1. The Privilege of Immediate Impact
Unlike many inpatient services, the oncology hospitalist role often means managing pivotal moments in a patient’s cancer journey. The admission might reflect a sudden decline, a shift in goals of care, or a complication that threatens ongoing treatment. What struck me most was how quickly our involvement can reorient the trajectory—clinically, emotionally, logistically. Whether initiating dexamethasone for cord compression within minutes of arrival, or facilitating timely discharge to inpatient hospice, the immediacy of our role never feels routine. Each encounter reminds me that cancer doesn’t wait—and neither should we.
2. Continuity in Discontinuity
There’s an irony to being a hospitalist in oncology. Our patients often have complex, longitudinal relationships with their outpatient oncologists, yet during admission, it’s us—the hospitalists—they see the most. Our goal is to never break continuity, even as we assume the inpatient reins. We text, call, and loop in the primary oncologist as often as possible. This tight coordination has become a defining characteristic of our model at Smilow1 and is part of why our length of stay improved without increasing readmission risk. True continuity doesn’t require physical presence—it requires presence of mind.
3. We Steward CRS and ICANS Complexity—So Others Don’t Have To
Oncology hospitalists have become the stewards of inpatient immunotherapy and cell therapy care. As therapies like TIL, BiTEs, and CAR-T become more common, so do high-risk complications like CRS, ICANS, and other inflammatory responses. These cases are routine for us, requiring specialized coordination, trained staff, and real-time clinical decision making.
Whether stabilizing patients when therapies work too well or managing severe toxicities, we ensure safe admissions, close monitoring, and proactive, guideline-driven care. These are complex scenarios, but they’re firmly in our wheelhouse—allowing patients to access cutting-edge treatments in a safe, structured environment while preserving capacity for oncologists and research teams to continue advancing care.
4. Hospitalists Belong in Cancer Care
Some still ask why hospitalists are managing oncology inpatients at all. Shouldn’t oncologists do this? But this isn’t about ownership—it’s about bandwidth, burnout, and better care. Our integration has allowed oncologists to focus on their outpatient practice without sacrificing inpatient safety or quality. In fact, our presence has improved discharge times, early discharge rates, and clinician satisfaction.1 We’ve published on it. We’ve talked about it at the American Society of Clinical Oncology. And we’ve lived it. Being a hospitalist in oncology isn’t an intrusion—it’s an evolution.
5. No Teaching Like Oncology Teaching
Finally, a word on education. At first, I worried that rotating house staff might miss “real” oncology by working with a hospitalist. But our service surveys have shown that trainees gain accessibility, hands-on teaching, and exposure to core topics in oncologic emergencies.3 We walk through spinal cord compression cases, dissect venous thromboembolism management in gastrointestinal (GI) cancers, and tackle the ethics of nutrition in malignant bowel obstruction—all before noon. Oncology hospitalist rotations don’t just complement oncologic education—they expand it.
6. Urgencies Are Frequent—and Manageable
Cytokine release syndrome. Immune effector cell-associated neurotoxicity syndrome. Spinal cord compression. Pathologic bone fractures. Brain metastases. Mucositis. Neutropenic fever. Bowel and biliary obstruction. Hypercalcemia. Superior vena cava syndrome. Colitis. Hepatitis. Endocrinopathies. Myocarditis. Venous thromboembolism. Overt and occult GI bleeding. Cancer-related pain requiring a PCA (patient-controlled analgesia) or complex opioid titrations. These aren’t “zebras” on our service—they’re routine. Teaching others how to recognize and manage these conditions, whether through bedside instruction or formal presentations, is central to our mission. But what I’ve come to appreciate is how reassuring our presence is to the rest of the team. When oncologic urgencies arise, everyone knows: we’ve got this.
7. Length of Stay Is a Mirror
When we first launched the oncology hospitalist model at Smilow, the primary motivator was pragmatic: improve throughput, reduce length of stay (LOS), and avoid inpatient gridlock. What emerged, however, was that LOS reduction wasn’t just a metric—it was a reflection of communication, coordination, and clarity of goals. LOS was shorter on our service, not because we discharged faster, but because we aligned care earlier, prevented redundancy, and managed complexity with focus.1 LOS doesn’t just tell you how long someone stayed—it tells you how well the team functioned.
