What Is a Laborist?
One of the interesting things about hospital medicine is our diversity. It is an evolutionary construct and can be both a strength and a concern as we all try to create and define our new specialty.
Most hospitalists are trained as general internists. This wasn’t always so. As recently as 1997 almost 50% of hospitalists were internal medical subspecialists. The thinking at that time was that because infectious disease docs, pulmonologists, intensivists, and others were already in the hospital seeing ill patients, why couldn’t they just also be hospitalists?
Well, it turned out they wanted to be infectious disease specialists and pulmonologists and they soon found out that being a hospitalist is somewhat different than these other specialties.
Now hospital medicine is a popular career path for those finishing a general internal medicine residency, as well as for those who are finding a career as a hospitalist preferable to their original choice as in traditional internal medicine. (See “Trendwatch: The Specialization of Hospital Medicine,” p. 27.)
PEDIATRICIANS AND FAMILY PRACTICE
At the same time, even though only 3% of hospitalists are family practitioners, more than 90% of hospitalists in Canada come out of family practice training. Increasingly, young graduates of family practice residency programs are choosing to become hospitalists.
And let’s not forget the pediatricians. Pediatricians comprise about 9% of all hospitalists, and more than 200 pediatric hospitalists got together for the largest pediatric hospital medicine meeting ever in Denver at the end of July. (See the “Pediatric Special Section,” p. 33.) It was an impressive community of pediatric hospitalists. Most children’s hospitals and many community hospitals now have pediatric hospital medicine groups. Most of the pediatric inpatient care in this country is now provided by hospitalists and pediatric subspecialists.
In fact, those who have taken training in med-peds are finding that a career as a hospitalist is a nice fit, and they are welcomed by those who care for children and adults in the hospital.
But hospital medicine is not only about physician caregivers. More than 5% of hospitalists in this country are nonphysician providers, either nurse practitioners or physician assistants. As the demand for hospitalists rapidly increases many hospital medicine groups find that adding nurse practitioners or physician assistants helps them to complete the workforce they need to have in place to meet their clinical and administrative demands.
And hospital medicine includes pharmacists, case managers, and administrators to round out the inpatient team. Each of these professions is developing “hospital medicine specialists” looking for skills and experiences to allow them to help facilitate the work of the hospitalists and to use a team approach to achieve the rapidly expanded expectations of hospital medicine groups.
EDUCATION AND CERTIFICATION ISSUES
This growing conglomeration of healthcare professionals in one specialty presents unique issues. Some of these come in the form of diverse and expanding educational needs. The patient wants to be assured that no matter where the individual hospitalist started his or her training, the hospitalist will bring to the bedside the appropriate skills for their acute medical problems. This leads to having SHM develop courses in critical care skills, perioperative medicine, leadership, and the like.
Yet even though the endpoint may need to be similar for all hospitalists, it takes a fine touch and significant customization to craft educational materials when many hospitalists may start from a different base point.
