Hospital medicine

Last updated
Hospitalist
Occupation
Names
  • Physician
  • Surgeon
Occupation type
 Specialty
Activity sectors
 Medicine, Surgery
Description
Education required
Fields of
employment
 Hospitals, Clinics

Hospital medicine is a medical specialty that exists in some countries as a branch of family medicine or internal medicine, dealing with the care of acutely ill hospitalized patients. Physicians whose primary professional focus is caring for hospitalized patients only while they are in the hospital are called hospitalists. [1] Originating in the United States, this type of medical practice has extended into Australia and Canada. The vast majority of physicians who refer to themselves as hospitalists focus their practice upon hospitalized patients. Hospitalists are not necessarily required to have separate board certification in hospital medicine.

Contents

The term hospitalist was first coined by Robert Wachter and Lee Goldman in a 1996 New England Journal of Medicine article. [2] The scope of hospital medicine includes acute patient care, teaching, research, and executive leadership related to the delivery of hospital-based care. Hospital medicine, like emergency medicine, is a specialty organized around the location of care (the hospital), rather than an organ (like cardiology), disease (like oncology), or a patient’s age (like pediatrics). [3] The emergence of hospital medicine in the United States can be compared and contrasted with the parallel development of acute medicine in the United Kingdom, reflecting health system differences. [4]

Complex work practices

In the US, a typical hospitalist workday in the hospital lasts roughly 10 hours, arriving around 7AM and taking care of a "census" of 14 to 18 patients. Hospitalists typically embrace the rhythm of a "7 on 7 off" schedule, starting each 7-day stretch on a Tuesday and ending on a Monday. While these are typical, what counts as a normal workday, census, and shift schedule can vary from hospital to hospital.

A hospitalist is like a football quarterback, a central node coordinating patient care for hospitalized inpatients for the duration of their stay. Compared to other medical specialties, hospitalists must work more closely with a much broader range of other healthcare professionals, such as specialist physicians, bedside nurses, charge nurses, pharmacists, and case managers. On a typical day in a hospital, a hospitalist is likely to have 10 to 30 different colleagues with whom they are collaborating on patient care.

When combined with the complexities of hospital medicine, complex interprofessional collaboration tends to allow for unnecessary miscommunication, oversight, errors, and delays. Attempts to reduce this complexity and strandardize interprofessional collaboration have resulted in care models like interdisciplinary bedside rounds that emphasize face-to-face communication, a contrast with communication that occurs solely through the electronic medical record, secure chat, pages, and calls.

By country

Australia

In Australia, hospitalists are career hospital doctors; they are generalist medical practitioners whose principal focus is the provision of clinical care to patients in hospitals; they are typically beyond the internship-residency phase of their career, but have decidedly chosen as a conscious career choice not to partake in vocational-specialist training to acquire fellowship specialist qualification. Whilst not specialists, these clinicians are nonetheless experienced in their years of medical practice, and depending on their scope of practice, they typically work with a reasonable degree of independence and autonomy under the auspices of their specialist colleagues and supervisors. Hospitalists form a demographically small but important workforce of doctors in hospitals across Australia where on-site specialist coverage is otherwise unavailable.

Hospitalists are typically employed in a variety of public and private hospital settings on a contractual or salaried basis. Dependent on their place of employment and duties, the responsibilities and remuneration of non-specialist hospitalists are usually comparable to somewhere between registrars and consultants. Despite the common trend for clinicians to specialise nowadays, non-specialist hospitalist clinicians have an important role in fulfilling shortages in the medical workforce, especially when specialist coverage or accessibility is unavailable and where there is an area-of-need or after-hours or on-site medical care is required. These clinicians and employed across Australia in a variety of environments which include Medical & Surgical Wards, Intensive Care Units and Emergency Departments. Nonetheless, these clinicians work closely and continually consult with the relevant attending specialists on-call; that is, final responsibility and care for the patient ultimately still rests with the attending specialist.

They are also known as: Career Medical Officers (CMO), Senior Medical Officers (SMO) and Multi-skilled Medical Officers (MMO).

