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The Hospitalist Movement

TO THE EDITOR: I am deeply disturbed by the articles in the supplement on hospitalists (1). This concept was developed by the insurance industry for economic reasons, and it appears to be gaining support from leadership of the American College of Physicians-American Society of Internal Medicine. The hospitalist concept significantly diminishes and devalues us as a specialty and in the eyes of the patient community. During a patient's hospitalization, we demonstrate our greatest worth to our patients, and they remember us most for helping guide, care, and advocate for them. This is especially important at a time when many patients believe that the interests of the physician community are divided between the patient and insurance companies. Daily interaction with residents, colleagues, and hospital staff is an essential aspect of who we are as specialists in internal medicine. We are viewed as resources because of our expertise in hospital care. We offer a comprehensive perspective on our hospitalized patient. If we allow the hospitalist concept to take root and help validate it, we will be playing a pivotal role in redefining ourselves simply as primary care providers (physician and nonphysician) delivering only outpatient care. In the eyes of the public and the insurance industry, little will differentiate us from the other members of this category. We were deemed primary care providers by the insurance industry. We earned our board certification in internal medicine. It is incumbent upon our leadership to vigorously defend and advocate who we are as internists and the importance and special role we play in the overall care of our patients. Shame on the leadership of the American College of Physicians-American Society of Internal Medicine if it fails to recognize this and helps diminish, devalue, and perhaps destroy the specialty that we have chosen as our careers.