Procedures Performed by Hospitalist and Non-hospitalist General Internists
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
In caring exclusively for inpatients, hospitalists are expected to perform hospital procedures. The type and frequency of procedures they perform are not well characterized.
To determine which procedures hospitalists perform; to compare procedures performed by hospitalists and non-hospitalists; and to describe factors associated with hospitalists performing inpatient procedures.
National sample of general internist members of the American College of Physicians.
We characterized respondents to a national survey of general internists as hospitalists and non-hospitalists based on time-activity criteria. We compared hospitalists and non-hospitalists in relation to how many SHM core procedures they performed. Analyses explored whether hospitalists’ demographic characteristics, practice setting, and income structure influenced the performance of procedures.
Of 1,059 respondents, 175 were classified as “hospitalists”. Eleven percent of hospitalists performed all 9 core procedures compared with 3% of non-hospitalists. Hospitalists also reported higher procedural volumes in the previous year for 7 of the 9 procedures, including lumbar puncture (median of 5 by hospitalists vs. 2 for non-hospitalists), abdominal paracentesis (5 vs. 2), thoracenteses (5 vs. 2) and central line placement (5.5 vs. 3). Performing a greater variety of core procedures was associated with total time in patient care, but not time in hospital care, year of medical school graduation, practice location, or income structure. Multivariate analysis found no independent association between demographic factors and performing all 9 core procedures.
Hospitalists perform inpatient procedures more often and at higher volumes than non-hospitalists. Yet many do not perform procedures that are designated as hospitalist “core competencies.”
- Wigton RS, Alguire P. The declining number and variety of procedures done by general internists: a resurvey of members of the American college of physicians. Ann Intern Med. 2007;146:355–60.
- Duffy FD, Holmboe ES. What procedures should internists do? Ann Intern Med. 2007;146:392–3.
- Wachter RM, Goldman L. The emerging role of "hospitalists" in the American health care system. N Engl J Med. 1996;335:514–7. CrossRef
- Farnan JM, Arora VM. The declining number and variety of procedures done by general internists. Ann Intern Med. 2007;147:814.
- The core competencies in hospital medicine: a framework for curriculum development by the Society of Hospital Medicine: Society of Hospital Medicine. 2006;42–57.
- Hoff TH, Whitcomb WF, Williams K, Nelson JR, Cheesman RA. Characteristics and work experiences of hospitalists in the United States. Arch Intern Med. 2001;161:851–8. CrossRef
- Lindenauer PK, Pantilat SZ, Katz PP, Wachter RM. Hospitalists and the practice of inpatient medicine: results of a survey of the National Association of Inpatient Physicians. Ann Intern Med. 1999;130:343–9.
- Lindenauer PK, Rothberg MB, Pekow PS, Kenwood C, Benjamin EM, Auerbach AD. Outcomes of care by hospitalists, general internists, and family physicians. N Engl J Med. 2007;357:2589–600. CrossRef
- Saint S, Christakis DA, Baldwin LM, Rosenblatt R. Is hospitalism new? An analysis of Medicare data from Washington State in 1994. Eff Clin Pract. 2000;3:35–9.
- Wachter RM. Hospitalists in the United States–mission accomplished or work in progress? N Engl J Med. 2004;350:1935–6. CrossRef
- Huang GC, Smith CC, Gordon CE, et al. Beyond the comfort zone: residents assess their comfort performing inpatient medical procedures. Am J Med. 2006;119:71.e17–.e24. CrossRef
- Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27. CrossRef
- Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 2002;137:511–20.
- McCormack J. The new proceduralists. Am Med News. 2007;14-15.
- Fischer JE. The impending disappearance of the general surgeon. JAMA. 2007;298:2191–3. CrossRef
- Lynge DC, Larson EH, Thompson MJ, Rosenblatt RA, Hart LG. A longitudinal analysis of the general surgery workforce in the United States, 1981-2005. Arch Surg. 2008;143:345–50. discussion 351. CrossRef
- Feller-Kopman D. Ultrasound-guided thoracentesis. Chest. 2006;129:1709–14. CrossRef
- Feller-Kopman D. Ultrasound-guided internal jugular access: a proposed standardized approach and implications for training and practice. Chest. 2007;132:302–9. CrossRef
- Society of Hospital Medicine, 2007-2008 Survey. The authoritative source on the state of the hospital medicine movement: Society of Hospital Medicine. 2008.
- Kuo YF, Sharma G, Freeman JL, Goodwin JS. Growth in the care of older patients by hospitalists in the United States. N Engl J Med. 2009;360:1102–12. CrossRef
- Procedures Performed by Hospitalist and Non-hospitalist General Internists
Journal of General Internal Medicine
Volume 25, Issue 5 , pp 448-452
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- time-activity criteria
- Industry Sectors
- Author Affiliations
- 1. Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD, 21224-2735, USA
- 2. American College of Physicians, 190 North Independence Mall West, Philadelphia, PA, 19106-1572, USA
- 3. University of Nebraska Medical Center College of Medicine, 985524 Nebraska Medical Center, Omaha, NE, 68198-5524, USA