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Vital Signs

Summer 2011

Hospitalists: New Breed of Specialists


VS-Summer11-HospitalistsPeople generally think of physicians as falling into two broad categories: those who provide primary care and specialists who focus on a particular organ system. But there is a new breed of specialist — a physician, typically trained in the more generalized fields of internal or family medicine, who is expert in caring for hospitalized patients.

Because these hospitalists devote their time almost entirely to inpatient care, they tend to be more skilled at managing the acute conditions that get patients admitted to the hospital and better able to navigate the hospital system than physicians who spend the vast majority of their time in office-based practice. Because of this, UCLA Health and other major centers are increasingly relying on hospitalists to coordinate care for patients, in close communication with their primary physician, during the patient’s hospitalization.

The ranks of hospitalists have soared to more than 30,000 in the United States barely 15 years after the term was first coined in a New England Journal of Medicine article. UCLA Health, an early adopter of the role, is currently expanding its program significantly — from 26 to 40 full-time hospitalists. Traditionally confined to medicine units, the hospitalist role is also moving into surgical services at UCLA — including orthopaedics, urology and, within the next year, neurosurgery.

Hospitalists began to increase in numbers in the 1990s in response to managed care and the growing emphasis on outpatient treatment, both of which meant an increase in the amount of time primary care physicians needed to spend in the office rather than tending to their hospitalized patients. “As a general internist, 20 years ago you would have at least one patient to visit in the hospital every week, and sometimes several at a time,” says Jan Tillisch, M.D., executive vice chair of the UCLA Department of Medicine. “Today, an office-based physician may go several weeks without having a patient in the hospital. As they were spending more of their time with patients in their office, the hospitalist concept began to evolve. And it has turned out to be an excellent idea from the standpoint of both efficiency and patient care.”

In addition to being more practiced at treating acutely ill patients and closer to the latest developments in inpatient technology and services, hospitalists’ constant presence in the facility makes them much more accessible than the patient’s primary care physician. This is more important than ever given that the emphasis on outpatient care and shorter hospital stays means that today’s hospitalized patients tend to be much sicker than in the past. “We provide a continuous presence in the hospital,” says Michael Lazarus, M.D., medical director of the hospitalist service for UCLA Health. “It makes the care more seamless when you have someone who understands the intricacies of care in that part of the hospital and is always there.”

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