Dr. Robert Wachter, Professor of Medicine at UCSF, gave a "state of hospital medicine" address at the annual meeting of the Society of Hospital Medicine (SHM). Wachter listed 3 reasons he believes hospital administrators will continue to promote the hospitalist movement; resident work-load limits, nurse shortage and retention and hospital efficiency (the through-put issue).
The first is only an issue in academic hospitals which is a tiny minority of the country's hospitals, the second is a issue that only time will tell. We do not know if hospitalists will help nurse retention and I am not sure why that would be the case. Working conditions and salary are major issues with all who work and I don't quite see how salaries would change and working conditions are more under the control of hospital administrators than the doctors. If hospital administrators want more nurses they should pay them more money, that makes more sense than hiring hospitalists.
The third reason is probably the driver which is in keeping with the rarely wrong follow-the-money concept. Administrators want hospital beds filled-briefly-with surgical patients. They want Medicare patients with medical illnesses out of the hospital as soon as possible. This what is meant by efficiency. That is where the profits lie. I have talked before about the degree to which salaried hospitalists may be conflicted with that imperative. It will continue to be a empirical question whether hospitalists make more money for the hospitals than they cost. If they make more, the trend will grow. Talk about efficiency seemed louder than talk about quality of care. Thomas Sowell says if you want to see what a organization is all about, do not look to their stated goals or values but rather to their incentives and constraints. I cannot believe that through-put concern of hospital administrators is all about quality.
Another speaker, Dr. Tom Baudendistal used the term "ambulist" in his statement that hospitalists were ideally suited to the role of "championing efficient care". I mention that seemingly self serving statement only to point out the neologism.
Another item which could be a sign of the success of the hospitalist movement is that reports are appearing of burnout.
Kevin, MD has a post linking to a Chicago Tribune article regarding some of the pros and cons of the hospitalist movement and speaks of the economic forces driving the movement.