Rethinking Hospitalist vs Specialty Care: The Devil's in the Details

Alok S. Patel, MD


July 20, 2018

During every shift, there's at least one argument about an admitted patient and which service he or she belongs on. You know exactly what I'm talking about. Am I right?

"This patient's not neurology? He's GI."

"He's on GI. Don't dump him on general medicine."

"Why does surgery want to put this patient on team 2?"

This happens all the time, and usually things work out fine. One team gets annoyed and life goes on. But recently I saw a study in the American Journal of Cardiology [1] that had me rethinking the importance of this debate.

The study looked at more than 900 patients with heart failure and found that patients admitted to a general medicine service, under the care of a hospitalist instead of a cardiologist, were less likely to have a follow-up cardiology appointment after discharge and more likely to be rehospitalized.

Does this mean that hospitalists can't do adequate discharge planning for complex patients? No way. We are powerhouses. It does imply that specialists are probably better with those fine details within their field, which makes sense. But I do worry that this one study is an example of a much larger problem in medicine.

Here's the thing: Regardless of the study, we don't have enough subspecialists in this country to ensure that every patient is on the right service and gets white-glove treatment. Like it or not, hospitalists have to get used to taking care of complex patients and getting them the right follow-up. Hospitalists have to be proactive about encouraging shared communication, and when needed, we have to get those consults, especially as they relate to discharge planning.

Consults: This means you have to stop yelling at us at 5 AM.

What are your thoughts? What should we be doing differently? We want to hear them.


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