The growth of the ______ hospitalist, where _____ is nearly any specialty you can name

John Nelson writes…

As I’ve written before (here and here), nearly every specialty in medicine is continuing to turn to the hospitalist model.  I’m aware of community, and in many cases academic, hospitalist practices in nearly every specialty in medicine including surgical (general surgery) hospitalists, orthopedic hospitalist, and more.  The list includes psychiatry, obstetrics, gastroenterology, infectious disease, and on and on.  Someone once told me he knew of a dermatology hospitalist somewhere. (I’d love to talk to this doctor, but never got any details and wonder if this was a myth or a very loose interpretation of what makes one a hospitalist.)

How can we document this growth?

Because the AMA, most specialty societies, and state licensing boards don’t collect data on which doctors practice as hospitalists, we have make estimates by relying on other sources.  While I had to rely on my own anecdotal experience to track the growth of “medical” hospitalists in the mid-1990s, Google alerts now give me a way to corroborate my impression of growth in other specialties.   Several years ago had Google send me an e-mail link every time the term “surgical hospitalist” (or “surgicalist” or “acute care surgeon”) appeared in a new place in the Internet.  There was just a trickle a few years ago and I’m now getting several every week.  My guess is that this provides a reasonable estimate of the growth of such practices, and it matches my anecdotal experience.

Google trends let’s you see the search volume trend for any term.  There are too few searches on “surgical hospitalist” or “laborist” to register, but look to see if you think the search volume for “hospitalist” parallels the growth in the field.  (I’m not advertising for Google; in fact I’m concerned the company is too far along the path to Big Brother and I typically use other search vendors.  But some of their tools are awfully valuable.)

While the hospitalist model seems to be penetrating nearly every specialty, the adoption curve will probably not be as steep for any field as it has been for “medical” hospitalists.

Questions raised by the growth in so many fields

All of this growth raises a lot of questions such as what will be the best terminology to use.  Will we always need to use a modifier in front of “hospitalist”?  So “medical” hospitalists, “surgical” hospitalists, etc.  Or will other fields tend to adopt other labels; for example a lot of surgeons favor using the term “acute care surgeon” to refer to any surgeon with a hospital-focused practice that manages acute surgical issues.  (Some surgeons also believe that a surgical hospitalist and acute care surgeon are two different, though overlapping, models.)

Another question is what each of these specialty hospitalists will see as their real job.  The same as any other doctor in their field except without any (or much) outpatient work?  Or will they see themselves as being responsible for participating in the development of new systems and models of care to improve the quality, safety, and cost of care?

The job description for a hospitalist in each field will probably change in unanticipated ways just because of greater in-hospital availability.  That has certainly happened for “medical” hospitalists. And the way hospitalists in different specialties working in the same hospital interact with one another is likely to change also.

I hope that in most hospitals the medical hospitalist practice can serve as a template or starting point for the development of specialty hospitalists at that hospital.  If you’re a medical hospitalist you should be talking with other doctors and administrators about their interest in developing specialty hospitalists.  They could use your help, and it is in your interest to be involved.  I plan to write more about these issues in future posts.

2 Comments

  1. Brad Brad on December 3, 2009 at 7:55 pm

    John
    Good point and should lead to greater discussion within SHM re: how do you define term. The fact that ______ hospitalists (fill in the blank) have been around for a good number of years, and very few are seen within SHM circles is probably telling in terms of professional identity. Could change, but i think it is less likely.

    Additionally, within definition, consideration of role as transitionalist, continuum coordinator, etc., and not just comanager or acutist is a concept that will gain momentum as we learn more about the importance of this interface. That also is a breech i dont see many of these docs stepping into, although I am sure there are some wonderful exceptions.

    brad

  2. Ken on January 22, 2010 at 10:01 pm

    I am interested in this discussion. Does anyone have more information about the “transitionalist” concept? If so, please email me at [email protected]. Thank you.

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