The American healthcare system is in a period of rapid flux and transition. Having reached a crisis point as far as the ability to extend care to millions of uninsured and underinsured patients, while still trying to provide the best medical care possible for all people who need it, the system and its overworked doctors in the hospital and in primary care have struggled to find a way to patch things up.

Chris Nussbaum, MD

Enter the hospitalist—medicine's newest specialist. What do hospitalists do, and how are they helping to increase the quality of care at hospitals?

Patient-Focused Care

In the same way that a cardiologist is a medical doctor who pursues advanced, specialized study into diseases and behaviors of the heart, a hospitalist is a specialist trained in how to ensure that a patient gets the best care and the best treatment from the hospital institution.

Whereas hospitalist programs have been standard in many European countries, this practical method of ensuring dedicated care for patients has only recently taken the American hospital system by a storm.

A hospitalist is a specialist at hospital medicine, a doctor whose office is the hospital itself and who focuses intensely and completely on patient care at every stage of a person's hospital visit.

The majority of hospitalists (about 80%) have been trained in general internal medicine, with the vast majority of them trained in critical and pulmonary care. A hospitalist is a doctor who specializes in navigating the ins and outs of the hospital system and understands the specific challenges and struggles that patients, and their family members, face during a hospital stay.

Hospitalists are intimately familiar with the specialists, nurses, and management members that will provide treatment and can help eliminate communication errors between several treating doctors, or bureaucratic mistakes, while ensuring effectiveness and concern.

Hospitals with hospitalists let primary care physicians keep to their private practices, ensuring that the doctors that provide care at a hospital level have only one thing on their mind: the patient.

Getting Results

The patients for whom hospitalists are most able to provide a substantial increase in both care and cost-savings to the hospital are those who have no medical insurance, and people who therefore have no primary care physician in the first place. In this instance, hospitalists are able to ensure good care"*"shepherding people through the hospital's doors who otherwise would be adrift and confused, shuffled from one overworked resident to another.

In addition, hospitalists have been shown to be excellent at outreach for other patients, for whom it has been often difficult to find physicians to provide long-term care, such as people in nursing homes or in other institutions. Hospitalists can be a permanent solution to the problem of in-patient and emergency room care for such patients.

But hospitalists are equally adept at dealing with the most run-of-the-mill hospital cases, and helping to eliminate the red tape and mess that can plague a visit. When people are at their sickest and most vulnerable state, the last thing they want to be worried about is the bill, and whether the doctor treating them is well experienced or not. Hospitalists seek to ensure professionalism and ease the burden of hospital-related worries.

The hallmarks of a quality hospitalist stay involve high levels of patient satisfaction, shorter hospital stays, less variable cost, and better management of a person's transition from the in-patient to an outpatient environment.

Freeing the office-based physician to focus on walk-in patients, the hospitalist physician leads and harmonizes in-patient care as an extension and enhancement of the service that a primary physician provides.

Adapting to Change

With incredible advances in information-sharing technology always looming, the hospitalist makes more sense than ever. The person who knows how to get the best care out of a hospital should be the person treating its patients. A mechanic who has to learn how to use his tools every time he wants to fix a car will cost a lot more than a mechanic who is intimately familiar with all of the available machinery.

The Society for Hospital Medicine is celebrating its 10th anniversary this year, and the number of hospitalists in America keeps climbing. Hospitalists are able to deliver the kind of hands-on, effective care for patients who have been admitted that other specialists crave.

As the healthcare system continues to grow and evolve, the future looks bright for hospitalists, hospitals, and patients alike. Fulfilling an important niche, hospitalists will be around for a long time"*"making sure that hospitals themselves are the apex of care and attention, staffed by the best and brightest.

Dr Nussbaum is CEO of Synergy Medical Group, PA, an independent hospitalist group in Tampa Bay, Fla.