Celebrating 30 Years of Hospital Medicine With 11 Hospitalists

Hospitalists who entered the field of hospital medicine two or three decades ago may not have anticipated how their careers and the specialty would evolve over time.

They have witnessed the expansion of the field into areas such as quality improvement and patient safety, as well as a growing recognition of their contributions. Many of these hospitalists are still amazed at how much the specialty has grown, both in terms of practitioner numbers and the range of services provided.

The Hospitalist spoke with 11 experienced physicians to discuss their journeys in hospital medicine. They shared insights into the bright spots and challenges currently facing the specialty, as well as advice for new hospitalists entering the field.

Dr. Arora

Vineet Arora, MD, MAPP, MHM, Herbert T. Abelson Professor of Medicine, dean of medical education and vice dean of education in the biological sciences division at The University of Chicago Pritzker School of Medicine and an academic hospitalist at UChicago Medicine, both in Chicago

Dr. Arora became interested in hospital medicine as a fourth-year medical student after reading Robert Wachter, MD’s 1996 article in the New England Journal of Medicine that described the specialty.1

“I ended up going to the University of Chicago, where hospitalists were being studied, and joined the team,” she said.

Dr. Arora describes the specialty as advancing from start-up mode to sustained purpose, with subfields like quality and safety, education, informatics, and leadership.

“Seeing that the nation’s (former) surgeon general, Dr. Vivek Murthy, was a hospitalist was a particularly pivotal moment because it put hospitalists on the map as someone who could be ‘the nation’s doctor,’” she said.

Going forward, it will become even more important for hospitalists to define their professional identity and expertise, she says—a challenge as more hospitals look for ways to cut costs and find sustainable, meaningful jobs.

Although Dr. Arora still identifies as a hospitalist and researcher, her primary work focuses on overseeing education. “I think this speaks to the maturity of the field where you now see hospitalists,” she said.

Dr. Auron

Moises Auron, MD, FAAP, FACP, FRCP(Lon), FRCPCH, DFPM, BCC, SFHM, professor of medicine and pediatrics at the Cleveland Clinic Lerner College of Medicine in Cleveland

Dr. Auron originally planned to pursue subspecialization during training at MetroHealth Medical Center in Cleveland but saw the high value of hospital medicine while working with James Pile, MD, who was also editor-in-chief of The Hospitalist at the time.

“I confirmed my passion for the profession,” Dr. Auron said.

During his career, he’s observed a similar phenomenon among residents who considered cardiology or oncology and then developed a passion for caring for adult inpatients and serving as a crucial stakeholder in hospital systems’ outcomes—all leading them to enter hospital medicine rather than what they had originally planned.

Dr. Auron believes that hospitalists can lead with a strong voice within the hospital system and care for patients throughout the continuum of care, helping improve patient safety across the system.

At the same time, there’s a huge need for patient care and not enough people to provide it, Dr. Auron observes. That makes it harder to do a thorough review of the patient’s medical history and problems. In turn, clinicians may sometimes focus on just one problem or prioritize expedited throughput to maintain bandwidth for new admissions.

Dr. Auron finds his work as an academic med-peds hospitalist “infinitely fulfilling” and takes pride in training future leaders in the field.

Dr. Bonsall

Joanna M. Bonsall, MD, PhD, chief of hospital medicine at Grady Memorial Hospital and associate professor of medicine at Emory University School of Medicine, both in Atlanta

While she was a resident, Dr. Bonsall intended to take a break between residency and fellowship and applied for a hospital medicine job.

She took that hospitalist position and didn’t look back. She felt well-guided to the specialty when she joined SHM’s Academic Hospitalist Academy as a member of its inaugural cohort in 2009.

“We’re now seen by many as ‘experts on inpatient care,’ whether that’s the care of a single patient, such as care of patients in the perioperative period, or expertise in how hospitals work—from administration to care coordination to quality improvement,” Dr. Bonsall said.

One challenge she observes in today’s hospital medicine is fractured care.

“I feel our healthcare system—speaking broadly, across the U.S.—is not set up to encourage or facilitate conversation between care teams, whether that’s between hospital medicine and a specialist, between primary care and hospital medicine, or between hospitalizations. Care suffers as a result. Chart documentation can’t replace human conversation,” Dr. Bonsall said.

Yet that hasn’t dampened her passion for leadership and hospital medicine.

“I love collaborating with others to solve problems or build things,” she said.

Dr. Dunn

Andrew Dunn, MD, MPH, MACP, SFHM, professor of medicine for the Icahn School of Medicine at Mount Sinai and chief of the division of hospital medicine at Mount Sinai Health System, both in New York, and an SHM board member

Dr. Dunn enjoyed his work as a clinician educator in primary care before the term hospitalist was coined. This work included traditional weeks covering the wards.

“Our institution had a growing need for inpatient leadership, which mirrored the national experience. I stepped into that leadership opportunity and have loved it ever since,” Dr. Dunn said, explaining how he made the transition to hospital medicine.

He says the specialty began as a small and often marginalized component of general medicine, with little or no emphasis on inpatient quality, education, or scholarship.

