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A Bigger Role for Hospitalists

Joe Cantlupe, for HealthLeaders Media, April 15, 2013
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This article appears in the April 2013 issue of HealthLeaders magazine.

Years ago, doctors would make rounds to supervise care for dozens of hospitalized patients. Now physicians often want to orchestrate care from their office, so they'll make fewer trips to the hospital—or none at all. Many especially don't want to be called at 3 a.m. to report to the hospital for one of their patients, or even get involved in certain procedures beyond their specialties.

Increasingly, hospitalists are gaining more responsibilities in areas such as monitoring patients day to day, ordering tests, performing surgeries, handling specialized care, or taking on leadership roles. Their specializations are many—from laborists who handle OB-GYN cases to surgicalists who specialize in trauma care and neurohospitalists who handle brain cases, as well as nocturnalists, who work strictly on the overnight shift.

Hospitalists are among healthcare's fastest growing specialties, with at least 60% of hospitals now employing these professionals. Since 2003, when there were an estimated 8,000 hospitalists, the specialty has grown to about 30,000, according to the Society of
Hospital Medicine.

Those urging expansion of hospitalist programs see them as a way to reduce length of stay while improving patient satisfaction. In addition, some hospitalists are specializing in acute care transitions for uninsured patients who have no primary care physicians, and for elderly patients who are cared for in hospitals then nursing homes.

"The whole field has exploded in the last 10 years or so. It's been born out of logistical need," says Louis J. Lux, MD, chief of hospital medicine at the 156-bed St. David's Round Rock (Texas) Medical Center. "Doctors used to follow patients into the hospital when they got sick. Now, the overwhelming majority is choosing to stay in the office. It's hard to be in two places at once," says Lux, also cofounder of Central Texas Hospitalists in Round Rock, a hospitalist physician group.

Philip Vaidyan, MD, FACP, director of hospital medicine in the department of internal medicine at the 525-bed SSM St. Mary's Health Center in St. Louis, says some hospitals see hospitalists as "quarterbacks" who enhance relationships with primary care physicians, coordinate care with multidisciplinary teams, and overcome the fragmentation of care. These specialists are playing an increasingly important role in keeping tabs on patients after they are discharged from hospitals to help prevent 30-day readmissions, he says. "We're seeing a majority of patients in the hospital," says Vaidyan, referring to the gamut of patients cared for by hospitalists.

Vaidyan himself is an example of how hospitalists are playing more of a leadership role in hospitals, especially those who are contracted from outside hospitalist groups. In addition to his role at St. Mary's, Vaidyan also is practice group leader of a team from IPC The Hospitalist Company, a North Hollywood, Calif.–based hospitalist physician provider group.

Shifting roles
The diminishing amount of time doctors are spending at hospital bedsides is reflected in national surveys. The average physician devotes only 12% of his or her time to hospital consultations with patients, according to the Society of Hospitalist Medicine. Hospitalists are becoming more central to coordinating care. St. David's Round Rock Medical Center and St. Mary's are among the hospitals that are increasing their general and specialized hospitalists on staff and the number of patients those doctors see.

"What's driving the growth of hospitalists these days is that patients who are in the hospital with very complex conditions … need to be seen multiple times a day, so someone is needed right there," Vaidyan says. "Hospitalists also are essential for providing patient safety and quality, and they play a major role in residency education. You need to have folks dedicated to the hospital with all the multidisciplinary team members, the nursing staff, the case managers, the social work consultants." In 2005, St. Mary's started its hospitalist program with four physicians and by early 2013, it had 13 hospitalists and four nurse practitioners working with them. The team increased care from 30 patients per day to at least 140, he adds.

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