Published in the October 2004 issue of Today’s Hospitalist
Are hospitalists a niche of internal medicine, or are they part of a separate and unique specialty? While this is not exactly a new question, the answer is beginning to have very real effects on some physicians.
As this month’s cover story explains, a few hospitals have restricted who can work on their wards as hospitalists, and their reasoning hinges on how they define hospitalists.
Put simply, these hospitals say hospitalists are part of a distinct specialty similar to hospital-based specialties like anesthesiology or radiology. As a result, they argue, it’s only natural that they should have similar exclusive contracting arrangements.
Most hospitalists, however, see things differently. They argue that because they’re internists, hospitals have no right to deny them privileges to see patients. Hospitals don’t limit the number of internists who can work in their wards, after all, so how can they exclude those who only see inpatients?
The reality is that there is room for hospitals to contract for hospitalist services for the patients they control “unassigned patients and referrals from the practices they own “but still allow other hospitalists to practice on their wards. Outpatient practices that have already signed their own contracts with hospitalist groups, for example, shouldn’t be forced to break those contracts because of an arrangement the hospital made.
The hospitals that have gone down the path of exclusive contracting are allowing only hospitalists from groups they have contracted with to work as hospitalists. Outpatient physicians can continue to treat their inpatients, but no other hospitalists are allowed “even if their primary care doctor wants a hospitalist from another group to care for their patients.
The good news is that for now, relatively few hospitals have forced the issue of exclusive contracting for hospitalists. Whether the trend grows or not, however, it is likely to put more pressure on hospitalists to define themselves “before others do it for them.
Editor and Publisher