Dr. Joseph Ming Wah Li

Hospitalists are celebrating their 15th anniversary this year; their unique subspecialty – which has been growing by leaps and bounds in recent years – was labeled and defined in 1996 by R. M. Wachter and L. Goldman, who described such specialists as hospital-based physicians who devote much of their professional time and focus to the care of hospitalized patients, often taking the place of the patients’ primary care physicians during the patients’ hospital stay.

The hospitalists’ recent growth has been dramatic, surpassing that of emergency room doctors, who were previously the fastest-growing specialty. 

“The hospital medicine specialty has grown significantly over the past decade,” observed Joseph Ming Wah Li, MD SFHM FACP, President, Society of Hospital Medicine. “The need to provide high-quality, timely care for hospitalized patients fueled this growth. Hospitalists provided cost-efficient care by improving the quality of care provided to patients.

“For example, hospitalists developed processes to improve glycemic control and developed systems to minimize the risk of venous thromboembolic disease in hospitalized patients,” Li continued.  “As our nation’s leaders debate how to provide increasingly high-value healthcare for our citizens, we expect hospitalists to not only continue, but expand their leadership role in managing patients across the continuum of care before, during and after hospitalization.”

Wiley Robinson, MD, FHM, president, Inpatient Physicians of the Mid-South, believes the recent growth phenomenon to be the result of several additional factors, as well: “Many physicians are choosing not to go to the hospital any longer due to the inefficiency of running both an office practice and also seeing patients in the hospital. Some physicians continue to go to the hospital, but may choose to go to only one hospital. However, if their patient’s insurance changes and requires them to go to a different hospital, very few physicians are going to chase that patient across town. It’s not cost-effective. That’s one reason our services are in great demand.”

Robinson’s group of hospitalists serves practices that are facing such conditions, ensuring that their hospitalized patients are taken care of, and that they return to their original primary care physicians once they are released from the hospital. 

A local pioneer of the profession, Robinson’s interest in the subspecialty began to evolve early. 

“I have always had a desire to become a physician ever since I was a young child,” he recalled. “My father was a physician, and my grandfather and great-grandfather were pharmacists who owned the Mosley-Robinson Drug Company in Memphis.”

After his medical residency, Robinson trained for five years with his father, a cardiologist. After his father retired, managed care came to Memphis “and changed the demeanor of medical practice dramatically,” Robinson said. “I chose not to run patients through the office like an assembly line, and as managed care demands.”

The opportunity to focus instead exclusively on hospitalized patients presented itself, and Robinson partnered with a colleague, Mark Hammond, MD. In the mid-nineties, they established Inpatient Physicians of the Mid-South, the first hospitalists group in Memphis and still the largest in the area, with 18 physicians.

“At the time, there wasn’t a subspecialty of hospital medicine, and Dr. Hammond and I actually went to work for the Family Physicians Group in Memphis, seeing their patients in the hospital, exclusively, while those physicians stayed in the office,” said Robinson.

Eventually, Inpatient Physicians expanded their service to include other family practice groups, while in other parts of the country, other inpatient physicians were following the same path, and helping to establish the new subspecialty. According to the Society of Hospital Medicine (SHM), there are currently more than 30,000 hospitalists practicing across the country in 3,300 large hospitals and half of all community hospitals.

Although most hospitalists undergo residency training in general internal medicine, general pediatrics, or family practice, training isn’t the only criterion for a good hospitalist, Robinson believes.

“You have to learn to work well with others,” he said. “Hospital patients receive care from a team that includes the nursing staff and ancillary staff, and there’s also a significant amount of interaction with the administration of hospitals, since their interest is in quality care of the patient as well as efficiency.”

In addition to their core expertise, managing the clinical problems of acutely ill hospitalized patients, hospital medicine practitioners work to enhance the performance of hospitals and healthcare systems by attending to all patient care needs, including diagnosis, treatment, and the performance of medical procedures within their scope of practice. They employ quality and process improvement techniques as well as collaborate, communicate, and coordinate with all physicians and healthcare personnel who care for hospitalized patients. And they safely transition patient care within the hospital and from the hospital to the community, as well as striving to utilize hospital and healthcare resources as efficiently as possible.

Published studies cited by SHM find that one in five hospitalized patients is readmitted to the hospital within a month of their discharge, creating a major drain on Medicare in the amount of $17.4  billion per year. Additional studies find that hospitalists have reduced the risk of patient readmissions by as much as 41.8 percent and increased coordination of care by 13.2 percent. In addition, re-hospitalization also has been reduced by interdisciplinary teamwork during discharge—which is often coordinated by hospitalists. 

Hospital costs and length of stay for patients have also been decreased by the implementation of hospitalist programs.

The most significant challenge hospitalists face is shared by other physicians who see patients in a hospital, says Robinson: an increase in regulations regarding how those patients are cared for—from insurance companies as well as from federal or state government.

“Today,” he pointed out, “it feels as if there’s a new regulation every week—which translates into an enormous amount of non-medical work associated with the care of each patient, including numerous forms to fill out.”

Healthcare reform may make things better—and worse, he explains.

“We’re going to have a significant increase in the number of patients who will be utilizing hospitals as their place of medical care, and we are not meeting the demand by training enough physicians to care for them. The largest challenge for the healthcare system in our country is going to be the lack of physicians—especially those in primary care and general internal medicine—when we dump a significant amount of patients on the system.  These patients will be accessing hospitals and hospitalists because there won’t be anyone else to care for them.”

Recruiting and training more physicians would help, as would a reduction in the amount of regulation associated with hospital patients, Robinson believes.

 “This is the largest obstacle facing most of us in healthcare; I’m not confident that’s going to change, but in order to continue to practice quality medicine as unfettered as possible, that would be at the top of my wish list.”

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