Hospitalists and family physicians: Understanding opportunities and risks

,

Original Research

Hospitalists and family physicians: Understanding opportunities and risks

J Fam Pract. 2004 June;53(6):473-481

By

Ann Scheck McAlearney, ScD

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References

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Practice recommendations

Family physicians can leverage relationships with hospitalists by ensuring strong, ongoing communication to reduce risks to patients associated with lost information, miscommunications, and gaps in continuity of care.

Family physicians will be well served by supporting new research on the influence of the hospitalist model on family practice; especially research that demonstrates the value of continuity of care, alternative compensation models, and longitudinal studies that assess qualitative and quantitative outcomes of hospitalist systems from the perspective of family physicians.

ABSTRACT

Background: Emergence of the hospitalist as a specialist in inpatient medicine provides an opportunity to examine a new provider type and its relation to family physicians.

Objectives: To review the hospitalist literature to understand the hospitalist role, identify benefits and risks of the hospitalist model to family physicians, and discuss future opportunities to study and work with hospitalists.

Methods: An integrative review of published literature about the hospitalist model focused on the influence of hospitalists on family practice.

Results: Three main themes were identified as interest areas for family physicians: descriptions of the hospitalist role and responsibilities; hypothesized benefits and risks of the hospitalist model; and reported research results evaluating the effect of the hospitalist model. Two major opportunities related to hospitalists and family physicians were also uncovered: opportunities to conduct future research to study the influence of hospitalists on family physicians; and opportunities to create workable relationships with these new practitioners.

Conclusions: Despite some opposition to hospitalist programs, the economic climate and increasing productivity standards suggest that these programs are here for the foreseeable future, and it is in family physicians’ best interests to understand the opportunities and risks of the hospitalist model. Family physicians can work proactively with this new patient care model by participating in the development of standardized and efficient ways to communicate and to partner with hospitalists. Meanwhile, future research studies can help inform the debate by investigating the specific influence of hospitalist models on family practice.

The hospitalist model has spread relatively rapidly throughout hospitals in the United States. Family physicians can proactively work with this new patient care model by developing standardized and efficient ways to communicate and to partner with hospitalists.

Advances in electronic data exchange can help facilitate these communications, and can reduce the risks associated with discontinuity of care inherent in the hospitalist model. Developing communications protocols involving transfer of patient information and maintaining contact with hospitalists while patients are under their care can help family physicians best serve the needs of their patients and ensure continuity of care and compliance with patient wishes.

Hospitalists in the US

Rarely in medicine does the opportunity arise to examine a newly developed area of medical specialization and its effect on other providers. The emergence of the hospitalist, a specialist in inpatient medicine, provides this opportunity. Although dedicated inpatient physicians have been in practice in Canada and overseas for some time,^1-6 attention to, and experimentation with, this role in the US has been relatively new.

Hospitalists were first described in 1996 by Robert Wachter and Lee Goldman,⁷ who coined the term and have widely studied and promoted the model. Presently, approximately 6000 US hospitalists are practicing inpatient medicine in diverse organizations, including adult and children’s hospitals and skilled nursing facilities. The number of hospitalists in practice in the US has been projected to increase to around 19,000 within the next 10 years, making the size of hospitalist physician practice similar to that of the specialty of cardiology,¹ but far smaller than that of family practice.

Yet the introduction and spread of hospitalists throughout the US has not occurred without controversy. Given substantial debate about the changing role of family practitioners with respect to such issues as scope of practice, professional identity, and care and service to patients, the emergence of hospitalists has been perceived by many as a potential threat on all fronts.

Responses to the hospitalist movement

Responses to the hospitalist movement vary. To many, a specialty in hospital medicine appears to threaten the role of generalists in health care practice, and risks such as a reduced practice scope or the loss of hospital privileges are real concerns.^8-11 For others, the introduction of hospitalists has increased flexibility for family practitioners who are interested in working with or becoming hospitalists themselves.

As of 2001, 1 in 5 members of the American Academy of Family Physicians reported using hospitalists. Further, reasons such as economics, lifestyle choices, and concern about maintaining competence in caring for hospitalized patients have contributed to the decision of as many as 1 in 5 family practitioners who have chosen not to be involved in hospital care.¹² Yet, as noted by Edsall,¹³ for family practitioners who choose not to practice inpatient medicine, the philosophical, professional, and financial risks of that decision should not be trivialized.