Hospitalists and the doctor-patient relationship

Hospitalists--physicians whose practice focuses on the care of hospitalized general medicine patients--are increasingly common in the United States, often displacing primary care physicians from this role. While advocates of hospitalists point to evidence of cost reduction and perhaps improved short-run outcomes, critics question whether costs or long-run outcomes are improved and whether there may be insidious effects on the doctor-patient relationship. I define a framework for addressing these questions, assess the available evidence, and identify a research agenda to better understand the implications of the hospitalist movement for the doctor-patient relationship. Using a framework that emphasizes general and patient-specific knowledge as crucial to a successful doctor-patient relationship, I argue that the success of the hospitalist model will depend on its ability to continue to develop its areas of technical expertise while ensuring care that is both continuous and appropriate to the needs and values of individual patients.