the hospital, focusing on synergistic goals that benefit not just our field but future needs of our population and internal medicine as a whole.  The shrinking primary care pool and aging population point us in the direction of geriatric medicine, better coordination of chronic disease management and, in particular, participation in the development of the advanced medical home (AMH).  Research has shown that the transition from hospital to home is fraught with errors and information gaps.  One of the touted benefits of hospitalists has been increased communication with the primary care physician and yet formalization on a national level has really not yet occurred.  Even the creation of discharge appointments, which we often use as the anchor for the transition of care, is a fickle and variable process.  This transition from hospital-to-home is one that we should take on as ours, despite all its logistical difficulties.

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