Hospitalist

Key facts

Term introduced

1996, in a New England Journal of Medicine article by Wachter and Goldman

Common training

Internal medicine; also family medicine and pediatrics

Certification options

ABIM Focused Practice in Hospital Medicine; Pediatric Hospital Medicine

Taxonomy code

208M00000X (Hospitalist)

What is a hospitalist?

Hospital medicine is organized around a place of care rather than an organ system or age group. Hospitalists admit patients, manage them through the stay, coordinate with specialists and plan discharge. Many work in shifts, and those who cover overnight are often called nocturnists. The model spread because it lets office-based physicians stay in their clinics while dedicated inpatient clinicians handle hospital care.

Most adult hospitalists trained in internal medicine, with others coming from family medicine. Pediatric hospital medicine is a board-certified subspecialty, and adult hospitalists can earn a Focused Practice in Hospital Medicine designation through the American Board of Internal Medicine.

How hospitalist programs are organized

Hospitals staff hospitalist services in several ways:

Many hospitals use these programs to care for the inpatients of community physicians who no longer admit their own patients.

• Groups employed directly by the hospital or health system.
• Independent or multispecialty medical groups contracted to staff the hospital.
• Regional and national staffing organizations that run programs for many hospitals.
• Academic programs in which hospitalists also supervise residents as attending physicians.

Why hospitalists matter

Hospitalists influence inpatient drug choices, formulary adherence, transitions of care and length of stay, which makes them relevant for hospital-focused products such as anticoagulants, antibiotics and other acute care therapies. Because hospitalists often start therapies in the hospital, their choices can carry over into what patients take after discharge.

They are easy to misread in data. Their work shows up as inpatient evaluation and management services under Medicare Part B, while drugs given during an inpatient stay are generally paid within the hospital's Part A payment rather than as Part D prescriptions, so hospitalists look like low-volume prescribers in Part D data. NPPES records may also list them under internal medicine rather than the hospitalist taxonomy code.