Supply of Medical Services

Hospitalists emerging role

Generalists can give holistic, cost-effective care to patients, but may be limited in their ability to treat complex diseases.  Specialist may offer a superior quality of medical services and advance knowledge in their field, but this premium medicine comes at a high cost.  Generalist or specialist…Specialist or generalist…which to chose?  

A 1996 New England Journal of Medicine (Wachter and Goldman 1996) article claims that hospitalists are the forgotten third category of physicians.  Why would a hospitalist be necessary?  Couldn’t a primary care physician care for his patients in the hospital?  The article believes hospitalists will emerge for the following reasons:

“First, because of cost pressures, managed-care organizations will reward professionals who can provide efficient care. In the outpatient setting, the premium on efficiency requires that the physician provide care for a large panel of patients and be available in the office to see them promptly as required. There is no greater barrier to efficiency in outpatient care than the need to go across the street (or even worse, across town) to the hospital to see an unpredictable number of inpatients, sometimes several times a day. There are parallel pressures for efficiency in the hospital. Since the inpatient setting involves the most intensive use of resources, it is the place where the ability to respond quickly to changes in a patient’s condition and to use resources judiciously will be most highly valued. This should prove to be the hospitalists’ forte.”

Hospitalists have already been used in Canada and Great Britain.  In the U.S., Scripps Clinic in La Jolla, California as well as Park Nicollet Medical Group in Minneapolis medical groups which both use hospitalists.  Hospitalists may form a multi-disciplinary group where responsibility for patient care is given to the hospitalist with the most expertise in the patients area of need.  The only problem with shared responsibility is that this may lead to occasions where no one takes responsibility.  Also, primary care physicians often dislike the fact that they must give up patient control to hospitalist once they enter the in-patient setting.  Specialists fear that hospitalist may reduce the number of consultations the patients may have. 

Since this article was written ten years ago, I was wondering if any of my readers could update me as to the current popularity in the use of hospitalists in 2006.  The website has some additional information on this type of physician as well.