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What’s ahead for hospitalists?

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What’s ahead for hospitalists?  Two experts on them, Robert Wachter. M.D., and Lee Goldman, M.D.,  discussed in The New England Journal of Medicine the specialty’s rise and  future role.

“Although we continue to believe that the hospitalist model is the best guarantor of high-quality, efficient inpatient care, it’s clear that today’s pressures require innovative approaches around this core,”  Dr. Wachter, of the University of California, San Francisco, and Dr. Goldman, of Columbia University, wrote.

To read their piece in the NEJM, please hit this link.

But  Richard Gunderman, M.D., of the Indiana University School of Medicine, questioned in his own NEJM article hospital medicine’s impact on healthcare overall. “The acute-care focus of hospital medicine may not match the need of many patients for effective disease prevention and health promotion,” he wrote. “I suspect the inherent tensions will remain fundamentally irresolvable.”

“What we don’t yet know sufficiently well is the impact of the rise of hospital medicine on overall health status, total costs, and the well-being of patients and physicians,” Dr. Grunderman wrote.  To read his piece in NEJM, please hit this link.

Modern Healthcare noted: “These questions emerge amid a growing emphasis in medicine on coordinated, integrated care. And while in many ways a hospitalist’s job is to provide precisely that, some see the growing reliance on them as indicative of healthcare becoming too hospital-centric, in a way that hinders comprehensive care.”

“In 2003, when the American Hospital Association first began tracking the specialty, the U.S. had slightly more than 10,000 hospitalists. In 2016, the country had more than 50,000, an increase driven by both economic necessity and a spate of government changes that emphasized efficiency and quality in healthcare. The field’s boom is showing no signs of slowing.”

“We’re seeing many medical students start medical school saying. ‘I want to be a hospitalist,’” Dr. Wachter said, adding that  hospitalists will remain crucial to the healthcare system even as the industry tilts toward population health.

“There are people talking about how we can eventually close down all the hospitals,”  Dr. Wachter said. “That’s not going to happen.”

After all, patients who end up in the hospital tend to be even sicker, with even more complex conditions,   than inpatients tended to be, say, 20 years ago. Many patients who used to be treated in hospitals can now be handled on an outpatient basis. So physicians who specialize in handling the sickest — and thus hospitalized — patients are ever more necessary.

Meanwhile, in recent years, hospitals looking for ways to improve efficiencies and lower costs, have begun outsourcing hospitalists. That’s led some hospitalists to raise concerns about being spread to thin.

“We’re now a mature, really important field,” said  Dr. Wachter. “That’s my biggest worry: that we’ll become old and staid and rest on our laurels.”

For a good overview of the state of hospitalists,  please hit this link.


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