What's in a name? Plenty, for hospitalists

It is right there in the name: hospitalist. But, as the profession has only blossomed over the past few decades, many people outside the medical field may remain unfamiliar with the term coined in the 1990s and what it entails.

Dr. Wes Chandler, a hospitalist with Hoag Memorial Hospital Presbyterian in Orange County, California, points out that roughly one-third of doctors coming out of their residency these days choose hospitalist as their profession — with relatively the same percentage choosing to be clinical physicians and another third taking fellowships to become specialists.

“We do this all the time now,” Chandler says. “We specialize in taking care of hospitalized patients.”

It is similar to the role of an internist, including the training, but while those doctors may also see people in outpatient settings, hospitalists work almost exclusively in a hospital setting. They also focus on patient cases rather than some of the other obligations facing clinicians.

St. George’s University states hospitalists treat a variety of illnesses, and the job tends to appeal to those looking for unique challenges, as hospital cases can be complex and co-morbid, and days are never the same. Chandler’s training and certifications are the same as those of doctors going into internal medicine. But the “intellectual stimulation” of the challenges presented to hospitalists are what drove Chandler into the just-budding field in 1991.

“When you do your training in a university hospital, you spend about 90% of your time taking care of hospitalized patients and maybe 10% of your time taking care of patients in an outpatient clinic setting,” Chandler says. “Then, you graduate. Now you’re 90% in the outpatient clinic setting and less than 10% of your work life is actually in the hospital.

“My first job was in a clinic setting for six months. I felt like I was losing and not using at least 50-60% of the knowledge I had gained working as a resident because the outpatient clinic setting wasn’t quite as challenging as the hospital setting.”

So, he found a job with a local HMO that was hiring doctors strictly to do inpatient hospital rounds. That HMO was one of the first to grab onto the concept of in-house doctors, which were “incredibly rare” at the time, Chandler says, with probably fewer than 1,000 across the country. Chandler embraced the profession, which has since grown to include roughly 50,000 doctors in the United States — with hospitalists outnumbering cardiologists.

“I suppose I was more interested in just taking care of hospitalized patients and the acuity of care that goes along with it,” Chandler says.

Hospitalists are often generalists who see a variety of cases, though some may still have hospital-specific specialties. Drawbacks include hours that may not be as regular as those associated with a clinical physician.

“It does come with nights and weekends,” Chandler says. “It’s a 24/7 job, and you’re going to be working night shifts and certainly weekends.”

Hospitalists rarely have long-term relationships with patients, unless those patients frequently find themselves in the hospital. But Chandler says the work can be incredibly rewarding, in large part because of the types of patients hospitalists treat.

“You’re taking care of critically ill people who, if they didn’t get admitted to the hospital, quite frankly there’s a possibility they might die,” Chandler says. “I enjoy taking care of patients in that critical illness phase, taking care of them in the hospital, watching them improve rapidly over a few days, then becoming well enough to go home.”

In some places, it is a lot more common to see a hospitalist than one’s primary care physician in the hospital, Chandler says. That arrangement keeps primary care doctors from being pulled away from their offices and upsetting patients, and reduces the inefficiencies of those calls. Hospitalists also tend to see a higher volume of the types of illnesses that require hospital care, meaning they have more experience treating them and are typically in a better setting to do so. They can offer rapid response, day and night.

“That’s led to lower mortality rates and lower readmission rates,” Chandler says. “I think everyone has recognized there is improved quality of care with hospitalists.”

In addition to efficiency, MedicineNet notes hospitalists have become more common in recent years because of the convenience they offer patients, the financial strains on primary care doctors, patient safety, cost-effectiveness for hospitals, and more need for coordinated care for hospitalized patients.

MedicineNet also notes hospitalists meet with families, follow-up on tests, answer nurse’s questions and address problems. They are part of a team, coordinating care with others, including one’s primary care physician, Chandler explains. That is integral to the process for patients who may only be in the hospital for four or five days.

“Part of our role is to ensure good communication back to the primary care physician,” Chandler says. “Patients should be aware there is good communication between the hospitalists and primary care physicians. Rest assured: The primary care physicians are getting the information they need.”

Hospitalists also help implement evidence-based guidelines and practices for optimal care in both hospitals and health care systems, according to the Society of Hospital Medicine. They also help patients safely transition within the hospital, as well as from the hospital to other settings, according to the SHM.