How Hospitalists have Innovated US Healthcare

"BOB WACHTER: The U.S. health-care system is often criticized for its failure to innovate. With our costs far higher than those of any other developed country and our outcomes, on average, no better, such critiques are not unfounded.

However, over the past 20 years, a new specialty has developed that represents a substantial innovation. The story of this specialty–hospitalists–illustrates our great potential for innovation. As we consider all sorts of new innovations, from tele-visits, to precision medicine, to new delivery models such as accountable care organizations, it’s a story worth telling.

The traditional model for hospital care in the U.S. was one in which a patient’s primary-care physician was expected to remain in charge of her care in the hospital. While this model seems to have much to recommend it–after all, who wouldn’t want to be cared for by their regular doctor when they’re really sick–in reality, it didn’t work very well. Primary-care physicians are extraordinarily busy in the office, so hospital patients often languished, or were cared for haphazardly by multiple specialists, with no one there to serve as the orchestra conductor. And it became increasingly difficult for primary-care physicians to keep up with new advances in both office practice and hospital medicine. As hospital care became faster paced and more expensive, the downsides of the traditional model became ever more evident.

About 20 years ago, a new specialist emerged, which a colleague and I dubbed a “hospitalist” in an article in the New England Journal of Medicine. Hospitalists are generalist physicians who take on the role of managing a patient’s hospital care, returning the patient to his or her primary-care physician at the time of discharge."

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