Friend or Foe?

Abstract

THE NUMBER of hospitalists—physicians employed by managed care organizations and hospitals to care for hospitalized patients—is increasing in the United States, and their use may be redefining the role of the primary care physician.¹ Hospitalists threaten to transform primary care physicians into practitioners of an office-based specialty largely focused on the care of patients who are not acutely ill. Hospitalists may also be substantially changing the practice of medicine. Critics believe that hospitalist systems disrupt key elements of patient care, citing the importance of the continuity of the physician-patient relationship when patients are most ill.^2,3 They express concern that the quality of care of hospitalized patients will suffer, and posit a decrease in overall quality of care if important information is lost in the change of physicians upon admission or discharge. Opponents of hospitalist systems also note the potential for cost shifting if patients discharged early from the hospital by cost-conscious hospitalists require extra attention and additional costly testing from the primary care physician. However, proponents of hospitalist systems cite studies that show that hospitalists' care results in increased efficiency and improved quality of inpatient care.^4-6 They argue that efficiency and quality will also improve in the outpatient setting as primary care physicians concentrate their efforts on ambulatory care.^7-9