Hospital medicine is 15 years old now and, as the fastest-growing medical specialty, has created innovation and excitement in healthcare. With more than 34,000 hospitalists at more than 4,000 hospitals, hospitalists are now an accepted part of the medical community. But clearly HM is still a work in progress, with our best days still ahead of us.
So what’s in store for us as we look to the next five to 10 years?
First, it is important to note that the very institution of the hospital is evolving. Hospitals no longer are defined by the walls of their buildings; hospitals view themselves as significant community resources along a continuum of care that includes care when the patient is horizontally confined during an acute illness. Just as hospitals need to be involved in the care of the community (e.g. to reduce preventable readmissions or ED visits), so too hospitalists’ scope of practice is expanding.
Expanding HM Scope
At one time, long, long ago, the scope of hospitalists’ work could be narrowly defined as the care of the acutely ill patient with such a medical illness as heart failure or pneumonia. Today, hospitalists routinely comanage surgical problems and serve as the prime admitter for medical cases (acute chest pain, sepsis, and the like) previously sent directly to specialists.
As surgeons and specialists have narrowed their practices, hospitalists have been called on to be proceduralists, inserting central lines and even doing bedside ultrasound. With a decreasing workforce of critical-care-trained physicians, hospitalists are being challenged to provide an ever-increasing amount of critical care, a phenomenon that will increase in the future and further stretch the competencies and training of most hospitalists.
At the edges of acute care, hospitalists are being called upon to augment the “neighborhood” around the patient-centered medical home. In some settings, hospitalists now provide the initial post-discharge, follow-up outpatient visits to “complete” the hospitalization, stabilize the patient, and transition them back to their community provider. CareMore Health Plan in California is setting the standard for this transitionalist role, also known as an “extensivist.” As the demand from hospitals and payors to reduce post-discharge bounce-back to the ED or to be readmitted increases, hospitalists and the medical home will need to carefully coordinate their roles if HM is to provide our patients (and their families) with what they need and expect—a smooth, coordinated transition from the hospital to home with clear communication and accountability
Fulfill the Promise
To do this, and do this well, hospitalists will need to fulfill our promise. We have spent the last decade positioning hospitalists as having two patients: the clinical care of the patient in front of us and the improvement of the system we work in. We have acknowledged that most hospitalists don’t come out of residency, or even years in practice, with all the skills needed for this unique and important role.
In many ways, SHM has become the society of “everything you didn’t learn in training that you found out you need to know in practice.” SHM has trained more than 2,000 hospitalists in our Leadership Academies. We have expanded our annual-meeting course offerings to include perioperative care, neurology, critical care, and procedures.
Through the Center for Hospital Improvement and Innovation, SHM has developed courses in quality-improvement (QI) skills and processes, as well as support and tactics for helping hospitalists make real change at their institutions through SHM’s mentored implementation in transitions of care (Project BOOST), preventing DVT, and improving glycemic control.