Hospitalists are represented by the Australian Medical Association (AMA), Australasian Society of Career Medical Officers (ASCMO) and Australian Salaried Medical Officers Federation (AMSOF). Despite being non-specialist clinicians, they are still required to meet continuing professional development requirements and frequently attend courses facilitated by these organisations and hospitals to keep their practice and skillets up-to-date alongside their specialist registered colleagues.

Canada

In Canada, there are currently no official residency programs specializing in hospital medicine. Nevertheless, some universities, such as McGill University in Montreal, have come up with family medicine enhanced skills programs focused on hospital medicine. This program, which is available to practicing physicians and family medicine residents, has a duration of six or twelve months. The main goal behind the program is to prepare medical doctors with training in family practice to assume shared care roles with other specialists, such as cardiologists, neurologists, and nephrologists, in a hospital setting. Moreover, the program prepares family physicians by giving them a set of skills required for caring for their complicated hospitalized patients. [5] [6]

United States

Training

Hospitalists are physicians with a Doctor of Medicine (M.D.), Doctor of Osteopathic Medicine (D.O.), or a Bachelor of Medicine/Bachelor of Surgery (MBBS/MBChB) degree. [7] Most hospitalists practicing in hospitals in the United States lack board certification in hospital medicine. To address this, residency programs are starting to develop hospitalist tracks with more tailored education. Several universities have also started fellowship programs specifically geared toward hospital medicine.

According to the State of Hospital Medicine Survey by the Medical Group Management Association and the Society of Hospital Medicine, 89.60% of hospitalists specialize in general internal medicine, 5.5% in a pediatrics subspecialty, 3.7% in family practice and 1.2% in internal medicine pediatrics. [8] Data from the survey also reported that 53.5% of hospitalists are employed by hospitals/integrated delivery system and 25.3% are employed by independent hospitalists groups.

According to recent data, there are more than 50,000 hospitalists practicing in approximately 75% of U.S. hospitals, including all highly ranked academic medical centers. [9]

History

Hospital medicine is a relatively new phenomenon in American medicine and as such is the fastest growing specialty in the history of medicine. Almost unheard of a generation ago, this type of practice arose from three powerful shifts in medical practice:

  • Nearly all states, as well as the national residency accreditation organizations, the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA), have established limitations on house staff duty hours, the number of hours that interns and residents can work. Many hospitalists are coming to perform the same tasks formerly performed by residents; although this is usually referred to as a House Officer rather than a hospitalist.[ citation needed ] The fundamental difference between a hospitalist and a house officer is that the hospitalist is the attending physician of a patient while that patient is hospitalized. The house officer admits the patient for another attending physician and cares for that patient until the attending physician can see the patient.
  • Most primary care physicians are experiencing a shrinking role in hospital care. Many primary care physicians find they can generate more revenue in the office during the hour or more they would have spent on inpatient rounds, including traveling to and from the hospital.[ citation needed ]

In addition to patient care duties, hospitalists are often involved in developing and managing aspects of hospital operations such as inpatient flow and quality improvement. The formation of hospitalist training tracks in residency programs has been driven in part by the need to educate future hospitalists about business and operational aspects of medicine, as these topics are not covered in traditional residencies.[ citation needed ]

Certification

As a relatively new specialty, only recently has certification for specialty experience and training for hospital medicine been offered. The American Board of Hospital Medicine (ABHM), a Member Board of the American Board of Physician Specialties (ABPS), was founded in 2009. The ABHM was North America’s first board of certification devoted exclusively to hospital medicine. In September 2009, the American Board of Internal Medicine (ABIM) created a program that provides general internists practicing in hospital settings the opportunity to maintain Internal Medicine Certification with a Focused Practice in Hospital Medicine (FPHM).

Employment

The number of available hospitalists positions grew exponentially from 2006 to 2010 but has since then leveled off. [10] However, the job market still remained very active with some hospitals maintaining permanent openings for capable hospitalists. Salaries are generally very competitive, averaging almost $230,000 per year for adult hospitalists. [11] Hospitalists who are willing to work night shifts only (nocturnists) are generally compensated higher than their day shift peers. [12]

Hospitalist groups as employers

Hospitalists typically work for a hospitalist group that is employed either directly through the hospital or through a phyisician services company, which earns a multimillion-dollar subsidy from the hospital to operate the group. This arrangement is a contrast to other physician specialities which typically recoup their costs directly though their billing for medical services.

