California hospital leaders' views of hospitalists: meeting needs of the present and future

Abstract

Background: Hospital medicine has grown rapidly, but hospital leaders' perceptions of current and future drivers of hospitalist growth are unknown.

Objective: : To determine hospital executives' perceptions of factors leading to hospitalist implementation and their vision for hospitalists' work roles.

Setting: Nonfederal, acute care hospitals in California.

Participants: California hospital leaders (eg, chief executive officers).

Intervention: Cross-sectional survey from 2006 to 2007.

Measurements: We asked California hospital leaders whether their hospitals had a hospitalist service and the prospects for growth. In addition, we examined factors responsible for implementation, scope of hospitalists' practices, and need for additional certification as perceived by hospital leaders.

Results: We received surveys from 179 of 334 hospitals (response rate of 54%). Of the 64% of respondents that reported the use of hospitalists, none intended to decrease the size of their hospitalist group, and 57% expected growth over 2 years. The most common reasons for implementing a hospitalist program were to care for uncovered patients (68%) and improve cost/length of stay (63%). Respondents also indicated that demand from other physicians was an important factor. Leaders reported that hospitalists provide a wide range of services, with a majority involved in quality improvement projects (72%) and medical comanagement of surgical patients (66%). Most leaders favor additional certification for hospitalists.

Conclusions: There is widespread adoption of hospitalists in California hospitals, with an expectation of continued growth. The drivers of the field's growth are evolving and dynamic. In particular, attentiveness to quality performance and demand from other physicians are increasingly important reasons for implementation.

Figure 1

Reasons for Implementing a Hospitalist System among Respondent Hospital Leaders with a Hospitalist System (N = 115)

Figure 2

Activities Provided by Hospitalists among Respondent Hospitals with Hospitalists (N = 101)

Figure 3

Activities Hospital Leaders Would Like to Have Implemented by Their Current Hospitalist Group(s), if Not Currently Providing