Advantages and Limitations of the Hospitalist Movement

To the Editor: As an internal medicine residency training program director, I have had a unique vantage point to view the growth of the hospitalist movement through the eyes of our recent graduates who have entered into this fledgling specialty. Drs Wachter and Goldman¹ provide insight into the developing academic dimension of the field and introduce the notion of an academic hospitalist. I, unfortunately, have become very alarmed regarding the academic hospitalist's polar opposite. Namely, the all-to-common full-time, revenue-generating, quick-rounding, inpatient physician who often works exceedingly long hours without interruption while caring for many patients, often in multiple institutions. Such care runs the risk of being superficial and pedestrian. Sometimes these physicians elect very unreasonable duty hours for themselves and other times institutions foist them upon hospitalist physicians through extreme employment agreements.