For more than 2 decades, U.S. health systems have drawn on hospitalists’ expertise to lower length of stay and enhance safety for general medical patients. Many hospital medicine groups have extended this successful practice model across a growing list of services, stretching the role of generalists as far as it can go. While a diverse scope of practice excites some hospitalists, others find career satisfaction with a specific patient population. Some even balk at rotating through all of the possible primary and comanagement services staffed by their group. A growing number of job opportunities have emerged for individuals who are drawn to a specialized patient population but either remain generalist at heart or don’t want to complete a fellowship.
The latest State of Hospital Medicine (SoHM) report provides new insight into this trend, which brings our unique talents to subspecialty populations.
It is hard to know what we should even call these hospitalists. The term “specialty hospitalist” is ambiguous because it could reasonably describe board-certified subspecialists who only practice in the hospital or hospitalists who only comanage a unique patient population. Nonetheless, I’ll call the latter group “specialty hospitalists” until a better term emerges.
To understand the prevalence of this practice style, the following topic was added to the 2016 SoHM survey: “Some hospital medicine groups include hospitalists who focus their practice exclusively or predominantly in a single medical subspecialty area (e.g., a general internist who exclusively cares for patients on an oncology service in collaboration with oncologists).” Groups were asked to report whether one or more members of their group practiced this way and with which specialty. Although less than a quarter of groups responded to this question, we learned that a substantial portion of respondent groups employ such individuals (see table below).
The prevalence and diversity of specialty hospitalist positions suggests they can be readily arranged in ways that benefit and engage all stakeholders. The report particularly indicates that hospital medicine groups have become a home for many palliative care specialists, allowing them to alternate between a primary and a consultative role. For the other specialties, common co-management pitfalls should be anticipated and addressed through clear descriptions of team expectations for decision making, communication, and workload.
We look forward to tracking this area with subsequent surveys. Already, national meetings are developing for specialty hospitalists (for example, in oncology), and we see opportunities for specialty hospitalists to network through the Society of Hospital Medicine annual meeting and HMX online. My prediction is for growth in the number of groups reporting the employment of specialty hospitalists, but only time will tell. Hospital medicine group leaders should consider both participating in the next SOHM survey and digging into the details of the current report as ways to advance the best practices for developing specialty hospitalist positions.
Dr. White is associate professor of medicine at the University of Washington, Seattle, and a member of SHM’s Practice Analysis Committee.