Big Kahunas
Disclaimer: SHM Members William Atchley, MD, FACP, Ron Greeno, MD, Stacy Goldsholl, MD, and Mark V. Williams, MD, FACP, are quoted in this article. Their opinions do not reflect or represent the opinions of SHM.
Hospital medicine may be a young field, but several major providers have already been established. Each of these rapidly growing organizations employs dozens—or even hundreds—of hospitalists and is establishing or revamping hospital medicine programs across the United States.
As these organizations grow, they are shaping hospital medicine. “I think that what the large companies really bring to the table is a vision of what hospital medicine is supposed to be about: evidence-based medicine and other things important to the hospital,” says William Atchley, MD, FACP, a practicing hospitalist in Hampton, Va.
This month, we examine just a few of the many large hospital medicine groups in order to set the stage for this growing trend and the issues presented by these groups. That said, here is an overview of some of the largest national players in hospital medicine, their perspective on the industry, their philosophies, and dialogue about their astonishing growth.
The Players
Which organizations have become the nation’s largest employers of hospitalists?
Cogent Healthcare
Based in Irvine, Calif., Cogent employs approximately 130 full-time hospitalists, with an additional 70 who “work with us in other arrangements; some are partnered with us,” says Ron Greeno, MD, FCCP, Cogent chief medical officer.
Cogent was founded by four physician groups in Los Angeles County. “We started in late 1997 and spent the first several years developing the model,” recalls Dr. Greeno. “In the 2000s, we started building programs for hospitals. We’ve seen growth of around 40% a year for the last several years. Frankly, we started too early; the market wasn’t really ready.”
What sets Cogent apart, says Dr. Greeno, is its focus. “We’re not a physician practice management company,” he stresses. “Our competitors’ goal is to build large, successful practices. We built a practice that’s hospital-centric. This helps the hospital satisfy its goals.”
EmCare
Perhaps the first of the national players to actively undertake hospital medicine, EmCare developed its first hospitalist program in 1993 at Baylor University Medical Center (BUMC) in Texas. “[Baylor is] still with us,” says Michael Wagner, MD, CEO, Hospitalists Division, EmCare.
EmCare has more than 30 years of experience with emergency department (ED) staffing, which is how it got its foot in the hospitalist door.
“In the late ’90s, other hospital EDs talked to us” about bringing in a hospitalist program, says Dr. Wagner. “So in each ED region, we worked to sell [the] hospital medicine program. It didn’t really take off until the 2000s, when non-clients started approaching us.”
Today, EmCare employs 350 hospitalists, 240 of whom work full-time. They provide hospital medicine to 47 clients in 60 programs in 37 states.
Emory Healthcare
Emory Healthcare’s Hospital Medicine Unit in Atlanta is the largest academic hospital medicine program in the United States.
“We occupy five hospitals,” says Mark V. Williams, MD, FACP, director of Emory’s Hospital Medicine Unit and editor of the Journal of Hospital Medicine. “Thirty of our hospitalists teach at the two university hospitals, and an additional eight teach at [one of three] community hospital[s]. Others will teach in-service training as well.”
The two university hospitals—Emory University Hospital and Crawford Long Hospital—are “solely staffed by Emory physicians,” explains Dr. Williams. “A third of what we do in these settings is teaching, and the rest is direct care.”
The university’s hospitalist program started in 1999 with eight hospitalists; today, it employs 60. The difference with an academic hospitalist program, explains Dr. Williams, is that “we’re essentially dealing with staffing teaching teams, teaching, and having research components.”
