More Doctors Specializing in Hospital Medicine

Hospitalists are doctors who specialize in hospital medicine. This means they help patients in hospitals (inpatients). Hospitalized patients tend to be sicker than those helped by doctors at clinics away from hospitals (outpatients).

Hospital medicine is a very new medical specialty.

"The word 'hospitalist' didn't exist until 1996, so it's gradually growing in its presence, and knowledge of it as an option for residency is growing," says Dr. Eric Mueller. He's the site chief for a regional hospital that is starting a hospitalist program.

"I think nowadays most people in a medical-school-sized hospital will be exposed to hospitalists and will know what they are," says Mueller. "A little tiny hospital at the periphery might not, but by the time you're at hospitals that medical schools train in, almost all of them would have hospitalists."

In addition to caring for patients, hospitalists engage in the research, teaching, and administration of hospital medicine.

There are more than 30,000 hospitalists in the U.S., according to a Society of Hospital Medicine fact sheet.

"This is the fastest growing medical specialty in the U.S.," says Mueller. "[And] programs are starting at hospitals throughout Canada."

Before this specialty was created in the 1990s, primary care doctors had to take time away from their clinics to visit their hospitalized patients. Often, they would do this before their clinic opened each morning. It made for some very long days!

Most medical graduates who become hospitalists are trained as family physicians. Some will have specialist training in internal medicine. Family practice typically requires two years of residency after medical school, while internal medicine requires four.

Mueller says a rewarding part of this specialty is being able to help patients who need care the most.

"Inpatients are the sickest persons accessing a health-care system," says Mueller. "These patients benefit from acute care and their improvement is often visible day to day."

Another appealing aspect of hospital medicine is that you're not always tied to your patients in the same way that doctors with their own practices tend to be.

"Shift work means that when a hospitalist is not on service, they are generally free to travel or do whatever non-work activity they enjoy most," says Mueller.

This is part of the appeal for Dr. Brenda Trenholme. She's now the head of hospital medicine at a regional hospital, but for many years she had her own practice.

"I had a practice for 25 years and every time I wanted to go for a ski, I had to check with the maternity ward to see that I didn't have anybody in labor and I had to tell my secretary where I was going," says Trenholme.

"If I was going away for the weekend, I had to arrange for someone else to cover my patients if anyone was admitted to the hospital. So it's a completely different obligation, a different time commitment."

But don't think hospital medicine is easy. A typical schedule for a hospitalist might be seven days on and seven days off, or four days on and four days off. Those days when you're "on" can be grueling.

"We work intensively," says Trenholme. "At our hospital, we're on call seven days in a row for 24 hours a day. We work a week solid and then we have time off...

"I see every patient every day that is under my jurisdiction, but I'm also called all night about somebody's chest pain... or they need a blood transfusion or whatever, so I have to be available 24/7 for my patient population in the hospital," Trenholme adds.

"I don't necessarily have to go down to the hospital at night [though] sometimes I do, but I have to be available within short notice to be there and I field phone calls all night."

Trenholme says many hospitalists are older doctors who enjoy no longer having to deal with the hassles of running their own practice, such as paying overhead and staff and getting colleagues to cover for you when you want time off.

"They've done general practice for years and it's just a new and exciting area of medicine where they get to take care of much more acutely ill patients all day and converse with your colleagues, which is really fun," says Trenholme. "You get to be working on a team."

"I like taking care of patients that are in the hospital more than I like taking care of patients that are outside the hospital," says Dr. Danielle Scheurer, a hospitalist in South Carolina. "They tend to be a little more sick and in my mind a little more interesting because of that."

Scheurer says one big reason for the growth of hospital medicine has been a shortage of primary care doctors. This made doctors busier and busier in the outpatient realm. As a result, it got harder for doctors to do both inpatient and outpatient care.

"The second huge impetus for growth was that the clinical competencies required to be either an outpatient doctor or an inpatient doctor have become more complicated," says Scheurer.

"In other words, the knowledge base you need to be a good primary care doctor is growing and the knowledge base you need to be a good hospitalist is also growing, and so... if you get good in one area, then you tend to lose your knowledge base in the other area."

A third factor, says Scheurer, is that training programs have started limiting the number of hours that interns and residents can work.

"The patient load is not going down, but the amount of training hours is going down," says Scheurer. "So a lot of hospitals have hired hospitalists to sort of fill that void, [to fill] a deficit in manpower that came along with work-hour restrictions within training programs."

The growth in the number of hospitalists provides many benefits to patients.

"The advantage to the system is that people who are doing inpatient care [are doing] very good inpatient care, because that's all they do," says Mueller.

Scheurer agrees: "As far as how the patients benefit, one huge advantage is ... the clinical competence of the hospitalist. They're very good at taking care of acute medical problems [such as] severe pneumonia or an acute cardiac arrhythmia -- things that are traditionally managed in a hospital setting but not in outpatient settings. So the patient can definitely benefit from ... their clinical knowledge base."

Despite the benefits, the growing number of hospitalists in the health-care system has raised concerns.

"The downside that we're struggling with, I think, as a specialty and as a health-care system, is that there is that additional fragmentation in a patient's care," says Scheurer.

"Because they have this home-based primary care doctor, but then when they get admitted (to hospital) they're seen by someone they've never met before.

"We're trying to fill those gaps in communication and work collaboratively with primary care doctors, but that's still clearly an area of vulnerability in our system, where patients are transitioning from home to hospital and [from] hospital out of the hospital," Scheurer adds.

People who are good at dealing with people make the best hospitalists.

"Teamwork is really important and being able to listen," says Trenholme. "I think certainly people skills are really important because you're dealing with patients and families in crisis, and they're scared and they really don't need an arrogant sort of authoritarian doctor ... They need someone who's going to listen and respond to them."

Hospitalists need "excellent communication skills and a 'team' mentality," agrees Mueller. "Hospitalists work in a system that involves many resources and people -- understanding the value and role of the other members of the team is essential."

Hospital medicine seems poised for continued growth, especially with our society's aging population. If you're leaning toward a medical career, you'll surely find lots of opportunities in hospital medicine when you finish your medical training.


Hospitalists at the Helm
Learn how hospitalists help hospitals and patients

Hospitalists Take Charge of Patient Care
An interesting article about the work done by hospitalists

Hospital Medicine Quick Hits
Read clinical updates for the busy hospitalist

Wachter's World
An informative blog by the doctor who coined the term 'hospitalist'

Society of Hospital Medicine
Info on certification, professional development, and events

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