Is there a hospitalist in the house?

A new breed of specialists cuts lengths of hospital stays and lessens demands on primary care doctors

Hospitalists—physicians who specialize in inpatient care—are revolutionizing hospitals nationwide. These new specialists are cutting lengths of hospital stays, improving patient care and alleviating demands placed on primary care physicians.

Relatively new in the United States, the hospitalist trend has its roots in the United Kingdom and Canada. The need for hospitalists in the United States has arisen from changes in medical practice over the past few decades.

Since its inception two years ago, the Washington University School of Medicine hospitalist service at Barnes-Jewish Hospital has been the only academically based hospitalist service in the St. Louis area.

Changing times have created a need for these specialists. In the mid-1970s, an average physician had about 10 hospitalized patients at any given time and spent about 30 to 40 percent of the day visiting them. In today’s era of managed care, physicians have fewer inpatients, so they spend less time at the hospital.

Mark Thoelke
Mark Thoelke

According to Mark S. Thoelke, M.D., clinical director of the hospitalist service and assistant professor of medicine at Washington University, today’s physicians are refocused away from the hospital and toward the outpatient clinic. Consequently, commuting to and from the hospital has become less cost- and time-efficient. As primary care physicians spend less time visiting hospital patients, the demand for inpatient physicians has increased.

Because hospitalist physicians do not maintain outpatient practices, they spend all of their time in the hospital, and they treat a wide range of patients.

“A hospitalist who spends all of his or her time in the hospital would seem to be ideally suited for the unique needs of an acutely ill inpatient,” Thoelke says.

By serving as an easily accessible, centralized resource for information and patient care, hospitalists can, in many cases, reduce the length of inpatient stays and, at the same time, improve the quality of treatment. And since hospitalists can be reached 24 hours a day, patients and their families are reassured by having a physician available as a constant resource.

The emergence of this new specialty also allows for improved outpatient care. With their inpatients cared for by a qualified hospitalist, primary care physicians can focus more of their time on the needs of the outpatients who make up the vast majority of their practices.

But despite cuts in overall time on-call and traveling time and increases in their freedom to concentrate on outpatients, many primary care physicians at Washington University have expressed concern about continuity of care when their patients are hospitalized. Hospitalists address that concern by striving to maintain communication between the primary care physicians and their patients, and hospitalists keep primary care physicians informed of any changes in patients’ conditions.

Mark S. Thoelke, MD, clinical director of the division of hospitalist medicine, talks with patient Willie E. Cox.
Mark S. Thoelke, MD, clinical director of the division of hospitalist medicine, talks with patient Willie E. Cox.

Although at first skeptical about the merits of the hospitalist program, internist Melvin J. Butler, M.D., instructor of clinical medicine, now regularly refers patients to the hospitalist service at Barnes-Jewish Hospital.

“I cannot praise the hospitalist program enough,” Butler says. “Its wonderful service manages to increase hospital efficiency and at the same time improve the quality of care. The program is certainly a benefit to those of us who use it.”

According to Thoelke, patients and physicians using the service for the first time soon are won over by the program’s benefits.

“We have had extremely positive feedback from patients and their families,” he says. “We also have surveyed the physicians who refer to our service, and their responses have been equally strong.”

Aside from inpatient care, hospitalist physicians also are dedicated to research and teaching. Patient-based clinical trials they conduct are aimed at improving the quality of care provided within the hospital system.

For example, national studies have shown that the ineffectiveness of diagnosing and treating osteoporosis in elderly patients is a problem that exists in hospitals throughout the country, according to Thoelke. But, he says, recent research done by hospitalists at Washington University and Barnes-Jewish Hospital has shown that hospitalists can do a better job in such areas.

Additionally, hospitalist physicians work closely with medical students and residents in a variety of hospital settings.

“Because we are so involved with students, we have attracted a faculty that is very interested in teaching,” says Thoelke. “Teaching the next generation of doctors keeps us up to date on what’s new in hospital medicine. That, in turn, helps us provide the best possible care for our patients.”