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Hospital C-suite Favors Hospitalist Growth, Says Survey

By Karen M. Cheung  
   January 22, 2010

Hospital leaders in the C-suite support hospitalist program growth, according to a recent study, "California hospital leaders' views of hospitalists: Meeting needs of the present and future," which was published in the Journal of Hospital Medicine.

As hospitalists take on more roles in the hospital, rotating between the inpatient, emergency, and surgery floors, hospital leaders also support additional training for these physicians.

The study surveyed hospital leaders—CEOs, COOs, CMOs, vice presidents of medical affairs, and medical directors—at 179 nonfederal, acute hospitals in California in 2006-2007. More than half (57%) expected hospitalist program growth during the next two years, according to the study.

And at hospitals without existing programs, 44% of hospital leaders planned to implement one within the next two years. None of the respondents planned to cut the size of their hospitalist groups.

With 25,000 hospitalists in the U.S., hospital medicine is the fastest growing medical specialty.

What is the catalyst for this boom? Whereas startup reasons used to be about cost containment, hospital administrators are now more interested in initiatives of quality and patient coverage.

"The C-suite has an interest in improving the quality of care. They're responding to the transparency movements of public metrics for CMS, The Joint Commission, for the public setting," said lead author of the study, Dr. Eduard Vasilevskis, MD, associate professor of medicine and staff physician at Vanderbilt Center for Health Services Research in Nashville. "They see hospitalists as a solution toward improving quality of care in the hospital."

For institutions with existing programs, leaders implemented hospitalist programs to meet patient coverage (68% of respondents), improve costs and length of stay (63%), and improve ED throughput (62%), according to the study.

For hospitals that planned on starting programs, leaders said they were going to implement hospitalist programs within the next two years for quality improvement (54%) and demand for primary care doctors (46%).

A moving target definition

As they make their way onto different department floors, defining what a typical hospitalist does may become challenging, according to the study.

"Hospitalists are doing a lot of different things in the hospital. In addition to the standard inpatient ward care, they are doing surgical comanagement, quality improvement activities, safety activities, ER staffing and triaging; they are doing a lot of things in addition to caring for inpatients," Vasilevskis said.

The study defined hospitalist, simply put, as a "physician who spends all or the majority of his or her clinical, administrative, educational, or research activities in the care of hospitalized patients."

Last month, the Society of Hospital Medicine released its official definition of a hospitalist as a "physician who specializes in the practice of hospital medicine. Following medical school, hospitalists typically undergo residency training in general internal medicine, general pediatrics, or family practice, but may also receive training in other medical disciplines."

According to Vasilevskis, the definition of a hospitalist depends on the place of practice in which he or she fulfills the needs and creates the job description.

Supporting extra training

As hospitalists expand the hats they wear and the roles they play, more of these physicians may require additional training or certification to work beyond their traditional comfort zone of the inpatient ward and more in the ICU and ED.

"Certification might be worth while," Vasilevskis said. "Hospitalists can provide and fulfill the skills that hospitals are seeking, and whether a hospitalist seeks those additional skills requires that matching between what a hospital wants and what do hospitalists have to offer."

According to the study, most leaders (64%) support extra training or certification for hospitalists.

"The good news is there is someone a) who is there to fulfill that need and b) someone who is willing to respond to that need," Vasilevskis said. "It's a nice marriage of what the C-suite is responding to and having the personnel to do it."


Karen M. Cheung is an associate editor for HCPro, contributing writer for HealthLeaders Media, and blogger for HospitalistLeadership.com. She can be contacted at kcheung@hcpro.com.

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