What is a hospitalist?

The term "hospitalist" can mean a variety of things. But most physicians agree that it is a doctor, based in the hospital, who is there to accept admissions from physicians whose patients require hospital admission and who are not able to, or do not wish to, supervise the patient’s inpatient stay, says Ronald Greeno, MD, chief medical officer and vice president for physician services for Cogent Health Care Inc., an inpatient physician management company.

"Some people think that if you spend a certain percentage of your time in the hospital, you are a hospitalist, but that’s neither here nor there," he states.

What became known as the hospitalist movement evolved in the early 1990s during the rapid expansion of managed health care. As primary care physicians (PCPs) began to see more patients, they found it difficult to balance their office practice with supervising the care of their patients who were hospitalized.

"More and more physicians began to realize that it was an inefficient and ineffective use of their time to take care of 30-40 patients a day in the office and then try to run over to the hospital to see one patient who had been hospitalized," he explains.

At first, PCPs mostly made referrals to specialists in the area covering the patient’s complaint. If the patient was hospitalized for chest pain, the PCP might ask the cardiologist to go see the patient. Pulmonologists were called for patients with breathing problems, etc.

Eventually, some physician groups decided that it made sense for some physicians to specialize in caring for patients in the hospital, supervising and coordinating care, regardless of their diagnosis.

"When groups of doctors started forming independent practice associations and assuming risk from health plans, the most efficient model for taking care of those hospitalized patients was to have designated doctors admit them when they needed to come to the hospital," Greeno says. "My group and several other groups in California started doing this in the 1990s. This phenomenon was occurring in pockets throughout the country."

At first, hospitalist groups marketed themselves to primary care physicians. The PCPs contracted with the hospitalist group to care for their admitted patients. Increasingly, however, hospitals have started their own hospitalist programs and offered hospitalist services as a benefit for PCPs.

And hospitals found that such programs were more efficient ways to care for patients, Greeno says.

Primary care providers can typically only perform rounds twice a day — in the morning and evening. Because hospitalists are always at the hospital, they are available to interpret test results, make referrals, and make decisions about patient care in a much more efficient manner, some centers have found.