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The new “universal physician”

January 2009

A recent conversation on the AAP’s pediatric hospitalist listserv about InterQual (should they have picked a name not so reminiscent of Interpol?) and the subsequent responses dealing with policy, coupled with the incredibly cold weather, too much coffee, and a plane gliding unto the Hudson River, has me thinking about our specialty.

And yes, I call it a specialty, because from the ongoing threads in the listserv (in itself a revolutionary and open exchange of ideas), I am sensing that our specialty is nearing its maturity point. We are part of a groundbreaking group of individuals, a strange one if you ask my father and other physicians from previous generations. While a lot of physicians in the past have been involved in health care policy and administration, it seems to me that we hospitalists have now positioned ourselves as an integral cog in the wheel of the health care industry.

We are true hybrids, emerging to fill a perceived need and turning it into an indispensable service. And now, because of our continuous involvement in “The House,” we have become part doctor, part administrator and part policy-makers. We are the “universal physician” to again borrow a phrase from my dad, who instilled in his four boys a sense that the world is a big place and that specialization must be accompanied by a basic knowledge of everything.

With great leadership comes great responsibility. From the discussion on DRGs, complaints about the current state of health care, and the continued characterization of the system as adversarial and feudal, I sense an opportunity to once again morph our own specialty, and physicians in general.

We have the opportunity to position ourselves as true seers and innovators. But we must remember that, at the center of all these technical and policy decisions, there are patients who depend on our leadership to help them get better and, most importantly, help them ward off disease.

The health system in this country is in terrible shape. We know the statistics, the problems and the many proposals for fixing then. I think hospital medicine has stumbled unto something that will carry a lot of weight at the legislative level: You can provide high-level care while at the same time saving the hospital money.

I went to medical school with the altruistic illusion that doctors cared for patients and yes, they got paid, but that was almost a side effect of their daily routine. Very quickly, I realized that medicine, like everything else in our capitalistic society, is a business, and that people went into medicine (not only as doctors, but as nurses, techs, administrators, etc.) to make money.

I became so disillusioned, I almost quit, and I credit becoming a hospitalist with making me regain some of the vision I once had, now in a more mature way. Hey, I like to make money as much as everyone else, and seeing it evaporate in the digital world of 401(k)’s makes me want to grab an extra dose of ranitidine. But as a hospitalist, I can regain the possibility of actually effecting change on a grander scale.

Setting policy within a hospital, helping shape protocols, helping community physicians with their patients, serving on national organizations that guide the thought process of decision-makers, all these aspects of hospital medicine make it a unique field, one we should embrace with responsibility, commitment and humility.

I would like to exhort my hospitalists colleagues to not let the immense pressure bearing upon our health care system bring you down. Live your hospitalist life with an eye for opportunity, not for self-promotion, but for creating a better health care system. The coming years portend incredible changes. Let’s make sure the changes benefit those who put their lives and their ailments in our hands, our patients.