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THE EVOLUTION OF HOSPITAL MEDICINE

In August 1996, Robert Wachter, MD, MHM, chief of the medical service at the University of California San Francisco Medical Center, and Lee Goldman, MD, chair of UCSF’s department of medicine, published an article introducing the term “hospitalist” and the new concept of “hospital medicine” to a broad professional audience through the prestigious New England Journal of Medicine (NEJM). The article generated tremendous interest throughout the U.S. healthcare system and gave rise to an emerging medical specialty defined by its setting of care, the hospital.

The hospitalist field has since grown to more than 30,000 physicians. Although there existed antecedents for the coalescing field of HM prior to the NEJM article, its publication remains one of the fundamental milestones in HM’s history. And such an anniversary is worth commemorating by the field’s members, its professional society, and The Hospitalist. The following identifies many of the highlights in HM’s growth and development, both before and after publication of the NEJM article.

Shortly after the article appeared, Dr. Wachter was contacted by two other practicing hospitalists: John Nelson, MD, MHM, an inpatient physician since 1988 at the North Florida Regional Medical Center in Gainesville, and Winthrop Whitcomb, MD, MHM, since 1994 at Mercy Inpatient Medical Service in Springfield, Mass. The trio soon began discussing the creation of a professional society, which in 1997 became the National Association of Inpatient Physicians (NAIP, now the Society of Hospital Medicine, or SHM). Drs. Nelson and Whitcomb served as NAIP’s first co-presidents from 1997-2000.

Indispensable figures in the birth and growth of HM, Drs. Nelson, Wachter, and Whitcomb were recognized in 2010 by SHM as its first Masters in Hospital Medicine.

• 129 A.D. – Galen, called by some the father of hospital medicine, is born in Pergamon, today called Bergama, in Turkey. He studies medicine, surgery, and philosophy and becomes medical attendant to gladiators at a medical center called Asklepion, named for Asklepius, the Greek god of medicine and healing.
• 1960s – A group of pediatricians in Atlanta, Ga., reportedly practices an early version of hospital medicine.
• 1968 – American College of Emergency Physicians, an essential antecedent for the site-based specialty of hospital medicine, is established. Board certification of emergency physicians begins in 1979.
• 1972 – EmCare (Emergency Medical Services Corp.), a future hospitalist company, is founded in Dallas, Texas.
• 1978 – Pediatric hospital medicine service launches at UC San Diego Children’s Hospital.
• 1979 – TeamHealth, Knoxville, Tenn., a future hospitalist company, is formed to manage hospital EDs.
• 1983 – Medicare DRGs (diagnostic related groupings) fundamentally transform hospital payment and economic models.
• 1988 – John Nelson, MD, an HM pioneer and co-founder of SHM, joins another physician already in full-time hospitalist practice at North Florida Regional Medical Center in Gainesville, Fla.
• 1993 – Kaiser Permanente, a group-model HMO based in Oakland, Calif., begins experimenting with hospital-based specialist physicians. Other health systems exploring similar HM models include Park Nicollet in Minnesota, California Lung Associates in Southern California, and Scripps Clinic in San Diego. Mercy Hospital in Springfield, Mass., puts board-certified internists on-site 24 hours a day.
• 1994 – Win Whitcomb, MD, a primary care internist seeking definable boundaries around his professional practice, joins Mercy Inpatient Medical Service in Springfield, Mass. Soon he becomes its medical director.
• 1995 – Robert Wachter, MD, a UCSF faculty member based at San Francisco General Hospital and directing UCSF’s internal medicine residency program, is recruited by Lee Goldman, MD, UCSF’s new chair of medicine, to head the inpatient service, with strong encouragement to “innovate.” Dr. Wachter writes an article for the resident newsletter about the new “hospitalist” concept and is encouraged to submit it to a major medical journal.
• 1995 – Drs. Nelson and Whitcomb individually begin to seek other physicians with inpatient practices for networking purposes.
• 1995 – IPC is founded by physicians in North Hollywood, Calif.; it eventually becomes a private practice hospitalist group subtitled “The Hospitalist Company.”
• 1996 – Landmark article by Drs. Wachter and Goldman is published in August in NEJM, introducing the term hospitalist.
• 1996 – Drs. Nelson and Whitcomb contact Dr. Wachter and start talking by phone and through the new medium of email about the U.S. hospitalist movement and the need for a professional association to guide its growth. They agree that Drs. Nelson and Whitcomb will organize the association while Dr. Wachter focuses on academic issues like outcomes research and education. In October, Internal Medicine News runs a cover story profiling Dr. Nelson and hospital medicine.
• 1997 – (Jan)Drs. Nelson and Whitcomb send a letter to several hundred physicians announcing a new professional society, the National Association of Inpatient Physicians (NAIP).
• 1997 – (Feb) A cover story in Modern Healthcare, “What’s a Hospitalist?” profiles Weston G. Chandler, MD, a hospitalist in Southern California.
• 1997 – (Mar) The inaugural issue of The Hospitalist is published as a five-page newsletter.
• 1997 – (Mar) The New York Times prints an article about hospitalists.
• 1997 – (Apr) Dr. Wachter convenes the first UCSF CME conference, “Care of the Hospitalized Patient,” in San Francisco, which also provides a venue for an organizing meeting of NAIP.
• 1997 – (Jul) NAIP is incorporated as a 501(c)3 non-profit organization.
• 1997 – (Jul) Spring-Fall: NAIP leaders meet with representatives of organized medicine, including the American Board of Internal Medicine (ABIM), the American College of Physicians (ACP), and federal health officials.
• 1997 – (Dec) Dr. Wachter holds first policy conference on the hospitalist movement, funded by a grant from the Agency for Healthcare Research and Quality, which draws a crowd of about 500. Its proceedings are later published in the Annals of Internal Medicine.
• 1997 – (Dec) Cogent Healthcare, another major national hospitalist company, is founded by four physician groups in Southern California.
• 1998 – NAIP becomes an affiliate of the American College of Physicians (ACP).
• 1998 – First annual meeting of NAIP is held in San Diego; NAIP begins accepting memberships.
• 1998 – Dr. Wachter’s research study on outcomes for an academic hospitalist service is published in JAMA.
• 1998 – NAIP website is launched.
• 1998 – First hospitalist program at a public hospital, Grady Memorial Hospital in Atlanta, Ga., is established by Mark V. Williams, MD, FHM.
• 1999 – NAIP issues policy statement that referrals to hospitalists from PCPs should be voluntary—not mandated by managed care plans; other medical societies follow suit.
• 1999 – Palliative care emerges in the HM division at UCSF, led by hospitalist and ethicist Steven Pantilat, MD, SFHM.
• 1999 – UCSF’s Kaveh Shojania, MD, is the first hospitalist fellow.
• 1999 – Institute of Medicine begins publishing landmark reports on patient safety, medical errors, and quality, which provide a major focus for the aims and advancement of the emerging field of HM.