HM Spreads Its Wings


Hospitalists are not just general internists anymore, having successfully branched out into such subspecialties as cardiology, pulmonology, and gastroenterology, according to a March 12 study in the New England Journal of Medicine (2009;360:1102-12).

In the first quantitative national review to study hospitalists based on Medicare payment data, a team of researchers at the University of Texas Medical Branch at Galveston calculated that the percentage of internal medicine physicians practicing as hospitalists jumped to 19% in 2006 from 5.9% in 1995.

Perhaps more interesting is the number of cardiologists, pulmonologists, gastroenterologists, family physicians, and general practitioners who work as hospitalists totaled roughly 20% in 2006. The study defined hospitalists as those who generated more than 90% of their E/M claims from hospitalized patients.

HM appears to have even more room to grow, as more physicians move toward the HM model and away from primary care, according to an editorial accompanying the NEJM study. The editorial debated the value-adds and the complications caused by the presence of hospitalists in all phases of the care continuum. The authors also acknowledged the model is widely accepted as beneficial.

"The economic and practical forces that promoted the growth in the care of patients by hospitalists are intensifying, not lessening, and hospitalists are here to stay," according to the editorial, written by a trio of NEJM editors, including editor-in-chief Jeffrey M. Drazen, MD. "It is time to focus on how to enhance the value."

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