“I don’t want to be rude or sarcastic,” he implored rudely and sarcastically, a pretentious smirk materializing, “but for hospital medicine to be considered a specialty, don’t you need to do something ‘special’?”
As I spun my internal Rolodex of responses for a setting-appropriate rebuttal, he exchanged knowing glances with the group of grizzled subspecialist academics surrounding him. The crowd, sensing its young prey was cornered, looked on with pitch-forked stares. The prey, sweaty-palmed and tachycardic, made a valiant yet ultimately futile attempt to stave off the questioner.
This exchange came during the question-and-answer portion of a medical grand rounds presentation that I made as a visiting professor at a major academic medical center many years ago. I was asked to talk about the growing specialty of HM, then a relatively new concept to the starched white coats in the academic ivory tower. To be fair, my interpretation of this interaction might be tainted by transference of an early-career inferiority complex. The inquiry had more than a kernel of legitimacy. Is HM really anything special? That query has lived with me for years in the form of a running internal discussion I’ve had with that questioner’s visage.
A Hospitalist is Born
I distinctly remember the day I became a hospitalist. Unlike for most of you, it wasn’t the day I began practicing as a hospitalist. Rather, it was about two years after I started, when my boss dropped off a brochure to join the National Association of Inpatient Physicians (NAIP). “You should probably join this group, whatever it is,” my nonhospitalist boss said dismissively. I nodded my head approvingly, my face contorting into a deferential and admiring look that indicated appreciation for the boss’s all-knowing greatness (note to my hospitalist group: Read that last sentence again). Moments later, I accessed this group’s Web page and found that the position I’d really been filling, what we called “attending on the medical wards 10 months a year,” was called a “hospitalist.”
OK, I had a name.
But was I special?
Growing Up and Finding Our ‘Disease’
Over the ensuing years, NAIP became SHM, HM textbooks were written, national and local CME meetings sprouted up, and a newsmagazine (this one) and medical journal for hospitalists (Journal of Hospital Medicine) were born.
“That’s terrific,” my imaginary grand rounds visage patronizes, “but a specialty needs more than a few people. It needs a critical mass of providers.”
By the beginning of this decade, the number of hospitalists had surpassed the number of practitioners in such time-honored specialties as geriatrics, critical care, and infectious diseases. By 2005, estimates had hospitalists trumping the number of cardiology and emergency medicine doctors. It is likely that the next decade will see the field mushroom to as many as 50,000, even 70,000, providers.
“But you don’t ‘own’ a disease,” exclaims the organ-centric visage. “You can’t be a specialty without ‘owning’ something.”
About five years ago, SHM decided to embrace VTE as a “hospitalist disease.” For sure, we treat the vast majority of pulmonary embolisms and DVTs, and we are best positioned to prevent the hospital-acquired variants. This, along with the realization that hospitalists care for the vast majority of myocardial infarctions, pneumonia, and stroke cases, provided us several diseases to “own,” or at least share with our subspecialist colleagues. The past decade has seen hospitalists take—and eventually run with—the QI and patient-safety baton. These are not diseases per se, but efforts poised to define the next generation of U.S. healthcare.