Analysis

Renaissance of hospital generalists

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e652 (Published 13 February 2012) Cite this as: BMJ 2012;344:e652
  1. Robert M Wachter, professor of medicine and chief1,
  2. Derek Bell, chair in acute medicine2
  1. 1Division of Hospital Medicine, University of California, San Francisco, CA 94143-0120, USA
  2. 2Chelsea and Westminster Campus, Imperial College London, London, UK
  1. Correspondence to: R M Wachterbobw{at}medicine.ucsf.edu
  • Accepted 2 January 2012

Hospital medicine in the US and acute medicine in the UK are the fastest growing specialties in their countries. Robert M Wachter and Derek Bell examine the factors behind their rise and how the differing national healthcare systems have influenced their structure

In the past 15 years, the organisation of hospital care has been transformed in both the United States and United Kingdom. In the US, the traditional model—in which primary care physicians came to the hospital to oversee inpatient care—was supplanted by one in which a hospital based generalist physician, the hospitalist, assumed this role.1 In UK hospitals, acute physicians have taken over from disease specialists in the management of acutely unwell patients and those with complex multisystem illnesses during the first 48-72 hours of admission.2

The growth of the generalist in both countries has been rapid. The number of hospitalists in the US has expanded from a few hundred 15 years ago to over 30 000 today. Around 70% of US hospitals now employ hospitalists,3 and the odds that an older patient admitted to hospital would receive care from a hospitalist increased by 29% a year between 1997 and 2006.4 Although the number of acute physicians in the UK is much smaller (roughly 600), the field grew by 63% between 2002 and 2007, making it the fastest growing specialty in Britain.5 Here, we describe the impact of these twin movements and analyse how both have been shaped by the structure and culture of their national healthcare systems.

Factors driving the growth of the hospitalist and acute medicine

The American hospitalist is a generalist physician who is responsible for patients throughout their hospital stay—not only in medicine units but often in intensive care units, “step-down” units (high dependency units in the UK), and surgical units (where the US model is known as co-management).3 6 …

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