“Hospital medicine has since flourished to entail leadership in improving hospital efficiency, quality, and patient safety, inpatient medical education, and practice-changing scholarship and research,” Dr. Dunn said. There is also growth in innovative spaces like hospital at home and virtual hospital medicine.

“I feel the expansion is due to recognition that dedicated clinicians develop an expertise that leads to improved patient care and helps hospital systems maximize efficiency,” he said.

One challenge not yet overcome will be for hospitalists to help patients make the transition from the inpatient to the outpatient setting as seamlessly as possible to curtail the outpatient-inpatient continuity gap, Dr. Dunn says.

Dr. Dwyer-Matzky

Keely Dwyer-Matzky, MD, MS, FHM, associate chief medical officer for patient flow and capacity at the University of Rochester Medical Center, associate professor of pediatrics and medicine at URochester Medicine, and a med-peds hospitalist at Golisano Children’s Hospital and Highland Hospital, all in Rochester, N.Y.

Dr. Dwyer-Matzky knew she wanted to care for acutely ill children and adult hospitalized patients, and she became one of the first med-peds hospitalists at the University of Rochester when the program started in 2007.

Like her colleagues in this article, Dr. Dwyer-Matzky has observed the growth of the specialty to expand from expert clinical care and complex care coordination to areas like hospitalist sub-specialization, patient safety, and operations. In fact, her interest in patient safety and quality led her to pursue a Master of Science in business administration, as she also saw the need to understand the business aspects of medicine.

Hospitalists also played a crucial role during the COVID-19 pandemic, she says.

“We showed up every day for our sickest patients, exemplifying selflessness, creativity, and compassionate solutions that helped lead healthcare and the country through that challenging period,” she said.

Dr. Feldman

Lenny Feldman, MD, FACP, FAAP, MHM, associate professor of internal medicine and pediatrics at Johns Hopkins School of Medicine and founder and program director of the combined internal medicine-pediatrics urban health residency program at Johns Hopkins, both in Baltimore

When Dr. Feldman began as a hospitalist at Johns Hopkins in 2004, there were only five or six fellow hospitalists.

Fast forward to today, and there are about 60 hospitalists there.

He arrived at Johns Hopkins after a med-peds residency at the University of North Carolina in Chapel Hill, followed by a year as internal medicine chief at WakeMed in Raleigh.

His father, who was battling kidney cancer at the time and receiving treatment at Johns Hopkins, heard about the open hospitalist position from his oncologist.

“I just happened to be in a really great place at the right time to be able to watch hospital medicine grow at Johns Hopkins,” he said.

His career has led him through the program’s growth, the creation of the med-peds residency, a variety of leadership roles, and serving as the brains behind the popular “Things We Do for No Reason™” column in the Journal of Hospital Medicine and related talks. There have been more than 120 “Things We Do for No Reason™” articles published since 2015.

Although he loves his work as a hospitalist, one thing Dr. Feldman finds challenging is the pressure put on hospitals by the government to fix patient issues around social determinants of health.

“At times it becomes frustrating to be the Band-Aid and not have better solutions for the social issues so prevalent for many of our patients,” he said.

Dr. Fromme

H. Barrett Fromme, MD, MHPE, professor of pediatrics at UChicago Medicine and chief of the section of academic pediatrics at Comer Children’s Hospital, both in Chicago

Like other hospitalists who have watched the specialty evolve, the hospital medicine story for Dr. Fromme evolved, from her early days in medical school, thinking she would be an outpatient pediatrician, to her later work within hospital medicine. 

That included a leadership role as a senior resident within the specialty’s early days.

“I loved standing in the hospital knowing that as a senior resident, I taught the students and the buck stopped with me,” she said.

That led her to her career in Chicago, where one major shift she’s observed in hospital medicine is a change to the typical level of patient acuity. Many pediatric patients now handled as outpatients would have been treated as inpatients near the start of her career.

“We shifted everything to a much higher complexity in the hospital. It gives a different feel for the patient population,” she said.

The past three decades have also given hospitalists the chance to become key drivers within hospital operations and to make themselves known among patients and colleagues for their particular kind of expertise.

It also means that hospitalists have become the quarterback, so to speak, for more unusual cases. Dr. Fromme shares the example of diagnosing and treating a pediatric patient with vaccinia that occurred after a smallpox vaccine. She and her colleagues had to call a physician out of retirement to help guide them with treatment.

“It’s always surprising with some of the more unique and kind of crazy changes we see,” she said.

Dr. Lenchus

Joshua D. Lenchus, DO, RPh, FACP, SFHM, medical director for Aetna’s Florida market, southeast region, and vice president and trustee of the American Osteopathic Association

Whether it was the acuity of a patient’s presentation, illness severity, or the rapid nature of change in a hospital, Dr. Lenchus says that he was excited early on to care for the diverse inpatient population and speak with patients multiple times throughout the day.

Yet his career extended much further than he had anticipated.

