Clinical Privileges

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Clinical Privileges

Question: Is there a standard percentage of time for inpatient care that is used to define a hospitalist? (i.e., 25% of time in inpatient activities = expert in hospital medicine). Our hospitalist section is drafting a clinical privilege form, and I have been searching for a national standard.

Heather Toth, MD, Hospital Medicine, Department of Pediatrics, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee

I will caution you as you draft your clinical privilege form that whether you are a hospitalist or not is a different issue than whether you are qualified or not to provide a specific type of clinical care.

Dr. Hospitalist responds: You and others may be aware of a little secret in hospital medicine: hospitalists have been around in this country for decades.

Even though Drs. Robert Wachter and Lee Goldman coined the term “hospitalist” in the New England Journal of Medicine in 1996, hospitalists have been working our nation’s hospitals for a long, long time.

Don’t get me wrong—I am not diminishing their roles in establishing the field of hospital medicine. What I am saying is that hospitalists were around before 1996, but nobody had defined their role. and nobody knew what to call them.

Drs. Wachter and Goldman did not only name the profession, they also gave it credibility. Prior to the mid-’90s, I get the sense most medical professionals viewed hospitalists as second-rate doctors. These hospital doctors were doing the jobs most respectable doctors didn’t want to do or didn’t have to do.

Trying to define the amount of inpatient care one must perform to be called a hospitalist might not be the easiest or best way to define the role.

Trying to define the amount of inpatient care one must perform to be called a hospitalist might not be the easiest or best way to define the role.

Those jobs included caring for critically ill patients when other doctors were unavailable or didn’t have the time to see their patients. This could be at 2 p.m. or 2 a.m. in most hospitals. Drs. Wachter and Goldman were, and are, respected academic physicians. In their seminal article, they essentially called out these hospital doctors and lauded their roles in the hospital. Moreover, they anticipated growth in this field of medicine. In some ways, they were saying, “I’m OK and you’re OK. It’s OK to be a hospitalist.”

Well, the rest is history; whereas we had about 2,000 hospitalists in the mid-’90s, we now have an estimated 20,000 hospitalists in the country.

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