American College of Physicians: Internal Medicine — Doctors for Adults ®

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Will woes of management companies hurt hospitalists?

From the February 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Deborah Gesensway

From the fate of hospitalist-oriented practice management companies to evolving relationships with drug companies, the nation's inpatient physicians—also known as hospitalists—are watching several trends that may affect the growth of their profession.

Many of the dozen or so practice management companies that have sprung up in the past two years to employ hospitalist physicians appear to be struggling financially, according to John R. Nelson, FACP, co-president of the National Association of Inpatient Physicians (NAIP), an affiliate of ACP-ASIM, and founder of the hospitalist movement. Many of these companies modeled themselves on the organizations developed in the 1970s to supply emergency room physicians to hospitals. While those organizations were financially successful, Dr. Nelson said that hospitalist companies have struggled because they have encountered more opposition from local physician groups than companies supplying emergency medicine physicians.

Dr. Nelson noted that the failure or success of these companies could affect hospitalists' work arrangements and salaries. And while hospitalists tend to earn more than their colleagues in outpatient only or mixed primary care practice, Dr. Nelson said, there is talk that any decrease in demand may hurt pay for today's 3,000 to 3,500 practicing hospitalists.

In another development, drug companies appear to be increasingly interested in wooing hospitalists. In part, that's because hospitalists often sit on hospital formulary committees and are charged with choosing drugs not generally marketed directly to consumers. NAIP plans to examine exactly what sorts of relationships hospitalists should have with drug companies, Dr. Nelson said.

The following are other developments in hospitalist practice that will occur this year:

  • NAIP's second annual meeting will be held Wednesday, April 21, at the Morial Convention Center in New Orleans, the day before ACP-ASIM's Annual Session begins. The keynote speaker will be Christine K. Cassel, MACP, chair of the department of geriatrics and adult development at New York's Mt. Sinai Medical Center. Dr. Cassel is also a former ACP-ASIM President.
  • ACP-ASIM's research center is gathering data about different models of hospitalist practice, as well as generalist physicians' attitudes toward and experiences with hospitalists.
  • The Feb. 16 issue of Annals of Internal Medicine features a special supplement about hospitalism based on papers given at a national policy conference in San Francisco in December 1997.

For more information about hospitalists, the NAIP annual meeting and poster competition or other NAIP business, go to NAIP's Web site at www.naiponline.org.

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