Hospital Medicine Celebrates 30 Years With 11 Doctors

For physicians who entered the field of hospital medicine two or three decades ago, the trajectory of their careers and the specialty itself has been remarkable. They have watched the field expand into quality improvement and patient safety, areas that were not even on the radar when they started. Many of these doctors are still surprised by how much the specialty has grown in terms of practitioner numbers and the range of services provided. The Hospitalist spoke with 11 experienced physicians to discuss their journeys, offering insights into the bright spots and challenges currently facing the specialty, as well as advice for new hospitalists entering the field.

A Shift from Marginalized to Essential

Andrew Dunn, MD, MPH, MACP, SFHM, describes the early days of hospital medicine as a small and often marginalized component of general medicine. At that time, there was little emphasis on inpatient quality, education, or scholarship. The setting has changed drastically since then. The specialty has flourished to encompass leadership in improving hospital efficiency, quality, and patient safety, inpatient medical education, and practice-changing scholarship. Dr. Dunn notes that growth has also occurred in innovative spaces like hospital at home and virtual hospital medicine.

He attributes this expansion to the recognition that dedicated clinicians develop an expertise that leads to improved patient care and helps hospital systems maximize efficiency. There is a persistent challenge, however. Dr. Dunn says hospitalists must continue to help patients make the transition from the inpatient to the outpatient setting as seamlessly as possible to curtail the outpatient-inpatient continuity gap.

Dr. Dunn worked as a clinician educator in primary care before the term “hospitalist” was coined. His institution had a growing need for inpatient leadership, which mirrored the national experience. He stepped into that leadership opportunity and has loved it ever since. He believes the ability to lead within the hospital system and care for patients throughout the continuum of care has become a defining characteristic of the profession.

Defining the Role

Vineet Arora, MD, MAPP, MHM, an academic hospitalist at UChicago Medicine, says the specialty has advanced from “start-up mode” to “sustained purpose.” She describes the evolution of subfields, which now include quality and safety, education, informatics, and leadership. The profession has matured to the point where you see hospitalists in roles that were previously occupied by specialists or administrators. Dr. Arora still identifies as a hospitalist and researcher, but her primary work focuses on overseeing education.

She believes it will become even more important for hospitalists to define their professional identity and expertise going forward. This is a challenge as more hospitals look for ways to cut costs and find sustainable, meaningful jobs. Dr. Arora cites a particularly important moment when she saw that the nation’s former surgeon general, Dr. Vivek Murthy, was a hospitalist. This helped put hospitalists on the map as someone who could be “the nation’s doctor.”

While the specialty has grown, the daily work remains demanding. Many hospitalists find themselves managing a high volume of patients with complex needs. This pressure can sometimes lead to clinicians focusing on just one problem or prioritizing expedited throughput to maintain bandwidth for new admissions. The sheer volume of patients can make it difficult to do a thorough review of a patient’s medical history and problems.

Looking at the broader picture, the role has shifted from simply treating illness to managing the complexities of the healthcare system itself. Modern hospitalists are increasingly expected to understand the business aspects of medicine and the social determinants of health that impact patient outcomes. This requires a different set of skills than those required a generation ago, blending clinical judgment with operational awareness. The pressure to address social issues like housing and food insecurity can be particularly frustrating for clinicians who feel like they are acting as a Band-Aid on a much larger wound.

Building the Future Workforce

Lenny Feldman, MD, FACP, FAAP, MHM, began his career at Johns Hopkins in 2004 when there were only five or six other hospitalists there. Today, there are about 60. He credits much of this growth to the development of the med-peds residency program, which he helped create. His career has led him through various leadership roles and serving as the founder of the “Things We Do for No Reason™” column in the Journal of Hospital Medicine.

Joanna M. Bonsall, MD, PhD, chief of hospital medicine at Grady Memorial Hospital, took a break between residency and fellowship to apply for a hospital medicine job. She didn’t look back. She felt well-guided to the specialty when she joined the SHM Academic Hospitalist Academy as a member of its inaugural cohort in 2009. She says hospitalists are now seen as “experts on inpatient care,” whether that expertise involves the perioperative period or how hospitals work from administration to care coordination.

Dr. Bonsall observes a challenge in today’s healthcare system: fractured care. She feels the U.S. system is not set up to encourage or facilitate conversation between care teams. This lack of communication happens between hospital medicine and specialists, between primary care and hospital medicine, or between hospitalizations. Care suffers as a result, and she notes that chart documentation cannot replace human conversation.

Keely Dwyer-Matzky, MD, MS, FHM, became one of the first med-peds hospitalists at the University of Rochester when the program started in 2007. Her career has taken her into patient safety and quality, areas that led her to pursue a Master of Science in business administration to understand the business aspects of medicine. She says hospitalists played a vital role during the COVID-19 pandemic, showing up every day for the sickest patients and exemplifying selflessness, creativity, and compassionate solutions.