Status of US Hospital Medicine Groups

The term hospitalist was coined in 1996 in an article1 that appeared in the New England Journal of Medicine. Robert M. Wachter, MD, and Lee Goldman, MD, of the University of California, San Francisco, defined hospitalists as hospital‐based physicians who take responsibility for managing medical inpatients. Hospitalists were described as having responsibility for seeing unassigned hospital patients and being available for in‐hospital consultations. Several years later, the Society of Hospital Medicine posted the definition of a hospitalist as someone whose primary professional focus is the medical care of hospitalized patientsin patient care, education, research, and administrative activities.

In January 2002, Wachter and Goldman published a follow‐up article,2 The Hospitalist Movement 5 Years Later, in the Journal of the American Medical Association. This formal review of 19 published studies analyzed the impact of hospital medicine groups on financial and clinical outcomes. Wachter and Goldman concluded, Empirical research supports the premise that hospitalists improve inpatient efficiency without harmful effects on quality or patient satisfaction. These studies indicate an average reduction of cost per stay of 13.4% and an average reduction in length of stay of 16.6%.

The evolution of the hospitalist movement has been fast paced and extensive. Given the recent pace of growth, a scholarly analysis estimated that the mature hospitalist workforce in the United States will eventually total 20,000, making it the equivalent of the cardiology specialty.3 Beyond sheer growth, medical literature has demonstrated positive effects of the hospitalist model on patient quality outcomes, including readmission rates, postoperative complications, and mortality.47

In addition to peer‐reviewed medical literature, there is anecdotal evidence about the growth and effects of the hospitalist movement:

• The Society of Hospital Medicine (SHM), the hospitalist professional society, estimated that in 2003 there were 8000 physicians practicing as hospitalists in the United States.8

• Twelve of the country's top 15 hospitals have hospital medicine groups.8

As hospital medicine groups have proliferated, 4 major employment models have evolved. Hospitalists can be employees of: 1) a hospital or a hospital subsidiary; 2) a multispecialty or primary care physician group; 3) a medical group (local or national) of independent hospitalists; or 4) a university or medical school. However, there is little published data on the prevalence of each of these hospitalist employment models, nationally or by type of hospital.

To better understand the extent and nature of the hospitalist movement, the American Hospital Association (AHA) utilized its 2003 Annual Survey to gather data on hospital medicine groups in the United States

DATA AND METHODS

The data for our analysis came from the 2003 AHA Annual Survey. Conducted since 1946, this survey is the principal data collection mechanism of the American Hospital Association and is a basic source of data on hospitals in the United States about the availability of services, utilization, personnel, finances, and governance. Its main purpose is to provide a cross‐sectional view of hospitals and hospital performance over time. In the 2003 survey, a series of items were added about hospitalists including whether hospitals had hospital medicine groups, the number of hospitalists operating in such groups, and the employment model used.

The study population for this analysis was limited to US community hospitals (n = 4895). Community hospitals are defined as all adult and pediatric nonfederal, short‐term general, and specialty hospitals whose facilities and services are available to the public. Excluded from the analysis were all federal hospitals, long‐term care hospitals, and psychiatric hospitals.

RESULTS

CONCLUSIONS

Hospital medicine groups appear to have become part of the mainstream delivery of health care. With more than 11 000 hospitalists, the specialty is equivalent in size to the gastroenterology medical specialty.9 Fifty‐five percent of hospitals with more than 200 beds have hospital medicine groups. Furthermore, it appears that the growth of the hospitalist movement has not peaked. It is likely that the number of hospitals with hospital medicine groups will increase and that existing hospital medicine groups will continue to add hospitalists.

No one employment model of hospital medicine group appears to dominate the health care landscape. We expect that there will continue to be diversity among the organizations that choose to establish hospital medicine groups.

In light of this growth and diversity, hospital medicine groups appear to be valued by a wide range of stakeholders in the health care industry. The potential benefits provided by hospitalists include financial savings, improved throughput efficiency, improved quality and safety, improved medical education, and better provider satisfaction.

