The hospitalist

Efforts to improve the efficiency and quality of hospital inpatient care have led to the movement to replace the primary care physician with the hospitalist as the inpatient physician of record. A hospitalist serves as the physician of record after accepting referrals of hospitalized patients from primary care physicians. The hospitalist then keeps the primary care physician informed of major healthcare decisions during the patient's entire hospital stay. One of the forces promoting the hospitalist movement is the assumption that inpatient care provided by a small number of physicians is less costly, of higher quality, and less variable than the care provided by primary care physicians who see patients only briefly once a day. Hospitalists are accessible throughout their shifts and can better respond to changing patient needs. With this model of care, hospitalists have taken a more proactive role in redesigning support-care systems based on the needs of the patient. Many perform quality improvement and utilization review, and engage in the development of clinical practice guidelines. Concern over the hospitalist model has focused on the break in continuity of care. Patients and their families may feel that they are losing a physician whom they know and for whom they have some level of comfort and confidence. As the hospitalist movement picks up momentum, so too does its expectation to improve and provide for quality end of life care.