Hospital medicine
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Hospital medicine in the United States is the discipline concerned with the general medical care of hospitalized patients. Physicians, physician assistants, and nurse practitioners 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 Dr. John Nelson and Dr. Win Witcombe who founded the National Asscociation of Inpatient Physicians. Dr. Robert Wachter mention the name "Hospitalists" in 1996 New England Journal of Medicine article.[1] Hospitalist activities may include patient care, teaching, research, and leadership related to hospital 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).
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[edit] Training
The majority of hospitalists are physicians with a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree[2]. 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 assurance 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 hospitalist medicine.
According to the Society of Hospital Medicine's(SHM) recent analysis of data from the 2007 American Hospital Association (AHA) survey, there are currently 28,000 practicing hospitalists in the United States. These hospitalists practice in approximately half of the nation's community hospitals.[3]
[edit] History
Hospital medicine is a relatively new phenomenon in American medicine. Almost unheard of a generation ago, this type of practice arose from three powerful shifts in medical practice:
- Nearly all states, as well as the national residency accreditation organizations, the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA), have established limitations on house staff duty hours, the number of hours that interns and residents can work. This effectively reduces by 10-25% the amount of inpatient coverage provided per[citation needed]. Many hospitalists are coming to perform the same tasks formerly performed by residents; although this is usually referred to as a House Officer rather than a Hospitalist[citation needed].
- Most primary care physicians are experiencing a shrinking role in hospital care. Many primary care physicians find they can generate more revenue in the office during the hour or more they would have spent on inpatient rounds, including traveling to and from the hospital[citation needed].
Hospitalists represent one of the most rapidly growing forms of medical practice in the US. Currently a large proportion of hospitalists are recently-graduated residents, who continue familiar duties for a few years. As residency programs are encouraged to limit inpatient duty hours and provide more outpatient education, this pattern may shift. 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[citation needed].
In addition to patient care duties, hospitalists are often involved in developing and managing aspects of hospital operations such as inpatient flow and quality assurance. The formation of hospitalist training tracks in residency programs has been driven in part by the need to educate future hospitalists about business and operational aspects of medicine, as these topics are not covered in traditional residencies[citation needed].
[edit] American Board of Hospital Medicine
The American Board of Hospital Medicine (ABHM), a Member Board of the American Board of Physician Specialties (ABPS), the nation’s third largest physician multispecialty certifying organization, was founded in 2009. The ABHM is North America’s first and only board of certification devoted exclusively to hospital medicine --- founded by hospitalists and governed by hospitalists.
The term “hospitalist” refers to physicians whose practice emphasizes providing care for hospitalized patients. The term was coined by Drs. Robert Wachter and Lee Goldman in a New England Journal of Medicine article in August 1996.
According to ABHM Chair, Dr. Thomas G. Pelz, a hospital based physician at Boscobel (Wisconsin) Area Health Care, “The American Board of Physician Specialties recognizes the vital role that hospitalists play in the delivery of health care in the United States and Canada. Hospital medicine is one of the fastest growing and most dynamic medical specialties in North America and the ABPS is excited about taking the lead in the formation of the American Board of Hospital Medicine.”
Canadian ABHM board member, Dr. Luay Dindo of Surrey, British Columbia, said, “The ABHM is not a subspecialty of another board of certification but a fully fledged, comprehensive board in hospital medicine. I believe that hospital medicine is its own specialty and necessitates a board of certification reflecting that fact.”
The ABHM’s founding American and Canadian physician leaders represent Diplomates from the ABPS, the American Board of Medical Specialties (ABMS), and the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS).
In its 58th year, the American Association of Physician Specialists, Inc. (AAPS), and its official certifying body, the American Board of Physician Specialties (ABPS), is one of three nationally recognized multispecialty medical organizations overseeing physician certification. It assists its 15 Member Boards in their efforts to develop and implement educational and professional standards for the evaluation and certification of physician specialists. The AAPS is a not-for-profit organization headquartered in Tampa, Florida. For more information please visit www.abpsus.org or www.abhmus.org[citation needed].
[edit] Society of Hospital Medicine
After Dr. Robert Watcher and Dr. Lee Goldman coined the term “hospitalist” in a 1996 New England Journal of Medicine article, the National Association of Inpatient Physicians (NAIP) was founded to support this newly recognized distinct field of internal medicine. In 2003, NAIP officially changed its name to the Society of Hospital Medicine (SHM), who continues to be the only medical society devoted solely to hospitalists and the growing hospital medicine movement. SHM is committed to promoting excellence in the practice of hospital medicine through education, advocacy and research.
Today, the SHM is the largest organization in the nation representing hospitalists and leading this growing population to offer the highest quality care for all hospitalized patients, as well as offering support and resources to hospitalists’ practices. SHM provides continuing medical education opportunities (CMEs) and physician practice management support for hospitalists in order to successfully care for patients. With the expected growth within the decade of the hospitalist population to reach 33,000, SHM provides a medium for the latest hospital medicine industry updates, useful medical technology, and a forum for professional networking and community.
SHM is the only organization in hospital medicine to offer a Fellow in Hospital Medicine (FHM) designation for hospitalists who have devoted significant time, quality of care and training to their field. “Hospitalists have been asking for a unique designation that clearly identifies those physicians whose career is committed to hospital medicine,” said Dr. Larry Wellikson, MD. “A fellowship program was the natural next step. Hospitalists who earn their FHM designation will have a demonstrated commitment to hospital medicine, systems change, and quality improvement principals.” To qualify for the FHM designation, a hospitalist must be practicing and have involvement in the industry movement, as well as demonstrate their dedication to quality and process improvement, commitment to organizational teamwork and leadership, as well as lifelong learning and education.
[edit] References
- ^ Wachter R, Goldman L (1996). "The emerging role of "hospitalists" in the American health care system". N Engl J Med 335 (7): 514–7. doi:. PMID 8672160.
- ^ New Kinds of Primary Care, O The Oprah Magazine March 2009
- ^ New Study Finds Over Half Of US Hospitals Utilize Hospitalists, Medical News Today January 09, 2009
