Hospitalist practices became bastions of independence and freedom. No longer were these physicians chained down to their small area in one hallway of the clinic, nor did they cling to the metaphor of the fast-moving production line. Hospitalists could roam the hospital at will, from inpatient unit to ED to ICU. Hospitalists could eat lunch when they wanted to! Gen-X physicians flocked to this model of independence that so aligned with their own inner desire to work at their own pace and in their own way.
These early hospitalist programs, still trying to find their way in a complicated and changing healthcare environment, necessitated continued resourcefulness. We saw creative approaches to scheduling that favored continuity (seven on/seven off), transitions to hospitalists as teaching attendings, and early attempts at night coverage. The transition from at-home call or coverage by residents to in-house shifts to nocturnists could fill its own column. The creative opportunities offered by these early practices strongly appealed to the Gen-X sensibilities and values.3
Lastly, work-life balance strongly resonated with Gen-X physicians. Many of the Boomer physicians of the time were content to stay in the clinic and “run faster” to keep up with the demands of managed care; however, the Boomers who migrated to the hospital and the early Gen-X physicians seemed to have a different mindset. They relished the opportunity to work in the new hybrid model. I say hybrid because it certainly wasn’t the ongoing continuity model that it originated from in primary care, but neither was it pure shift work like in the ED. It had the element of daily shifts—but clustered together in five to 14 day runs, often with an equal amount of time away from work. Additionally, nobody was taking work home—at least not until EMR. Work-life balance was the recruiting “pitch” during the late 90s and early 2000s.
So, after the creation of the field by Baby Boomers, the Gen-X doctors were the fuel needed to grow the specialty at a pace never before seen in medicine. Wachter and Goldman’s article opened the floodgates. Between 1997 and 2006, the number of hospitalists grew by 29%—not in total, but 29% per year!
Gen-X physicians latched onto the idea created and publicized by the Boomers, but the movement needed more to sustain, even accelerate, that early growth than just an interesting new idea for how to see hospital patients. What was the oxygen? What gave the HM social movement its purpose?
In my August column, I will explore what came next to propel HM from a new area of practice, an offshoot of primary care, into a full-fledged movement. It was that next thing that made our field “go viral.”
Dr. Kealey is SHM president and medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.