NEW DATA show that the hospitalist workforce grew about 50% from 2012 to 2019, making the specialty one of the five biggest in American medicine.
Research published in the Journal of Hospital Medicine found that 44,037 physicians were working as hospitalists in 2019. Between 2012 and 2019, the study found, U.S. medicine added 2,228 hospitalists a year to its workforce.
Researchers noted that identifying hospitalists is a challenge. While Medicare created a designation for physicians to self-identify as hospitalists in 2016, researchers found that only about 27% of the physicians they identified as hospitalists used the Medicare code.
To find practicing hospitalists, researchers searched claims data for 20 codes commonly used by hospitalists. Those codes focus on acute inpatient care, observation, observation/inpatient same day, and critical care. Researchers designated physicians who billed 90% more of their work in those 20 codes as hospitalists.
Here are some of the study’s findings:
• In 2019, hospitalists billed for those 20 codes more than twice as much as nonhospitalist internists and family physicians. In 2012, by comparison, nonhospitalist physicians billed more for those 20 codes than hospitalists.
• Hospitalists accounted for 30% of total billing for those 20 codes. The other 70% was being billed by other specialties like pulmonology, cardiology, infectious disease, general surgery and nonphysician practitioners like NPs and PAs.
• The growth in the number of hospitalists occurred as the number of hospital beds in the U.S. shrank. Hospital beds per 1,000 population dropped from 3.0 in 1999 to 2.4 in 2019.
Researchers said health care may have needed more hospitalists even as bed capacity shrank because a growing number of primary care physicians abandoned inpatient work, driving up the demand for hospitalists even as bed counts dropped.
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Researchers also speculated that some hospitalists might have seen fewer patients per shift during that time frame or that hospitalists were being pulled away from patient care by a growing list of administrative tasks. Both scenarios would produce an increased need for hospitalists.
Finally, nearly 25% of physicians who researchers identified working as hospitalists in 2012 had shifted to other settings by 2018 while still working part time as hospitalists. Those other settings skilled nursing facilities and office-based settings. Researchers said that figure raises questions about the sustainability of hospital medicine as a career.