When the Society of Hospital Medicine was very young and headquartered in the home computers of myself and Win Whitcomb (and known then as the National Association of Inpatient Physicians), I spent a lot of time thinking about the future of our field. Whether we would, or should, become a recognized specialty was one of the things I particularly enjoyed thinking about. Believing the history of Emergency Medicine might provide some insights for Hospital Medicine, I tracked down Dr. John Wiegenstein, who played a major role in the founding of the American College of Emergency Physicians (ACEP) in 1968, served as the group’s first president, and helped mold Emergency Medicine into a distinct specialty recognized by the American Board of Medical Specialties.
The parallels between the first few years of Emergency Medicine and Hospital Medicine are striking (see Table 1, milestones in Emergency Medicine). Dr. Wiegenstien told me that there was tremendous enthusiasm among early ACEP members for the opportunity to create a new specialty and invent the systems of care in the emergency room (now department) that would best serve patients and the overall enterprise of health care. At the time of ACEP’s founding, there was no group that was primarily devoted to ensuring that emergency rooms were held to high standards of care and operated efficiently. In the late 1960’s, when ACEP sought to fill this void, Dr. Wiegenstein said that the medical leaders of the day in the AMA and other organizations, tended to smile patronizingly, pat him on the shoulder figuratively, and suggest that it would be fine to busy himself with such a project since it would keep him and his colleagues out of the way of those who were doing the important things in medicine. After all, the leaders of the day reasoned, there were already existing specialties with more expertise at any kind of care that an ER doctor might provide, so creating a new breed of doctor or specialty seemed like it would be an unnecessary duplication of existing specialties. Yet Dr. Wiegenstein and his colleagues did exactly what they set out to do, and today there is probably no one who questions the importance of the contribution of Emergency Medicine to our healthcare system, and its status as a distinct specialty.
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The case for Hospital Medicine becoming a recognized specialty or subspecialty.
The question for those of us in Hospital Medicine is should we, and can we, be about doing the same thing in our field that has happened, and is ongoing, in Emergency Medicine? I suspect nearly all hospitalists believe the answer is yes, and I sense growing support for this goal from those in nearly all other fields in medicine. And I think an important factor in ensuring success is to think of ourselves as a distinct specialty or subspecialty.
In fact, Hospital Medicine functions as a distinct specialty in many respects already. There is a growing body of distinct literature about clinical and operational aspects of hospitalist practice, distinct educational materials and CME courses, and an active and growing professional society. Hospitalists are taking leadership positions in developing optimal systems of inpatient care in many institutions. And SHM is now working to launch its own journal of Hospital Medicine.
What existing specialties have that Hospital Medicine does not (yet) is certification criteria, including an exam, and separate credentialing categories in hospitals and payer organizations such as Medicare. While I’m not eager to take or pay for another certifying exam myself, it would help to maintain high standards among hospitalists and encourage focus on the core competencies in Hospital Medicine. It would shape residency training and CME courses as well. At the outset, and maybe permanently, I envision a Hospital Medicine exam (with versions for pediatric and adult medicine hospitalists) as a certificate of added qualification to the existing board exams in Internal