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Is it time for a new kind of hospital physician?

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2240 (Published 04 April 2012) Cite this as: BMJ 2012;344:e2240

Rapid Response:

Re: Is it time for a new kind of hospital physician?

We read the article by Temple et al (BMJ 2012; 344 doi: 10.1136/bmj.e2240) with interest, who make a timely suggestion of defining physicians in the lines of Hospitalists and Office Physicians. This will be much more compliant with their lifestyle choices rather than the rather ambiguous distinction between generalists and specialists (to use an analogy from cricket: a bowler from a Test Cricket team is likely to be a better batsman compared to an average 'specialist' batsman from the 4th division local village league!).

In keeping with Temple et al.'s suggestion of reviving high quality General (Internal) Medicine and to deliver successfully on the efficiency challenge that the health service faces, our view is that:

1. It is absolutely essential to distinguish between Hospitalists and Office Physicians

2. Preferentially those Office Physicians should be encouraged to practice in hospital who deliver the QIPP (Quality Innovation Productivity Prevention) agenda on Long Term Conditions, i.e.

a. 25% reduction in LOS
b. 20% reduction in unscheduled care utilisation
c. 20% reduction in readmission rates
(more on http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPPworkstream...).

All other Office Physicians should be encouraged to work directly in Primary Care. We have got excellent examples of a select group of such Office Physicians in the health service, who have already voluntarily given up some Programmed Activities, enabling the recruitment of high quality Hospitalist colleagues.

Also, it is high time that training programmes are broadened in such directions as suggested by Temple et al., so that all trainees receive a foundation of exposure to health care management and health services delivery, enabling them to participate as informedcitizens in the systems in which they work and learn and future physicians are better equipped to interpolate themselves in the wider context of the whole health economy.

Competing interests: No competing interests

09 April 2012
Rahul Mukherjee
Consultant Physician
Birmingham Heartlands Hospital & Birmingham Chest Clinic, Heart of England NHS Foundation Trust
Academic Department of Sleep & Ventilation, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS