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Did Low Payments in Ambulatory Care Spawn the Hospitalist Movement?

One of the most interesting developments in American healthcare in the past decade is the emergence of hospitalists: internists whose sole job is to manage hospitalized patients, and who never venture into the more traditional outpatient setting.
One hospitalist, who goes by the pen name Happy Hospitalist on his eponymous Web site, believes that his specialty was born from market forces:


The salaries of hospitalists have been climbing quickly in the last 5 years. The same cannot be said for office based internal medicine/family practice/pediatrics. There is a reason hospitalist medicine is the fastest growing field in medicine and the reason is money. It will always be about money. Every job is based on a compensation model. Nobody works for free, unless by choice.

Market forces at its best. Supply and demand. The demand for hospitalist services is exploding, bringing quickly rising reimbursements which must be subsidized by hospitals, as medicare has failed to do so. And as resident physicians chose hospitalist medicine because of the money, office based practice will slide deeper down the path of extinction. Why? Money. The roots lie in the flawed reimbursement system ingrained in the medicare system, and exacerbated by all subsequent 3rd party systems, which use the medicare system as their excuse for decreasing their own reimbursements, while continuing their unrelenting rise in premiums which have outpaced inflation for years.

Primary care must change the system, or get out. It is amazing to me, as a hospitalist, that you have the incredible costs savings to the health care system that 24 hour access to primary care within the confines of a hospital can bring. Yet our government elects to sit by...

I commend capitalism for figuring it out. In the entrepreneurial spirit of medicine, it is a major success story in market forces and why I am a firm believer in allowing the market figure it out. At the expense of outpatient primary care? Yes. But not the cause of the decline. If outpatient primary care paid a wage comparable to the specialties available to medical students, hospitalist medicine would have never thrived in the way that it is.




One of the Happy Hospitalist's main complaints is about the hoops he has to jump through to collect money from Medicare. He has explained in great and often hilarious detail about his adventures in coding, his encounters with documentation specialists, and how his charts now must reflect arcane trivia for financial gain, instead of medically relevant facts.

But it would be a mistake to assume that this physician is just about economics. He shares with readers some of his family travails, his foray into alternative medicine, and more than a few pictures of his pets.

"I enjoy bringing a mix of personal experience both on and off the job into my blog," he explained to me. "Some of my personal experiences resonate strongly with my readers. Some have told me that they come to my blog simply to check out my dog pictures. That's okay as well. I enjoy bringing the lighter side of life to my blog. And I love finding those tidbits of information that few others have found through linking."

On June 3, 2008, the Happy Hospitalist will be bringing readers plenty of links when he hosts Grand Rounds. Join him as he highlights the best in online medical writing from doctors, nurses, students, researchers, and others in the vast healthcare industry.

 Reviewed by Dr. Ramaz Mitaishvili
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