Something about the hospitalist model, he adds, “just makes sense.”
“There are people virtually everywhere who are very enthusiastic about it. We in the United States can learn a lot from their enthusiasm,” he says. “It will evolve in different ways. The future is already here; it’s just unevenly distributed.”
Larry Beresford is a freelance writer in Alameda, Calif.
Hospitalist Programs as Islands
Felipe Lucena, MD, FHM, an internist at Clinica Universidad de Navarra in Pamplona, Spain, founded the first hospitalist program in that country a decade ago to focus on the medical management of hospitalized patients. In 2013, he was recognized by SHM with the Fellow in Hospital Medicine (FHM) designation. A number of other facilities in Spain have developed hospitalist programs, he says, but they operate independently—“as islands.”
Dr. Lucena is active in multisite and multinational clinical research, studying sepsis and noninvasive mechanical ventilation, as well as outcomes from new programs such as an intermediate care unit staffed by hospitalists, with results published internationally and reported at the Spanish Society of Internal Medicine.9
Developing a national society of hospital medicine in Spain is not going to be easy, Dr. Lucena admits, but he says the recognition from U.S. hospitalists will aid his efforts to promote the development of local hospital medicine chapters. He is working with SHM to advance professional recognition and mentorship from the U.S., including Efren Manjarrez, MD, SFHM, who runs the hospital medicine rotation at the University of Miami Hospital in Florida. One of Dr. Lucena’s colleagues will soon start a yearlong clinical research placement in Miami.
“Although in general terms our work is very similar to U.S. hospitalists, we have a long way to go to learn and improve,” Dr. Lucena says. “Spain’s medical societies do not recognize the term ‘hospitalist’ or its special work among the clinical specialties.”
In fact, many internists work in hospitals, both urban and rural, without understanding the implications of the work or their need for specialized training, he says. “We need to develop best practice models for our centers and define our core competencies,” he says.
Although in general terms our work is very similar to U.S. hospitalists, we have a long way to go to learn and improve. Spain’s medical societies do not recognize the term ‘hospitalist’ or its special work among the clinical specialties. —Felipe Lucena, MD, FHM
The development of hospital medicine also is impacted by an economic downturn in Spain, which affects the National Health System’s provision of health coverage for Spanish and European citizens. The government and medical boards are trying to reorganize medical specialties to establish two- to three-year training in internal medicine before doctors pursue medical specialization, rather than medical graduates applying directly to specialty programs.
Dr. Lucena says this change will help ease the problems caused by fragmented medical care and could also further the development of hospital medicine. Hospitalists in Spain are mainly salaried employees in both public and private academic medical centers.
“In general terms, physicians are underpaid in Spain,” he says. “Of course, with the economi
c crisis, salaries are getting worse. But when we compare
with other groups in our society, such as architects, engineers, and lawyers, we have more stable work and better salaries.”
Brazil: Early Stages of Development
Brazilian hospitalist pioneer, Guilherme Barcellos, MD, SFHM, began exploring hospital medicine for his country a decade ago with a small study group during his medical residency at a hospital in Porto Alegre. He and some committed colleagues have built the concept into a movement, with an association and website, national conferences with visiting speakers from other countries, and opportunities to network with colleagues in the U.S. and elsewhere.
Dr. Barcellos now runs the hospitalist program at Divina Providância Hospital in Porto Alegre. He has attended SHM conferences in the U.S. five times, always accompanied by visits to hospital medicine programs, and he has been recognized by SHM as a Senior Fellow of Hospital Medicine.
Guilherme BraunerBarcellos, MD, SFHM, (right) of Divina Providencia Hospital in Porto Alegre, Brazil, with Neil Winawer, MD, SFHM, of Emory University School of Medicine in Atlanta, Ga., standing inside the famous Maracana Football Stadium of Rio de Janeiro, Brazil
“Now other groups around this big country are doing exactly what my U.S. hospitalist friends do,” Dr. Barcellos says. “There aren’t so much differences as just an earlier stage in the process of maturation in Brazil.” Many of the challenges of developing hospitalist programs—and the needs driving that development—are the same that he has heard from U.S colleagues.
Unfortunately, some Brazilian hospitals treated their hospitalists as “super residents” or as if they were mid-level providers, which led some programs to close, Dr. Barcellos says. Remuneration for salaried hospital physicians is another problem, and some have to work for multiple hospitals or see too many patients, with no time for nonclinical activities to advance hospital medicine. “We have pressures to do things we don’t like, but it’s also a learning experience.”
He also finds supportive colleagues through the Pan American Society of Hospitalists, which brings together hospitalist pioneers from across the Americas. He estimates a hundred hospitalist programs in Brazil, 20 of which he has visited in person, and about 1,000 working hospitalists.
“We are still promoting the dissemination of ideas and the improvement of hospital medicine practice through the Future Hospitalist Movement website, and planning another meeting for 2016,” he says.