Hospitalists: Your Around the Clock Caregiver

Hospitalists are partners in personalized, around-the-clock care
By William DeMarco, DO, and Laurie Dugan-Macchi, RN 

The relationship between patients and their primary care doctors remains the core of excellent medical care in this country. There is no replacement for the personal, one-on-one connection a patient has with a primary caregiver who is intimately familiar with the patient’s unique medical history and needs. If and when a patient is hospitalized, the focus today is on maintaining that continuum of personal care, using on-site teams of specially trained physicians as partners in their treatment. 

Back in the mid-1990, it was already becoming clear that the number of primary care physicians would decline sharply over the next several decades, just as the number of patients in need of care – namely, the aging Baby Boom generation – would continue to expand dramatically.  The question became how to serve that growing population, not only in terms of regular office hours, but in the daily rounds of hospital visits primary care doctors were still making in those days. 

Foreseeing that logistical challenge, healthcare systems throughout the nation over the past 20-plus years saw the emergence of a whole new discipline: the hospitalist.  The now-common term was first coined in 1996 to describe this growing corps of specially-certified doctors whose job it is to oversee inpatient care. It has become a standardized system providing around-the-clock, in-hospital care by individually assigned physicians working with a dedicated on-site team – in consultation with the patient’s primary care doctor – to manage hospital stays.  

Some 50,000 dedicated hospitalists practice today in U.S. hospitals, which have almost universally embraced the discipline of hospital medicine as the standard model for admitted patient care. Trained in internal medicine, with a specific focus on acute inpatient treatment, hospitalists see and treat a wide range of disorders, injuries, and conditions. They are specially qualified to oversee and co-manage (just as the primary care physician does outside the hospital) all aspects of care.  A patient may be in the hospital for orthopedic surgery, but may have diabetes, heart disease or other health issues. The hospitalist is there to ensure all of those issues are managed together. 

In that way, the hospitalist is like the captain of the ship, navigating the patient through a journey, coordinating the larger crew of specialists, surgeons, RNs, Physician’s Assistants and other medical professionals who interact with the patient during their hospital trip. Hospitalists can see a patient multiple times a day if necessary, welcoming family members to join the discussion if the patient wishes.  If an issue arises overnight, a hospitalist is on duty to see patients and will confer directly with their assigned hospitalist in the morning. A hospitalist can see a patient, order lab or imaging tests and adjust care plans in real-time as patients’ conditions require. 

The use of hospitalists has freed up primary care physicians to focus full-time on treating patients outside the hospital, and therefore more available to their practices.  Not having to do daily hospital rounds means more time to see patients in the office, keeping them healthy and out of the hospital. 

Primary care physicians and hospitalists continue to seek ways to enhance real-time communication, including the use of encrypted text technology to quickly confer on the details of a patient’s evolving treatment from admission to discharge, as well as ongoing improvement and integration of electronic medical records. 

The partnership between hospitalists and primary care physicians has become an important part of the overall approach to population healthcare today. While the emphasis remains on staying out of the hospital, odds are most of us will end up needing a hospital stay at some point in our lives. When that happens, it’s good to know you and your doctor have trusted, qualified partners inside the hospital to help manage your care. 

William DeMarco, DO, is the Division Chief of Hospital Medicine at Berkshire Medical Center. Laurie Dugan-Macchi, RN, is the program’s clinical coordinator.