What is an academic hospitalist?

Yesterday at a faculty meeting, one of my faculty members asked this question. The context comes from my attempt to add to our general internal medicine.

I believe that we all know what a community hospitalist does. Hospitalists at community hospitals work almost solely caring for inpatients. They do not have an outpatient practice.

In academic medicine, few faculty spend all their time doing any one thing. Many academic centers have “uncovered” inpatient services (no housestaff) in addition to housestaff supervision services. Many traditional academic internists (myself included) spend several months each year on the housestaff inpatient service.

The two movements (community hospitalists and academic hospitalists) actually have slightly different drivers. Community hospitalists provide inpatient care and allow many physicians to devote themselves to outpatient practice only. They also provide concurrent care for many surgical patients – allowing the surgeon to focus on operative care rather than pre and post operative care.

Academic centers often employee community hospitalists, because with current work hour requirements we have too many patients for the housestaff to follow. These hospitalists help decompress the teaching service and allow that service to remain “right sized.”

Academic hospitalists claimed their label because they did at least 2 months each year of teaching residents. This movement is growing because most internal medicine chairs and program directors now understand that having an attending who only does one month each year means that you usually have an inadequate attending physician. These one month stints decrease the quality of both education and patient care.

Academic hospitalists often participate in housestaff education at a leadership level. They (like their community counterparts) often participate in hospital quality projects. An increasing number of academic hospitalists engage in research relevant to hospital care, quality and safety.

Most hospitalists are internists with a hobby – like the more traditional academic general internists. Many classic academic general internists have (and continue) to supervise the inpatient housestaff services 2 or more months each year.

So what is an academic hospitalist? Why are we trying to make this distinction? Why do we call some internists general internists? What the heck does general mean? I believe that all of us who have not subspecialized are internists. We have different hobbies, but we are all internists. In academic medicine, internists without a subspecialty usually have an array of skills, e.g. inpatient attending, clinic attending, covering an uncovered service, caring for private outpatients, doing research, writing papers or books, serving administrative roles, etc. We are internists. Perhaps we should eliminate the unnecessary adjective (general) and remember our Oslerian roots.

I cannot answer the question. Perhaps defining an academic hospitalist is like defining pornography. Perhaps the question is moot.