Despite this success story, the hospitalist movement has maintained a relatively low profile among consumers and some segments of the health care industry. This is likely to change. As the hospital medicine specialty gains recognition, hospitalists will receive increased scrutiny and attention. This emerging specialty will need to be able to clearly define its role and document its performance in the constantly changing health care industry.

ADDENDUM

Subsequent to the acceptance of this manuscript, the authors received results of the 2004 Annual Survey of the American Hospital Association. Some highlights of the new data and comparisons to the 2003 results are as follows:

• The penetration of hospitals with hospital medicine groups grew from 29% to 34% (for hospitals with 200+ beds, the penetration grew from 55% to 63%)

• An estimated 1,661 hospitals have hospital medicine groups (an increase of 17% from 2003)

• The average size of a hospital medicine group decreased from 7.9 physicians to 7.5 physicians (a decrease of 5%)

• It is estimated that there are 12,504 hospitalists in the U.S. (an increase of 12% from 2003)

• Hospital medicine groups remain equally distributed among the three employment models: employees of hospitals 30%, employees of medical groups 29%, employees of independent hospitalist groups 29%

These updated results indicate strong hospitalist growth over the one year period and continued diversity among hospital medicine programs, reinforcing the conclusions of the manuscript.

The term hospitalist was coined in 1996 in an article1 that appeared in the New England Journal of Medicine. Robert M. Wachter, MD, and Lee Goldman, MD, of the University of California, San Francisco, defined hospitalists as hospital‐based physicians who take responsibility for managing medical inpatients. Hospitalists were described as having responsibility for seeing unassigned hospital patients and being available for in‐hospital consultations. Several years later, the Society of Hospital Medicine posted the definition of a hospitalist as someone whose primary professional focus is the medical care of hospitalized patientsin patient care, education, research, and administrative activities.

In January 2002, Wachter and Goldman published a follow‐up article,2 The Hospitalist Movement 5 Years Later, in the Journal of the American Medical Association. This formal review of 19 published studies analyzed the impact of hospital medicine groups on financial and clinical outcomes. Wachter and Goldman concluded, Empirical research supports the premise that hospitalists improve inpatient efficiency without harmful effects on quality or patient satisfaction. These studies indicate an average reduction of cost per stay of 13.4% and an average reduction in length of stay of 16.6%.

The evolution of the hospitalist movement has been fast paced and extensive. Given the recent pace of growth, a scholarly analysis estimated that the mature hospitalist workforce in the United States will eventually total 20,000, making it the equivalent of the cardiology specialty.3 Beyond sheer growth, medical literature has demonstrated positive effects of the hospitalist model on patient quality outcomes, including readmission rates, postoperative complications, and mortality.47

In addition to peer‐reviewed medical literature, there is anecdotal evidence about the growth and effects of the hospitalist movement:

• The Society of Hospital Medicine (SHM), the hospitalist professional society, estimated that in 2003 there were 8000 physicians practicing as hospitalists in the United States.8

• Twelve of the country's top 15 hospitals have hospital medicine groups.8

As hospital medicine groups have proliferated, 4 major employment models have evolved. Hospitalists can be employees of: 1) a hospital or a hospital subsidiary; 2) a multispecialty or primary care physician group; 3) a medical group (local or national) of independent hospitalists; or 4) a university or medical school. However, there is little published data on the prevalence of each of these hospitalist employment models, nationally or by type of hospital.

To better understand the extent and nature of the hospitalist movement, the American Hospital Association (AHA) utilized its 2003 Annual Survey to gather data on hospital medicine groups in the United States

DATA AND METHODS

The data for our analysis came from the 2003 AHA Annual Survey. Conducted since 1946, this survey is the principal data collection mechanism of the American Hospital Association and is a basic source of data on hospitals in the United States about the availability of services, utilization, personnel, finances, and governance. Its main purpose is to provide a cross‐sectional view of hospitals and hospital performance over time. In the 2003 survey, a series of items were added about hospitalists including whether hospitals had hospital medicine groups, the number of hospitalists operating in such groups, and the employment model used.

