Hospital medicine in the United States is the discipline concerned with the medical care of acutely illhospitalizedpatients. Physicians whose primary professional focus is hospital medicine are called hospitalists; this type of medical practice has extended beyond the US into Canada. The practical effect of the hospitalist is to act as transition coordinator and case manager, due to the tremendous growth in medical knowledge and resultant number of medical specialists.
The term hospitalist was first coined by Robert Wachter and Lee Goldman in a 1996 New England Journal of Medicine article. Hospitalist activities may include patient care, teaching, research, and leadership related to hospital care. Hospital medicine, like emergency medicine, is a specialty organized around a site of care (the hospital), rather than an organ (like cardiology), a disease (like oncology), or a patient’s age (like pediatrics).
The majority of hospitalists are physicians with a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine(D.O.) degree. While it was commonly believed that any residency program with a heavy inpatient component provided good hospitalist training, studies have found that general residency training is inadequate because common hospitalist problems like neurology, hospice and palliative care, consultative medicine, and quality assurance tend to be glossed over. To address this, residency programs are starting to develop hospitalist tracks with more tailored education. Several universities have also started fellowship programs specifically geared toward hospitalist medicine.
According to the State of Hospital Medicine Survey by the Medical Group Management Association and the Society of Hospital Medicine, 89.60% of hospitalists specialize in general internal medicine, 5.5% in a pediatrics subspecialty, 3.7% in family practice and 1.2% in internal medicine pediatrics. Data from the survey also reported that 53.5% of hospitalists are employed by hospitals/integrated delivery system and 25.3% are employed by independent hospitalists groups.
According to the recent data, there are more than 30,000 hospitalists practicing in 3,300 large hospitals and half of all community hospitals.
Hospital medicine is a relatively new phenomenon in American medicine. Almost unheard of a generation ago, this type of practice arose from three powerful shifts in medical practice:
In addition to patient care duties, hospitalists are often involved in developing and managing aspects of hospital operations such as inpatient flow and quality assurance. The formation of hospitalist training tracks in residency programs has been driven in part by the need to educate future hospitalists about business and operational aspects of medicine, as these topics are not covered in traditional residencies.
As a relatively new specialty, only recently has certification for specialty experience and training for hospital medicine been offered. The American Board of Hospital Medicine (ABHM), a Member Board of the American Board of Physician Specialties (ABPS), was founded in 2009. The ABHM was North America’s first board of certification devoted exclusively to hospital medicine. In September 2009, the American Board of Internal Medicine (ABIM) created a program that provides general internists practicing in hospital settings the opportunity to maintain Internal Medicine Certification with a Focused Practice in Hospital Medicine (FPHM).
Research shows that hospitalists reduce the length of stay, treatment costs and improve the overall efficiency of care for hospitalized patients. Hospitalists are leaders on several quality improvement initiatives in key areas including transitions of care, co-management of patients, reducing hospital acquired diseases and optimizing the care of patients