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Do We Need a New Specialty: Hospitalist?
Richard L. Reece, MD
As our society ages, the cost of caring for the sick is becoming more nettlesome. Even if we cut hospital utilization drastically, hospitals would remain expensive critical care units, consuming a disproportionate amount of resources. In fact, they should consume more resources than other settings because, despite what critics say, hospitals are the best place to treat the seriously ill. Indeed, the current trend to enroll more Medicare and Medicaid patients into HMOs exacerbates this problem as more of the aged, poor, and disabled flood into hospitals.
The problem, of course, is that caring for these people efficiently and humanely without busting capitated budgets requires specialized skills. Perhaps the answer lies in fostering a new breed of physician, a “hospitalist,” a specialist or generalist dedicated to inpatient care. Such a new breed of specialist is evolving in mature managed care markets, according to an article, “The Emerging Role of ‘Hospitalists’ in the American Health Care System,” in the New England Journal of Medicine, Aug. 15. Written by Robert M. Wachter, MD, and Lee Goldman, MD, of the University of California, in San Francisco, the article states that hospitalists generally are members of multispecialty groups and have the responsibility of managing inpatient care. Anecdotal reports from mature capitated markets, such as California and Minnesota, indicate that hospitalists decrease length of stay, hospital costs, and specialty consultations.
Since heavy costs are incurred during intensive hospital stays, hospital administrators in markets with high levels of managed care recognize that an experienced specialist—or hospitalist—can help manage care appropriately while keeping costs down. The best of this new breed knows whom to admit, whom to return to primary care, how to be cost-conscious, how to manage critically ill patients, when to discontinue needless treatment, how to develop effective practice guidelines ....
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