Hospitalists and family physicians

The editorial in the April issue of Canadian Family Physician¹ makes the valid point that questions about the organization of hospital care need to be asked. However, it appears to be somewhat of a stretch to compare Canadian hospitalist outcomes with US intern and resident results.

Several factors make such a comparison—although a useful exercise—less valid. First of all, hospitalist rotations vary greatly among Canadian hospitals of all sizes. There are no data that indicate Canadian hospitalist rotations are similar to intern and resident rotations. No one would argue against continuity of care being extremely important. Hospitalist programs organize themselves to maximize continuity of care and minimize the risks of transitions of care. Hospital lengths of stay are much reduced from years ago and thus continuity of care is very often preserved. Canadian data regarding outcomes are being produced and will soon be found in the peer-reviewed literature.

Second, hospitalist care in Canada is very different from what family medicine care was or currently is. Most hospitalists in Canada now function in a scope of practice that not long ago would have been considered general internal medicine (minus critical care). In Ontario, 30% of hospitalists are non–family medicine physicians (Canadian Society of Hospital Medicine, 2008, unpublished data). Comparisons with “the way medicine used to be practised” are difficult.

Finally, as evidenced by the recent Canadian Society of Hospital Medicine document “Core Competencies in Hospital Medicine,”² inpatient physician care is highly focused on quality improvement, safety, and medical expertise, as well as the whole range of CanMEDS roles. As chief editor of this document, I look forward to its wide dissemination and application, including in the areas of education, research, reviews, and evaluation of scopes of practice—not just by individuals who consider themselves hospitalists, but by any practitioners (including more traditional full-service family physicians) who play important roles in inpatient care.

Inpatient medicine today is very different from what it was “back in the day” when I provided full-service family medicine care. Ideally we will continue to focus on patient care, safety, and quality improvement in a collaborative fashion with hospital interdisciplinary team members and community physicians. I totally agree that the question regarding outcomes needs to be answered; however, comparisons between family medicine hospital practice and hospitalist practice are less productive. More effort should be spent on developing better systems to ease transitions of care from community to hospital, on collaboration when patients are hospitalized, and on mechanisms to ensure safe transitions back into the community.

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