The Upside to Independents
One factor that helps hospitals decide between bringing in a national company and using an independent local group is the cost.
“[Local programs] may not be as expensive as the large groups,” says Dr. Atchley. “When my hospital sent out an RFP [request for proposal], we saw that some of our costs were much less than what a national company” has to charge.
One major concern individual hospitalists and smaller groups may have regarding employment in a national corporation is loss of autonomy. Would they be expected to follow rigid rules and regulations set forth by a distant corporation office? The leaders in those offices say no, absolutely not.
“We actually manage down to a small practice,” says Dr. Singer. “Concerns are that there will be a loss of autonomy; that’s not true.”
Regardless of which type of hospital medicine program one prefers, having options is good for both the hospital and the physician. “Competition is good,” maintains Dr. Atchley. “When these companies come in, they’ll definitely provide superior infrastructure and can track outcomes. Homegrown hospital medicine programs should use the same approach.”
A Glimpse of the Future
Will all hospitalists eventually work for a behemoth corporation? Not a chance, say the CEOs and CMOs of the current hospital medicine company leaders. “There are lessons to be learned from the emergency department,” says Dr. Wagner. “Large companies don’t have the majority of ED contracts. There’s only so much [large companies] can manage before it starts to get picked off by smaller, younger practices that are more nimble and quick to respond.
“All the big players won’t be dominant from a market-share point of view,” he adds. “But what they will do is set expectations for good hospital medicine practices.”
However, the employment model for hospitalists will continue to change. “We’re going to see existing [large] companies increase their regional presence,” predicts Dr. Reynolds. “The hospital-owned model will fade away. Physicians make lousy hospital employees—they just don’t fit into the hospital’s view of an employee.”
Dr. Atchley agrees with this point: “We’ll probably see fewer and fewer programs where the physician is employed by the hospital. That’s pretty much what the SHM surveys are showing.”
And when will the booming market for hospitalists start to slow? “I see [the market] growing well beyond my crystal ball,” says Dr. Singer. “I see a soon-to-be emerging trend of hospitals wanting hospitalists rather than internists. More groups are going to step up and add that—make an internist into a subspecialist. It’s a new way of thinking.”
Even without a crystal ball, leaders in hospital medicine forecast that the field will continue to grow and that hospitalists will become better trained, credentialed, and accepted as a specialty—regardless of what type of organization they work for. TH
Jane Jerrard writes “Career Development” and “Public Policy” for The Hospitalist.