If you or a loved one has spent time in the hospital recently, you’ve likely encountered a doctor called a hospitalist. And there’s a good chance you may not have fully understood who these doctors are or what they do.
A hospitalist is a physician who cares for inpatients, meaning they only work inside a hospital. These doctors have often completed residency training in general internal medicine, pediatrics, neurology, obstetrics and gynecology, or oncology. They may also be board-certified in hospital medicine. Hospitalists provide timely attention to all your needs, including diagnosis, treatment, and coordination of care across the many specialists you might see during your stay.
Because they only work in this setting, hospitalists know how to navigate the hospital staff and protocols, and they are experts in treating the most common conditions that bring people to the hospital. You can think of a hospitalist as an in-house, temporary primary care physician focused on your care while you are hospitalized. Though hospitalists sometimes get to know their patients well, they do not continue to care for them after discharge.
And just as the rest of medicine becomes increasingly specialized, the same applies to hospital medicine. Now, more medical subspecialists, including gastroenterologists, are choosing to work primarily in hospitals.
We talked with several Yale Medicine hospitalists to better understand what they do and how this specialty came to be. Below are answers to commonly asked questions.
How did the hospitalist field come about?
The primary care physician (PCP) has evolved from doctors who carried black leather bags and made house calls to physicians who work in offices. Office-based physicians would also often check on their patients in the hospital if they ended up there during an emergency, had a surgical procedure, or were undergoing treatment by a specialist.
By the early 1990s, with administrative tasks piling up and life, in general, growing more complicated, over-burdened PCPs were finding it increasingly difficult to visit their hospitalized patients either before or after a long day of seeing people in their offices. Meanwhile, as hospitals reorganized in a continual effort to improve inpatient care, leaders realized it made sense to have in-house doctors who were general but specialized in taking care of hospitalized patients.
The term “hospitalist” was first coined by two physicians who wrote about hospital-based physicians in The New England Journal of Medicine in 1996. It caught on quickly. The number of practicing hospitalists has grown to more than 50,000, making it the fastest-growing medical specialty in the United States.
Does a hospitalist have different skills than a PCP?
The medical training and skills of a hospitalist and a PCP are the same. The difference is the setting in which they practice medicine. Hospitalists work solely in hospitals and are, therefore, more familiar with common hospital tests and procedures, as well as hospital-related conditions like hospital-acquired pneumonia.
“They will also know the most up-to-date infection-control standards and protocols for the hospital, which is important,” says Thomas Donohue, MD, a Yale Medicine cardiologist and director of the Hospitalist Service at Yale New Haven Hospital.
A hospitalist will only see you for the length of your hospital stay. When you are discharged, you will return to the care of your PCP. One way to think of the difference between a hospitalist and a PCP is their goals: The hospitalist works to address all your immediate needs while you are hospitalized, and their focus is to help you get back home. It’s a short-term relationship. In contrast, your PCP handles care throughout your lifespan, including managing hypertension, diabetes, or other long-term conditions.
What is the value of a hospitalist?
As people live longer and visit the hospital with multiple, complicated medical problems, there is a need for specialists trained in taking care of inpatients, Dr. Donohue explains. To illustrate, he describes two common hospital scenarios: cancer and hip fracture.
“An oncologist can treat a hospitalized patient’s cancer, but they might not be as skilled at treating a patient’s renal failure or pneumonia,” says Dr. Donohue, adding that the latter two conditions are common among people in the hospital. “Hospitalists have a breadth of knowledge in all issues affecting hospitalized patients and can manage all the problems in the background.”
This is true for hip fracture patients as well, adds Dr. Donohue. “The average age of a hip fracture patient at the hospital is 81,” he says. “And few people at that age group come in without other health problems. That means we have to figure out how to fix their hip and get them home while managing their blood pressure and any other conditions they may have.”
Can a hospitalist specialize in certain disciplines?
Yes, some hospitalists specialize in pediatrics, for example. Plus, other specialties have embraced hospital medicine. For instance, gastroenterology (GI) hospitalists are board-certified in gastroenterology and internal medicine and only treat hospitalized patients experiencing acute GI issues.
“Gastroenterology, by its very nature, intersects with a variety of other medical fields, making it a hotspot for the development of GI hospitalists,” says Darrick Li, MD, PhD, a Yale Medicine GI hospitalist. “GI hospitalists help patients get faster access to appropriate consultation and appropriate procedures, and also facilitate multidisciplinary decision-making and management plans among themselves, nutritionists, surgeons, and a variety of other specialties within the hospital quickly.”
Furthermore, a GI hospitalist will not only treat a patient’s GI bleeding and other serious conditions but will also focus on putting patients at ease in an unfamiliar setting, says Kenneth Hung, MD, MS, a Yale Medicine GI hospitalist.
“Being in the hospital is very anxiety-inducing. Patients don't know what's going on. So, I try to empower them and explain things in a simple manner,” Dr. Hung says. “Explaining what’s happening and giving people time to digest the information is helpful.”
Interestingly, GI hospitalists are not the primary caregivers for hospitalized patients, explains Dr. Hung. Rather, they act as consultants who offer input and perform procedures. “So, we provide less care coordination than hospitalists who specialize in Internal Medicine; they are really the primary caregivers of hospitalized patients,” says Dr. Hung.
The growing movement toward hospitalist subspecialization follows the general trend in medicine, which is in the direction of greater specialization, adds Alexis Rodriguez, MD, a Yale Medicine pediatric hospitalist who takes care of newborns through adolescents.
“Before, it used to be general pediatricians who took care of children for all their needs, in the hospital or the office,” she says. “But now even children often see different specialists.”
With newborns, Dr. Rodriguez says pediatric hospitalists help those who experience trouble in their first few days of life. “This can include supporting mother and child with breastfeeding, addressing breathing problems, or any other issues,” she says. “For older children, common problems we treat include asthma, influenza, dehydration, and anything else that would get a child sick enough to be in the hospital. We try to figure out if they have any underlying illnesses and get them to the point where they can transition to their outpatient doctor. We do that quickly and effectively.”
As a pediatric hospitalist, Dr. Rodriguez says much of her time is spent managing the experience for families. “And the other big part of the job is communicating with all the teams involved and organizing it in a way that families feel confident in the care their child is receiving,” she says.
How does a hospitalist impact health care?
“After the hospitalist movement arose in the 1990s, it became apparent from multiple studies that the use of hospitalists improved various metrics, including length of stay, hospital expenditures, the speed at which patients get appropriate care, the time they spend in the hospital, and overall satisfaction,” says Dr. Li.