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Letters |

Advantages and Limitations of the Hospitalist Movement—Reply

Robert M. Wachter, MD; Lee Goldman, MD, MPH
JAMA. 2002;287(16):2073-2076. doi:10.1001/jama.287.16.2073.
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In Reply: We have previously described the advantages and disadvantages of the rotational (hybrid) model described by Dr Applebaum.1 Although that model does preserve some hospital experience for primary care physicians, a 1-week-in-6-week rotational model has fundamental flaws that undermine its value. Physicians who compress their hospital time into week-long rotations accrue no more overall hospital experience than they would if they made daily hospital rounds on their own patients. No physician becomes fully invested in hospital care or in leading hospital quality improvement activities, the office practice frays during the hospital week, and the continuity advantages are illusory—an individual patient has only a 1-in-6 chance of being cared for by his or her own physician in the hospital. If the hybrid model can produce the quality and efficiency outcomes of a true hospitalist program, it may be a reasonable alternative. We doubt it will but studies are needed.

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