What Is a Hospitalist?

Read Transcript

A hospitalist is a general, a generalist physician. Most of them are general interners like me, who manage the care of hospitalized patients. Really acting is the orchestra conductor for a hospitalized patient. In American medicine , the way we have previously organized hospital care was that, your primary care doctor was expected to be your doctor if you were hospitalized.

And the first place that seem really attractive, if you know my doctor was Marcus [xx], he or she has known me for 20 years and I get hospitalized of course I would want that doctor to be at my side. The problem is it doesn't work and it doesn't work for few reasons. One is that the average primary care doctor only has one or two patients in a day now in the hospital.

So there is no way that doctor can be there in the hospital all day long. That doctor's probably going to see me at seven in the morning and go back to his or her office for the whole day, leaving me really stranded. And so as a patient in the hospital, I might be seeing four, five different specialists and physical therapist, and nutritionist but not my doctor because my doctor is not there to organize things and keep, and have a kind of unified game plan.

The second problem is the world of hospital care has become extraordinarily complex and amazingly fast paced. So, if you come into the hospital, you know that there's a huge number of things that are happening in real time. Consultants test, and there need to be someone, who is an expert in all of that, who knows how the hospital legal system works, knows to find the case where tp find the case manager when she's on break, keeps up on hospital care and the latest developments.

Goes to those conferences and is there throughout the day and often through out the night, and your primary care doctor can't possibly do that. And so about 15 years ago, I noticed that A, the old system wasn't working and B, a new model of care was emerging, really quite organically where in different parts of the country, this new kind of Doctor was emerging.

This Generalist who was taking over as the orchestrator hospital care. I wrote an article in [xx] journal that came up with this clunky term called Hospitalists, it seemed to stick, and it's become the fastest growing specialty in the history of American medicines. So from a few 100 doctors that were had this role 20 year, 15 years ago, now there are about 40, 000 of these doctors.

So there are more hospitals now than cardiologists in my own group at the University of Califonia, San Fransisco, I have 60 of these doctors working for me. And what's been I think particularly gratifying and exciting, actually a few things. One is we often think of the American health care system is being incredibly classified and fossilized, things don't change easily, but this is an example of how rapidly things can change if you have a good idea, if you approach it the right way, if you tested and demonstrate that it's actually better mouse trap.

So there was no federal mandate to develop hospitals, there was no change in payment system, it was just something that a bunch of us thought this might actually be a better way of organising care and we developed it, but I think we made a good decision earlier on to not go around and say we're sure that this is better, but to say it should be tested.

We should figure out whether in fact this works better and all of the early research demonstrated that it cut the cost of care, it cut the lengths of hospital stay and if anything it improved the quality of care, it improved the safety of care and the fear I think a lot of us had that patients would hate it, because if you ask patients in the vacuum, do you want to see your regular doctor in the hospital, of course they would say, yes.

But study after study said patients thought this was just fine because I think patients recognized that their regular doctor simply couldn't.