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Where would hospitals be without hospitalists?
Today, hospitalists are so deeply integrated into many organizations that it might be hard to remember this role has only existed for a few decades.
Robert Wachter, MD, and Lee Goldman, MD, coined the term “hospitalist” in The New England Journal of Medicine article in 1996 to describe “a new breed of physicians” who were specialists in internal medicine. They described doctors who could provide efficient, high-value care in response to growing cost pressures of managed care.
The concept took off. The population of hospitalists in the United States grew by more than 50% between 2012 and 2019, according to a 2022 study in the Journal of Hospital Medicine. More than 62,000 hospitalists are practicing today, according to the Society of Hospital Medicine (SHM).
“Beyond our presence at the bedside, hospitalists are leaders in health systems,” said Flora Kisuule, MD, MPH, the society’s board president.
An Evolving Role
Research suggests hospitalists provide efficient care without sacrificing care quality. In fact, hospitalist care is associated with improved patient satisfaction and decreased lengths of stay, according to a meta-analysis of 61 studies in the Journal of Community Hospital Internal Medicine Perspectives.
“In recent years, hospitalists have become an integral part of quality improvement initiatives and even payor strategies in many organizations,” said Jeremy Tinnerello, RN, MSN, MHA, president of St. Dominic Hospital in Jackson, Mississippi, which has a hospitalist squad of 26 full-time providers and a management team.
It’s a role that continues to evolve, and demand for their services is expected to increase. “As healthcare organizations continue to face challenges related to patient volume, complexity, and cost, the hospitalist role will remain indispensable,” predicted Jennifer Colella, MD, a hospitalist and the medical director of patient experience for Nebraska Medicine, Omaha, Nebraska.
The Rise of Subspecialist Hospitalists
One way that hospitals have pivoted to meet the challenges of providing high-quality patient care in today’s healthcare climate is by incorporating subspecialist hospitalists into their model.
“It is a model that truly makes sense,” said Kisuule.
Hospitalists are no longer only physicians trained in internal medicine. As more organizations adopted a hospitalist model, some nurse practitioners and physician assistants who work in general internal medicine also began identifying as hospitalists, according to SHM. And physicians began subspecializing, too.
Otolaryngologist Ran Wang, MD, is one of a small but growing number of ENT hospitalists. “I have found eight of us so far, and our numbers are continuing to grow,” said Wang, who practices at Houston Methodist in Houston.
“I have seen that my role has supplied the hospital with a stronger presence of the ENT team due to our increased ability to focus on the inpatients,” she continued. “I have received stellar feedback from all departments, and we have been exploring new innovative ways to deliver ENT care for these complex hospitalized patients.”
Amy VanBlaricom, MD, chief clinical officer with Ob Hospitalist Group (OBHG), noted that the OB hospitalist role allows clinicians to stay engaged and current with evidence-based practices while reducing some of the challenges associated with OB/GYN private practices — an important concern given the high burnout rate among OB/GYNs.
“We’ve heard from our clinicians that the OB hospitalist model has improved their work-life balance, increased their leadership skills, and offered more opportunities to work on challenging, life-saving cases while maintaining their autonomy,” she said.
Additionally, research suggests that healthcare systems that integrate full-time OB hospitalists experience significant reductions in risk and liability, as well as decreased maternal morbidity rates and reductions in perinatal adverse events.
Pediatric hospital medicine has also grown and evolved over the past couple of decades.
Richard Engel, MD, associate division chief of Hospital Medicine at Phoenix Children’s in Phoenix, remembers physicians discouraging him from pursuing this specialty, calling it “perpetual residency.” But over time, pediatric hospital medicine began to take off, and his hospital now employs more than 60 pediatric hospitalists.
“Today, many of us are boarded subspecialists in this role, and we have our own fellowship training programs,” he said. “We have also taken on large roles within the hospital at large, including in the areas of patient safety, quality, medical education, research, and other administrative operations. I expect this trend to continue as our field matures and our physicians look to continue making larger impacts.”
What It Takes to Be a Successful Hospitalist Today
Hospitalists must always be prepared to face day-to-day challenges on the job. This can include building a rapport with new patients, getting up to speed quickly on their medical conditions, assessing social determinants of health that may affect post-discharge outcomes, navigating family conflicts, and even delivering catastrophic diagnoses.
“It happens probably once every few months where I have to walk in a room and give someone a cancer diagnosis that they’ve never had, and I’m just meeting them,” said Lee-Ann Wagner, MD, medical director of an Inpatient Hospitalist Team at University of Maryland Capital Region Medical Center in Largo, Maryland.
Teresa Marlino, MD, an OB/GYN with OBHG, emphasized the importance of always taking time to listen to patients and make sure they feel heard, as it feeds directly into patient satisfaction, a key metric for hospitals.
“That is probably the greatest challenge,” she said.
It’s also important to remember that you’re part of a team, said Ethan Babcock, MD, who leads Providence Swedish’s Hospital Medicine program in Seattle. “That compassion has to extend not just to the patient but to everyone who is involved in the care,” he said.
Finding a mentor can help new hospitalists as they learn these types of skills, said Kisuule. She also suggests reframing challenges as opportunities.
“I think it’s important to set some stretch goals, to put yourself out there, to be creative and innovative, to take some leaps of faith,” she added.
Michael Gao, MD, suggested that technology, including AI, can play a significant role in relieving clinicians of the burden of many administrative tasks — a common source of burnout — freeing them up to spend more time with patients and work on solutions.
“I think that’s what the future of being a hospitalist looks like: You’re much more focused on the component of your job that is patient care, and because of that increased focus, you are able to deliver that care to many more folks as well,” said Gao, who worked as a hospitalist in New York before taking on the role as chief executive officer of SmarterDx, an artificial intelligence firm.
Beyond the bedside, hospitalists must be prepared to address larger systemic challenges facing their organizations.
As organizations continue to grapple with the aging population of patients with increasingly complex and costly needs, they will need hospitalists more than ever, said Linda Greif Adler, MD, chief of the Division of Hospital Medicine at the University of Maryland St. Joseph Medical Center, Baltimore.
“Hospitalists can provide benefit by not only providing timely care for all patients but also aligning with hospitals’ goals, including improved patient flow, reduction of hospital-acquired infections and complications, and engaging with the broader staff to help improve camaraderie and teamwork,” she said.
