People are drawn to medical careers because they want to help patients and to make a difference in the lives of the people living in their communities. Fortunately for those who are drawn to medicine, there are a number of specialties to choose from. One of the fastest-growing specialties is hospital medicine. This article explains the role of physicians who practice hospital medicine and how that role relates to patient care on the whole.
What is a Hospitalist?
A hospitalist is a doctor who specializes in working in a hospital or nursing facility: He/ she does no outpatient work (usually). This is a person who practices hospital medicine. This type of doctor has been described as a generalist-specialist. They have specific skill sets that they must master in order to become this type of physician: (more on that in a bit).
However, whatever other knowledge the doctor has, he/ she always works specifically in a hospital or nursing facility. This doctor has no office outside the walls of the hospital. All work done on behalf of the patient/s is done at the facility. That being said, the Annals of Internal Medicine specifically describes these doctors as those who spend at least 25% of their time being a patient’s physician of record.
This definition helps separate the doctors who primarily practice medicine as hospital-based doctors and those who do mostly research or who hold leadership position within an organization. Truth be told, most hospital-based doctors spend more than 25% of their time seeing patients. Additionally, this physician’s role is defined by Webster’s Collegiate Dictionary as one who treats hospitalized patients so that the need for other visiting doctors is lessened.
Hospital medicine represents the fastest-growing specialty for doctors. If someone would have asked 30 years go, “What is a hospitalist?” that person probably would have been met with a blank stare. Although it wasn’t a specialty until about 20 years ago, it is now considered one. As such, there are programs that allow these doctors to demonstrate their skill levels and get certified hospital- or facility-based specialists. Right now, about 44,000 doctors practice hospital medicine in the United States.
What is the History of the Hospital-Based Physician?
In the 1990s, the emphasis on primary care physicians shifted. Through most of the history of modern medicine, primary care doctors maintained their external medical practices and saw the patients from their day-to-day practices in the hospital if these patients required a hospital stay.
However, as the nature of medicine, and indeed, even illnesses changed, it become increasingly difficult for a primary care doctor to see his/ her private practice patients and to see his/ her hospitalized patients. That’s when doctors that were hospital- or facility-based became more common. A Dr. Robert M. Wachter, a medical school professor at University of California, San Francisco, was the first to call those who specialized in hospital medicine “hospitalists.”
Why is This Specialization Important?
Patients in the hospital often come into care because they have a level of illness that can only be treated in a hospital. Many procedures, like dialysis or IV drips used to be hospital-only procedures. However, with the advances in medicine, many of these once hospital-only treatments can be given at home or in an outpatient facility. What this means, then, is that there is now an expectation that the patients who do get admitted for care must be sicker than most or they wouldn’t be admitted to the hospital.
The doctor who practices hospital medicine has been likened to a conductor. He/ she needs to fill in the gaps between all the different medical professionals who will see a patient. Many patients have multiple issues that require separate but parallel interventions when they are in the hospital. Their primary care doctor may not have the tools to keep track of all of these issues and to still see patients outside the hospital. The doctor who specializes in hospital-based care fills in the gaps. This not only ensures that the patient gets better care, but that the hospital is meeting its regulatory criteria as well.
This is important because these doctors encounter just about every kind of medical issue imaginable. Whereas the heart doctor would really only see heart patients, the doctor specializing in hospital medicine sees patients with heart issues, cancer-related issues, infections, diseases in their various states of advancement, etc.
That being said, many hospital-based doctors get additional training in specialties, like cardiology, neurology, surgery, pediatrics, or oncology.
What is Significant About This Type of Physician?
Many of the doctors practicing hospital medicine are internists, though not all people practicing internal medicine are also practicing hospital medicine. Additionally, many who practice this branch of medicine will develop a reputation as doctors who mostly work overnight (called “nocturnists), or they may specifically work with patients in intensive care (intensivists).
Finally, on a related note, many of these physicians have a specific time block that they work. Often, their scheduled work hours put them in the facility for a week (or two) with the same amount of time off at the end of these work blocks. The rationale for this type of schedule has to do with how much time critically-ill patients spend in the hospital. These patients will need more intensive care for a week or two. The hospital-based doctor is their doctor of practice for the entire week/ two weeks that these patients spend in the hospital.
Basically, when the patient goes home, so the does the doctor. The one-week on, one-week off model gives these doctors the proper downtime they need in order to avoid burnout and to be fresh for the next one- or two-week stint that he/ she will be working.
What are the Benefits of Seeing a Hospital-Based Doctor Versus my Primary Care Physician?
