A hospitalist is an inpatient physician who coordinates care for hospitalized patients. Hospitalists are a branch of hospital medicine, which was organized in 1998 with the formation of the National Association of Inpatient Physicians, which in 2003 grew into the Society of Hospital Medicine. The society estimates that nearly 31,000 physicians practice hospital medicine, making it a rapidly growing specialty.
From the patient’s admission from emergency room until discharge, the hospitalist delivers direct patient care, consultations and preoperative evaluations. The following is an example of the kind of daily schedule a hospitalist might experience on the job.
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6:55 a.m.: A hospitalist’s day begins by having a conversation with the nocturnist, the overnight admitting physician. He or she will give the hospitalist a brief idea of any new patients, including any outstanding issues.
Some days no new patients are added. Censuses vary depending on the institution and generally include 17 to 25 patients per hospitalist.
Next, you will review morning labs, radiographic studies and overnight events while listening for pages. If you receive an announcement regarding your patient, your focus will immediately shift to manage the emergency.
8:30 a.m.: At this point, a hospitalist will head to the floor to see patients, prioritizing the sickest ones first. A lot of time is spent educating patients and updating family members.
It’s ideal if a family member is present, especially as the doctor prepares to discharge the patient. It also saves time on phone calls later.
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10:30 a.m.: Later in the morning, a hospitalist will sit with social workers and case managers to discuss the patient list. These professionals can provide information about a patient’s situation in development for the optimal discharge environment. This might include discussing background information about a patient’s home and insurance information, both of which can help determine the best possible discharge location. A patient that is homeless or uninsured may need a different solution for ongoing care.
For example, a hospitalist might learn that a bed has opened up at a nursing home and a is patient scheduled to leave at 4 p.m. The doctor will need to write a discharge summary and prescriptions, as well as perform medicine reconciliation. Medicine reconciliation is the process of comparing inpatient medications with outpatient medications and determining which medications are needed upon discharge.
As always, there is a chance that your pager will go off. A hospitalist may have to run to the emergency department to meet, evaluate and assess a new patient, develop a treatment plan and write orders for admission.
1 p.m.: As a hospitalist, you will eat lunch on the run as you still have many patients to see and daily notes to write on all of them.
The nurse calls you and tells you that the intravenous team is unable to get intravenous access on a patient and needs a central line. Fortunately, the procedurist — physicians who only do procedures are an evolving part of hospital medicine — arrives and handles this task.
Throughout the remainder of the day, nurses page with questions and pharmacists request clarification of a medication order while the hospitalist completes rounds and documentation.
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7 p.m.: Pager coverage shifts to the nocturnist. This means it’s time to sign out to the nocturnist and tie up loose ends from the day.
Hospitals are constant learning environments due to access and interaction with other specialties. The beauty of hospital medicine is the variety of patients, disease presentations and personal interactions required to care for people during a very vulnerable time. When the patient is discharged, the hospitalist’s duties end.
Medical school students contemplating becoming a hospitalist train in internal medicine or family practice. There are now postresidency training fellowships in hospital medicine. If you want to be a part of a health care team providing direct patient care in an acute setting, consider hospital medicine.
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Get to Know a Day in the Life of a Hospitalist originally appeared on usnews.com