As of 2023, there are around seven large national physician services companies which compete to provide the hospitalist group for health systems, along with many smaller companies. Most of these companies, however, traditionally focus on the emergency department, where billing is lucrative and margins are higher, and they accept the hospitalist group management partnership as a necessary and less profitable add-on.

From the perspective of a hospital CFO, hospitalists require large subsidies that other physicians may not need. The drive to minimize these subsidies incentivizes the reduction of shifts and increase of a hospitalist's average patient census, which can in turn decrease hospitalist job satisfaction and increase risks to patient safety. Whether these incentives are acted on depends on the financial situation of the hospital, the relationship between the hospitalist group and the hospital, and the working conditions acceptable to the employed hospitalists.

Quality initiatives

Research shows that hospitalists reduce the length of stay, treatment costs and improve the overall efficiency of care for hospitalized patients. [13] Hospitalists are leaders on several quality improvement initiatives in key areas including transitions of care, co-management of patients, reducing hospital acquired diseases and optimizing the care of patients.[ citation needed ]

Though hospital medicine is a young field, there have been attempts at further division of labor in the field.

The following are other commonly used (negative) nicknames:

See also

Related Research Articles

<span class="mw-page-title-main">Neurology</span> Medical specialty dealing with disorders of the nervous system

Neurology is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the spinal cord and the peripheral nerves. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system.

<span class="mw-page-title-main">Physician</span> Professional who practices medicine

A physician, medical practitioner, medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the study, diagnosis, prognosis and treatment of disease, injury, and other physical and mental impairments. Physicians may focus their practice on certain disease categories, types of patients, and methods of treatment—known as specialities—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known as general practice. Medical practice properly requires both a detailed knowledge of the academic disciplines, such as anatomy and physiology, underlying diseases and their treatment—the science of medicine—and also a decent competence in its applied practice—the art or craft of medicine.

<span class="mw-page-title-main">Emergency medicine</span> Medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians specialize in providing care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with emergency medical services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency medical physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics.

In the medical profession, a general practitioner (GP) or family physician is a physician who treats acute and chronic illnesses and provides preventive care and health education to patients of all ages. GPs' duties are not confined to specific fields of medicine, and they have particular skills in treating people with multiple health issues. They are trained to treat patients to levels of complexity that vary between countries. The term "primary care physician" is more usually used in the US. In Asian countries like India, this term has been replaced mainly by Medical Officers, Registered Medical Practitioner etc.

Internal medicine, also known as general internal medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of internal diseases in adults. Medical practitioners of internal medicine are referred to as internists, or physicians in Commonwealth nations. Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes. They provide care to both hospitalized (inpatient) and ambulatory (outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone postgraduate training in internal medicine, and should not be confused with "interns”, a term commonly used for a medical doctor who has obtained a medical degree but does not yet have a license to practice medicine unsupervised.

<span class="mw-page-title-main">Anesthesiology</span> Medical specialty concerned with anesthesia and perioperative care

Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialized in anesthesiology is called an anesthesiologist, anaesthesiologist, or anaesthetist, depending on the country. In some countries the terms are synonymous, while in other countries they refer to different positions and anesthetist is only used for non-physicians, such as nurse anesthetists.

<span class="mw-page-title-main">Residency (medicine)</span> Postgraduate medical training

Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, veterinarian, dentist, podiatrist (DPM) or pharmacist (PharmD) who practices medicine, veterinary medicine, dentistry, podiatry, or clinical pharmacy, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. In the meantime, they practice "on" the license of their supervising physician. An individual engaged in such training may be referred to as a resident, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training.

<span class="mw-page-title-main">Family medicine</span> Medical specialty

Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is named a family physician. It is often referred to as general practice and a practitioner as a general practitioner. Historically, their role was once performed by any doctor with qualifications from a medical school and who works in the community. However, since the 1950s, family medicine / general practice has become a specialty in its own right, with specific training requirements tailored to each country. The names of the specialty emphasize its holistic nature and/or its roots in the family. It is based on knowledge of the patient in the context of the family and the community, focusing on disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is "promoting personal, comprehensive and continuing care for the individual in the context of the family and the community". The issues of values underlying this practice are usually known as primary care ethics.

