UC San Francisco will establish the country's first formally funded training program in an academic medical center for doctors who specialize in the care of hospital patients, thanks to a grant from a New York City-based foundation with a history of funding innovative projects in medical education. The Josiah Macy, Jr. Foundation will give UCSF $712,000 over three years to establish the program for doctors in the recently emerged specialty of hospital care, called hospitalists. About six of UCSF's approximately 30 internal medicine residents are participating in the pilot program, which began in July 1998.
Having doctors who specialize in hospital care is a departure from the way doctors have traditionally functioned in American academic hospitals. Traditionally, the care of hospital patients has been managed by residents, who are medical school graduates in the late stages of training, in academic medical centers. Residents work under the supervision of faculty members who rotate in that role infrequently, often just for one month each year. Patients' primary care doctors traditionally managed their care in non-teaching hospitals. The emergence of hospitalists is based on the idea that inpatient care specialists will be better skilled, more efficient and more available to hospitalized patients than primary care physicians or residents.
UCSF's hospitalist-track residents will receive special training in a variety of subjects related to hospital care, said Robert Wachter, MD, UCSF associate professor of medicine and epidemiology, associate chairman of UCSF's Department of Medicine and chief of the Medical Service at UCSF's Moffitt-Long Medical Center.
In addition to standard training in internal medicine, residents in the program will study aspects of medicine they are more likely to encounter in hospitals, such as the care of dying patients, Wachter said. They also will work on developing skills in areas that will help them be more efficient and better leaders. Those areas include communications, quality improvement, the economics of health care and team building, he said.
Skills in those areas are necessary, Wachter said, because part of hospitalists' jobs will be to make sure hospital patients get quality care at a time when managed care is forcing hospitals to cut costs. "We believe that hospitalists not only need to learn to be excellent and efficient clinicians, but they also need to learn to be leaders in making the system work better," Wachter said.
Though hospitalists currently work in a number of hospitals throughout the country, including the UCSF Medical Center, part of UCSF Stanford Health Care, which has used hospitalists for about three years, there is currently is no formal training program for them. There are an estimated 2,000 to 3,000 hospitalists working in the U.S. today and the ultimate demand could reach 30,000, experts have predicted.
Developing a special training program is one of three key steps that must take place before a specialty, such as hospital care, is formally recognized by the medical community.
The specialty has already met the other two challenges, developing a body of research and forming a national organization, Wachter said. A year-long UCSF study recently published in the Journal of the American Medical Association found that increasing the involvement of hospitalists may be a key to shorter, less costly hospital stays that don't compromise quality. In addition, hospitalists have already formed a formal association, the National Association of Inpatient Physicians.
Those advances have taken place since Wachter and Lee Goldman, MD, UCSF professor of medicine and chairman of the UCSF Department of Medicine, co-authored a 1996 New England Journal of Medicine article in which the term "hospitalist" was coined.
While improving value may not have been a primary focus as little as five years ago, managed care now forces health care providers to look for ways to cut costs without harming quality or patient satisfaction, Wachter said. Hospitalists are an increasingly popular solution to this difficult challenge, he said.