Are hospitalists to be the change agents for universal medical coverage?

Some would argue that various economic forces coalesced to animate and catalyze the hospitalist movement. This report from the national hospitalist meeting would indicate that Dr. Berwick,of safety fame has lofty goals for the nation's hospitalists whatever the "follow-the-money" reasons may have been for their birth.

Delivering the first keynote address at the meeting of the Society of Hospital Medicine (SHM)Dr. Berwick speaks of the need for a financial management system, public health initiative and universal access to medical care. He would have hospitalists as the integrators of this new system focusing their boundless energy on what he call the triple aims which are:

1)the experience of care (safety and quality)
2)the per capita cost of care,
3)population health

I would hope that my hospitalist will provide good care ( o.k., call it high quality and we certainly hope it is safe-remember first do no harm.) And I hope the second aim won't trump the first. I wonder when she will have time to also fix- or at least improve- population health.

I imagine that many internists choose the hospitalist role because it provided an opportunity to spend much of their professional time doing what they were mainly trained to do-take care of complex,complicated, very sick patients-while having regular hours,no call and relative to what internists incomes have become a fairly good income. Dr. Berwick would like to task them to do much more than "simply" take the best care they know how for each individual patient and to act primarily in the interest of the patient; he wants hospitalists working for the common good. Will the number 2 and number 3 goals above conflict with the primary fiduciary duty of the physician to his patient?

Pleas and exhortations to work for the greater good and eschew one's own interests for a greater interests somehow never really change human nature or reality. The reality is that after you put in your shift at the hospital and devote as much time as many do in their off hours to trying to keep up with the medical literature there may be little time or energy left to rebuilt the system in Dr. Berwick's or anyone else's vision.