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Hospitalists and the Practice of Inpatient Medicine: Results of a Survey of the National Association of Inpatient Physicians
- Peter K. Lindenauer, MD, MSc;
- Steven Z. Pantilat, MD;
- Patricia P. Katz, PhD; and
- Robert M. Wachter, MD
- From Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts; and the University of California, San Francisco, San Francisco, California. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “ The Hospitalist Movement in the United States.” To see a complete list of the articles included in this supplement, please view its Table of Contents.
Abstract
The number of hospital-based physicians, or hospitalists, in the United States has grown rapidly, yet no published data have characterized hospitalists or their practices. A self-administered questionnaire was used to describe 1) the features of hospitalists, 2) the hospitals in which they practice, and 3) the practice of inpatient medicine. The questionnaire contained 48 questions that covered four domains: demographic information about the respondent, the clinical and nonclinical workload and responsibilities of the respondent, organizational and financial aspects of the respondent's practice, and the respondent's satisfaction and his or her perception of the reaction of other physicians and nurses to the hospitalist system. The overall response rate was 57%. Data are reported on 372 surveys. Respondents were young and most were men, and only 48% had practiced hospital-based medicine for more than 2 years. Eighty-nine percent of respondents were internists; of these, 51% were generalists and 38% were subspecialists. Most hospitalists limited their practices to the inpatient setting, but 37% practiced outpatient general internal medicine or subspecialty medicine in a limited capacity. In addition to providing care for inpatients, 90% of hospitalists were engaged in consultative medicine. Quality assurance and practice guideline development were the most frequently reported nonclinical activities (53% and 46%, respectively). Small group practices (31%) and staff-model health maintenance organizations (25%) were the most common practice settings, and 78% of participants were reimbursed through salary. Financial incentives were common (43%) but modest. Accurate information about hospitalists and their practices will be important to clinicians, educators, researchers, and policymakers as the hospitalist movement continues to grow.
Article and Author Information
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Acknowledgments: The authors thank John Nelson, MD, and Winthrop Whitcomb, MD, co-presidents of the National Association of Inpatient Physicians, and the membership of the National Association of Inpatient Physicians for help and support. They also thank Ms. Indria Sylvester for administrative support.
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Requests for Reprints: Peter K. Lindenauer, Office of Clinical Practice Evaluation and Management and Department of Medicine, Baystate Medical Center, Tufts University School of Medicine, 759 Chestnut Street, P-5928, Springfield, MA 01199; e-mail, lindenauer{at}bhs.org.
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Current Author Addresses: Dr. Lindenauer: Office of Clinical Practice Evaluation and Management and Department of Medicine, Baystate Medical Center, Tufts University School of Medicine, 759 Chestnut Street, P-5928, Springfield, MA 01199.
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Dr. Pantilat: Division of General Internal Medicine, Department of Medicine, Program in Medical Ethics, University of California, San Francisco, 521 Parnassus Avenue, C-126, San Francisco, CA 94143-0903.
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Dr. Katz: Institute for Health Policy Studies and Department of Medicine, University of California, San Francisco, 1388 Sutter Street, San Francisco, CA 94143-0936.
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Dr. Wachter: Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, M-998, San Francisco, CA 94143-0120.
- Copyright ©2004 by the American College of Physicians
