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The making of a hospitalist

December 2007

Here it goes! Ever wondered who blogs and why? I considered myself the non-blogger type, someone who never had an interest in keeping a journal. In an effort to understand this issue, I will take a plunge into the churning water of the blogging world and spill my thoughts on the Web.

I started out as a general internist who did it all: had an office, rounded on my patients in the hospital and nursing homes, made an occasional house call, and even pulled a shift in the local emergency room every now and then.

Great way to learn medicine, hands down! But by my second year, I began to realize that as much as I loved my patients and what I did, I just could not bear the thought of watching someone’s creatinine creep from 0.7 to 2.3 during the course of my career.

My days started and ended in the hospital, and I always felt more comfortable there as opposed to my office. I soon traded my life as the general internist and stepped into the shiny world of hospital medicine in 1999. I loved it.

During my nine years as a hospitalist, I have seen the field evolve. In fact, change has been the only real constant, from hospital medicine being grudgingly accepted and at times scorned, to being a service in hot demand.

My take is that, in the ever-changing world of health care economics, hospitalists are now indispensable, an absolutely essential expense and resource for hospitals. Some hospitals may still struggle with that fact, but take us away and the hospital system will undergo a “withdrawal reaction,” and local referral networks may grind to a halt.

Having said that, the incredible rise of hospital medicine would have been stunted over the past 10 years without forward-thinking hospital systems. I have just helped launch a new hospitalist program this fall at a brand new hospital outside Phoenix, one in which admissions and the use of technology all depend almost completely on hospitalists. That’s a measure of how far we’ve come over the past decade.

Suffice it to say that, as hospitalists, we are living in exciting times. Our specialty–and yes, I consider hospital medicine to be a specialty–is maturing at various levels. And like any specialty, I anticipate hospitalists subspecializing down the road, initially as a result of their interest and experience, and later on by structured training.

The constant change I’ve experienced over my career in hospital medicine will only continue, driven by CMS-mandated core measure reporting, computerized physician order entry, increased scrutiny of health care costs, and an escalating focus on quality of care and reducing medical errors. Hospitalists are uniquely positioned to have a positive impact on hospital systems on every one of those factors.

During the course of my blogging, I will discuss or ramble on various issues that we encounter in our professional lives. I hope to solicit feedback from readers like you. So dear readers, tighten your seat belts, and let the ride begin!