A 20-year lookback: Has the hospitalist movement actually improved patient care?


In the last 20 years the healthcare industry has welcomed a new type of specialist that focuses on the general medical care of hospitalized patients. Since the concept was first introduced in 1996, 75 percent of U.S. hospitals now employ these hospitalists and the field has grown to 50,000 physicians.

And the specialty continues to expand with more physicians becoming post-acute care hospitalists and laborists.

But is hospital care better for it? That’s a question The New England Journal of Medicine explores in two new articles in recognition of the 20th anniversary of the field.

In many instances, hospitalists do add value to improve quality, safety and innovation, writes Robert M. Wachter, M.D., a professor at the University of California, San Francisco School of Medicine, and Lee Goldman, M.D., who works for the College of Physicians and Surgeons, Columbia University, New York, in the first commentary. And they believe that the model is the best way to guarantee hospitals provide high-quality, efficient inpatient care.

The model has led to reductions in length of stay, cost of hospitalization and readmission rates, but there are challenges.

“Although hospitalists have been leaders in developing systems (e.g., handoff protocols and post-discharge phone calls to patients) to mitigate harm from discontinuity, it remains the model’s Achilles’ heel,” they write.

The lack of care coordination between hospitalists and primary care physicians during admission and discharge is a big concern, agrees Richard Gunderman, M.D., Ph.D.,  of the Indiana University School of Medicine, Indianapolis, in the second piece.

“Gaps between community physicians and hospitalists may result in failures to follow-up on test results and treatment recommendations,“ he said.

Furthermore, it’s unclear what the model’s impact is on overall health status, total costs, and the well-being of patients and physicians, according to Gunderman.

- read the first piece
- here’s the second article

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