Within the last two years, hospital-based medicine reached its 20-year milestone as an acknowledged specialty, making it the perfect time for a look at how coverage was provided historically in hospitals, how it is provided in today’s healthcare environment, and how things will change in tomorrow’s value-based world. The market dynamics that shifted how call coverage is administered and compensated have left both physicians and hospitals unsatisfied with the new status quo. Now, an innovative approach to creating fair and sustainable call coverage arrangements is being employed.
THE ORIGINS OF THE HOSPITALIST DESIGNATION IN THE CONTEXT OF CALL COVERAGE
Prior to the 1990s, most physicians, regardless of specialty, spent a portion of their time rounding in the hospital to not only care for their own hospitalized patients but also unassigned patients. However, the need for specialized hospital-based medicine became increasingly evident. The “hospitalist” designation was coined by UCSF in August 1996 to describe primary care physicians dedicated to the practice of acute inpatient care. As the hospitalist specialty evolved, the rounding obligations of clinic-based primary care doctors were reduced, especially pertaining to the care of unassigned patients. Today, most clinic-based primary care physicians do not even round on their own hospitalized patients, leaving this work to the hospitalists.