The hospitalist model: Perspectives of the patient, the internist, and internal medicine

The use of hospitalists has implications for patients, for internists, and for the specialty of internal medicine. For patients, the greatest concern is interrupting the continuity of a supportive relationship with their regular physican. For many internists, the hospitalist model is attractive, but they are concerned that health plans will compel physicians to transfer their patients to a hospitalist at the time of admission to the hospital (mandatory hand-off). Thus, the hospitalist could become the means to exclude internists from hospital care and deprive them of an important source of professional satisfaction. The specialty of internal medicine is very concerned about the mandatory hand-off because it threatens the internist's identity as the physician who can care for the sickest patients in any venue, making it harder for patients and health plans to distinguish the internist from family physicians and nurse practitioners. The hospitalist movement has much to offer internal medicine. To enjoy the benefits and avoid the harms associated with the hospitalist model, internal medicine must resist the imposition of the mandatory hand-off and use the hospitalist's focus on excellent inpatient care to improve the practice of medicine by all internists.