In the United States and Canada, an attending physician is a physician who has completed residency and practices medicine in a clinic or hospital, in the specialty learned during residency. An attending physician typically supervises fellows, residents, and medical students. Attending physicians may also maintain professorships at an affiliated medical school. This is common if the supervision of trainees is a significant part of the physician's work. Attending physicians have final responsibility, legally and otherwise, for patient care, even when many of the minute-to-minute decisions are being made by house officers (residents) or non-physician health-care providers. Attending physicians are sometimes the 'rendering physician' listed on the patient's official medical record, but if they are overseeing a resident or another staff member, they are 'supervising.'

<span class="mw-page-title-main">Medical education in Australia</span> Summary of education and training of medical practitioners (doctors) in Australia.

Medical education in Australia includes the educational activities involved in the initial and ongoing training of Medical Practitioners. In Australia, medical education begins in Medical School; upon graduation it is followed by a period of pre-vocational training including Internship and Residency; thereafter, enrolment into a specialist-vocational training program as a Registrar eventually leads to fellowship qualification and recognition as a fully qualified Specialist Medical Practitioner. Medical education in Australia is facilitated by Medical Schools and the Medical Specialty Colleges, and is regulated by the Australian Medical Council (AMC) and Australian Health Practitioner Regulation Agency (AHPRA) of which includes the Medical Board of Australia where medical practitioners are registered nationally.

Internal medicine-pediatrics, or med-peds, is a medical specialty in which doctors train to be board certified in both internal medicine and pediatrics. A residency program in med-peds is four years in length, contrasted with three years for internal medicine or pediatrics alone. Upon completion of a med-peds residency, a doctor can practice in the areas of internal medicine, pediatrics or can complete a fellowship program to further specialize in an internal medicine or pediatrics sub-field.

Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or have severe physical trauma.

The American Board of Hospital Medicine (ABHM) is a Member Board of the American Board of Physician Specialties (ABPS), the nation's third largest physician multispecialty certifying organization and was founded in 2009. The ABHM is North America's first and only board of certification devoted exclusively to hospital medicine founded by hospitalists and governed by hospitalists.

<span class="mw-page-title-main">Society of Hospital Medicine</span>

The Society of Hospital Medicine (SHM) is a membership society for hospitalists, physicians, and other caregivers who practice the specialty of hospital medicine.

<span class="mw-page-title-main">Robert M. Wachter</span> American physician

Robert M. "Bob" Wachter is an academic physician and author. He is on the faculty of University of California, San Francisco, where he is chairman of the Department of Medicine, the Lynne and Marc Benioff Endowed Chair in Hospital Medicine, and the Holly Smith Distinguished Professor in Science and Medicine. He is generally regarded as the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine. He and a colleague, Lee Goldman, are known for coining the term "hospitalist" in a 1996 New England Journal of Medicine article.

<span class="mw-page-title-main">Physicians in the United States</span>

Physicians are an important part of health care in the United States. The vast majority of physicians in the US have a Doctor of Medicine (MD) degree, though some have a Doctor of Osteopathic Medicine (DO), or Bachelor of Medicine, Bachelor of Surgery (MBBS).

Post-Hospitalist Medicine is the discipline concerned with the medical care of patients residing in Post-Acute, Long-Term Care, Rehabilitation and Assisted Living Facilities. The Physicians whose primary professional focus is the post-hospital medical care of these patients are called Post-Hospitalists.

Obesity medicine is a field of medicine dedicated to the comprehensive treatment of patients with obesity. Obesity medicine takes into account the multi-factorial etiology of obesity in which behavior, development, environment, epigenetic, genetic, nutrition, physiology, and psychosocial contributors all play a role. As time progresses, we become more knowledgeable about the complexity of obesity, and we have ascertained that there is a certain skill set and knowledge base that is required to treat this patient population. Clinicians in the field should understand how a myriad of factors contribute to obesity including: gut microbiota diversity, regulation of food intake and energy balance through enteroendocrine and neuroregulation, and adipokine physiology. Obesity medicine physicians should be skilled in identifying factors which have contributed to obesity and know how to employ methods to treat obesity. No two people with obesity are alike, and it is important to approach each patient as an individual to determine which factors contributed to their obesity in order to effectively treat each patient. Physicians specializing in obesity medicine may choose to obtain board certification by the American Board of Obesity Medicine.