8. When Goals Shift, We Walk Together
One of the most meaningful and humbling aspects of our work is leading goals-of-care conversations during moments of acute change. On the oncology hospitalist service, these conversations aren’t optional—they’re essential. Many of our patients are navigating serious illness, unexpected complications, or disease progression. And during hospitalization, they’re often at an inflection point in their cancer journey.
What we’ve observed—both anecdotally and in our published work—is that transitions to inpatient hospice occur more often and earlier for patients on our service.² But these moments don’t happen in a vacuum. They arise from hospitalist-led collaborative, interdisciplinary communication among oncologists, surgeons, radiation oncologists, palliative care clinicians, advanced practice providers, nurses, case managers, social workers, and—most importantly—patients and their loved ones. Sometimes, these conversations even include remote team members joining from across the country or abroad.
What makes these transitions possible isn’t a single decision or directive, but a shared commitment to ensuring patients have the time, space, and support to reflect on their values, especially when navigating new challenges in the context of their advanced illness journey. When patients and families choose hospice, it happens in the context of trust, clarity, and alignment. And in a field where “doing more” often means intervention, this is one instance where doing more means connecting better.
9. Our Job Is Also System Design
One of the underappreciated aspects of oncology hospitalist work is how often we find ourselves on the boundary between individual care and systemic structure. Whether helping define triage priorities during bed shortages or streamlining admissions from outpatient centers, our job bleeds into operations. If we don’t shape the system, the system shapes us—and often not in the direction of equity, efficiency, or clarity. Being an oncology hospitalist means doing the work and building the framework in which the work can succeed.
10. Excellence Isn’t Optional—It’s Urgent
Perhaps most humbling of all: our patients are often critically ill, emotionally raw, and carrying the weight of complex treatment decisions. They don’t have time for delays, inefficiencies, or fragmented care. We don’t get the luxury of becoming “gradually better” over time—we have to show up prepared, aligned, and communicative today. This urgency drives our commitment to daily interdisciplinary rounding, rapid documentation, timely consults, and same-day family meetings. Our patients deserve that—and more.
Final Thought
The oncology hospitalist service is still a relatively new model, but at Smilow, it already feels indispensable. It gives our patients consistency in a time of chaos, our oncologists breathing room to sustain their outpatient work, and our trainees immersive, high-acuity learning. I signed up to be a hospitalist. What I didn’t expect was to become part of something that helps reshape cancer care—one admission, one discharge, one conversation at a time.
Dr. Parker
Dr. Parker (he/him/his) is an oncology hospitalist and one of the original members of the Smilow Cancer Hospital hospitalist service at Yale New Haven Hospital. He also serves as an assistant professor of medicine within the internal medicine residency program at the Yale School of Medicine in New Haven, Conn.
References
- Morris JC, et al. Outcomes on an inpatient oncology service after the introduction of hospitalist comanagement. J Hosp Med. 2023;18(5):391-397. doi: 10.1002/jhm.13071.
- Prsic E, et al. Oncology hospitalist impact on hospice utilization. Cancer. 2023;129(23):3797-3804. doi: 10.1002/cncr.35008.
- Bhatt, SM, et al. The impact of oncology hospitalist utilization on resident education. J Clin Onc. 2023; doi.org/10.1200/JCO.2023.41.16_suppl.11034.
Additional Reading
- Jensa C. Morris, MD: Oncology Hospitalist Co-Management May Be Linked to Efficient, High-Quality Care and Education. 2022. The ASCO Post. https://ascopost.com/videos/2022-asco-quality-care-symposium/jensa-morris-on-oncology-hospitalist-co-management/
- Morris J. Involving Hospitalists in Inpatient Cancer Care Reduces Patient Stays, Oncologist Stress. Yale School of Medicine website. 2023. https://medicine.yale.edu/news-article/involving-hospitalists-in-inpatient-cancer-care-reduces-patient-stays-oncologist-stress/
Excellent article that is setting a new paradigm for quality of inpatient oncology care. What a difference from the hospitalist work I did with oncology patients in the 1990s!