All Hospitals Could Benefit from Hospitalist Programs, Say Advocates

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Hospitalist programs could help all types of institutions, according to speakers at the pre-course of the Society of Hospital Medicine (SHM) annual meeting in Washington, DC Thursday.

"I couldn't think of one institution that wouldn't benefit from [a hospitalist program]; it's pretty universal," said Martin B. Buser, MPH, FACHE, partner at Hospitalist Management Resources, LLC, in San Diego, CA.

All institution types—large, small, urban, rural, community, teaching—could see advantages from implementing a hospitalist program, Buser added. Residency caps have contributed to an overflow of patients, which is one reason why the hospital medicine movement is considered the fastest growing medical specialty.

Despite variations in institution size, the need for hospitalists exists everywhere, according to Buser. With growing numbers of patients, resident duty hour restrictions, and reduced primary care physician time in the hospital, many institutions have turned to the hospital medicine model as a solution.

Despite similar needs, the infrastructure will be different depending on the institutional.

"It's crucial to get this right," said John Nelson, MD, FACP, FHM, medical director of the hospitalist practice at Overlake Hospital Medical Center in Bellevue, WA, and founder of Nelson/Flores Associates. The infrastructure of the hospitalist program should be balanced in workload, billing responsibilities, patient care, and even a social life, according to Nelson.

The most important thing before taking the dive of starting a hospitalist program is good leadership, including a medical director who acts as a champion for the program, Buser said. The hospital and the medical director can establish expectations for the program, and, therefore, set staffing levels to meet those needs.

New programs might fail if they are too ambitious and take on too many patients from multiple specialties all at once. Instead, Buser recommended setting the priorities for which patients hospitalists will take on first.

Even if practice administrators make the decision to utilize hospitalists, there's still the question of whether to employ or outsource to contract hospitalists. Most practices with hospitalists are employed by the hospital (40%), according to the SHM 2007-2008 Biannual Survey. Another 14% use local hospitalist-only groups.

For those starting new programs, there's no best employment model, said Buser. For those who aren't familiar with the hospital medicine concept, it might be better to outsource instead of directly employ, he added.

So when is the best time to start? There's no better time than now to start considering a hospitalist program, according to Buser.

"Years ago, we had more time because it was a foreign concept. Now, it's becoming a point of 'we want it yesterday,'" he said.

In fact, nearly half (44%) of hospitals without hospitalist programs planned to implement one within the next two years, according to a January Journal of Hospital Medicine study of surveyed CEOs, COOs, CMOs, vice presidents of medical affairs, and medical directors.

"The biggest challenge for hospitalist programs is accommodating for growth," Buser said about trying to stay ahead of the curve. "A conservative approach never pays off. It's always better to be a little overstaffed. The volume will come," he said.

Karen M. Cheung is an associate editor for HCPro, contributing writer for HealthLeaders Media, and blogger for She can be contacted at