The Hospitalist: Physicians Find New Opportunities in Hospital Medicine

The term “hospitalist” was first used by Robert Wachter, MD, of the University of California, San Francisco, in a 1996 article written for the New England Journal of Medicine. Dr. Wachter, generally considered the academic leader of the hospitalist movement, might have done well to copyright the term, because today it’s practically a household word.

“The future has a way of arriving unannounced.” —George Will

The term “hospitalist” was first used by Robert Wachter, MD, of the University of California, San Francisco, in a 1996 article written for the New England Journal of Medicine. Dr. Wachter, generally considered the academic leader of the hospitalist movement, might have done well to copyright the term, because today it’s practically a household word.

The hospitalist movement has grown exponentially over the last decade. According to the Society of Hospital Medicine, there were 2,000 practicing hospitalists in 1998. Today there are more than 20,000—and that number is expected to surpass 30,000 over the next two years. Why the phenomenal growth?

“If you go back 30 years, everyone did their own intensive care medicine,” explains Steve Frankel, MD, who has spearheaded the effort by the National Jewish Medical and Research Center to operate and staff the hospitalist program at Rose Medical Center in Denver over the past two years. “You didn’t have critical care doctors, and you didn’t have emergency room doctors. This specialty of hospitalist medicine is really the next logical step.” A professionally and financially rewarding step.

Attracting Young Doctors

Monal Shah, MD, is a hospitalist at Parkland Hospital in Dallas. He admits that he was not certain where he wanted to focus his education when he started his residency. But by his second year, Shah—like many other hospitalists—had found his calling.

“Most [hospitalists] like to do clinical work; we like taking care of patients who are sick and in the hospital,” Dr. Shah explains. “There’s definitely immediate results as opposed to watching someone over several months, adjusting medication on an outpatient basis. And most hospitalists tend to have a global view of healthcare. We actually like to see systems change, so we tend to do a lot of committee work and become involved with cost containment endeavors that the hospital may have.”

But there are lifestyle attractions as well, including work schedule and financial compensation. According to the Society of Hospital Medicine’s 2007-2008 Bi-Annual Survey, the average hospitalist today receives a total annual compensation of $193,000—a step up from what most primary care practitioners earn—and an increase of almost 13% over the last two years. Hospitalists also work more defined shifts, so when their shift is over, their time is truly their own.

“For people who have families, or for people who have a lot of personal interest in other areas, [the defined shifts] definitely allow for that balance between professional and personal life,” explains Dr. Shah. “I think it has been a huge contribution to the growth of hospital medicine.”

Making the Transition

The Society of Medicine survey notes that the average age for a hospitalist is 37, with an average of 3.7 years of experience and nearly two out of three are men. But not every hospitalist is fresh out of residency. Martha Danhof, MD, is an IPC Hospitalist at Baylor All Saints Medical Center in Ft. Worth, Texas, but in her former life, was a sole practitioner for four years.

“The overhead was a killer,” explains Dr. Danhof. “There was significant frustration in trying to get reimbursed and the constant hassles of dealing with insurance companies. Plus, from a personal standpoint, one of the reasons I went into internal medicine was I really enjoyed the diagnostic challenges. And as a primary care physician, I was not challenged.”

Chris Edwards, MD, was a partner in an Orlando-based internal medicine practice for 14 years before becoming a hospitalist. Today he is the chief medical officer for PrimeDoc, a 100% physician-owned and managed private-practice hospitalist company. “Ninety-five percent of our call on weekends and at night had to do with hospital work, but it was only 5% of our income,” explains Dr. Edwards, referring to his internist practice. “So, we got rid of our hospital work, and that was great for everyone in the group except me. I decided I really liked the hospital and wanted to go back to do work there. Of course, the rest of my group thought I was nuts.”

Neither Drs. Danhof nor Edwards is nuts; they are extremely happy with the work they’re doing. “This was the perfect choice for me,” says Dr. Danhof. “I smile every day.” Echoes Dr. Edwards, “I’ve done this for four years straight. I know I’ve made the right decision.”

Special Skills Required

Whether targeting hospital medicine as a career or making the transition, doctors agree that communication skills are essential to being a successful hospitalist.

“If a patient is very sick, we want to expedite a diagnosis and treatment as quickly as possible,” explains Dr. Shah. “In order to do that, we have to coordinate tests and treatment in a very precise manner. That involves interaction with every department from radiology to pharmacy and sometimes administration. If you’re not able to communicate effectively in this type of setting, you’re not going to be an effective hospitalist.”

Dr. Danhof agrees, “You have to be very confident in your medical and communication skills, and that’s the biggest reason why not everyone can be a hospitalist,” she says. “You have to be able to deal with critical issues at any time. It’s a tough, challenging job, but I love it.”

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@ptd.net.

82%Percentage of hospitalists who have their MD degree in general internal medicine. (Society of Hospital Medicine, 2008)

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