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Hospital Medicine Continues to Make Inroads Overseas


Attendees at this year’s SHM Annual Meeting in San Diego brought with them exciting news of international developments that might broaden the scope of the specialty.

For example, Efren Manjarrez, MD, director of clinical operations for the division of hospital medicine of the Leonard M. Miller School of Medicine at the University of Miami, recently discovered a 500-plus-bed facility at the Universidad de Navarra during his trip to Pamplona, Spain.

Because Dr. Manjarrez is bilingual, past SHM President Mark Williams, MD, professor and chief of the division of hospital medicine at the Northwestern University Feinberg School of Medicine in Chicago, asked him to give a lecture.

“[The Universidad de Navarra] has one of the top two medical schools in Spain and they had the very first symposium on the management of the hospitalized patient,” Dr. Manjarrez says. “They had the very first hospitalist conference in Spain and quite possibly in Europe.”

While in Spain, Dr. Manjarrez realized hospitalists there were “at the grassroots level, where we were about 10 to 12 years ago,” just starting to have a few hospital medical units. The clinic in at the Universidad de Navarra had about five units, and there was a small hospitalist group near Valencia, as well.

Dr. Manjarrez

Dr. Manjarrez is highly complimentary of the university’s “top-flight medical school,” where he said doctors perform liver transplants.

“They could compete favorably with any city in the United States,” he notes. “They’re interested in organizing hospitalists like Mark Williams and what people ahead of me did for SHM.”

Dr. Manjarrez and Dr. Williams have discussed what will happen with the hospital medicine movement internationally. They forecast that the work begun in the U.S. will globalize fairly soon.

“The Spaniards are very, very on the ball to ask us over there to see what’s going on to get a jump on it,” Dr. Manjarrez says. “SHM needs to start thinking ahead and have an international chapter and plan international meetings abroad to have SHM’s message spread globally. The time is ripe to export what SHM and hospital medicine is doing here”

Dr. Manjarrez notes that Argentina has small pockets of hospitalists. And, Guilherme Brauner Barcellos MD, specialist in internal medicine and intensive care at the Nossa Senhora de Conceicao Hospital in Brazil, is excited about the establishment of a hospital medicine program there. He finds the attempts to develop the specialty in his country “fascinating and challenging.”

“The implementation of hospital medicine, especially those aspects that involve more than just having a general medicine physician dealing with inpatient care, is brand new in Brazil,” Dr. Barcellos says. “We understand there is a long journey ahead.”

Dr. Barcellos is president of the recently formed Brazilian Society of Hospital Medicine and became a member of SHM last year, attending May’s meeting in Dallas. He says the number of hospitalists in Brazil is limited, but “a rapid expansion is predicted.”

“As in the U.S. several years ago, the case for hospitalists in Brazil is still being made,” he notes. “We did a hospital medicine meeting last October, and it led to the formation of the Brazilian Society of Hospital Medicine. We definitely fostered the discussion about the specialty and the model in Brazil.”

He hopes more people will talk about the topic through the new group’s Web site ( and in hospitals throughout the country.

“Before the year of 2005, the majority of people here didn’t know about the hospitalists,” he explains. “After that, we had a period in which people were confused, thinking hospitalists were the same as doctors who work in the rapid response teams only. Currently, everybody at least knows about hospital medicine.”

Dr. Williams notes that hospital medicine organizations are forming in Chile, Argentina, Australia, and New Zealand.

Dr. Barcellos believes hospitals across his country “will awake to hospital medicine” when they realize that traditional models aren’t property servicing hospitalized patients anymore. “Much of what is present is wrong, obsolete or out of time, and we should try new attempts to create a different organization,” he says. TH

Molly R. Okeon is a journalist based in California.

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