JAMA editorial analyzes potential for improvements in care, calls for more data on key outcomes
by Richard Quinn
The growth of specialty hospitalist medicine is an opportunity to improve patient outcomes, but the evolution of care delivery must be closely watched, according to one of the authors of an editorial in the Journal of the American Medical Association.
"It's a mistake to dig your heels in and insist on preserving traditional practice models when they may no longer fit," says John Nelson, MD, MHM, FACP, medical director of the hospitalist practice at Overlake Hospital Medical Center, Bellevue, Wash. "It's just as big a mistake to blindly hop on the hospitalist bandwagon without thinking deliberately about its costs and benefits and how to make it the best it can be."
Dr. Nelson, an SHM co-founder and practice management columnist for The Hospitalist, penned the editorial, "Specialty Hospitalists: Analyzing an Emerging Phenomenon,” with SHM CEO Larry Wellikson, MD, SFHM, and HM pioneer Robert Wachter, MD, MHM. The two-page article suggests that the growth of the hospitalist model to include such specialties as neurology, dermatology, obstetrics, surgery, and psychiatry is a natural extension of how the hospitalist model blossomed in the early 1990s.
"Doctors are headed elsewhere, away from the hospital," Dr. Nelson says. "The solution is, in many cases, if we can't get a lot of these doctors to do hospital work some of the time, can we get a few doctors to do hospital work all of the time?"
The article, which echoes a 2011 blog post by Dr. Wachter, proposes four guiding questions on whether the use of the hospitalist model is appropriate for a given specialty. Those answers are being answered by the marketplace which, in turn, is propelling the trend of specialty HM doctors.
"So many things that happen in medicine are engineered and tracked by some entity," Dr. Nelson says. "Not in this case—and that is huge."
The Hospitalist newsmagazine reports on issues and trends in hospital medicine. The Hospitalist reaches more than 25,000 hospitalists, physician assistants, nurse practitioners, residents, and medical administrators interested in the practice and business of hospital medicine.