The study population for this analysis was limited to US community hospitals (n = 4895). Community hospitals are defined as all adult and pediatric nonfederal, short‐term general, and specialty hospitals whose facilities and services are available to the public. Excluded from the analysis were all federal hospitals, long‐term care hospitals, and psychiatric hospitals.

RESULTS

CONCLUSIONS

Hospital medicine groups appear to have become part of the mainstream delivery of health care. With more than 11 000 hospitalists, the specialty is equivalent in size to the gastroenterology medical specialty.9 Fifty‐five percent of hospitals with more than 200 beds have hospital medicine groups. Furthermore, it appears that the growth of the hospitalist movement has not peaked. It is likely that the number of hospitals with hospital medicine groups will increase and that existing hospital medicine groups will continue to add hospitalists.

No one employment model of hospital medicine group appears to dominate the health care landscape. We expect that there will continue to be diversity among the organizations that choose to establish hospital medicine groups.

In light of this growth and diversity, hospital medicine groups appear to be valued by a wide range of stakeholders in the health care industry. The potential benefits provided by hospitalists include financial savings, improved throughput efficiency, improved quality and safety, improved medical education, and better provider satisfaction.

Despite this success story, the hospitalist movement has maintained a relatively low profile among consumers and some segments of the health care industry. This is likely to change. As the hospital medicine specialty gains recognition, hospitalists will receive increased scrutiny and attention. This emerging specialty will need to be able to clearly define its role and document its performance in the constantly changing health care industry.

ADDENDUM

Subsequent to the acceptance of this manuscript, the authors received results of the 2004 Annual Survey of the American Hospital Association. Some highlights of the new data and comparisons to the 2003 results are as follows:

• The penetration of hospitals with hospital medicine groups grew from 29% to 34% (for hospitals with 200+ beds, the penetration grew from 55% to 63%)

• An estimated 1,661 hospitals have hospital medicine groups (an increase of 17% from 2003)

• The average size of a hospital medicine group decreased from 7.9 physicians to 7.5 physicians (a decrease of 5%)

• It is estimated that there are 12,504 hospitalists in the U.S. (an increase of 12% from 2003)

• Hospital medicine groups remain equally distributed among the three employment models: employees of hospitals 30%, employees of medical groups 29%, employees of independent hospitalist groups 29%

These updated results indicate strong hospitalist growth over the one year period and continued diversity among hospital medicine programs, reinforcing the conclusions of the manuscript.

The term hospitalist was coined in 1996 in an article1 that appeared in the New England Journal of Medicine. Robert M. Wachter, MD, and Lee Goldman, MD, of the University of California, San Francisco, defined hospitalists as hospital‐based physicians who take responsibility for managing medical inpatients. Hospitalists were described as having responsibility for seeing unassigned hospital patients and being available for in‐hospital consultations. Several years later, the Society of Hospital Medicine posted the definition of a hospitalist as someone whose primary professional focus is the medical care of hospitalized patientsin patient care, education, research, and administrative activities.

In January 2002, Wachter and Goldman published a follow‐up article,2 The Hospitalist Movement 5 Years Later, in the Journal of the American Medical Association. This formal review of 19 published studies analyzed the impact of hospital medicine groups on financial and clinical outcomes. Wachter and Goldman concluded, Empirical research supports the premise that hospitalists improve inpatient efficiency without harmful effects on quality or patient satisfaction. These studies indicate an average reduction of cost per stay of 13.4% and an average reduction in length of stay of 16.6%.

