If imitation is the sincerest form of flattery, then hospitalists have a lot to crow about. For the same reasons that sparked the original hospital medicine movement, HM’s specialist colleagues are flocking to the HM model.
“I switched because your impact with consultation is limited,” says geriatrician-hospitalist Jeffrey Farber, MD, assistant professor of geriatrics and palliative medicine and director of the Mobile Acute Care for the Elderly Service (MACE) at Mount Sinai Hospital in New York City. As the former director of the Department of Geriatrics’ consult service, Dr. Farber adds, “I like being able to call the shots and direct the care.”
He’s not the only one. Neurologists, surgeons, and even dermatologists and otolaryngologists have been establishing inpatient services based on the HM model. While many of these programs first begin in the academic setting, where resident work-hour limits necessitate faculty coverage, community hospitals increasingly are turning to specialist hospitalists to address patient-safety and treatment-innovation issues.
According to a leading surgical hospitalist, more than 250 such programs exist throughout the country.
Shaun Frost, MD, FACP, SFHM, chair of SHM’s Membership Committee and SHM’s Emergency Medicine Task Force, an SHM board member, and regional medical director for Brentwood, Tenn.-based Cogent Healthcare, views the growth of specialty hospitalist programs as a positive development. “In many ways, [this trend] is confirmatory regarding the key reasons for creation of the hospital movement,” he says.
For example, mirroring the performance of adult inpatient hospitalist programs, pediatric hospitalist programs have now documented improved throughput, increased efficiency, and increased patient satisfaction, especially when such programs combine pediatric emergency department and pediatric inpatient coverage.1
“We’ve all been inspired by the success of the medical hospitalist model, and we want to acknowledge and credit them for being the trailblazers and pioneers who are leading the way,” adds John Maa, MD, FACS, assistant professor in the Department of Surgery, assistant chair of the Surgery Quality Improvement Program, and director of the Surgical Hospitalist Program at the University of California at San Francisco (UCSF). Dr. Maa and colleagues introduced the surgical hospitalist program at UCSF in July 2005.
It used to be that neurologists didn’t have to get out of bed at night for most strokes. But with innovations in stroke treatments, that’s all changed. It really helped to give birth to the neurohospitalist movement.
—David Likosky, MD, FHM, neurohospitalist, stroke program director, Evergreen Hospital Medical Center, Seattle
What’s Driving the Trend?
The impetus for adopting and adapting the HM model varies across medical specialties. For some, it was necessity; for others, it was a way to extend coverage or streamline the hospital stay; and for still others, it was a matter of personal choice.
“We couldn’t continue in the old paradigm and deliver safe care, because it was traditionally resident-dependent,” says Dr. Maa, explaining that the 80-hour resident workweek restriction mandated by the Accreditation Council for Graduate Medical Education (ACGME) “annihilated” the old-school model.
The goal in organizing the Society of Dermatology Hospitalists (SDH), according to SDH cofounder Lindy P. Fox, MD, assistant professor of clinical dermatology and director of the hospital consultation service at UCSF, was to ensure 24/7 coverage by a dedicated group of dermatologists whose skill set is focused on inpatient care, and who, because of their involvement with the university hospital, are probably more comfortable with the nuances of inpatient dermatologic care than their outpatient-based colleagues. The SDH currently has 20 members representing about 15 academic programs.
Innovations in stroke treatment caused a “sea change” for the field of neurology, says David Likosky, MD, SFHM, hospitalist and stroke program director at Evergreen Hospital Medical Center in Seattle. Dr. Likosky, who is board-certified in neurology and internal medicine, says the HM model allows neurohospitalists to enjoy a work-life balance.