The Hospitalist of the Future

Elyas Bakhtiari, for HealthLeaders Media, January 15, 2009

Most people instinctively associate hospitalists with internal medicine—that is where the specialty has its roots, and roughly three-quarters of practicing hospitalists are trained in general internal medicine.

But other specialties have been adopting the model—obstetrics and general surgery were among the first—and tomorrow's hospitalist may as likely be trained in neurosurgery, pediatrics, or virtually any other specialty.

We're already seeing the model spread. Baptist Memorial Hospital-DeSoto in Tennessee recently hired orthopedic hospitalists to handle hospital care 24/7, for instance. For an upcoming magazine article about women's health service lines, I spoke with executives from six leading hospitals about their obstetrics programs, and nearly all of them are working with laborists—also known as OB hospitalists—in one form or another. And all of them expect the model to become even more influential in the industry.

Why does it matter? For one, it's more than a passing fad—the hospitalist model will likely change recruitment and training in other specialties in the same way it has internal medicine. But more importantly, it is an effective approach to bridging the growing divide between physicians and hospitals, and it's one of the few that benefits both parties.

Hospital executives like the model because having a physician onsite 24/7 has been proven to improve quality and can help with ED coverage. Physicians like it as an option for avoiding the burdens of private practice, and those already in private practice can more efficiently focus on outpatient care, which often leads to more revenue. It has provided an option—though often expensive for the hospital—to avoid paying stipends for ED call coverage, and it appeals to a generation of doctors with new work-life balance goals.

When AtlantiCare Regional Medical Center lost four of its private practice OB/GYNs a few years ago, administrators couldn't even recruit replacements without laborist options, says Ann Szapor, RN, MBA, executive director for women's and children's services.

"We were finding that new OB/GYN physicians coming out of training weren't interested in joining private practices where they had to be on call every third night," she says.

The story is the same in most surgical and medical specialties, and if the trend plays out to its conclusion, the future healthcare marketplace will be very segmented. Private practice physicians that formerly divided their time between outpatient care and the hospital will focus primarily on the former, and hospital care will be the domain of on-site, employed specialists.

But both hospitals and physicians seem increasingly happy with that arrangement. And that doesn't happen very often.

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at
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