The Emerging Role of Hospitalists--Will Family Physicians Continue to Practice Hospital Medicine?

Should I continue to treat my patients when they are admitted to the hospital? You can probably imagine my surprise when I first faced this question. Like most of my family physician colleagues, my training taught me how to care for all aspects of my patients' health regardless of illness, organ system, age, or setting. Today, as a family practice educator, I teach the concepts of comprehensive care, sometimes referred to as womb-to-tomb or cradle-to-grave care. Soon, however, our family practice department will discuss proposals for a new inpatient care model that challenges this family medicine paradigm. Instead of managing my patients in the hospital, I might be transferring them to physicians who practice only inpatient medicine. There is an intensifYing national debate centered on who is most appropriate to provide inpatient medical care: the patient's personal physician (family physician or other primary care physician) or an inpatient specialist. What is driving this debate, and what is the potential impact on family physicians and family medicine? Inpatient specialists, or hospitalists, are physicians who spend 25 percent or more of their time in the hospital setting working as the physicianof-record of hospitalized patients.! Although there are several variations of inpatient-only practice arrangements,2,3 the basic concept is that the inpatient specialist accepts patients from community physicians and manages their in-hospital care. The inpatient specialist keeps the primary physicians up to date on their patients' progress and transfers care back to those physicians upon a patient's discharge. Although the concept of a house physician is not new, hospitalist groups are becoming increasingly common in managed care organizations, larger hospitals, and some large