Is there a
HOSPITALIST
in the house?

A new breed of specialist is revolutionizing
hospital care, benefiting patients and their
primary care physicians.

BY DANIEL SIEGEL

“A hospitalist who spends all of his or her time in the hospital would seem to be ideally suited for the unique needs of an acutely ill inpatient.”

MARK S. THOELKE, MD

A FEW YEARS AGO, the word “hospitalist” was not in common usage. Today, the term has emerged in the medical vernacular and in dialogues across the country. Hospitalists—physicians who specialize in inpatient care—are practicing in hospitals nationwide and have found a home at the School of Medicine.

Created in August 2000, the division of hospitalist medicine at Washington University has grown from a staff of five physicians to 11. Increasing demand for their services, as well as an expanding role at the university, has sparked the division’s rapid growth.
Washington University’s hospitalist physicians render many services at Barnes-Jewish Hospital (BJH): They monitor inpatients who don’t have primary care physicians, act as attending physicians on the oncology service, and provide a hospital-wide consult service to fellow physicians.

But, primarily, hospitalists treat patients referred to the BJH hospitalist service by their primary care physicians. Doing so allows referring physicians to leave their hospitalized patients in the care of knowledgeable doctors familiar with the hospital who can be reached 24 hours a day.

Mark S. Thoelke, MD, clinical director of the division of hospitalist medicine, talks with patient Willie E. Cox.

Relatively new in the United States, the hospitalist trend has its roots in the United Kingdom and Canada. The need for hospitalists in the United States has arisen from changes in medical practice over the past few decades.

In the mid-1970s, an average physician had about 10 hospitalized patients at any given time and spent about 30 to 40 percent of the day visiting those inpatients. In today’s era of managed care, physicians have fewer inpatients and therefore spend less time at the hospital.

According to Mark S. Thoelke, MD, clinical director of the hospitalist service and assistant professor of medicine, today’s physicians are refocused away from the hospital and into the outpatient clinic. Consequently, commuting to and from the hospital has become less cost- and time-efficient. As primary care physicians spend less time visiting hospital patients, the demand for inpatient physicians has increased.

Because hospitalist physicians do not maintain an outpatient practice, they spend 100 percent of their time in the hospital setting, where they treat a wide range of patient populations and are equipped to provide the best possible hospital care.

Says Thoelke: “A hospitalist who spends all of his or her time in the hospital would seem to be ideally suited for the unique needs of an acutely ill inpatient.”

Hospitalists’ around-the-clock care comforts patients with the knowledge that a physician will be available for them when needed. Furthermore, because hospitalists are familiar with each patient’s case, they can provide continuous updates to concerned family members.

By serving as an easily accessible, centralized resource for information and patient care, hospitalists manage, in some cases, to reduce length of inpatient stay and, at the same time, improve quality of treatment.

Medical student Jonathan Dorff and hospitalist Myra L. Rubio, MD, instructor of medicine.

Referring physicians also benefit. The hospitalist service allows a patient’s primary care physician to concentrate on the needs of outpatients, secure in the knowledge that a qualified physician is caring for his inpatients. This does not mean, however, that there is a loss of communication between referring doctors and their patients. One of a hospitalist’s responsibilities is to ensure continuity of care by keeping patients’ primary care physicians informed of any changes in their conditions.

Although at first skeptical about the merits of the hospitalist program, internist Melvin J. Butler, MD, instructor of clinical medicine, now regularly refers patients to the BJH hospitalist service.

“I cannot praise the hospitalist program enough,” Butler says. “Its wonderful service manages to increase hospital efficiency while at the same time improve the quality of care. The program is certainly a benefit to anyone who uses it.”

According to Thoelke, patients and physicians using the service for the first time are soon won over by the program’s benefits.

“We have had extremely positive feedback from patients and their families,” he says. “We also have surveyed the physicians who refer to our service and their responses have been equally strong.”

Aside from inpatient care, hospitalist physicians also are dedicated to research and teaching. Patient-based clinical trials they conduct are aimed at improving the quality of care provided within the hospital system.

For example, national studies have shown that the ineffectiveness of diagnosing and treating osteoporosis in elderly patients is a problem that exists in hospitals throughout the country, according to Thoelke. But, he says, recent research done by hospitalists at Washington University and Barnes-Jewish Hospital has shown that hospitalists do a better job in such areas where quality is lacking.

The university’s hospitalists also play an important teaching role. Whether on an inpatient ward, medical oncology service, or providing advice elsewhere in the hospital, hospitalist physicians work closely with medical students and residents.

“Because we are so involved with students, we have attracted a faculty that is very interested in teaching,” says Thoelke. “Teaching the next generation of doctors keeps us up to date on what’s new in hospital medicine. That, in turn, helps us provide the best possible care for our patients.”