As part of the hospitalist model, patients have a quicker response to the medical care they require. Prescriptions can be quickly ordered, administered and adjusted as their needs progress. Tests, x-rays and lab results can be ordered and evaluated in real time. Hospitalists also have access with other physicians and specialists (cardiologist, neurologist, radiologist, surgeons, etc.) to keep patient care progressing more efficiently. 

Hospitalists typically do not have an office where they see patients. Their time is primarily spent in a hospital setting as opposed to a clinic or office which means patients will have more access to them during their hospital stay.

They can be involved in family meetings to provide quicker updates or to discuss care options and make treatment recommendations. This new presence allows the hospitalist to devote more time to the overall care of the patient. And if it all works the way it is intended there will be improved communication between the hospitalist physician and the patients primary care physician. Hospitalists need to keep that line of communication with the patient open to ensure best results. We find we have a more satisfied patient when we have improved communication of care during a hospital stay. And if done correctly, patients are less likely to ask why they aren't being seen by their family physician.  

The hospitalist concept emerged in the mid to late 1990's. At that time, patients were seeing fewer Primary Care Providers (Physicians, Physician Assistants and Nurse Practitioners). At that time Physicians were trying to see their regular office patients in addition to their patients who were in the hospital and it was absorbing too much of their time. The new model allowed hospitalists to spend the majority of their time in the hospital as opposed to an outpatient practice.

Once the hospitalist concept began to develop and had some success, it became organized by a physician out of California named Robert Wachter. The new hospitalist model was described in an Article in Annals of Internal Medicine in March of 1999 and titled: "An Introduction to the Hospitalist Model."

I started the first hospitalist program at a neighboring hospital in 2004. It was started as a voluntary program that allowed physicians the option to use the new hospitalist model. If physicians chose to use it, we would admit their patients for them. We would also do their service call requirements for the emergency room. And when the physicians had time off, they were not called back in. 

In 2006, we implemented it at Union Hospital under the leadership of CEO Dave Doer. When the concept started to grow I began attending national meetings to learn more about the hospitalist approach and I liked it. When we implemented it at Union Hospital in 2006, we started with 2 doctors that has since grown to 14 hospitalists today. We now offer 12 hour shifts and maintain a hospitalist (in the hospital) 24/7. We have also begun using mid-level providers (Nurse Practitioners and Physician Assistants). 

There has been an on-going educational piece for patients who may be unclear why their primary care physician (PCP) was not seeing them regularly in the hospital. If a PCP left their busy office to come to the hospital to see one patient, it could take an hour of their time. But if they remain in their office, they could see up to 4 patients. So, it is a more efficient use of both physician's time. And this new method allows PCP's to stay in their practice to work on more preventative medicine, which should actually help reduce the number of hospital and ER visits to begin with.

The career of a hospitalist is better suited for physicians who enjoy patient care within a hospital setting. Hospitalists routinely have consistent hours and are rarely on-call. At Union hospital, Hospitalists normally work 12-hour shifts with 7 days on and 7 days off. Because they only see patients within the hospital they no longer have to worry about running back and forth between an office and the hospital. Hospitalists can also gain a vast amount of experience treating patients within a hospital scenario. Hospitalists often have more expertise when overseeing the care of hospitalized patients that range from simple to various complications.

• Develop comprehensive treatment plans for hospitalized patient
• Address any specific treatment questions from staff
• Consult with or recommend specialty physicians (cardiologist, pulmonologist, etc.) as needed
• Oversee patient medications (while patient is in the hospital)
• Have the ability to order and review diagnostic tests and x-rays for a more accurate diagnosis 
• Educate patients about their conditions, ailments or test results
• Oversee the hospital discharge process
• Hospitalists are often involved in improved patient safety and cost-effective care.

New medical students today are often interested in becoming a hospitalist as opposed to starting their own practice. The advantage to new hospitalists are they have predictable hours competitive salaries and they don't have to worry about starting or growing a practice. Hospitalists typically don't receive patient phone calls when they are off work, because they don't have assigned patients. These can all be important to young physicians who may be starting a family or faced with student loan debt. 

I predict that the hospitalist model will continue to grow, and I believe it is safe to say it is a successful system that is here to stay.