The Hospitalist: A New Kind of Acute Care Physician


For a caregiver who is unfamiliar with how hospitals operate, caring for a loved one who has been hospitalized can raise a lot of questions:

"When will my mother's test results come back?"

"How long will she have to stay in the hospital?"

"What do the people who're treating her know about her medical history and what prescriptions she's on?"

And, most importantly, "Who's in charge of making sure my mother gets the care she needs?"

The answers to these queries may lie in an emerging trend in the field of hospital care: the hospitalist.

What is a hospitalist?

Up until the mid-1990s, if a senior had to go to the hospital, their primary care doctor would be the person who would oversee and coordinate their care.

A physician would split their time between their outpatient practice and the hospital(s) where their patients were staying. But, as patient care has become increasingly complex and health care costs have continued to rise, this method of having a doctor shuttle back and forth between the hospital and their office became less efficient.

The hospitalist sub-specialty was introduced as a possible solution to this problem.

First outlined in 1996 by the New England Journal of Medicine (NEJM), "hospitalist," is the term used to describe a physician who focuses on treating and coordinating care for people who have been hospitalized. These doctors are generally board-certified internists who are trained to be intimately familiar with the ins and outs of hospital care.

About 75 percent of hospitalists specialize in internal medicine. However, some are also experts in other fields, including: pediatrics, and family medicine. According to the America Hospital Association, there are currently more than 20,000 hospitalists practicing in hospitals throughout the United States.

The pros and cons of hospitalist care

The hospitalist's "office" is the hospital itself, which means that they have a wealth of knowledge about the inner-workings of their particular facility. They know who to talk to in order to get a patient's test results expedited and schedule any necessary follow-up diagnostics.

Because they deal with the complicated conditions of hospital patients every day, hospitalists are also very good at responding quickly to changes in the health of their hospitalized patients.

The fact that a hospitalist works exclusively in the hospital can be a benefit, but it may also create a few issues

A hospitalist will generally be a stranger to a patient and their caregiver. And, even though a hospitalist will communicate with a senior's primary care doctor, they aren't likely to be aware of a patient's entire medical history.

Additionally, the fact that most hospitalists work in shifts means that more than one of these physicians may be handling a loved one's care during a hospital stay.

Despite these drawbacks, research suggests that hospitalists have serious potential to improve patient care.

According to a study published in the NEJM in 2007, hospitalist care has been linked to reductions in both the duration of a patient's hospital stay as well as their risk of readmission.

5 questions to ask a hospitalist

Not all hospitals employ hospitalists. But, if a senior is staying in a facility that does, these clinicians can be a great resource for you and the person you're caring for.

Making the most out a hospitalist's unique skill set will require some work.

Managing a relationship with a hospitalist is similar to managing a relationship with any other new medical professional. However, there are some particular questions that you can ask a hospitalist, which may make a hospital stay easier and more productive:

  • How long will you be on duty? Since these physicians work in shifts, your loved one is likely to be cared for by multiple hospitalists during their stay. This question will help you get a feel for when a particular hospitalist is going to be available to you.
  • How and when can I contact you? One of the primary advantages of having a hospitalist is that they are more accessible than a primary care doctor would be to seniors staying in the hospital and their caregivers. But, this is only a benefit if you know how to get a hold of the hospitalist when you have questions and concerns regarding your loved one's care.
  • Who else will be involved in taking care of my loved one? What will their roles be? It can be very difficult to keep the names and roles of each member of your loved one's hospital care team straight in your mind. If you find yourself getting confused, ask the hospitalist for clarification. A hospitalist is the one in charge of your loved one's medical team so they should be able to answer any questions you have regarding who's who or who does what.
  • Are you sending my loved one's results, charts, etc. to their primary care doctor? One of the primary problems that arise when trying to coordinate a senior's care in the hospital is making sure their primary care physician remains in the loop. While your loved one is in the hospital, it's vital that their hospitalist and primary care doctor continue to communicate. This is the best way to ensure that an elder is getting the care that's optimal for them.
  • When will my loved one be discharged? There a number of things that will need to be figured out before a senior gets c. Can they go home right away? Will they need skilled nursing care? What does their follow-up appointment schedule look like? Since post-hospital care options (home care, nursing home, etc.) take time to research coordinate, it's important for a caregiver to know when their loved one is expected to be discharged. The hospitalist is the person who must sign off on your loved one's discharge so they generally have a pretty good idea of when a senior will be released.

In addition to these questions, it can't hurt to double-check the accuracy of the information the hospitalist and their team have regarding your loved one's current prescription medications and their past medical history.

Remember, the hospital staff doesn't have the depth of knowledge about your loved one's previous health concerns like you do. You are your loved one's best advocate. Politely making sure the hospital staff knows the important information doesn't make you a pest—it makes you a caring caregiver.

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I was not too happy with the hospitalist experience. They are so busy with other patients, it is hard to get in touch with them. If you have a dr that knows you, you don't want someone new coming in and changing meds around and having no personal knowledge or history of your famiy member. I wish you would write about the need for home visiting nurse practitioners. If drs had these nurses on staff, this would eliminate the need for many to end up in the hospital or nursing home when they can't get to a dr. A good nurse practitioner is just as good as a dr b/c they deal directly hands on more with patients and have more time. Medicare should start giving drs credits who establish home visiting nurse practitioners in their practices. In my community I have access to a dermatologist practitioner who works under a dr and makes home visits. This has been wonderful since she can treat the patient in their home and in bed when they otherwise could not get up on a dr table in an office or even make the trip.
but i do want to add, that a hospitalist is better than an absent physician.