As the American health care system continues to evolve under the pressure of managed care and increasing competition, a rapidly emerging specialty promises to make fundamental changes in the way hospitalized patients receive care.

The purpose of the new system is to ensure better care for patients by putting one doctor--who works in the hospital full-time--in charge of their care. Primary care doctors--who in the past would have managed their patients in the hospital--are freed under this new model to focus on caring for patients in their offices and clinics.

The growing role of the new breed of specialist, given the name “hospitalist” by a pair of UCSF researchers instrumental in identifying and defining the trend, will be the subject of a two-day conference Dec. 5 and 6 at the Mark Hopkins Hotel in San Francisco. More than 500 are expected to attend.

“The Emerging Role of Hospitalists in American Health Care: A National Conference” will bring together national health policy experts, health maintenance organizations and other medical industry representatives, academic researchers and other health care leaders. (See speakers and topics)

The conference is sponsored by the UCSF Department of Medicine and supported by a grant from the US Agency for Health Care Policy and Research.

“The growing reliance on hospitalists has become a focus of health policy experts over the past year, and I think the general public is on the verge of realizing that a change is taking place in the way they receive hospital care,” says conference chair Robert M. Wachter, MD, UCSF associate professor of medicine and epidemiology and associate chair of the department of medicine.

Within the next two years, Wachter predicts the hospitalist model will become the predominant form of hospital care throughout the country, as it already has become in San Francisco, San Diego, and Minneapolis.

Wachter and Lee Goldman, MD, UCSF professor of medicine and chair of the UCSF Department of Medicine, wrote the defining article in the August 15, 1996 edition of the New England Journal of Medicine on the trend toward the use of hospital-based physicians specializing in the care of inpatients. In the article, Wachter and Goldman coined the term hospitalist.

“This is an example of the newly competitive health care market forcing the system to re-examine traditional ways of providing medical care. The model it has produced appears to reduce costs without compromising quality of care, patient satisfaction, doctors’ satisfaction, or medical teaching,” Wachter says.

Advantages of the hospitalist model include greater expertise of the hospital-based specialists and their ability to follow a patient’s progress throughout the day, he notes.

While a typical primary care doctor may supervise the care of one or two hospitalized patients as part of their day, a hospitalist generally cares for about 20 hospitalized patients on a full-time basis.

The primary care doctor, as a result, may see fewer than five patients annually suffering from any one condition requiring hospitalization. The hospitalist may care for as many as 50 patients annually who suffer from the same condition.

“The increased expertise born of the greater experience of hospitalists coupled with their greater availability makes a compelling argument for the new model,” Wachter says.

Results of research studies examining medical outcomes, patient satisfaction, and cost savings of the hospitalist system will be discussed at the conference. The studies have been conducted at UCSF, Kaiser Permanente in Northern California, and the Park Nicollet Clinic in Minneapolis.

By Bill Gordon

1st appeared 11/20/97

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