March 4, 2021, is National Hospitalist Day. Observed the first Thursday in March annually, it celebrates hospitalists' contributions to healthcare in what the Society for Hospital Medicine calls the "fastest-growing specialty in modern medicine."
The National Hospitalist Day celebration is especially needful now, given that the past year has been particularly challenging for hospital medicine (HM) providers. We want to highlight their bravery and call attention to the extraordinary ways that HM has innovated to grow the specialty and adapted to survive during this difficult time.
Hospitalist Background and History
The term "hospitalist" was first introduced in 1996 by Drs. Robert Watcher and Lee Goldman in their New England Journal of Medicine article, "The Emerging Role of 'Hospitalists' in the American Health Care System," where they presented what they thought was a better way of handling inpatient care.
Since that time, the specialty has proliferated from fewer than 1,000 practicing hospitalists in the mid-90s to over 60,000 in 2020. And, the job is still in demand. Merritt Hawkins' 2019 Review of Physician and Advanced Practitioner Recruiting Incentives reported a 21 percent year-over-year increase in the number of searches for hospitalists.
According to Dove Medical Press, a peer-reviewed journal publisher, hospitalists represent specialties ranging from internal medicine and cardiology to pediatrics and family practice. General internal medicine accounts for about 75 percent of hospitalists practicing today, however.
It is also worth noting that more than 3,200 physician assistants now work in hospital medicine, according to the National Commission on Certifying Physician Assistants' most recent Statistical Report of Certified PAs by Specialty, a 21 percent increase over three years. Physician assistants are often in charge of patients throughout their hospital stay, with a physician available to see the patient when necessary.
Hospitalists' Unique Value Proposition
Hospitalists offer a unique value proposition that benefits patients, hospitals, and other physicians. Hospital-based physicians are more efficient in reducing LOS and costs while providing similar or better quality and patient satisfaction compared to their non-hospitalist counterparts, Dove Medical Press says.
Additionally, hospitals have found that staffing hospitalists benefits not only patient satisfaction but also provider satisfaction. Recruiting and retaining specialists is easier when hospitals can promise a better work-life balance with less call rotation for unassigned patients.
Hospitalists and COVID-19
The COVID-19 pandemic put pressure on hospitalists to expand their role to meet critical patients' needs, adjust staffing to manage surges, quickly restructure clinical operations, and deal with the shortfalls of PPE and COVID-19 testing.
"Hospitalists have been at the forefront of the COVID-19 response, helping to lead frontline work, orchestrating complex and dynamic clinical operational plans, and partnering with clinicians and leaders from many different specialties," the National Center for Biotechnology Information said, heralding the work of hospitalists during the pandemic.
According to the Journal of Hospital Medicine, managing the crisis is equivalent to running a sprint and marathon at the same time.
Although runners typically focus on either the sprint or the marathon, healthcare systems and hospital medicine providers must prepare for both types of races simultaneously, the Journal said.
On the sprint side, hospitalists have had to respond to a rapidly-changing environment, making critical decisions within hours and days. At the same time, they had to plan for the marathon of increased clinical needs that would span several months, confront the possibility of burnout, and address concerns about staff wellbeing.
Future of the Hospitalist Specialty
In a November 2019 SCP Health blog post, Dr. David Grace, hospital medicine provider at SCP Health, said he believed hospital medicine (and, by extension, the hospitalist specialty) would flourish in the future due to the aging population and a shift in the payment model, from volume to value-based.
"The average number of hospitalizations for patients aged 65 and over has remained constant for the past 20 years," Dr. Grace said. "In the future, as the Baby Boomer generation continues to age, that number will rise dramatically. As the population gets older, the need for hospitalists will increase to the point where they become the de facto caregivers in the inpatient world."
The shift from a volume to a value-based payment system means hospitals will have a significant financial relationship with quality measures, readmission rates, core measures, and meaningful use, Dr. Grace noted.
"Over time, as we continue to move in that direction, hospitals will need champions who understand those processes, and that will fall on the shoulders of hospitalists," he said.
Hospitalists and Telehealth
Telehealth is one area where hospitalists play an increasingly important role by donning the "telehospitalist" lab coat.
"This innovative care delivery model, administered by a telehospitalist, allows hospitals to provide more cost-effective hospital medicine services and offer an end-to-end solution for seamless care coordination while maintaining care quality, documentation compliance, and patient satisfaction," an SCP Health blog post said regarding the role's significance in the changing healthcare landscape.
Telehospitalist programs benefit hospitals and patients by easing the burden on recruiting, reducing physician burnout, providing backup support for surges, coordinating patient care, and improving patient experience and provider satisfaction.
For example, during the pandemic, SCP Health initiated a 24/7 Telehospitalist Response Team to support surge, triage, daytime rounding, COVID isolation units, night coverage, and more.
Recently, we also began offering ongoing 24/7 telemedicine services, one of the first such programs in the country.
Since its inception, the hospitalist's goal has been three-fold: provide the best quality care, give patients an excellent experience, all at an affordable cost—and continue doing so during this very tumultuous time.
That's why, on Thursday, March 4, we encourage you to celebrate this much needed and vital specialty. If you are a physician interested in joining our team as a hospitalist or telehospitalist, visit our job board. We just might have the right fit for you.