“While I always envisioned being an academic hospitalist, I never thought I would create a curriculum on bedside procedures, be so involved in committee work that it would culminate in my election as president of the medical staff, or leverage my administrative experience into a position as a health system chief medical officer,” Dr. Lenchus said. “I have grown beyond where I thought I would be. It has been a fantastic journey, and I credit many others, hospitalists and non-hospitalists, with helping me get there.”

The specialty has also evolved and grown within that same time period, with hospitalists serving in leadership roles at the hospital level, at companies, and in the federal government.

Yet challenges remain within the specialty, even with exponential growth.

“By and large, elected officials still do not know who we are or the significant impact we have on caring for hospitalized patients,” Dr. Lenchus said.

Dr. Manjarrez

Efren Manjarrez, MD, FACP, SFHM, associate professor of clinical medicine in the division of hospital medicine at the University of Miami Miller School of Medicine in Miami and president of SHM

The journey to hospital medicine in the specialty’s earlier days was often not a straight line, as Dr. Manjarrez knows.

He had graduated from his combined internal medicine and pediatrics residency at the University of Miami Jackson Memorial Hospital in Miami. He planned to return home to work in Los Angeles when the contract was pulled.

Some classmates asked if he wanted to work in the newer specialty of hospital medicine at a community hospital in Miami for a while, and then he could make his way back to California.

Fast forward from 1999 to today, and Dr. Manjarrez remains in Miami.

After a few months at that community hospital where he was involved in starting up the program (“It was almost like doing an MBA,” he said), the program was closed, and he got recruited back to the University of Miami to start hospital medicine for the department of internal medicine.

He recently celebrated 25 years there.

“I started the program as the first director, and I’ve stayed here ever since,” he said.

Dr. Manjarrez says the rapid growth within the specialty is something that has surprised him, with nearly 60,000 hospitalists in the U.S. in just 30 years. The specialty has also expanded into many other countries.

Dr. Nye

Heather E. Nye, MD, PhD, FACP, SFHM, chief of medicine at the San Francisco VA Health Care System and professor, vice chair, and the Marvin H. Sleisenger Endowed Chair at the University of California San Francisco department of medicine, all in San Francisco, and SHM board member

Intellectual stimulation, high-impact patient relationships, and interactions with trainees are just a few of the things that led Dr. Nye to hospital medicine while she was a med-peds resident.

“The field has grown like gangbusters since the early 2000s,” she said. “I started in a group of 17 hospitalists at UCSF led by Dr. Bob Wachter. The group is now over 150 physicians.” Nearly all of the original hospitalists are now in leadership roles.

“Hospital medicine has worked its way into the problem-solving machinery of nearly every part of the hospital…healthcare systems’ leadership sees hospitalists as a necessity, not a luxury,” she said.

Yet Dr. Nye never envisioned that she would be part of administrative leadership as a “final hurrah.”

Still, she says the chance to try areas like co-management and the preoperative clinic that handled hospital operations and program building helped her see that type of work also was a good fit for her.

“We need happy and fulfilled providers to render the best patient care, and I view that as my ultimate responsibility. It’s certainly not always easy,” she said.

Dr. Pyke

O’Neil Pyke, MD, MBA, SFHM, chief medical officer at Jackson North Medical Center and affiliate professor of medical education at the University of Miami Miller School of Medicine, both in Miami

Although Dr. Pyke originally thought he would become an ophthalmologist, he turned his attention to internal medicine and considered cardiology or gastroenterology as a subspecialty.

Yet he realized he was less procedurally oriented and more relationship-oriented.

In his fourth year of medical school in Hershey, Pa., he received a call from a recruiter regarding a hospitalist job in Erie, Pa.

“This was in 1999, and I hadn’t heard of a hospitalist,” he said.

He initially said no—twice—but ultimately visited and took the position. He and his family stayed in Erie for eight years.

He began to take part in early meetings of the SHM—called National Association of Inpatient Physicians at that point—where newly minted hospitalists shared ideas.

“We realized that we were adding value to the care of hospitalized patients. This was a vulnerable population presenting at their worst, and we were asked to get them back to a better state,” Dr. Pyke said.

During his early days as a hospitalist, Dr. Pyke also had an impactful encounter during the night shift with a patient who didn’t want to be treated by him—he wanted to be seen by a white doctor. As fate would have it, their paths crossed a few more times, and he eventually let Dr. Pyke treat him.

The two became friends, with the patient one day gifting him a custom TV stand and Dr. Pyke naming a family dog after the patient.

Dr. Pyke tells this story frequently to trainees and shares it in his new book, “Informed and Engaged.”

“I want people to recognize that, especially in the hospital setting, people are their worst. None of us would like to be judged at our worst moments when we are fearful and in a place where we have no power. So we exert whatever power we can, and sometimes it comes out in a very inappropriate way,” Dr. Pyke said.

Dr. Pyke eventually moved to Miami, where he currently continues his work as chief medical officer at Jackson North Medical Center and runs an outpatient weekly preventive health clinic. 

Vanessa Caceres is a medical writer in Bradenton, Fla.

Reference

1. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335(7):514-7. doi:10.1056/NEJM199608153350713.