What Is a Hospitalist?

How Hospital-Based Physicians Improve Patient Care

Doctor greeting patient in hospital ward

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A hospitalist is a breed of physician who treats patients solely in a hospital. Hospitalists practice what is known as hospital medicine, a medical specialty centered on the care of acutely ill hospitalized patients. Hospitalists do not maintain outside practices but provide exclusive care to patients during the duration of their hospital stay. This improves the oversight and consistency of care for patients while providing a timelier response outside of a doctor's usual "rounds."

Hospitalists are not the same as attending physicians who are responsible for drawing up a treatment plan and the patient's overall care. Hospitalists may intervene if needed but are essentially on-call to address a patient's immediate medical needs.

The term hospitalist was coined in 1996 by Drs. Robert Wachter and Lee Goldman of the University of California, Southern California to describe a new model for inpatient care.

Concentrations

The overriding role of a hospitalist is to improve the quality of care of hospitalized patients. Doing so can reduce the length of a hospital stay, the cost of hospitalization, and the rate of hospital readmission.

Hospitalists serve as generalists, meaning they possess the education, experience, and certification to appropriately address the general medical needs of a patient irrespective of their condition. If there is an issue outside of the scope of the physician's practice, a specialist will be called in.

For example, although the hospitalist may prescribe medications to relieve pain, start an IV drip for dehydration, begin oxygen therapy, or intervene in an emergency, they are not there to change your treatment plan.

The aim of a hospitalist is not to replace your doctor but to complement your care when your doctor is unavailable or an urgent matter arises. A hospitalist is not a "second-string" doctor but a fully qualified physician who simply prefers to practice in a hospital setting. Once a patient is discharged, a hospitalist no longer participates in the ongoing care other than to consult with the primary physician during the transition.

Some patients appear to benefit more from hospitalist care, including people requiring extensive physical rehabilitation. Most studies suggest that hands-on, physician-led oversight appears to speed recuperation.

For example, a 2009 study out of Loyola University, involving 140 patients who had undergone orthopedic reconstruction surgery, concluded that hospitalist care reduced the duration of hospitals stays by 3.8 days and benefited severely ill patients the most.

Procedural Expertise

Most hospitalists are trained and board-certified in internal medicine, although some come from other fields of medicine, such as family practice or pediatrics.

As part of the hospital system, a hospitalist is responsible for improving (and sometimes tracking and measuring) the quality of patient care. They are not involved with cost management, budgets, or medical reimbursements (tasks typically assigned to the hospital administrator). Rather, their role is centered purely around patients' needs.

Hospitalists also serve as leaders in initiatives to improve patient safety. This includes reducing hospital-acquired diseases, ensuring the timely and appropriate discharge of patients, and reducing the 30-day hospital readmission rate. In their co-management capacity, hospitalists also relieve some of the financial and time-management strains experienced by primary care doctors.

Today, the responsibility of patient care is increasingly shared by the outpatient internist who sees patients in an office and the inpatient hospitalist who treats patients in the hospital.

Subspecialties

Depending on the size of the hospital, hospitalists will sometimes take on a specialist role. This is especially true of doctors who enter the profession from fields such as neurology, surgery, cardiology, or pediatrics.

Hospital medicine is constantly evolving and finding new and better ways to utilize a doctor's skills. To this end, there is an ever-widening range of subspecialties a hospitalist may choose to pursue:

  • Admitists are responsible for the appropriate admission and discharge of patients.
  • Neurohospitalists care of patients who are being treated or are at risk of neurological problems.
  • Nocturnists are hospitalists who work 12-hour night shifts.
  • Proceduralists oversee and perform procedures like lumbar punctures, catheter insertions, enteral feeding, oxygen intubation, etc.
  • Rounders are hospitalists who devote their full attention to admitted patients.
  • Surgicalists are surgeons who work exclusively in surgical wards.

Training and Certification

Like all physicians, hospitalists must complete a four-year bachelor’s degree plus four years of medical school to obtain their medical degree. Thereafter, the hospitalist candidate must complete several years of graduate medical education (GME), which includes a one-year internship and three years of residency training.

Some residency programs have developed instructional tracks that address the key facets of hospital medicine, including quality assessment/quality improvement (QA/QI) and the transition of care from inpatient to outpatient.

As a relatively new specialty, board certification was previously not actively pursued by many hospitalists nor required by all hospitals. That began to change with the growing presence of the American Board of Hospital Medicine (ABHM), which was founded in 2009 and is a part of the American Board of Physician Specialties (ABPS).

In additions to ABHM certification, the American Board of Internal Medicine (ABIM) offers certification programs to obtain the Focused Practice in Hospital Medicine (FPHM) designation.

Today, there are over 57,000 practicing hospitalists in the United States, according to the Society of Hospital Medicine. Most are employed by a hospital or a hospitalist contracting firm.

Seeing a Hospitalist

Hospitalists are there as physicians when you need them, especially rounders who are dedicated exclusively to patients in beds. You don't need to schedule an appointment. If you have a medical problem that the nursing staff is unable to address, you can request to speak to the hospitalist on duty.

Remember, though, that only the attending physician has the right to make treatment changes (and ultimately bears legal responsibility if or when changes are made). You can consult with a hospitalist about any treatment concerns, however.

Hospitalists are generally on-call and will frequently change during the course of a hospital stay. Hospitalists are usually block scheduled for 10- to 12-hour shifts for five to seven days straight, typically followed by five to seven days off. The block scheduling provides a greater consistency of care as opposed to having a different doctor every day.

A Word From Verywell

Being a hospitalist requires empathy, compassion, flexibility, experience, interpersonal skills, and stamina to deal with an ever-changing roster of medical conditions and personalities. It's not uncommon for patients to say that hospitalists are the staff members that seem to offer them the most comfort and reassurance during their hospital stay.

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Article Sources

  1. Palabindala V, Abdul salim S. Era of hospitalists. J Community Hosp Intern Med Perspect. 2018;8(1):16-20. doi:10.1080/20009666.2017.1415102


  2. Pinzur, M.; Gurza, E.; Kristopaitis, T. et al. Hospitalist-orthopedic co-management of high-risk patients undergoing lower extremity reconstruction surgeryOrthopedics. 2009 Jul;32(7):495. doi:10.3928/01477447-20090527-14.


  3. Salim SA, Elmaraezy A, Pamarthy A, Thongprayoon C, Cheungpasitporn W, Palabindala V. Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis. J Community Hosp Intern Med Perspect. 2019;9(2):121-134. doi:10.1080/20009666.2019.1591901


  4. Sara Royster. HospitalistCareer Outlook, U.S. Bureau of Labor Statistics. Published July 2015.


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