Hospital Medicine

Hospital medicine is a type of practice within internal medicine in which the clinical focus is caring for hospitalized patients. Internal medicine physicians practicing hospital medicine are frequently called “hospitalists.”  Although not all hospitalists are required to be internal medicine physicians, the nature of internal medicine training uniquely prepares internal medicine physicians for hospital medicine practice.  As a result, the vast majority of hospitalists caring for hospitalized adult patients are trained in internal medicine, usually general internal medicine. Pediatric hospitalists are pediatricians who focus on the care of hospitalized children.

The discipline of hospital medicine grew out of the increasing complexity of patients requiring hospital care and the need for dedicated clinicians to oversee their management. The hospitalist model supplanted the traditional method of caring for hospitalized patients, which was often done by clinicians also seeing ambulatory patients or with other clinical obligations that limited their ability to provide the intensity of care often required by these patients. By focusing their practice on this specific group of patients, hospitalists gain specialized knowledge in managing very ill patients and are able to provide high-quality, evidence-based, and efficient patient and family-centered care in hospital settings.  Additionally, hospital medicine expanded concurrently as increasing medical complexity of surgical patients.  Many hospitalists help provide medical care for surgical patients through consult or comanagement relationships.

There are many models of hospital medicine practice. A common model involves working for one to two-week blocks of time followed by a similar amount of time off, which allows continuity of patient care through the majority of hospital admissions as well as adequate time to decompress from the intensity of providing inpatient care. However, there are many different practice variations available for internal medicine physicians practicing hospital medicine.

Some hospitalists may also focus their practice further within hospital medicine. For example, some hospitalists may elect to work primarily overnight (“nocturnists”) or may gain experience or undergo further training to enable them to care for critically ill individuals (“intensivists”).  Additionally, hospitalists may expand their focus on point of care ultrasound (pocus), bedside procedures, addiction medicine, and perioperative medicine.

Many hospitalists are employed by medical institutions to provide inpatient services, while others may be part of larger group practices to admit patients from within the practice who require hospital care. An important aspect of hospital medicine is the ability to collaborate and communicate with other physicians providing longitudinal care to ensure continuity between inpatient and ambulatory settings.

In addition to clinical work, hospitalists may also be involved in other activities. Academic medical centers and teaching hospitals usually have medical students and internal medicine residents rotating on hospitalist-directed services, allowing the opportunity to teach. Hospitalists may perform research that may focus on treatment of specific diseases, investigation of care delivery models or systems based practice, quality improvement, and medical education. Hospitalists are also uniquely qualified to participate in or lead important hospital activities such as quality and patient safety initiatives as well as for administrative roles, such as medical directorships and leadership of medical organizations.

Although most internal medicine physicians practicing hospital medicine hold general certification in internal medicine, the American Board of Internal Medicine offers a specific certification called Focused Practice in Hospital Medicine for established internal medicine physicians who limit their practice to hospital medicine. This is separate from general internal medicine certification with slightly different requirements; general internal medicine certification and certification with Focused Practice in Internal Medicine are mutually exclusive. However, it is possible to switch back and forth between certificates based on changes in practice focus.