Is it time for a new kind of hospital physician?

The authors rightly describe the increase in the provision of care by acute medical units, which they attribute to a combination of increasing costs, the need to provide quality care, and the restriction in junior doctors' hours. However, I would argue that the real reason for this increase is actually the rising burdens of older, sicker patients, coupled with the 4-hour A&E target that was instituted by previous governments. This resulted in hospitals having to move patients from the emergency department to an inpatient bed for treatment before the arbitrary time-limit of 4 hours was reached. In many other countries, a patient might be seen and treated in the emergency department within in the acute period and discharged before needing to be moved to another inpatient area. I have worked with colleagues from Australia who have come to the UK and have expressed confusion over the purpose of the acute medical unit, which they see as an unnecessary development.