The Rise of Hospital Medicine

The financial viability of primary care physicians is structured around the outpatient setting where the physician has more control over their own environment.  Over the last 12 years, primary care physicians have seen a 40% decrease in the number of patients seen in the inpatient setting while experiencing a 19% reduction in time spent seeing those patients.  Reimbursements per hour spent have fallen more than 45% in the same time period.  This has led many primary care physicians to reduce or eliminate hospital rounds.  To remain financially viable, hospitals need to manage the patient population as cost-effectively as possible.

To meet this need, hospitals are turning to hospitalists - physicians whose total focus is the general medical care of hospitalized patients. There are currently 20,000 hospitalists in practice today and projections suggest the need for approximately 50,000 by the end of the decade, making it the fastest growing medical specialty in the United States.  Initially developed as a method of moving patients through the health care system more efficiently, the hospitalist movement has gained momentum over the past several years. Numerous studies have shown that the use of hospitalists reduce patient lengths of stay, decrease treatment costs, and reduce mortality rates. Additionally they improve overall efficiency and timeliness of care for hospitalized patients, while enhancing quality and patient satisfaction. They have also been shown to improve clinical outcomes and the quality of medical care for hospitalized patients.

Rural and suburban hospitals have seen a continued decrease in patient census over the last several years.  While there are numerous factors that contribute to this occurrence, the most significant has been the desire of primary care physicians to focus their practices on their outpatient setting.  Physicians coming out of residency programs have been exposed to hospitalist programs and make the conscious decision to eliminate hospital rounds.  Many feel their skill set is inappropriate for the hospital setting.  Others are more interested in having a professional position that keeps them busy from 9 – 6 with no hospital rounds and no unassigned call.

While every hospital is concerned with providing the most appropriate, most compassionate, most cost effective patient care, the rural and suburban hospitals face the added pressure of coverage for unassigned patients – especially on weekends.  Many primary care physicians choose not to admit patients if they feel they will have to round on them during a weekend.  They may choose to treat patients in an outpatient environment or transfer them to another facility where they will not be responsible for the continuing care. 

Fastest Growing Medical Specialty

As the fastest growing medical specialty, hospital medicine has attracted much attention in recent years, resulting in a large number of research studies with widely published results. These are just some of the documented benefits that a hospital medicine program can provide to your hospital:

v  Patients treated by hospitalists have lower costs, shorter lengths of stay and better medical outcomes, including higher survival rates.

v  Hospitalists can reduce hospital costs and length of stay by approximately 15-20 percent.

v  Hospitalists provide a solution for the care of unassigned patients.

v Being on-site and available 24 hours a day, hospitalists communicate more frequently with patients and their families, resulting in equal or higher levels of satisfaction with hospital care.

v Hospitalists are experts in the care of the growing number of acutely ill patients, exceeding the experience level of other primary care generalists. This enables them to recognize patients who require special attention, anticipate problems and rapidly respond to crises and changes in a patient’s condition to improve the overall outcome.