As the hospitalist model develops, some kind of subsidy from the system will be needed to support this activity. It is difficult for a physician to support an adequate salary by charging for 10 to 12 hospital visits per day when most of these visits are inadequately reimbursed through Medicare. The arithmetic simply does not work out. A large group, the hospital system, or a managed care organization has subsidized most successful hospitalist programs.
Hospitalists are here to stay. This new specialization seems to have come about to fill a need rather than from a mandate. As with the other arbitrary divisions of responsibility that have produced our fragmented care system, the hospitalist will be found in urban and suburban hospitals, but not in the rural areas. There will be attempts to exclude those physicians who do not fit the arbitrary definition from hospital care. Physician assistants will be hired to help out with the hospitalist’s tasks, thereby negating any argument about training and competence. In the end the hospitalist movement will reach a steady state driven by need and not mandate. Family physicians will choose to work in the hospital or not just as they make other scope-of-practice choices now.
Family physicians will continue to provide continuing, comprehensive, and personal care to most of their patients, in the context of family and community and taking advantage of the important integration of mind, body, and spirit. The specialization that has occurred during the last 50 years has not changed the essence of what we do for our patients. The hospitalist movement is not likely to precipitate that change either.