If a person has a primary care physician, then that person’s doctor will be in constant contact with the hospital-based doctor. What the hospital-based doctor brings to the equation is a knowledge of the hospital and its procedures. This allows him/ her to work with a patient’s primary care physician, who brings patient knowledge to the table.
Often, a person’s primary care physician will refer him/ her to a doctor who specializes in hospital medicine. At the hospital, the patient sees the hospital-based doctor. Once he/ she leaves the hospital, his/ her primary care physician takes over. This question of patient familiarity is one that hospital administrators consider when trying to improve the practices of hospital medicine. Patients whose care involves both a primary physician and a hospital-based one tend to do better in recovery overall.
However, the hospital doctor isn’t just responsible for talking to other doctors and medical staff. He/ she also communicates with the patient’s family, and because these doctors are based in the hospital, they are available to answer questions “after hours,” something that many family members find comforting.
Additionally, if the patient needs to see another type of doctor while he/ she is still in the hospital, the hospital-based doctor will arrange that meeting. This is similar to what the primary care physician would do when referring a patient to a specialist. However, in the case of the hospital-based doctor, the other medical professionals in question may be part of the medical staff, but in a different part of the hospital. The doctor practicing hospital medicine brings all of these medical professionals together for the sake of the patient.
Communication between all the parties involved a patient’s care proves to be key, which is again, why the hospital-based doctor is likened to a conductor. These physicians play a vital role in keeping the patient healthy. In 2007, the New England Journal of Medicine released a study focusing on patients who had been treated by doctors trained in hospital medicine. These patients’ stays in the hospital were shorter. Their costs for care were also decreased (compared to what they would have been had that patient needed to see a separate internist).
What is a Typical Work Day Like for a Doctor Specializing in Hospital Medicine?
This job requires a great deal of flexibility. The hospital-based doctor may not know what he/ she will be working on for the day until he/ she comes to work and logs into the hospital’s system. This initial workday act tells him/ her if patients have been admitted while he/ she wasn’t working. It also updates the doctor on what happened with his/ her current patients while he/ she was at home between shifts.
He/ she may meet up with his/ her hospital teams, other doctors, nurse practitioners, etc. These groups discuss urgent issues, recent hospital events, etc. This physician may also be involved in medical education, due to the integral role that he/ she plays in the patients’ hospital care routines. At the end of the day, this doctor may go to seminars that deal with this specialty.
In short, a doctor trained in hospital medicine may step in during an emergency and provide the care that an emergency room doctor does. He/ she may also prescribe medications for infections or for pain. This doctor might prescribe treatment for a patient suffering from dehydration, including taking care of the patient’s IV drip. If the patient need oxygen therapy, his/ her hospital-based doctor gets that started as well. Finally, the patient can also rely on this doctor if he/ she needs physical rehabilitation after medical treatment.
This doctor may also spearhead efforts to improve patient care and safety since this physician deals with all aspects of patient care. This could include efforts to reduce hospital-borne illnesses, to provide staff with best-practices knowledge, to ensure that proper patient discharge procedures are followed, etc. This physician’s findings may help to shape a facility’s infrastructure in the future. Typically, this doctor doesn’t deal with more administrative-type duties, like budgeting. Instead, this physician concentrates on what his/ her patients need.
What is the Training Required to be This Type of Medicine?
Most doctors who practice hospital medicine have training in internal medicine, though that’s not all. They may get additional training in other specialties, like pediatric medicine or oncology. This training includes all the required coursework of an undergraduate degree, plus a medical degree and residency. The decision to specialize in hospital medicine often comes after completing coursework.
Some hospitals have residency programs that allow the doctors-in-question to develop the key skills required of a doctor who practices hospital medicine. This training could include patient assessments. The doctor might also learn how to transition a patient from in-hospital care to outpatient care. Physicians who practice this specialty need to bring some soft skills to the table, too. These doctors must be empathetic and compassionate. They must also be willing to work with a great deal of flexibility, given the nature of their jobs. Finally, these doctors must have the stamina to work in such conditions.
Why Would a Doctor Want Additional Certifications/ Training in Hospital Medicine?
As of right now, there is no requirements for additional certifications in hospital medicine. Indeed, many doctors who practice this specialty fell into it after practicing another specialty, (often internal medicine). Those who do get special training and certifications in hospital medicine do so through the American Board of Physician Specialties. That being said, doctors who do opt for a certification do get benefits from doing so. Having the certificate may directly affect whether or not a doctor advances in his/ her career. This may hold especially true for small-town doctors who work in facilities that get purchased by larger ones.
In a sea of medical professionals, having a certification in hospital medicine can mean the difference between being hired or not. The same can be said for doctors who get practical training in the form of internships and other programs.
If you’d like to be involved in this important medical specialty, then apply for our healthcare internship today.