Rebuttal: Are inpatients’ needs better served by hospitalists than by their family doctors?

It seems that Dr Wilson’s arguments against hospitalists have little to do with serving inpatient needs and more to do with the reform and rebuilding of the primary care system. He readily admits that hiring the “best-of-the- best ... most competent, experienced, and efficient” in-house doctors reduces tensions on the system and improves the inpatient experience. He laments the loss of these physicians from the community and the missed opportunities for continuing professional development of those who decide to excuse themselves from inpatient care. Increasingly complex inpatients and the urbanization of society have made it more difficult for traditional FPs to provide all aspects of care to all of their patients all of the time. Society is changing and the system itself needs to change in order to adapt. Family physicians working as hospitalists do provide better care for inpatients; physicians need to start rebuilding the primary care system by first being champions of this improved patient care. Computer technology makes it possible for community physicians to follow their patients’ courses in hospital. Fee structure changes have allowed community physicians without hospital privileges to visit their patients in hospital, providing the rapport and trust needed to communicate patients’ values and priorities to inpatient physician team. These changes will “defragment” and improve patients’ transition from hospital to home, reducing the need for future hospitalizations. By working together, community FPs and hospitalist FPs will help preserve and strengthen the doctor-patient relationship. Now is not the time to argue against change that provides better patient care—we must embrace it and improve upon it to forge a better future for our health care system and everyone it serves.

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