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Vital Signs

Fall 2008

The New Hospitalists

Spurred by the advent of managed care, the ranks of physicians who are dedicated almost entirely to inpatient care have soared, and patients benefit.

It’s been only a dozen years since two UC San Francisco physicians, writing in the New England Journal of Medicine, coined the term “hospitalist” to describe a new type of physician devoted almost entirely to inpatient care. Since that time, the ranks of hospitalists have soared, from a few hundred a little more than a decade ago to an estimated 20,000 today, according to the Society for Hospital Medicine.

Managed Care Spurred Trend

Vital Signs Fall 2008 article: The New HospitalistsThe hospitalist trend was originally spurred by the development of managed care, which led to primary-care physicians needing to spend more time with patients in the office setting. “It has become significantly more difficult, if not impossible, for primary-care physicians to do rounds in the hospital — making provisions for their patients’ care and discharging some as well as admitting others — while also seeing patients in their office in the same day,” says Michael Lazarus, M.D., one of a group of 19 internal medicine-trained hospitalists at UCLA’s Westwood and Santa Monica facilities.

Thus, most medical centers across the country, including UCLA, now put patients under the care of a hospitalist while they are in the hospital. In addition to easing the burden on the patient’s primary-care physician, this brings benefits in terms of quality of care, Dr. Lazarus notes. For one, because they treat them full time, hospitalists are likely to be more abreast of the latest developments in inpatient care, more skilled in the management of the acute conditions that get patients admitted, and better able to navigate the hospital system.

More Accessible at Odd Hours

“We specialize in hospital care, just like medicine subspecialists specialize in their respective organ systems,” explains Roger Lee, M.D., a UCLA hospitalist. In addition, Dr. Lee notes, hospitalists are much more accessible at different hours of the day in case anything goes wrong with the patient than were primary-care physicians under the previous system — particularly important in an era when the emphasis on outpatient care and shorter hospital stays means that hospitalized patients tend to be much sicker than in the past.

Model Improves Patient Satisfaction

One of the initial concerns with the hospitalist model was that it would interrupt the continuity of patient care. But through an emphasis on electronic and verbal communication between the hospitalist and primary-care physician — typically at admission, discharge and whenever a major change occurs in the course of the patient’s inpatient care — that has not proved to be a problem, Dr. Lazarus notes. Studies have found that the hospitalist model reduces the average length of stay for patients and improves patient satisfaction.

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