"It's hard to build a new specialty when the underlying assumption is that it's not financially viable—that hospital medicine requires a subsidy to exist," Singer stated seven years ago.
He feels the same way today.
Aside from the subsidy issues, Singer has called for certain strategies to be initiated by hospitalists to be treated fairly "at the table."
For that to happen, hospitalists need to take clinical leadership, as well as ensuring a stake in hospital performance, in all ways: clinically, operationally and financially. While there have been inroads in many areas, there isn't enough, Singer insists.
To make inroads into being a complete part of a hospital, hospitalists need to develop clinical leadership, he says. "Hospitalists should be totally involved in the committee structure of the facility. They should be aspiring to be chief of staff of that hospital. They have been clinically involved in every level of the building."
"Doctors haven't figured out how to align with hospitals," he says.
So despite all these years of growth among hospitalists and health care systems, some basic issues need to be resolved, such as whether they are partners in treating patient care, and hospitalists are still trying to find their identity. Singer says healthcare reform may begin to help the process, but no one knows for sure.
The award-winning hospitalist says the term itself may be sort of a misnomer. "It is not that I do not like the term hospitalist," he says. "The issue is that we continue to evolve toward an environment of inpatient and outpatient only doctors. The generic term 'hospitalist' does not describe how many of these doctors identify themselves."