Science Fair Project Encyclopedia
Hospital medicine is the general medical care of hospitalized patients. Doctors whose primary professional focus is hospital medicine are called hospitalists. Their activities may include patient care, teaching, research, and leadership related to hospital care. Hospital medicine is a specialty organized around a site of care (the hospital) rather than an organ (like cardiology), a disease (like oncology), or a patientís age (like pediatrics). However, unlike medical specialists in the emergency department or critical care units, hospitalists help manage patients throughout the continuum of hospital care, often seeing patients in the ER, following them into the critical care unit and organizing post-acute care.
About 78 percent of practicing hospitalists are trained in general internal medicine. Another 4 percent are trained in an internal medicine subspecialty, most commonly pulmonary or critical care medicine. About 3 percent of hospitalists are trained in family practice; about 8 percent are pediatricians and 2 percent are trained as med-peds. The remaining 5 percent of hospitalists are non-physician providers, usually nurse practitioners and physician assistants.
Hospitalists are a relatively new phenomenon in American medicine. Almost unheard of a generation ago, this type of practice arose from two powerful shifts in medical practice: restriction on housestaff hours and increasingly powerful disincentives to primary care physicians to continue to care for hospitalized patients. Nearly all states as well as the national residency accreditation organization have put restrictions on the hours house officers (interns and residents can work), effectively reducing by 10-25% the amount of inpatient coverage provided per resident. Many hospitalists perform the same tasks previously performed by residents. The second change, a shrinking role of primary care physicians in hospital care, arises from the ability of a primary physician to generate more revenue in an hour in the office as well as decreasing proportions of physicians in solo practice. If one member of a large group is delegated to make hospital rounds, most of the patients have already lost their familiar contact. As length of stay continues to shrink and average severity of illness rises, continual on-site availability has become increasingly necessary and it has become increasingly difficult for an office-based physician to effectively direct this.
Hospitalists represent one of the most rapidly increasing forms of medical practice in the US. Currently a large proportion of hospitalists are recently graduated residents continuing familiar duties for a few years. If this specialty evolves as emergency and intensive care medicine did, it will become a formal speciality with its own residencies and board certification within a decade or two. A few distinct residency and fellowship training programs are currently operating at major universities.
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