When I meet new people, I’m commonly asked, “So what do you do?” The first answer is easy: “I’m a doctor.” It’s the follow-up question that’s tricky: “What kind of doctor?”
“I’m a hospitalist,” I say.
I imagine that each of us faces similar questions almost daily from friends, family, patients, or strangers we meet. This tells me people are still learning who we are and what we are. I also imagine each of us has developed a standard way of answering that second question.
I like to say that a hospitalist is “a doctor who is an expert in taking care of people in the hospital.” Though not necessarily comprehensive, my definition usually does the job in casual conversation. In many ways I find this explanation easier than when I tried to describe myself as an “internist,” for which I never developed an easy definition. My favorite one-liner for internist was “pediatrician for adults,” but even that prompted blank stares or polite nods.
Early Definitions of Hospitalists
My definition certainly works in casual conversation. But the question gets to the heart of who we are, what we do, and what our field is about. Our ability to define these issues is critical to clarifying what hospitalists and hospital medicine are about.
It is interesting to look at early definitions of hospitalists. The first time the word hospitalist was published in 1996, hospitalists were defined as “specialists in inpatient medicine … who will be responsible for managing the care of hospitalized patients in the same way that primary care physicians are responsible for managing the care of outpatients.”1
At the beginning there was a need to compare what hospitalists do, or will do, to something that was already known. The concept was so new that it needed an analogy to be explained. Even in 1999, a paper published in Annals of Internal Medicine defined hospitalists as “physicians who assume the care of hospitalized patients in place of the patients’ primary care provider.”2
Three years after the term was first coined, hospitalists were still being defined in relationship to other physicians. Another paper in Annals of Internal Medicine in 1999 defined a hospitalist as “a physician who spends at least 25% of his or her time serving as the physician-of-record for inpatients, during which time he or she accepts ‘hand-offs’ of hospitalized patients from primary care providers, returning patients to their primary care providers at the time of hospital discharge.”3 Of course that definition was quite a mouthful when explaining what you do to, say, your mother. But there were two important issues wrapped up in that definition.
The first was recognizing that some hospitalists were primarily engaged in research or leadership positions and did not provide a great deal of direct patient care, yet clearly defined themselves as hospitalists. The second was that we were still defined by our relationship to the primary care physician role. Our field was too new to be defined on its own and had to be explained in terms of the existing paradigm.
What became clear was that hospitalists should not be defined by the amount of inpatient care we provided but by our professional focus. For many hospitalists, the thought of caring for hospitalized patients only 25% of the time seemed ridiculous. To others involved in leadership or research who focused exclusively on hospital medicine yet did little patient care the definition seemed too restrictive.
In the end, any definition of hospitalists that depended on time could not encompass the wide range of roles and responsibilities that hospitalists held. Finally, a few months ago, hospitalist was included in the dictionary for the first time. 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.” Although I am delighted to see hospitalist in the dictionary, this definition is too limited to be useful or accurate. It is certainly true that the presence of hospitalists means other physicians can come to the hospital less, but that is far from what hospitalists or hospital medicine are about.