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Sub-specialty Hospitalists on the Rise

Analysis  |  By Debra Shute  
   June 23, 2016

The role of the hospitalist is alluring to physicians and hospitals and its growth is well established. But cultural and recruiting challenges remain.

The hospital-only specialty, which originated in primary care in the 1990s, has caught on throughout numerous sub-specialties.

Among  OB-GYN, gastroenterology, and general surgery services, the growth of the hospitalist is driven in part by physicians' desires for greater work-life balance, particularly when it comes to call coverage.

As a result of the growing interest, the physician recruiting database Profiles, which interviews graduating physicians (residents and fellows) about their career goals and specialty choices, has started asking several sub-specialties about their interest in a hospitalist positions.

The question has been standard for internists, pediatricians, and family medicine for many years.

The results show that at least half of nearly all newly graduating specialists are open to the idea of hospital work, and percentages rose almost across the board over the past year.

"Outpatient-only practices have historically also been attractive to physicians, and this is the first evidence we've seen of widespread interest in hospitalist, surgicalist, and laborist roles for other subspecialties," Shane Hollander, head of sales and operations for Profiles Database, told me by e-mail.

The hospitalist role is a "relatively novel career option for new physicians in gastroenterology, neurology, psychiatry, OB-GYN, and general surgery, as such jobs (100% hospitalist/inpatient roles) weren't available to their predecessors, who may have been interested in hospitalist work, if given the option," he said.

Hospital Needs and Expectations

Hospitals themselves are also embracing the trend, as patients increasingly expect prompt, high-quality care.

In OB-GYN, for example, it's become almost impossible to get community-based physicians to commit to delivering babies at the spur of the moment, says Brian Price, MD, MBA, FACOG, national medical director for OB-GYN services at TeamHealth.

"I have discussions almost daily with chief executive officers or chief medical officers at hospitals who say their community providers are getting to the ends of their careers and no one coming out of medical school or residency wants to be available all the time or feel this pressure," he told me.

"And hospitals are feeling pressure to have someone immediately available to care for patients in labor and delivery."

A (Practically) Perfect Solution

But while hiring hospitalists is relatively easy—and the physicians they're covering often make more money staying in the office—adjusting to any paradigm shift takes time, Price notes.

A sense of lost control can be unsettling for physicians, even if they understand the hospitalist model from a practical standpoint.

"From a theoretical point of view, almost everybody can agree to it," he says. "But when it comes down to, 'Gee, how is this going to affect my practice? How is this going to affect my income, that's where the challenge arises. Whenever there's a cultural change, there's going to be resistance."

There are other potential pitfalls, according to Hollander.

"As the physician workforce becomes increasingly specialized, and healthcare becomes even more segmented than it already is, there will be an impact on patient care, probably both positive and negative," he wrote.

"Additionally, the impact of the sub-specialty hospitalist trend on physician recruiting may make the proverbial 'needle' in the haystack even smaller, and more difficult to locate, than it has been before, as the candidate pool become more divided, as will the practice roles, if the sub-specialty hospitalist trend continues to grow in popularity as it has recently." 

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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