An obstetric hospitalist is an obstetrician and gynaecologist physician who is either employed by a hospital or a physician practice and whose duties include providing care for laboring patients and managing obstetric emergencies. Some obstetrics hospitalists also have responsibilities including resident and medical student teaching; providing backup support for family practitioners and nurse midwives, assisting private physicians with surgery, assuming care for ob-gyn patients unassigned to a physician and providing vacation coverage for the private practicing physician.

<span class="mw-page-title-main">Teaching hospital</span> Hospital or clinic providing medical education

A teaching hospital is a hospital or medical centre that provides medical education and training to future and current health professionals. Teaching hospitals are almost always affiliated with one or more universities and are often co-located with medical schools.

References

  1. ↑ Pantilat, Steve (February 2006). "What is a Hospitalist?". The Hospitalist. The Society of Hospital Medicine. Retrieved 1 March 2017.
  2. ↑ Wachter R; Goldman L (1996). "The emerging role of "hospitalists" in the American health care system". N Engl J Med. 335 (7): 514–7. doi:10.1056/NEJM199608153350713. PMID   8672160.
  3. ↑ "SHM". www.hospitalmedicine.org. Retrieved 10 April 2018.
  4. ↑ Wachter RM; Bell D (2012). "Renaissance of hospital generalists". BMJ. 344: e652. doi:10.1136/bmj.e652. PMID   22331278. S2CID   206896335.
  5. ↑ Jewish General Hospital; St. Mary's Hospital; McGill University Health Center; McGill University: Department of Family Medicine. Enhanced Skills Program in Hospital Medicine (PDF). McGill University: Department of Family Medicine. pp. 1–9. Retrieved 17 March 2015.
  6. ↑ "Hospital Medicine". McGill Universi Department of Family Medicine. Montreal: McGill University. Retrieved 17 March 2015.
  7. ↑ "New Kinds of Primary Care, O The Oprah Magazine March 2009". oprah.com. Retrieved 10 April 2018.
  8. ↑ "2012 Hospital Medicine Survey | Society of Hospital Medicine". Hospitalmedicine.org. Retrieved 2012-10-28.
  9. ↑ Wachter, Robert M.; Goldman, Lee (2016-08-10). "Zero to 50,000 — The 20th Anniversary of the Hospitalist". New England Journal of Medicine. 375 (11): 1009–11. doi:10.1056/NEJMp1607958. ISSN   0028-4793. PMID   27508924.
  10. ↑ "hospitalist Job Trends". Indeed.com. 2004-10-24. Retrieved 2012-10-28.
  11. ↑ "Today's Hospitalist :: Hospitalist pay is rising - survey results show pressure for productivity growth to match". Todayshospitalist.com. June 2011. Retrieved 2012-10-28.
  12. ↑ "Hospitalist Jobs | Hospitalist Positions from". HospitalistWorking.com. Retrieved 2012-10-28.
  13. ↑ Rachoin, Jean-Sebastian; Skaf, Jad; Cerceo, Elizabeth; Fitzpatrick, Erin; Milcarek, Barry; Kupersmith, Eric; Scheurer, Danielle Bowen (1 January 2012). "The impact of hospitalists on length of stay and costs: systematic review and meta-analysis". The American Journal of Managed Care. 18 (1): e23–30. PMID   22435787 . Retrieved 10 April 2018.
  14. ↑ "Neurohospitalist". www.neurohospitalistsociety.org. Retrieved 10 April 2018.
  15. ↑ "Surgicalists and Acute Care Surgeons". Archived from the original on 2015-12-08. Retrieved 2015-12-04.
  16. ↑ "Is it time to call the admitologist? - Today's Hospitalist". todayshospitalist.com. 1 March 2008. Retrieved 10 April 2018.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.