Hospitalists: Riding the Wave of Changes in Healthcare

Leigh Page


April 26, 2016

In This Article

A Rapidly Growing Specialty

Hospitalists and their specialty, hospital medicine, are in the throes of reinventing the physician's role.

Hospital medicine is celebrating its 20th anniversary this year. The number of physicians in the specialty has mushroomed to 52,000, making it "the fastest-growing specialty of all time," according to Lawrence Wellikson, MD, chief executive of their specialty group, the Society of Hospital Medicine (SHM).

Hospitalists started by providing round-the-clock primary care to hospital inpatients, and now that model has spread to such specialties as obstetrics, orthopedic surgery, and neurology. Nine out of 10 US hospitals with more than 200 beds have hospitalists working inside, says Dr Wellikson.

Hospital medicine is also, in the literal sense, a young specialty. "Many physicians become hospitalists right out of training," Dr Wellikson says. He reports that hospitalists' average age is 37 years; this would be the early years of a neurosurgeon's career and is well below the average age of all licensed physicians, which is 52.

It is also a restless specialty. Primary care hospitalists moved into the hospital operating room to take care of patients there, and then to postacute sites outside of the hospital. All these moves have spawned a plethora of new names for subspecialists: nocturnists, laborists, subacutists, transitionalists, even SNFists (skilled nursing facility practitioners).

Hospitalists generally are less fearful about the ongoing shift to value-based care, bundled payments, and shared savings in accountable care organizations (ACOs). The values behind these approaches—team care, use of outcomes data and protocols—have been part of their training since the beginning.

"We think about throughput, systems of care," Dr Wellikson says. Among the core competencies of the specialty, SHM lists "quality and process improvement" and "efficient use of hospital and healthcare resources." Almost 4 in 10 hospitalists are now in ACOs, according to the new Medscape Hospitalist Compensation Report.[1]


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