Ah, 15 years. My, how time flies. August 1996 seems like yesterday. I had just moved to Denver. It was a hot summer. I still had hair, a normal BMI, and a social life. The world was gearing up for the Olympics in Atlanta; my adrenal glands were gearing up for the hypertrophying journey called internship. The films of ’96 seemed to portend ominously about my year ahead: Twister (a whirlwind ride?), Jerry Maguire (you complete me, internship?), Independence Day (apocalypse?), The Nutty Professor (research attendings on the wards?), Mission: Impossible (hmmm).
The Spice Girls were spreading girl power, this thing called the Internet was sort of catching on with 10 million (yes, that’s an “m,” not a “b”) users worldwide, and the dotcom era introduced us to eBay, which offered to sell your junk “online.”
In Scotland, Dolly the sheep was cloned and the world grappled with the ethical implications. In England, Diana and Charles divorced and cows became mad (coincidence?). Back home, Seinfeld, ER, and Friends teamed for “must-see” Thursday nights, the average car cost $16,000, and Federal Reserve Chairman Alan Greenspan wondered if the Dow Jones was overvalued at 6,400.
Oh, and on Aug. 15, the term “hospitalist” appeared in print for the first time, helping launch the fastest-growing medical specialty of all time.1
Labor & Delivery
I remember as an intern seeing the article by Drs. Wachter and Goldman. I guess I didn’t get it, really. Was it that easy to create a new specialty? Just take something and add “ist” to the end? As interns, we excitedly begin to create new fields to describe our work: “dump-ologists,” “failure-to-thrive-ists,” “rectalists.” Much like Jamiroquai, however, our specialties never really caught on.
But HM did, and this month we celebrate 15 years. Now, I’ll recognize that its impossible to pin an exact date on the creation of a specialty, and in fact, hospitalists clearly existed prior to the term. But in terms of identifying a start date, Aug. 15, 1996, is as good as any.
The Early Days: Doing It
I don’t remember the day I became a hospitalist. It all sort of just flowed together. I finished residency, did a chief year where I taught, attended on the wards, and didn’t do any clinic, and then I took a job at the Denver VA, where I taught, attended on the wards, and didn’t do any clinic. It felt kind of all the same.
But from the outside, this was a significant transition point. Until this time, subspecialists or general internists, family medicine doctors, and pediatricians provided nearly all inpatient ward attending (and indeed, community inpatient care). I recall vividly the reaction of others; it was a mixture of amazement (you do what all year?), concern (you’ll burn out), apprehension (I won’t be able to care for my patients in the hospital), and enmity (you’ll destroy the fabric of internal medicine!).
And this was the point of the first few years: survival. These were the formative years. It was all about showing HM was a sustainable model that could enhance, not detract, from the system of care. And it had its very vocal critics, who saw it as a flash in the pan. They assumed it would go the way of the Tickle Me Elmo doll (a fad, for the record, that needed to die).
And this was the importance of the creation of the National Association of Inpatient Physicians (now SHM), HM textbooks, the development of hospitalist researchers, a national meeting, the creation of sustainable community hospitalist jobs, the growth of academic HM groups, and studies showing the model could indeed be implemented and wouldn’t negatively impact patient outcomes or outpatient provider satisfaction. These things legitimized the field, gave it legs, propelled it to the next phase.