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As Hospitalist Patient Loads Rise, So Do Hospital Costs

Cheryl Clark, for HealthLeaders Media, April 11, 2014

Wachter, who wrote a commentary in the same issue of the journal, says that while the study's conclusions didn't surprise him, the magnitude of the difference did. "It's a strikingly large effect. There's a sweet spot, and above that sweet spot, things start to deteriorate from the standpoint of efficiency."

Wachter says that ordinarily a higher hospitalist-to-patient ratio would "make you worry about" seeing more clinical judgment errors, which could result in higher mortality or readmissions.

"But my guess is what [hospitalists are] doing is triage. They're putting out fires first and doing a pretty good job. What falls off the back of the cart when you're too busy is that the patient who could get discharged today, they just can't get to it, and that instead ends up happening a day later."

Hospitalists are among the fastest growing medical specialties in the U.S.
According to the Society of Hospital Medicine, an advocacy group for the profession, there are 44,000 physicians working as hospitalists nationally, up from 11,159 in 2003.

Additionally, hospitalists were employed by or contracted in 72% of the nation's hospitals, up from 29% in 2003. Ninety percent of hospitalists receive some or all of their reimbursement from hospitals.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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