The Role of “Hospitalists” in the Health Care System

Abstract

In their Sounding Board article on the emerging role of “hospitalists” in the American health care system (Aug. 15 issue),¹ Drs. Wachter and Goldman express their view that developing a hospitalist specialty to care for inpatients is desirable and inevitable. I do not agree that separating patients from the doctor who knows them best, at perhaps the patient's moment of greatest need, is desirable. Nor is it clear that such separations save money. Often hospital-based physicians keep patients hospitalized longer and order more aggressive interventions than primary care physicians caring for patients with comparable conditions and outcomes, just as patients seen in emergency departments are often kept longer for more aggressive testing and treatment than comparable patients treated in a doctor's office. The reasons are similar: physicians are (rightly) more uncomfortable with unfamiliar patients and families and cannot rely on knowing their history and their ability to make follow-up visits. This is particularly true in my specialty, pediatrics.