Chapter 1: General Hospitalist Movement

BACKGROUND

According to the Society of Hospital Medicine (SHM), hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their duties include patient care, teaching, research, and leadership related to hospital medicine. The term hospitalist was coined in a 1996 article published in the New England Journal of Medicine by Wachter and Goldman, entitled “The Emerging Role of ‘Hospitalists’ in the American Healthcare System.”¹ Therefore, the field of hospital medicine is said to be just over 20 years old at the time of this writing, even though some physicians were known to be practicing hospitalists long before the specialty was formally established.

Hospital medicine is the fastest-growing specialty in the medical field, with over 50,000 hospitalists in the United States (Fig. 1-1). It is now the second-largest specialty in the United States, behind primary care. American Hospital Association recently reported the total number of US-registered hospitals is 5564; the number of staffed beds in all US hospitals is 897,961, with about 35,061,292 admissions annually. Hospitalists now manage over 50% of all Medicare inpatients. The majority (over 80%) of hospitalists have an internal medicine background. The remainder come from other specialties, including internal medicine subspecialties (infectious disease, pulmonary critical care, geriatrics, palliative care, cardiology, GI, nephrology, etc.), pediatrics and pediatric subspecialties, family medicine, neurology, psychiatry, surgery, and OB/GYN.

Hospital medicine is a location-based specialty. In healthcare, we have traditional organ-based specialties (e.g. cardiology, nephrology), disease-based specialties (e.g. infectious disease, oncology), procedure-based specialties (e.g. electrophysiology), population-based specialties (e.g. pediatrics, geriatrics, women's health), and now location-based specialties (e.g. hospitalist, emergency medicine, critical care). Location-based specialties developed because there is something unique about particular settings that allows us to optimize the care of patients and facilitate a safe transition to the next care setting. From an evidence-based practice standpoint, a patient with acute decompensated heart failure is different than a patient being managed for chronic heart failure. The same is true for an acute chronic obstructive pulmonary disease (COPD) exacerbation vs. chronic COPD, diabetic care in the acute setting vs. chronic diabetes in the ambulatory setting, etc.

THE MAKING OF A SPECIALTY

What creates a specialty? It requires the existence of a unique set of knowledge, skills, and attitudes, as defined by the specialty's core competencies. In 2006, the SHM published an article called “The Core Competencies in Hospital Medicine: A ...