I pose here a list of questions to consider before embarking on the creation of a new specialty in hospital medicine
1) What distinguishes the body of knowledge of hospital medicine from internal medicine (or pediatrics, for our colleagues in that field)?
While there is a body of literature supporting operational aspects of hospital care, as far as I can tell there is no difference in the way a hospitalist or office-based internist should treat pneumonia. Hospitalists develop areas of expertise in case management, understanding of hospital-based quality-improvement systems, communication skills, etc, but these fall short of a body of knowledge for a medical specialty. Books on hospital medicine do not differ from standard medicine texts in terms of disease pathophysiology, clinical presentation, diagnosis, or management. What then is the new body of knowledge?
2) Does hospital medicine really want to exclude office-based primary care doctors from managing their own cases in the hospital if they so choose?
Creating a new specialty of hospital medicine certainly would tend to do that. Let’s look at emergency medicine, for example. It used to be common for internists and surgeons to work in emergency rooms. That no longer is the case in many parts of this country because of the emergence of a new specialty. Do we want the same to be true for office-based doctors who care for their own patients?
3) Creating a new specialty requires special training. What is that going to be? Who teaches it and who will do it?
New subspecialties require additional training. For instance, electrophysiology is now a subspecialty of cardiology and requires an additional one or two years of training after a three-year cardiology fellowship. Working for 2-3 years as Dr. Nelson has proposed in the field of hospital medicine is not additional training, it is just additional practice. What is the formal training that the Society of Hospital Medicine proposes to qualify someone as a Board-certified hospitalist? Is it likely that young doctors are going to want to add on an additional 2 or 3 years of training beyond their internal medicine residency before they can start paying off their medical school loans? What will this training actually entail, and how will it merge with the internal medicine training programs that already exist?
I would point out that residents in fact are hospitalists in training. Certainly the vast majority of their clinical experience occurs in the hospital. Except for primary care residencies, I would estimate that 2/3 of the clinical care that internal medicine residents experience is in the hospital.