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Hospitalists Defined—Officially


 

W­hen I was a kid I remember saying that “ain’t ain’t a word because ain’t ain’t in the dictionary.” I just found “ain’t” in my online dictionary, which warned against using “ain’t” because it “does not form a part of standard English and should not be used in formal contexts.”

If the dictionary is the final arbiter of what is and is not a word, then finally “hospitalist” is a word (as we reported last month, see Nov. The Hospitalist, p. 17). Of course we have been using the word since Bob Wachter and Lee Goldman first coined it in their paper in the New England Journal of Medicine in 1996.1 But the 2005 update of the Eleventh Edition of Merriam-Webster’s Collegiate Dictionary defines a “hospitalist” as “a physician who specializes in treating hospitalized patients of other physicians in order to minimize the number of hospital visits by other physicians.”

While I am delighted that our specialty is in the dictionary, I would argue that the role of a hospitalist is about more than saving other physicians’ commute time. In fact SHM published an entire supplement that catalogued the many roles of hospitalists and how we add value.2 But even if the dictionary didn’t get the definition quite right, the presence of the word hospitalist is yet more evidence of the increasing importance and growth of our field. I want to share with you some of the exciting projects that the SHM is working on to further define our field.

Board Certification

We have been in discussion with the American Board of Internal Medicine and other societies that represent important interests in internal medicine regarding board certification for hospitalists. At this point I cannot tell you what certification will look like, how it will be conferred, or when it will come about; however, SHM is committed to developing a process that recognizes the expertise and experience of hospitalists and supports high quality care for patients. As you might imagine, any process of certification for hospitalists has huge implications for all physicians who practice internal medicine, and we are working to consider these issues carefully as we move ahead. Board certification, and the process of making it come about, marks another step along the path in the maturing of our field.

While I am delighted that our specialty is in the dictionary, I would argue that the role of a hospitalist is about much more than saving other physicians’ commute time.

Journal of Hospital Medicine and Research

More evidence of our growth as a field is the coming publication of the Journal of Hospital Medicine. Under the editorship of Mark Williams, MD, the journal will be the first dedicated to hospital medicine and the care of hospitalized patients. I still remember the early discussions at the SHM Board of Directors meetings where we first discussed having a journal. At the time there were only three or four hospitalist researchers and our major concern was whether there would be sufficient content to fill a journal once let alone six or more times a year; however, at the time we also saw where our field was headed. We knew that in order to continue to define the field of hospital medicine a journal was key.

Perhaps our decision several years ago was hubris, perhaps it was blind optimism, but I like to think it was faith in our members and our society and a belief that hospital medicine was here to stay and would only get bigger. Next month SHM will proudly publish the first volume of the Journal of Hospital Medicine. I am happy to report that we have plenty of high quality content to fill the journal. Our field has continued to expand and with it more and more researchers are focusing on hospital medicine. One walk around the poster session at our annual meeting is enough to demonstrate all of the outstanding academic work that hospitalists at academic centers and community hospitals are doing.

Hand in hand with the publication of our journal has been our research initiative. I firmly believe that in order for SHM to lead hospital medicine, we must also lead in the area of research. In order to coordinate and expand our efforts in research, we recently brought Kathleen Kerr on board at SHM as a senior advisor to lead our research initiative. Kathleen brings a new level of rigor and enthusiasm to our research initiative and helps support the outstanding work of our research committee led by Andy Auerbach, MD. At SHM research reflects our members and includes hospitalists from all settings. I invite you to present your work at our annual meeting (we are currently accepting submissions through Jan. 6, 2006, for the Research, Innovations and Clinical Vignettes competition for the 2006 annual meeting) so we can all benefit and learn from the work we are doing. I also invite you to submit your work for publication in the Journal of Hospital Medicine.

Core Competency

Yet another sign of our maturing as a field will be the publication of the Core Competencies in Hospital Medicine as a supplement to the first volume of the Journal of Hospital Medicine. The core competencies reflect hundreds of hours of work by a dedicated group of hospitalists and SHM staff led by Tina Budnitz MPH, to define the core of what hospitalists need to know. Yes, hospitalists are more than just timesavers for other physicians. The core competencies in hospital medicine will outline what hospital medicine is about and serve as the foundation for educational programs, curricula, and initiatives in hospital medicine. The core competencies will also form the basis for certification of hospitalists by defining the key attitudes and skills needed to be a hospitalist. Look for the core competencies in early 2006 along with your first volume of the journal.

Evolution of Other “Ists”

If imitation is the finest form of flattery, then hospitalists should be very flattered by the proliferation of other “-ists.” Within our own field we find “nocurnists,” hospitalists who care for patients in the hospital overnight. Although it is not clear whether being a nocturnist is a permanent state in which you work only nights or a title that you hold temporarily, it is clear that “hospitalist” is leading to a wide use of the “-ist” suffix to describe the practice of physicians.

Even more interesting is the emergence of hospitalists in other fields such as surgery and obstetrics (see our related coverage in The Hospitalist—“What Is a Laborist,” Oct. 2005, p. 6; “Trendwatch: The specialization of hospital medicine,” Oct. 2005, p. 27; and “The Doctor Is In: The role of psychiatric hospitalists,” Oct. 2005, p. 30). Because the “ist” doesn’t work well universally (neither “surgicalist” nor “obstetricist” sounds right and neither does “deliverist”) the terms being used are “surgical hospitalist” or “OB hospitalist.” In either case the idea is that there is a physician, surgeon, or an obstetrician who sees patients in the hospital instead of the patients’ primary physician. Typically these physicians are employed by the hospital to care for unassigned patients admitted through the emergency department. The adoption of “hospitalist” by other fields in medicine to describe clinicians whose professional identity revolves around the hospital is a testament to the acceptance—and even normalization—of hospitalists and to the profound change in the way we care for hospitalized patients brought about by our field.

We certainly have come a long way from the days when our newly formed society decided not to use the word hospitalist or hospital or anything like it in our name for fear of inciting animosity. In just a few short years we find a world where hospitalist is in the dictionary and other physicians begin to use the term to describe themselves. Reflecting this maturing of our field, SHM is involved in several initiatives including certification, research, a journal, and core competencies to further define hospital medicine.

If you have been thinking about getting more involved in the SHM, do so now. Become an active member; volunteer for committees. Help shape our field and the world of hospital medicine in the future. This ride certainly ain’t over. In fact, it’s just beginning. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

References

  1. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335(7):514-517.
  2. Pile J. How hospitalists add value. The Hospitalist. 2005;9:Supplement 1.

Letters

A Culture Resource

[In response to “Are You Culturally Competent?” (The Hospitalist, Sept. 2005, p. 1)]: Another resource for physicians is the book The Spirit Catches You and You Fall Down by Anne Fadiman. A sensitive and balanced account of the difficulties that even well-trained, compassionate physicians and caring, well-meaning, and involved parents can encounter when trying to bridge a cultural divide, and the multitude of ways that patient care can suffer as a result. Truly an excellent book.

Beth Robbins, Anne Arundel Medical Center, Annapolis, Md.

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