Twenty years ago, the idea of a doctor caring for people only when they're hospitalized was far-fetched. Today, hospitalists are the fastest growing medical specialty. These doctors who manage much of the care that goes on in hospitals.
At San Diego's Sharp Memorial Hospital, Dr. Brent Drouin checks on his first patient of the day.
"How are you doing?...I'm doing alright…Any problems last night?...
This elderly man was brought into the emergency room after he suffered a fall. It turns out he had broken his hip. He was also having trouble speaking.
"I'm going to take a listen to your lungs and your heart, okay?"
After he examines the man, Drouin grabs a seat and talks to the patient's daughter and son-in-law.
"As you know," Drouin says, "The MRI showed that he does have an acute stroke, to explain his symptoms."
Drouin is one of about 20 hospitalists that work at Sharp Memorial. They're in charge of patient care from the time someone is admitted, to when the patient is sent home.
"I enjoy admitting a patient that actually is quite sick," Drouin says, "And treating them throughout the process, getting them better, and being able to send them out to their primary care provider, and allowing them to enjoy their quality of life. It's very gratifying for me."
Hospitalists came into being in the early 1990s.
Before that, primary care doctors had to attend to their patients when they were hospitalized. They would often rush into the hospital first thing in the morning, then rush back to their office and see patients for the rest of the day.
Now, hospitalists are in charge. Drouin says they're always in house.
"Also we know all the departments," Drouin points out, "And the staff members have good working relationships with everyone, which improves the efficiency of care, and if a patient decompensates, acutely, and does poorly in the hospital, we can be there immediately to evaluate them, plus see patients multiple time a day; it would be very difficult to do that in the outpatient setting."
Most hospitalists do a residency in internal medicine. When that's finished, they can work as a hospitalist without having to go through years of additional training.
That's attractive to young doctors like Brian Clay, a hospitalist at UCSD Medical Center in Hillcrest. He says another advantage is the work schedule.
"You're going to be in the hospital for a number of days in a row, but then you're going to be off for a number of days in a row," Dr. Clay says. "And you're not on pager call, you're not doing nights."
Clay says it's vital work. For example, a patient who's hospitalized may have a surgeon, a cardiologist, and an endocrinologist involved in their care. Clay says that's when a hospitalist is extremely valuable.
"They can help all consulting specialties talk to each other and talk to the patient," Clay says. "They really do coordinate and quarterback that care in the hospital."
When patients are sent home, hospitalists try to make sure patients know exactly what to do. They also communicate with the patient's primary care doctor, to make sure nothing falls through the cracks.
Tim Smith is CEO of Sharp Memorial Hospital. He says hospitalists fit right in with healthcare reform.
"Health care reform's direction is how do we improve the efficiency of care while maintaining or improving quality," Smith says. "And hospitalists is one great tool for doing that. With hospitalists, we can coordinate the care better, provide patients with a shorter length of stay in the hospital, and yet keep their quality up. And that's exactly what healthcare reform is trying to accomplish."
Studies show hospitalists reduce the length of hospital stays by up to 30 percent. They also help cut costs.
But they don't have any control over what a patient does once they leave the hospital. In fact, a recent state report reveals one out of three people who are hospitalized in California are readmitted within a year.
Hospitalists say that doesn't mean they're not doing a good job. Rather, it probably indicates many of the factors that influence readmissions are out of doctors' control.
"You'll need to be discharged with insulin," says Drouin to a patient. "What we'll do is, we'll coordinate that, so you'll know exactly how to give injections, just like we're doing here in the hospital…"
