William N. Southern, MD
The Einstein/Montefiore Hospitalist Program began in 2000 with three direct-care hospitalists. The program now boasts 39 full time teaching-hospitalists, direct-care hospitalists, and nocturnists. Hospitalists serve the majority of ward-attending teaching months at both Weiler and Moses, and are the attendings of record for the majority of inpatients on the medical service. The implementation of this program coincided with a dramatic decrease in the length-of-stay on the medical service. A published analysis of our program suggested that hospitalists are responsible for about an average of 1 day shorter length-of-stay per hospital admission without a change in mortality or readmission rates. Hospitalists have the greatest benefit on patients who are medically complex, and who require close clinical monitoring. The decrease in length-of-stay allows patients to get home more quickly, reduces the risk of iatrogenic complications, and reduces the cost associated with inpatient care.
The growth of Einstein/Montefiore’s hospitalist program has mirrored the growth of the field nationally. Over the past decade, practicing hospitalists have grown from just a few hundred to over 30,000. (For comparison, there are ~20,000 cardiologists and ~12,000 gastroenterologists in the U.S.) The American Board of Internal Medicine now allows hospitalists to maintain customized certification through the Recognition of Focused Practice (RFP) in hospital medicine program. It is projected that the numbers will continue to grow and that hospital medicine will eventually have a separate specialty board certification.
When admitted to the hospital, patients do not see the physician they have come to know through outpatient visits. When introducing myself to a newly admitted patient, I always take this issue head on. "I know I am an unfamiliar face to you. The downside is that you are just meeting me. The upside is that I am here all day, so if you need to talk to me, or your medical situation changes and I need to respond quickly, I’m right here." My experience has been that patients and their families understand this trade-off and think it is well worth it.
Hospitalists tend to have long discussions with patients and their families, typically several times per day for days in a row, often when the patient and family are in a time of crisis. Very strong bonds form; the human element of medicine is not lost. Published reports consistently show high patient satisfaction with the hospitalist model.
On the national scene, many academic medical centers are integrating their hospitalist programs with quality improvement and patient safety efforts. It is thought that hospitalists are likely to understand the power of improving systems, offer valuable advice about implementation and workflow, and represent a relatively small pool of faculty who can respond nimbly to emerging quality priorities.
It is likely that hospitalists will play a key role in the transformation of our healthcare system to one that is patient-centered, evidence-based, and safe.
William N. Southern, MD
Chief, Division of Hospital Medicine
Associate Professor of Clinical Medicine