At one time, there was virtually no such thing as a “closed” ICU in hospitals.
Evidence suggested patients received better care when intensivists cared for ICU patients. Today, it is rare to find an academic medical center without a closed ICU, and many community hospitals have adopted a similar model.
Whether doctors are calling themselves “hospitalists” because it is the cool thing to do now or whether it is a matter of turf, you bring up a good question: “How much inpatient work does one have to do to be called a hospitalist?” Drs. Wachter and Goldman certainly didn’t specifically address this issue in their article, and neither has SHM.
SHM’s definition of a hospitalist is: “Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital medicine.”
This definition of a hospitalist is about as good as any I have heard. It should be noted this definition makes no mention of training. One can be an internist, family physician, pediatrician, obstetrician, or general surgeon and be a hospitalist.
With this definition, it does mean, however, you can take care of patients one to two months out of the year and still be considered a “hospitalist” as long as your non-clinical work (teaching, research, and leadership roles) is related to hospital medicine.
I will caution you however as you draft your clinical privilege form that whether you are a hospitalist or not is a different issue than whether you are qualified or not to provide a specific type of clinical care.
Hospitalists are individuals with different knowledge bases and skills sets. You can work clinically as a hospitalist 12 months a year, but if you have never put in a central line, your hospital should not grant you privileges to put in central lines until you have demonstrated some minimal level of competency.
I suspect you are not alone. There are many doctors and institutions around the country that are or will be struggling with the same issues you are facing. TH