Hospital Medicine - History

History

Hospital medicine is a relatively new phenomenon in American 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. This effectively reduces by 10-25% the amount of inpatient coverage provided per. 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. 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.

Hospitalists represent one of the most rapidly growing forms of medical practice in the US. Currently a large proportion of hospitalists are recently-graduated residents, who continue familiar duties for a few years. As residency programs are encouraged to limit inpatient duty hours and provide more outpatient education, this pattern may shift. If this specialty evolves as emergency and intensive care medicine did, it will become a formal specialty with its own residencies and board certification within a decade or two. A few distinct residency and fellowship training programs are currently operating at major universities.

In addition to patient care duties, hospitalists are often involved in developing and managing aspects of hospital operations such as inpatient flow and quality assurance. 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.