Academic turf wars, politics, and allocation of resources also play into the desire to keep hospitalists within divisions of general internal medicine. “Many chiefs don’t want them to separate because they see it as a reduction or fracturing of their division’s resources, both financial and human,” Dr. Flanders says.
Academic hospitalists who remain within divisions of general internal medicine need the support of those divisions. The SGIM task force recommended that divisions provide leadership to support hospitalists, build mentorships, create sustainable academic jobs, and value the education and quality improvement work of hospitalists, according to Dr. Flanders.
Many believe the independence of hospitalists is inevitable. “It’s where we are heading, and we will get there,” says Dr. Flanders.
Dr. Wachter says academic hospitalists are following the predictable “organizational rules of gravity. You start small and you build and you become more independent. Those who need parenting, over time, become adolescents and go to college and become independent. That’s just the nature of the beast,” he says. “It won’t happen at every place at the same minute, but I’ll be very surprised if 10 years from now, there aren’t very few academic hospitalists groups of any size that are not freestanding divisions.” TH
Barbara Dillard is a medical journalist based in Chicago.