Just when the country was starting to count on primary care to be the lynchpin for the new healthcare model, medical students were turning away from primary care in record numbers. Internal-medicine matches were near all-time lows. PCPs in practice were facing growing time and money crunches, and the medical students they were counting on to help out were choosing other fields. The cavalry of new doctors needed to bolster the ranks of those already struggling to keep up simply wasn’t coming.
Finally, unassigned care for hospitalized patients, which had always been a responsibility of local doctors, had frequently been a condition of hospital privileging, and was often seen by the doctors as a way to give back to their hospital and community, was now something that added even more time, work, and financial pressure to their growing burdens.
So, these doctors, just like the doctors in the Park Nicollet Medical Group, began to brainstorm new ways to improve efficiency and see if they could get on top of the changes happening around them. One such idea was to create rounder systems. These systems would have each doctor in the practice take a week away from clinic and care for all of the practice’s patients in the hospital. This way, only one doctor would have to spend time away from those ever-busier clinic practices during the week. By giving up the continuity of the individual rounder and trading it for the continuity of the group, these groups gained efficiencies for everyone in the practice. This was the first small, but critical, step toward hospital medicine. It would have been hard to get to hospitalists without PCPs taking that first mental leap.
Often, it was one or more of these rounders who decided, for various reasons—boredom with ambulatory care, dislike of the more frantic pace of clinic, or simply a realization that they enjoyed or excelled at hospital care—that maybe they would just take on all of the hospital care for their group. This is what happened at Park Nicollet, and what started happening all across the country. The tinder was assembled and stacked, ready for something else to happen.
The Spark
Word of these new types of models and practices began to spread and was even talked about inside the pages of some journals. It took a few years, but somebody noticed and finally put it all together into an article that was published in the most famous medical journal in the world. In that 1996 New England Journal of Medicine article, “The Emerging Role of ‘Hospitalists’ in the American Health Care System,” Wachter and Goldman gave a name to the strange creatures willingly giving up half of what they had been trained to do and devoting all their time to an inpatient practice.1 “Hospitalists,” they called them, and when the rest of the country read that article, the movement was no longer under the radar; it had a name. The spark had been ignited. What would become the fastest growing medical specialty in history was ready to take off.
But a spark needs more than tinder to truly ignite. Fuel and oxygen are necessary to give it life.
I’ll talk about that in my next column…
Dr. Kealey is SHM president and medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.