The evolution of the hospitalist movement has been fast paced and extensive. Given the recent pace of growth, a scholarly analysis estimated that the mature hospitalist workforce in the United States will eventually total 20,000, making it the equivalent of the cardiology specialty.3 Beyond sheer growth, medical literature has demonstrated positive effects of the hospitalist model on patient quality outcomes, including readmission rates, postoperative complications, and mortality.47

In addition to peer‐reviewed medical literature, there is anecdotal evidence about the growth and effects of the hospitalist movement:

• The Society of Hospital Medicine (SHM), the hospitalist professional society, estimated that in 2003 there were 8000 physicians practicing as hospitalists in the United States.8

• Twelve of the country's top 15 hospitals have hospital medicine groups.8

As hospital medicine groups have proliferated, 4 major employment models have evolved. Hospitalists can be employees of: 1) a hospital or a hospital subsidiary; 2) a multispecialty or primary care physician group; 3) a medical group (local or national) of independent hospitalists; or 4) a university or medical school. However, there is little published data on the prevalence of each of these hospitalist employment models, nationally or by type of hospital.

To better understand the extent and nature of the hospitalist movement, the American Hospital Association (AHA) utilized its 2003 Annual Survey to gather data on hospital medicine groups in the United States

DATA AND METHODS

The data for our analysis came from the 2003 AHA Annual Survey. Conducted since 1946, this survey is the principal data collection mechanism of the American Hospital Association and is a basic source of data on hospitals in the United States about the availability of services, utilization, personnel, finances, and governance. Its main purpose is to provide a cross‐sectional view of hospitals and hospital performance over time. In the 2003 survey, a series of items were added about hospitalists including whether hospitals had hospital medicine groups, the number of hospitalists operating in such groups, and the employment model used.

The study population for this analysis was limited to US community hospitals (n = 4895). Community hospitals are defined as all adult and pediatric nonfederal, short‐term general, and specialty hospitals whose facilities and services are available to the public. Excluded from the analysis were all federal hospitals, long‐term care hospitals, and psychiatric hospitals.

RESULTS

CONCLUSIONS

Hospital medicine groups appear to have become part of the mainstream delivery of health care. With more than 11 000 hospitalists, the specialty is equivalent in size to the gastroenterology medical specialty.9 Fifty‐five percent of hospitals with more than 200 beds have hospital medicine groups. Furthermore, it appears that the growth of the hospitalist movement has not peaked. It is likely that the number of hospitals with hospital medicine groups will increase and that existing hospital medicine groups will continue to add hospitalists.

No one employment model of hospital medicine group appears to dominate the health care landscape. We expect that there will continue to be diversity among the organizations that choose to establish hospital medicine groups.

In light of this growth and diversity, hospital medicine groups appear to be valued by a wide range of stakeholders in the health care industry. The potential benefits provided by hospitalists include financial savings, improved throughput efficiency, improved quality and safety, improved medical education, and better provider satisfaction.

Despite this success story, the hospitalist movement has maintained a relatively low profile among consumers and some segments of the health care industry. This is likely to change. As the hospital medicine specialty gains recognition, hospitalists will receive increased scrutiny and attention. This emerging specialty will need to be able to clearly define its role and document its performance in the constantly changing health care industry.

ADDENDUM

Subsequent to the acceptance of this manuscript, the authors received results of the 2004 Annual Survey of the American Hospital Association. Some highlights of the new data and comparisons to the 2003 results are as follows:

• The penetration of hospitals with hospital medicine groups grew from 29% to 34% (for hospitals with 200+ beds, the penetration grew from 55% to 63%)

• An estimated 1,661 hospitals have hospital medicine groups (an increase of 17% from 2003)

• The average size of a hospital medicine group decreased from 7.9 physicians to 7.5 physicians (a decrease of 5%)

• It is estimated that there are 12,504 hospitalists in the U.S. (an increase of 12% from 2003)

• Hospital medicine groups remain equally distributed among the three employment models: employees of hospitals 30%, employees of medical groups 29%, employees of independent hospitalist groups 29%

These updated results indicate strong hospitalist growth over the one year period and continued diversity among hospital medicine programs, reinforcing the conclusions of the manuscript.