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What Are Hospitalists? And What Value Do They Bring to Health Care?

To learn more, we turned to Marisha Burden, MD, MBA, head of the CU Division of Hospital Medicine and a leading researcher on hospital work design.

minute read

Written by Mark Harden on May 16, 2024

While hospitals have been around for centuries, hospitalists – hospital-based physicians and other practitioners – are far more recent. In fact, the term “hospitalist” wasn’t coined until 1996 in a New England Journal of Medicine paper.

In decades past, primary-care physicians typically would check on their patients when they were admitted to the hospital. But as office-based doctors got busier and hospital systems got larger and more complex, the need grew for on-site hospital clinicians to care for inpatients. The number of hospitalists across the United States has grown from fewer than 1,000 in 2000 to more than 60,000 as of 2020, making it one of the fastest-expanding medical specialties.

With the increasing complexity and specialization of hospital work, attention is turning to how best to manage the demanding workload of hospitalists to ensure the best care for patients and to avoid overload and burnout among practitioners.

At a Hospital, a Satisfied Workforce Can Mean Better Outcomes for Patients

Marisha Burden, MD, MBA, is head of the University of Colorado Division of Hospital Medicine in the CU Department of Medicine and one of the nation’s leading researchers on the dynamics of work design in the hospital setting. She is an advocate of evidence-based staffing models and work design.

At UCHealth University of Colorado Hospital on the CU Anschutz Medical Campus, Burden’s team of more than 120 physicians and 55 advanced practice providers care for almost half of UCH’s hospitalized patients. They’re supported by data, analytics, and administrative teams.

X Video: What CU hospitalists love about their jobs.

Burden has drawn national attention for her work. In 2022, the Society of Hospital Medicine presented her with its Award of Excellence in Clinical Leadership for Physicians. She is on the executive committee of HOMERuN, the Hospital Medicine Reengineering Network. And on May 16, Burden delivered a keynote lecture on the “Art and Science of Hospitalist Workloads” as part of the Society of General Internal Medicine’s Distinguished Professor Special Series at its annual meeting in Boston.

With National Hospital Week underway, we turned to Burden to help us better understand hospitalists and their role in medicine.

Photo at top: Marisha Burden, MD, MBA, speaking at the Society of General Internal Medicine’s Distinguished Professor Special Series at its annual meeting in Boston on May 16, 2024. Photo by Vineet Chopra, MD, MSc, | CU Department of Medicine.

Q&A Header

What is a hospitalist?

For me, the concept of being a hospitalist encompasses a wide spectrum of roles and contributions. Within my division, we encompass clinicians, a data and analytics team, and administrative staff. Despite the diverse functions, I see each of us as integral parts of the hospitalist ethos.

What hospitalists do typically is take care of patients within the hospital. The physicians and the advanced practice providers are the ones providing the clinical care. We have a broad variety of patients that we care for. We often care for medically complex patients, and we also help our surgical colleagues care for their patients as well.

And we’ve started to expand beyond the walls of the hospital. Across the country, you see hospital-at-home programs, and those are often managed by hospitalists. And here we have a virtual hospital service providing care at night to three rural hospitals.

We’re also systems experts. What hospitalists love to think about is, how do you improve structures and processes at hospitals to drive better outcomes?

Do hospitals and health systems value hospitalists?

Absolutely. Not everybody in the community may know the term “hospitalist” just yet, although that’s shifting over time, but our health systems certainly know. Whenever there’s a tough problem to solve, hospitalists are one of the first groups that our health systems turn to with questions like, how do we improve patient flow? How do we improve our process?

Look at our footprint at UCH. We care for almost half of the patients in our hospital. You see this trend nationally as well. Hospitals want to have a solid hospitalist team because it will heavily impact their outcomes.

You’ve built a research specialty around optimal hospital work design. What does that mean?

I love to think about how to help build optimal team structure so that all the incredible people I have on my team can do their best work and so patients get the best care. I have a lot of passion and fire around this.

How did you come to this focus of your medical career?

My first job was at a local safety-net hospital. They expected us to be academic hospitalists. They said, “You are going to think about problems. You’re going to study them. And you’re going to publish on them.” Often that’s not a skill set that you walk out of residency with, at least not back in those days. It was a daunting task when you didn’t know how to do something.

But I had – still have – the best mentor, Richard Albert, MD, who helped me see these interesting questions that fall into your lap every day at a hospital: Something doesn’t go as planned, or you hear someone say something and you don’t know if that’s true. He helped me to see the gems in those questions, how to turn them into excellent research topics that would be feasible and interesting and impactful. There’s an art to that.

And then he taught me how to write papers. I learned through that that you can have a very big voice when you have the opportunity to share your work. People listen and you can have an influence.

→ GrittyWork: Improving Patient, Clinician and Organizational Outcomes through Evidence-Based Hospitalist Staffing Models

Then, because the field is so young, and because I love operations, I was in leadership very early. And since then, I’ve faced a lot of tough questions. As division head, you’re constantly balancing a lot of things – like finances and workloads. But you start to see the consequences of that. The pandemic really showed us those consequences. As a human, you have breaking points. You can only do so much, there are high burnout rates, and there is a point beyond which you can’t provide care the way you want to.

So, seeing that over my career, my job as a division head is to make sure that I’m resourcing my team sufficiently. And as you get bigger and you take care of half of a hospital, your teams get bigger, and your expenses are large. So that led to a lot of conversation around what’s the optimal work design.

So we started thinking about, how do you measure work? What do people think about their experience of work? What are the outcomes when your work experience isn’t what you want it to be? For me, it ballooned into this massive, probably lifelong career of thinking about optimal work design. And the lovely thing is, it’s very much aligned with my division head role.

I feel very lucky to be able to work to address things that maybe aren’t working very well and make them better.

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Marisha Burden, MD, MBA