Bob Wachter, MD, MHM, has watched the hospitalist movement grow from its infancy in the mid-1990s to more than 30,000 hospitalists practicing nationwide today. As professor and chief of the Division of Hospital Medicine and associate chairman of the Department of Medicine at the University of California at San Francisco, and chief of the medical service at UCSF Medical Center, Dr. Wachter also has watched the HM model spread to other medical specialties, including a handful of departments in his own hospital. The Hospitalist caught up with Dr. Wachter and found out what he thinks about the spread of the HM model.
Question: Do specialist-hospitalist programs threaten to siphon off your medical hospitalist workforce, or are they a boon?
Answer: Having specialized physicians focus on hospital care is a powerful model. Not only are they available all the time, but they are keeping up with innovations in their field. More importantly, they get involved in system improvement in a way that the part-time hospital person will not.
—Bob Wachter, MD, MHM
Q: Are there direct benefits to the hospitalist on the floor?
A: I think it creates a vehicle for collegiality, interchange, and learning across the specialties, which is harder to come by when we’re in the hospital all the time, but the consults we’re interacting with may not be.
Q: Aren’t hospitalists already comanaging patients with neurosurgery, hematology/oncology, and orthopedics at your institution? How are specialist hospitalists different?
A: Neurohospitalists focus their professional practice on the hospitalized care of patients with neurological diseases—they perform the same function for those patients as we do for medical patients. That is, they admit patients, supervise their overall care, and discharge them. On our neurosurgery service, which has a census of 50 patients, the surgeons are in the operating room much of the day. Their post-surgical patients often have multiple medical comorbidities (heart failure, high blood pressures, diabetes, etc.), which is where the medical hospitalist comes in to comanage and coordinate their medical care.
We probably need new lingo to distinguish between medical hospitalists comanaging specialty patients and specialty hospitalists, because it can be confusing to people.
Q: Is this model sustainable in the community and rural settings, where specialists are in short supply?
A: There is a size below which you probably cannot support a specialty hospitalist. But larger places can, and their value is not only what they do at that individual hospital, but the fact that they can teach and do research and (quality improvement) that may help influence care beyond their organization’s walls.