Long gone are the days when primary care physicians stopped by a hospital on the way home from a hectic day to check on a patient.
Since 1999, hospitalists have largely taken over that job for primary care physicians and internists. The number of physicians practicing adult hospital medicine grew 50% in 2012 to 2019, totaling 44,037 by 2019. Rural and urban hospitals employ these hospitalists to cut costs, improve quality and perhaps make a small dent in the growing shortage of physicians who are leaving their practices because of burnout.
The term hospitalist was first used in 1996 in a New England Journal of Medicine article written by Robert Wachter, MD. There was a need for hospitals to have dedicated physicians for inpatient care round the clock. Studies have shown that hospitals and patients have benefited tremendously with these specialists replacing the traditional model, where primary care physicians would visit hospitalized patients after office hours.
Hospital medicine has grown steadily since 1999 and today faces a positive outlook based on projected growth and demand, making it one of the fastest growing medical specialties in the U.S. Now, with the dismal outlook for an unprecedented primary care physician shortage, the spotlight is back on the hospitalists.
In 2021, the Association of American Medical Colleges projected a shortage of between 17,800 and 48,000 primary care physicians by 2034. As the shortage intensified during COVID-19, the number of hospitalists grew by more than 50%.
Yet, despite their pivotal role, many people — even some within healthcare — are less familiar with what hospitalists do and the advantages and disadvantages of this model.
The benefits of employing hospitalists
There are advantages to the patient, as studies have shown, and to the hospitals, whether it is the proven reduction of length of stay or the reduction in readmissions. For the hospital, one study in the Journal of Community Hospital Internal Medicine Perspectives showed that hospitalist care decreased LOS while improving patient satisfaction. The conclusion was hospitalists increased the efficiency of care without sacrificing quality of care.
Another study in the same journal concluded that hospitalists reduce the overuse and overtreatment in healthcare systems, decrease costs, and improve healthcare quality and outcomes for patients. The study reported that teaching and larger facilities benefit from the use of hospitalists, who practice efficiently, provide better inpatient care and, at the same time, reduce the times for testing and length-of-stay compared to teaching teams.
Another advantage for outpatient physicians is they no longer have to add hospital rounding to their already busy daily patient load. Having someone on site who can help navigate the patient through the maze of multiple specialists and to oversee the care has become a more important aspect of caring for hospitalized patients — that's a pro for doctor and patient.
Are there any drawbacks to the rise in hospitalists?
Despite its success, the hospitalist model faces challenges. Perhaps the most concerning is the potential disruption of the long-standing relationship between patients and their primary care physicians. Some believe that hospitalists interfere in the valuable relationship shared between patients and their primary care physicians, a concern that remains one of the most debated issues surrounding the rise of hospitalists in healthcare.
Ironically, one of the downsides of the popularity of the career is that it is drawing primary care physicians and internists away from much-needed outpatient practices, further exacerbating the shortage in these areas. In large numbers, newly certified internists are opting to practice medicine in hospitals as hospitalists, a shift that contrasts sharply with more experienced physicians who once treated patients in both inpatient and outpatient settings but are now choosing to focus exclusively on outpatient care.
What's ahead for hospitalists?
The job outlook for hospitalists is highly promising, with demand projected to increase and an estimated 72,500 new positions expected by 2029.
The next decade will likely see not only a rise in the number of hospitalists but also an expansion of their roles into leadership positions in operations and medical education, according to the New England Journal of Medicine Career Center. The hospitalist model continues to expand in inpatient specialties such as orthopedics, trauma, anesthesiology, OB/GYN, general surgery and gastroenterology.