Non–housestaff medicine services in academic centers: Models and challenges

Abstract

Non-housestaff medicine services are growing rapidly in academic medical centers (AMCs), partly driven by efforts to comply with resident duty hour restrictions. Hospitalists have emerged as a solution to providing these services given their commitment to delivering efficient and high-quality care and the field's rapid growth. However, limited evidence is available on designing these services, including the similarities and differences of existing ones. We describe nonhousestaff medicine services at 5 AMCs in order to share our experiences and outline important considerations in service development. We discuss common challenges in building and sustaining these models along with local institutional factors that affect decision making. Keys to success include ensuring an equitable system for scheduling and staffing, fostering opportunities for scholarly activities and academic promotion (defining the ''academic hospitalist''), and providing compensation that supports recruitment and retention of hospitalists. With further work hour restrictions expected in the future and increased requests for surgical comanagement, the relationship between AMCs and hospitalists will continue to evolve. To succeed in developing hospitalist faculty who follow long careers in hospital medicine, academic leadership must carefully plan for and evaluate the methods of providing these clinical services while expanding on our academic mission.

Sleep and circadian misalignment for the hospitalist: A review

“…One reason for the growth in the number of hospitalists at academic medical centers has been the imposed work-hour restrictions for residents. 39 Across the county, hospitalist programs use a variety of shift work systems to ensure 24-hour patient care. Among those programs that provide continuous onsite coverage, many staff 3 shifts-day, late afternoon/ evening (swing), and night shifts.…”

Transition of Patients with COPD Across Different Care Settings: Challenges and Opportunities for Hospitalists

“…28 Growth in the profession has been attributed to an increased need for cost-effective, quality care by hospitals, 29 logistical challenges faced by primary care physicians in meeting the needs of hospitalized patients, 30 and a general increase in the demand for hospital services. [31][32][33] Evidence from the literature indicates that hospitalists are efficient providers of care, as demonstrated by reduced average lengths of stay (69%) and total hospital costs (70%) for all patients hospitalized for medical or surgical conditions. 29 Individuals who are under-insured, without a primary care physician, or taking improperly managed medications pose additional challenges for all health care providers.…”

Interprofessional communication with hospitalist and consultant physicians in general internal medicine: a qualitative study

“…The increase in the number of hospitalists in the last decade in North America has been attributed, in part, to promising evidence for positive financial and clinical outcomes when hospitalists are present [12], including shorter length of stay and lower hospital costs [17-20]. In academic centers in the United States, restrictions on resident work hours has led to the expansion of hospitalist programs of various design, with factors such as clinical hours worked, compensation structure, and research and administrative activities varying [21]. …”