The Canadian Society of Hospital Medicine, founded in 2001 and affiliated with SHM, has about 1,300 members.
“I’d say we’re more the same than different compared with the United States, with a similar focus on quality of care,” Dr. Jamieson says.
Interestingly, he says the moniker “hospitalist” is not helping the development—and recognition—of Canadians who practice hospital-based medicine. It’s a refrain echoed for years by many in the U.S.
“As leaders in hospital medicine in Canada, we’d prefer to move away from the term ‘hospitalist’ and toward ‘specialist’ or ‘expert in hospital medicine,’” he says. “That takes us more in the direction we want to go in defining the mission of hospital medicine.
“The model is manifest in a diverse fashion throughout the United States, yet it is agile enough to be adapted around the world and be truly relevant. But local tradition and the way hospitals are structured will determine how the model is established.” —Arpana Vidyarthi, MD
“First of all, in Canada and other places, there’s a bit of baggage attached to the term ‘hospitalist.’ These other terms help us get away from some of the historical assumptions of what people thought a hospitalist was—based on educational background.”
In Canada, that has largely been family medicine. Hospital medicine advocates are now exploring the best preparation for practicing the specialty.
“We want to define the mission around competency, rather than board certification,” Dr. Jamieson explains.
Listen to Dr. Jamieson discuss the evolution of hospital medicine in Canada.
The days when the majority of Canadian primary care providers would join the staff of a hospital and continue to manage their patients’ care during the hospital stay are long gone, he adds. In smaller and rural hospitals, the family doctor may still be the physician of record, although the number of such hospitals is dwindling.
HM clinicians generally are not employed by the hospital but often are sole practitioners with independent corporations or organized into groups that associate for the sake of the practice, signing a common contract with the hospital. Depending on provincial law, most hospitalist groups have leaders appointed and compensated by the hospital for scheduling and coordination.
On top of billing fee-for-service to the provincial health authority, hospitalists may also receive a stipend from the hospital, collectively or individually.
“There is a recognition that the physician fee schedule has not kept pace with the demands of hospital medicine, and that stipend also covers other services performed in the hospital,” Dr. Jamieson says.
Vandad Yousefi, MD, CCFP, FHM, hospitalist at Vancouver General Hospital in British Columbia, Canada, and co-founder and CEO of Hospitalist Consulting Solutions, has researched the development of hospital medicine in Canada and says that, even more than in the U.S., it was driven by the withdrawal of PCPs from hospitals, which created a vacuum.2,3
“For a lot of programs I’ve consulted with, the crisis point happened when physicians resigned en masse from hospital staffs,” he says.
Another driver is an increase in “unattached” hospitalized patients, which in Canada means they don’t have a specific medical provider willing to supply their inpatient attending-level care. In his surveys of typologies of roles played by hospitalists, Dr. Yousefi has observed a lot of variation in program models—not just between academic centers, teaching hospitals, and rural hospitals, but also within each category.
“These differences in programs make it hard to benchmark,” he says.
Hospitalist—or House Officer?
The Netherlands also has “hospitalists,” although they also refer to themselves as “house officers,” says Marijke Timmermans, a doctoral student in epidemiology at the Scientific Institute for Quality of Healthcare at Radboud University Medical Center in Nijmegen. As part of a long-standing system of post-graduate, on-the-job training for doctors, Dutch hospitalists typically are medical residents who perform the medical care of hospitalized patients, but not as the physician of record.