If I had tried to predict the future 10 years ago when I first became a hospitalist, I would not have been very successful.
First, I remember believing that this was not going to be a career, merely a way station on the path to a fellowship. Strike one. Second, I predicted I would never become one of those doctors whose vim and vigor would decline proportionally to his or her increased BMI. Strike two.
Third, I never would have guessed that I would be writing my 100th blog entry about hospital medicine. Really, honestly, no one would do that if they had a life. Strike three.
But undaunted by the fact that I have repeatedly proven to not be Nostradamus, I offer my hospitalist-centric predictions for when 2020 rolls around. Admittedly, many qualify for the “Ah, duh!” category, but hey, at least this way I may get a few correct.
1. You will work for either a hospital or a subcontracted group. Private groups, especially in our field, will be extinct. Hospitals will continue the trend of employing physicians, and primary care physicians and hospitalists will be at the epicenter of this movement. If the hospital outsources its hospitalist program, it will be to a large company that has a proven track record of efficiency.
2. Our salaries will stagnate relative to inflation, but inflate relative to other medical specialties. Even with reform, the health care well is running dry.
And I don’t buy the physician shortage projections. If reimbursement decreases for proceduralists, many of them will be forced to take care of patients again, which will moderate any pending shortage. The consult code expired last month, and I expect MedPAC to continue to kill other financial incentives that currently render medicine ill from “polyconsultationitis”. (Polyconsultationitis may develop a resistant strain, in which case this will be one of the many predictions that I will get wrong.)
3. A model of concierge hospitalist medicine will develop similar to what is expanding in primary care. No, you won’t be working for tips, but I suspect a market will develop for patients who are willing to pay more for “gold-plated” hospitalist service.
4. A small majority of hospitalists will become board certified in hospital medicine. But the transformational moment in our field will occur when medical education is restructured with a hospitalist track. Better yet, a fourth year of training will be offered for those who wish to become double-boarded in hospital medicine and critical care.
5. Nocturnal telehospitalist medicine will become the norm for most community hospitals.
6. Except for large academic centers, the medical staff at most hospitals will no longer include rheumatologists, radiologists, neurologists, endocrinologists and dermatologists.
7. Someone will create “Telespecialists Inc.” The foundation is already being built quickly in neurology and radiology. The competitive advantage for “Telespecialists Inc.” will be instant access to all the subspecialties that had fled the hospital. Hospitalists will utilize the “iSpecialist” application on their cell phone to call upon this fee-based service every time they have a difficult case.
8. By 2015, about the time the specialty glut results in a free fall in specialist wages, hospital medicine will be a preferred destination for most medical school graduates.
9. You will no longer own a pen.
10. Due to the introduction of bundled payments, you will no longer submit a bill. Just scan the patient’s wristband.
11. Your efficiency will be measured in real time compared to every hospitalist in the country, right down to that last KDur you ordered. If your phone starts flashing red, it’s time to cancel that next planned MRI.
12. Tort reform will happen. This reform will further fuel the subspecialist glut because of a decline in defensive medicine.
13. You will be practicing cookbook medicine–but most hospitalists will embrace their inner Julia Child because cookbook medicine will mean evidence-based medicine.
14. As a result of a hostile takeover, Today’s Hospitalist will be absorbed by SHM and live on in the back page of “The Hospitalist” under the monthly section, “OMG: What’s happening in community hospitalist medicine.”
15. If you introduce yourself to a patient as an “internist,” they will be more likely to believe you are a doctor who “inters” patients.
16. If you introduce yourself to a patient as a “hospitalist,” they will no longer slowly back out of the room for fear that you have come to place them in hospice.
17. Three words: “Doctor President DeLue.”
A belated Happy New Year!