In the near future, frequently hospitalized patients may not only require the services of hospitalists, but also comprehensive care physicians--an emerging specialty that would focus on the care of the seriously ill, according to David Meltzer, M.D., professor of medicine and director of the University of Chicago's Center for Health and the Social Sciences.
Meltzer, speaking last week at a conference organized by the Milton Friedman Institute at the University of Chicago, said that since hospitalists first were identified in a New England Journal of Medicine article in 1996, they have become the fastest-growing medical specialty in the U.S.--providing more than a third of all general medical care in the country.
The use of hospitalists, however, has the potential of creating communication problems because these physicians might not always known the full medical histories of their patients as well as those patients' primary care physicians. Therefore, the establishment of a specialty--called the comprehensive care physician, or comprehensivist--could overcome that problem.
The comprehensivist would work both in a hospital and an attached clinic--and also attend to those at the greatest risk of hospitalization, Meltzer said.
Chronic conditions such as congestive heart failure, end-stage renal disease or liver disease, sickle cell disease, or chronic-obstructive pulmonary disease could be reasonable models for such care--especially for those cases collected into centers of excellence with sufficient volume to support such degrees of specialization, he said.
While the comprehensivist model has not been introduced in the U.S., it is similar to other approaches in Canada, the United Kingdom, Australia, and New Zealand, Meltzer said.