Hospitalists fill a role in the changing medical landscape


As the health care field continues evolving to keep pace with the modern world, many new health professionals are emerging. Minnesota 2020 has detailed the rise in nurse practitioners and physician assistants, but the occupation the New York Times calls “America’s fastest-growing medical specialty” actually had an early start in Minnesota: hospitalists.

Hospitalists are doctors who work exclusively at hospitals, and thus are no one’s primary care physician. Problems in the early 1990s led to the creation of the position in many hospitals around the country. “If you rounded once a day and a patient had a change in condition, you were hard-pressed to make it back in,” Dr. Janet Grayson, a hospitalist with Park Nicollet Clinic, explains. “The basic inefficiency of sixty to a hundred doctors descending on the hospitals each morning to treat one to two patients [each]” prompted the clinic to implement a new model.

Grayson has been a hospitalist with Park Nicollet Clinic for 16 years – she was the first full-time hospitalist when Park Nicollet implemented the system in 1994. And while it might not have quite been the first institution to try a hospitalist model, the clinic developed the system independent of other hospitals. The fact that so many hospitalist systems developed near-simultaneously all around the country and without outside influence underscores how much of a need they were filling.

One of the first hurdles Park Nicollet’s hospitalist model met was the question of care quality. But five years after the system began, a study concluded that the system “was associated with cost savings and no decrease (and, in fact, some improvement) in satisfaction among inpatients, outpatients, and physicians.” The study also reported that length of stays averaged a decrease of 0.64 days per patient hospitalization.

Grayson points to other benefits of a hospitalist model, too. “It’s helpful to have people inside the hospital who know all these little tricks,” she says. “I know more now than I did fifteen years ago… It helps to have someone who knows a lot more about taking care of really sick people.”

Because of their ability to reduce inefficiencies, many medical experts point to hospitalists as a useful tool in the wake of the federal health care overhaul. Facilities with high readmission rates are penalized under the reforms, and hospitalist systems are associated with lowering those rates.

Yet Grayson warns against moving too far toward a hospitalist model. She says that while some advocate for fully separating primary care doctors from hospital doctors, she strongly supports Park Nicollet Clinic’s blended model. The clinic has about 15 hospitalists and 50 clinic doctors who still make hospital rounds periodically. Grayson believes “there is no substitute for the family doctor” who knows a person’s medical history. But she feels the older system often led to burn-out and high turnover among doctors, which increased costs. While not perfect, a blended hospitalist model seeks to maintain advantages of older models while correcting inefficiencies and maintaining quality of care.

As the medical field continues to evolve, hospitalists will no doubt have an important role to play.