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Are hospitalists suffering from an identity crisis?

From the June 2000 ACP-ASIM Observer, copyright 2000 by the American College of Physicians-American Society of Internal Medicine.

By Deborah Gesensway

PHILADELPHIA—Do hospitalists have an identity problem?

Charles Inlander, president of the Pennsylvania-based health care consumer group People's Medical Society, said that while he likes the concept of hospitalists, he hates the name. " 'Hospitalist' communicates zilch to people," he told the National Association of Inpatient Physicians (NAIP) at the group's meeting before Annual Session. "It sounds like you are an architect who builds hospital buildings. Get a new name, and then consumers will accept you."

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Mark V. Williams, FACP, director of inpatient physicians at Emory University School of Medicine in Atlanta, told the gathering that hospitalists need to concentrate on how to better describe themselves to the public. He said that more and more people are starting to see hospitalists as a tool of managed care to slash costs.

"It's potentially very dangerous" to the fledgling profession, Dr. Williams said. "Most people say, 'Huh?' when you say you are a hospitalist, but some people are starting to view us as a 'managed care hammer.' "

The hospitalist model that evolved in the late '90s faces a guilt-by-association problem. Because of the angst about managed care, the two have been naturally linked in the eyes of many physicians and some patients, said Robert M. Wachter, FACP, NAIP's new president and associate chairman of the department of medicine at the University of California, San Francisco. That perception has been compounded, he said, by the fact that most studies on hospitalist programs have shown that the new specialty can reduce costs and lengths-of-stay by up to 20%. He added that studies about the effect of hospitalist programs on the quality of care, on the other hand, have been slower to follow.

Dr. Wachter said that the NAIP will therefore spend the next year educating the public about hospitalists "so that when patients hear about us, they recognize our value. If we don't do that, the first message that people will get is that hospitalists equal cost reduction which equals managed care."

Very few hospitalists, in fact, work for managed care organizations. An NAIP survey found that about 10% of physicians who identify themselves as hospitalists are employed by health plans, and of those, most work at Kaiser Permanente facilities, Dr. Wachter said. Only about 2% of physicians surveyed by the NAIP and ACP—ASIM reported that mandatory hospitalist programs were operating in their community, he added. (NAIP is an affiliate of ACP—ASIM.)

"The word about hospitalists hasn't gotten out yet," he said. "When it does, we would like people to understand that in most cases, doctors are deciding that hospitalists make sense as a way to organize the care of sick people in hospitals."

And what about the idea of changing the name? As the man credited with coining the label "hospitalist" in a 1996 article in the New England Journal of Medicine, Dr. Wachter said he probably doesn't "think completely straight on this." But, he added, "I think 'hospitalist' and 'hospital medicine' describe what we do quite well."

Deborah Gesensway is a freelance writer in Abington, Pa.

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