Medical specialties are commonly defined in terms of patient population (pediatrics), organ (cardiology), disease (oncology), procedure (neurosurgery) or circumstance (emergency medicine). But there’s one field that gets its name from where it is practiced.
That would be hospital medicine.
As the name indicates, its focus is on the care of hospitalized patients.
“Our job is to establish a relationship with and care for inpatients over a short period of time, with the usual length of stay being four to seven days,” said Chi-Cheng Huang, M.D., chief of the section on hospital medicine at Wake Forest Baptist Medical Center. “We’re notified by the referring physician, emergency room or other department that a patient is being admitted and we’re sent their records so we know who and what we’ll be dealing with.
“We manage their treatment plan and make adjustments as needed. If a patient has a problem, whether it’s directly related to why they’re in the hospital or something else, we either address it, call in a specialist or send the patient on to intensive care.”
Hospital medicine is a relatively new discipline: The term for those who practice it – hospitalists – dates only to 1996 and its professional organization, the Society of Hospital Medicine, wasn’t founded until 1997. But it is one of the fastest growing fields in medicine today because of dramatic ways health care has changed over the past two decades.
“One of the reasons hospitalists are in such high demand today is that many doctors simply can’t afford to visit their patients in the hospital like they used to,” Huang said. “That takes a lot of time, and they can often use that time to see more patients in their clinics.”
Another factor is that people in the hospital are sicker than they once were.
“Many of the inpatients I saw in the late ’90s wouldn’t be admitted today,” Huang said. “Because our outpatient and transition-of-care services have gotten so much better, you now have to meet a much higher bar to get admitted to the hospital. But that means those patients who are in the hospital are in worse shape than before, and they require more complicated care.”
That trend, he predicted, is going to continue.
“Probably about 10 percent of the patients we see now won’t be admitted to the hospital three or four years from now,” Huang said. “But that doesn’t mean we’ll have fewer patients, because our population is aging. We’re living longer, and that means more complications and more hospitalizations.”
Another element for the rise in hospital medicine is the pressure on hospitals from government agencies and insurers to reduce the length of stays.
“Our first priority is of course seeing that patients are well taken care of, but we also do what we can to expedite things so people can go home, to a nursing home or to a rehab center as soon as possible,” said Huang, who also is executive medical director of general medicine and hospital medicine shared services for the Wake Forest Baptist Health network hospitals in High Point, Lexington and North Wilkesboro. “There’s no reason to have people in the hospital who don’t need to be here, for a number of reasons.”
Most of the physicians who practice hospital medicine are trained in internal medicine or family medicine, as are the majority of primary-care doctors. But the roster of hospitalists also includes physician assistants and nurse practitioners, who are collectively known as advance practice providers, or APPs.
Hospitalists work regular hours, but their schedules are anything but 9 to 5 weekdays. At Wake Forest Baptist, the shifts are 12 hours long, starting at 7 a.m. and 7 p.m., and the rotations are seven days on, seven days off.
“Those hours can be demanding, but they do contribute to a continuity of care that benefits our patients,” Huang said. “Most patients will see just one hospitalist during their stay, and very few will see more than two.”
The hospital-based providers also benefit, especially from the wide range of experiences they have on the job.
“All hospitalists are interested in being good clinicians first and foremost, and all the different things they encounter on an everyday basis can’t help but make them better providers,” Huang said. “But some folks also become interested in other areas, such as hospital administration, research and teaching.”
While Huang has served in administrative posts for more than 15 years, he remains devoted to patient care and tries to spend at least a quarter of his time at Wake Forest Baptist seeing patients.
“I love taking care of sick patients, being with them for three to six days when they’re really ill and seeing them get better right before my eyes,” Huang said. “I also like the fast pace of doing inpatient care, and the variety. I also really enjoy working collaboratively with nurses, specialists, sub-specialists, radiologists, case-management people, physical therapists and others to get the patients better and let them get back to their lives.”