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

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.