INPATIENT CARE: COST CONTAINMENT MAY CREATE NEW SPECIALTY
The changing health care environment may fuel the growth ofThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
a new type of physician called a "hospitalist," according to a
special article in today's NEW ENGLAND JOURNAL OF MEDICINE. The
authors, Drs. Robert Wachter and Lee Goldman of the University of
California at San Francisco, define a hospitalist as a specialist
in inpatient medicine "who will be responsible for managing the
care of hospitalized patients in the same way that primary care
physicians are responsible for managing the care of outpatients."
According to the authors, as the cost-containment pressures
created by managed care cause hospital stays to become shorter,
inpatient care will become "more intensive," resulting in the
need for physicians specially trained in acute hospital care.
GROWTH FIELD: The authors say the hospitalist trend can
already be seen in areas with high managed care penetration. The
Scripps Clinic in La Jolla, CA, is using a rotating schedule of
primary care physicians, with each doctor serving as the
"'dedicated admitting physician' for week-long tours of duty."
In Minneapolis, the Park Nicollet Medical Group "uses a hybrid
model with two full-time hospitalists complemented by rotating
general internists and family physicians." San Francisco's
Pacific Medical Group and Kaiser Permanente are both
experimenting with the use of full-time hospitalists.
THUMBS UP: The authors say that anecdotal feedback on these
projects suggests that the use of hospitalists "has resulted in
substantial decreases in lengths of stay, hospital costs and
specialty consultation." Wachter and Goldman conclude that while
the "hospitalist model ... challenges many of the basic
assumptions of generalists, specialists, academic medical centers
and managed care organizations," they believe that the forces
driving the development of the specialty "are sufficiently
compelling that it will continue to be adopted" (Wachter/Goldman,