When your care involves a hospitalist

Most patients admitted to the hospital expect their primary care doctor to come by. Instead, people often get a visit from a hospitalist — a physician who manages patients' care in the hospital, then transfers responsibility back to their personal physicians when the hospital stay is over.

Who are hospitalists?

The term “hospitalist” was introduced in 1996 to describe “a new breed of physicians” that provide care only in the hospital setting. Though relatively new as a full-time specialty, the hospitalist concept is a variation on certain established practices, such as the rotation system, in which one member of a group practice supervises all of its hospitalized patients while his or her partners remain in the office. Hospitalists also share features with emergency room (ER) doctors, who see patients only during their ER “shifts” and are in charge of patients’ care only while they’re in the ER.

Hospitalists have completed medical school and postgraduate training in internal medicine, family practice, or pediatrics. A hospitalist may work directly for a hospital or as part of a managed care organization, multi-specialty practice, or hospitalist or other group. About half the hospitals in the United States employ hospitalists.

Hospitalism is the fastest growing medical specialty in the United States. Demand for this specialty was initially fueled by managed care efforts to bolster efficiency, cut costs, and improve care. Today, patients admitted to the hospital tend to be more severely ill. (Certain conditions that once required hospitalization are now handled on an outpatient basis; also, more older people are in the hospital with chronic age-related illnesses.) Hospital-based doctors can better attend to such patients, respond to their problems, and navigate hospitals’ increasingly complex systems.

Some clinicians worry that this arrangement disrupts the physician-patient relationship just when a patient needs it most. But the concept sits well with other primary care doctors and internists, who find that they can use their time more efficiently, focusing on patients in the office, when they have fewer patients to visit in the hospital. One point of consensus is that close communication between hospitalist and primary care doctor is crucial.

What if I’m assigned a hospitalist?

If you know you’ll be going to the hospital, ask your primary care physician if she or he will be in charge or a hospitalist. Your physician might think it’s better for you to have a hospitalist, for several reasons: She may find it difficult to visit if her office is far from the hospital or she has a full in-office schedule; the hospital or your health plan might encourage the use of hospitalists; or your doctor may want to focus on office-based patient care.

Your physician will share your records and other information so the hospitalist will know your medical history, health condition, and preferences. Once you’re admitted, the hospitalist will examine you, coordinate all your tests and treatments, and visit you daily. He or she should be available throughout your stay to address your questions and concerns. When you’re discharged, the hospitalist is responsible for prescribing the medicines you’ll need to take when you leave the hospital and sending a summary of your hospital records and treatments to your primary care doctor. Your care then shifts back to your primary care doctor.

How do they measure up?

In the mid-1990s, proponents predicted that the use of hospitalists would reduce the length of hospitalizations and lower medical costs without compromising quality of care or causing patient dissatisfaction. Preliminary research suggests they may be largely right.

Reviews found that in hospitals with hospitalist care, costs fell by an average of 13% and the length of stays by an average of 17%. Most of the studies didn’t address patient satisfaction, but the few that did found no difference. There’s no evidence so far that quality of care has suffered, but larger-scale and longer-term studies are needed to weigh the impact on patient care and the patient-doctor relationship.

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