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The Journal of Hospital Medicine (JHM), the official peer-reviewed journal of the Society of Hospital Medicine (SHM), recently published a retrospective study, “Growth Trends of the Adult Hospitalist Workforce Between 2012 and 2019,” which identified a more than 50 percent growth in the adult hospitalist workforce in the United States between 2012 and 2019. The authors, Joshua Lapps, MA, Bradley Flansbaum, DO, MPH, MHM, Luci K. Leykum, MD, MBA, MSc, SFHM, Heidi Bischoff, and Eric E. Howell, MD, MHM, concluded that 44,037 adult hospitalists existed in 2019, including those who self-identified. The population of hospitalists continues to grow at a consistent rate and places hospital medicine among the top five largest physician specialties in the country.
“It has always been a challenge to accurately identify the number of practicing hospitalists across the United States,” explained Joshua Lapps, MA, Director of Policy and Practice Management at the Society of Hospital Medicine. “Fully understanding the complexities of the workforce is extremely important, especially when it comes to healthcare reforms and public reporting.”
One of the main challenges has been differentiating hospitalists from outpatient general internal medicine or outpatient family medicine physicians, which became more pressing with the recent revaluation of hospital visit evaluation and management (E/M) codes. Additionally, the designation of “hospitalist” was only available in Medicare’s Provider Enrollment Chain and Ownership System (PECOS) beginning in 2016 as “C6,” nearly two decades after the specialty’s inception.
To classify hospitalists who did not self-identify, the authors utilized national Medicare Provider Utilization and Payment (MPUP) data for Medicare Part B fee-for-service claims from 2012 through 2019 and applied a commonly used 90 percent threshold of Healthcare Common Procedure Coding System (HCPCS) codes commonly associated with hospitalist billing, including acute inpatient, observation, and critical care. Physicians who met that threshold were then identified as hospitalists for the purpose of this study.
“Despite a national reduction in hospital beds per capita, hospitalist numbers continue to grow dramatically,” said Gregory W. Ruhnke, MD, MS, MPH, SFHM, Senior Deputy Editor of the Journal of Hospital Medicine and Associate Professor, Section of Hospital Medicine in the University of Chicago Department of Medicine. “Among the many drivers of this trend is the exodus of primary care physicians from inpatient rounding, a process which has helped to solidify the boundaries between inpatient and outpatient medicine.”
Methods for identifying the entire field of hospitalists that do not rely on billing and coding have not yet been developed. The authors suggest that additional methods of accurate identification be made a priority moving forward to ensure proper representation and prudent decision-making at the health system and policymaking levels.
“This important study will not only help hospitalists have a louder voice in important policymaking discussions, but it will also equip professional societies like SHM to better understand the field and support hospitalists’ needs in education, professional development, and more,” noted Eric E. Howell, MD, MHM, Chief Executive Officer of the Society of Hospital Medicine.
Read the full study in the Journal of Hospital Medicine.