When HM was just a twinkle in Bob Wachter’s eye somewhere around 1998, the nascent board of the National Association of Inpatient Physicians (later to become SHM’s board of directors) tried to look forward to the scope and breadth of this new specialty they were hoping to help shape. With just 300 or so hospitalists in the country at that time, it is not surprising that the original board’s vision was that someday hospitalists might replace the inpatient work being done by 30% to 40% of internists and family practitioners. Now, a little more than a decade later, HM has a vista that in some ways can’t be contained inside a hospital’s four walls.
Today, with more than 30,000 hospitalists actively seeing patients in most U.S. hospitals, there has been a reinvention of primary care, with many of the inpatient duties now assumed by hospitalists. Although direct patient care likely will remain the primary role for hospitalists in the foreseeable future, it is not the whole story.
More and more, hospitalists have a leading role in improving the function of the hospital as a cohesive force in the healthcare community. Hospitalists are active in performance-improvement strategies, both in the implementation as well as the measurement and reporting of outcomes. Hospitalists are expected by other hospital health professionals to actively participate in the team approach to healthcare. As hospitals work to reinvent themselves to meet the challenges of the 21st century, whether driven by The Joint Commission, insurers, the business community, or government, the C-suite sees “their” hospitalists as part of the calculus for change.
And as surgical care and subspecialty care evolves, hospitalists are key partners. The fastest-growing aspect of HM today is the growth in the individual hospitalist’s role as the comanager of the surgical or specialty patient. This is much more than a consult. Comanagement involves a division of labor and accountability in which surgeons do what they do best and engage their partner hospitalists to prevent VTE, provide coverage to control perisurgical complications, and share the flow of information to the patients and their families.
So in some sense, the hospitalist provides the multiuse toolbox for all things “hospital,” sort of the Swiss Army knife of healthcare:
- Direct patient care;
- Systems fixer;
- Quality and safety officer;
- Teammate and team leader; and
- Partner to the surgeon and the cardiologist.
It’s quite a lot of value and versatility all wrapped up in one package.
But wait: That is just today. There is more out there on the horizon. (That, by the way, is hospitalist-speak for “some of this is already happening in real time; it’s just not being done by everyone.”)
HM: The Problem-Solver
Hospitalists are being engaged at the ebb and flow of healthcare. Most of us know that even when we do the A-1 job in the hospital that the voltage drops when patients are flung into the white space of the discharge process. Hospitalists know that a patient’s hospitalization doesn’t end at the hospital’s threshold. In many cases, the patient is not cured or returned to full function, but more often than not, the patient is just no longer sick enough to warrant the expense and the intensity of hospitalization.