Father of Hospital Medicine Has Mixed Review 15 Years Later

Carole Bullock

June 16, 2011

June 16, 2011 (Dallas, Texas) — Hospital medicine is entering a new growth phase that will capitalize on what it does best, "providing a brand of service and value," according to its founding father, Robert Wachter, MD, professor and associate chairman of the Department of Medicine at the University of California–San Francisco, who established the specialty some 15 years ago.

He spoke to a full audience on the topic "Hospital Medicine at 15: The Things I Never Would Have Guessed When the Fun Began," here at Hospital Medicine 2011: Society of Hospital Medicine (SHM) Annual Meeting.

The exponential growth of the specialty was a surprise to many. In 2003, 29% of US medical centers had hospitalists; by 2009, the number had increased to 61%. From 1996 to 2003, the number of hospital medicine physicians was 12,000. As of 2009, there were about 27,000. At this time, hospital medicine is the fastest-growing physician specialty.

"It's important to look back and see how the specialty has changed and what we can learn from our successes and failures," said Dr. Wachter.

"We guessed right that there would be a need for 'seamless care,' and that the hospital would see us as better mousetrap.... And that the field would have legs only if it could garner hospital support (psychic and monetary) and reduce cost," he said.

"Research was the core to success," he added.

"We thought there will be blood and pushback from [primary care physicians], worried specialists, [and] the traditionalists," Dr. Wachter said. "But by not overreaching and taking a 'wait 'em out' strategy, [we thought] the field would develop as a legitimate specialty.

"We didn't overreach. The game was going to be about value, and then we were surprised at the pace of change."

One of the positives is that there has not been as much cost pressure, "But this may have been mitigated by [a] supply-demand mismatch for hospitalists...which won't last forever," he said.

Another surprise that affected the specialty in a positive way was the "demand-effect" from the limits on residents' duty-hours and the effect of those limits on hospitalists in teaching hospitals.

According to John R. Nelson, MD, from Overlake Hospital Medical Center in Bellevue, Washington, who cofounded the SHM, hospital medicine is not only the fastest-growing specialty but salaries have increased 3% from last year, with the southern states paying higher salaries than other regions.

According to Dr. Wachter, hospitalists are unique players because "we focus on [the] numerator of [the] value equation and bring new competencies, such as systems thinking and integration."

Moreover, the specialty's forte is seeing the patient as "2 sick patients" that require care, taking into account both the disease and the medical environment.

Down the line, he expects budget battles to be "more hard-edged" and that the good hospitalist programs will be "paragons of integration," he said.

In addition, he predicts "intense cost reductions [and] more emphasis on deliverables. Quality will not be enough — there must also be waste-reducing."

The good news is that hospitalists are in step with changes in healthcare delivery, because they have already "recognized the need to remake delivery systems to survive and succeed in a new healthcare world."

Hospital Medicine 2011: Society of Hospital Medicine (SHM) Annual Meeting: Plenary. Presented May 19, 2011.


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