Can you point me to any information or articles that support my belief that hospital practice is now a separate specialty?
Dr. Hospitalist responds: Is a hospitalist practice sufficiently different than that of an office-based internist or cardiologist, so much so that peer-review activities would necessitate at a minimum some involvement of other hospitalists? To answer this question, I think we need to understand the definition of a hospitalist.
I recently heard a doctor describe himself as a hospitalist despite working clinically in the hospital only one month annually. Is he correct in defining himself as a hospitalist? If so, how would we distinguish him from primary care doctors who spend one-twelfth of their work life caring for hospitalized patients?
SHM defines hospitalists as “physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital medicine.” Based on this definition, the doctor who spends one month annually caring for inpatients could be a hospitalist if the remainder of his work involved teaching, research, and leadership related to hospital medicine.
In your example, you cite two physicians on the peer-review committee: an office based internist and a cardiologist. Is it reasonable to consider their work similar to or different from that of a hospitalist? In the case of the internist, I think the key point is the fact you described him as office-based. That suggests to me his primary professional focus does not involve hospitalized patients.
One could argue that since both the hospitalist and the office-based internist were trained in internal medicine and both have American Board of Internal Medicine certification, they should be considered peers. I would point out that one’s specialty training has nothing to do with the definition of a hospitalist.
Although the majority of hospitalists in this country are internists, many others are family physicians and pediatricians. Some have subspecialty training, some don’t. Even obstetricians and surgeons are defining themselves as hospitalists.
With all that in mind, would we consider the cardiologist a hospitalist? Again, I think it would depend on the nature of the cardiologist practice. If this cardiologist has a primarily outpatient practice, that would be quite different from a hospitalist practice.
What if this cardiologist’s practice primarily is inpatient? I think it is reasonable to think about the scope of these physicians’ practices. Assuming the cardiologist practice is limited to the care of patients with primary cardiac issues, this would be a much narrower scope than that of most hospitalists.
It also is important to consider the training of the hospitalist. Take geriatrics hospitalists, for instance. The scope of their practice may be quite similar to that of a geriatrician who spends the majority of time caring for hospitalized patients.
Does the hospitalist have additional cardiology training? Does the focus of discussion at peer-review committee involve care of patients with primarily cardiac needs? The issue of which physicians should serve on peer-review committees when evaluating hospitalists is a complicated one that demands further scrutiny. TH