Hospital medicine

Hospital medicine in the United States is the discipline concerned with the medical care of acutely ill hospitalized patients. Physicians whose primary professional focus is hospital medicine are called hospitalists; this type of medical practice has extended beyond the US into Canada.

The term hospitalist was first coined by Robert Wachter and Lee Goldman in a 1996 New England Journal of Medicine article. The scope of hospital medicine includes acute patient care, teaching, research, and executive leadership related to the delivery of hospital-based care. Hospital medicine, like emergency medicine, is a specialty organized around a site of care (the hospital), rather than an organ (like cardiology), a disease (like oncology), or a patient’s age (like pediatrics). A similar field, acute medicine, has recently developed in the United Kingdom.

Hospitalists are physicians with a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree. While it was commonly believed that any residency program with a heavy inpatient component provided good hospitalist training, studies have found that general residency training is inadequate because common hospitalist problems like neurology, hospice and palliative care, consultative medicine, and quality improvement tend to be glossed over. To address this, residency programs are starting to develop hospitalist tracks with more tailored education. Several universities have also started fellowship programs specifically geared toward hospital medicine.

According to the State of Hospital Medicine Survey by the Medical Group Management Association and the Society of Hospital Medicine, 89.60% of hospitalists specialize in general internal medicine, 5.5% in a pediatrics subspecialty, 3.7% in family practice and 1.2% in internal medicine pediatrics. Data from the survey also reported that 53.5% of hospitalists are employed by hospitals/integrated delivery system and 25.3% are employed by independent hospitalists groups.

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