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Anticipation vs Reality

Andrew D. Auerbach, MD, MPH; Mark D. Aronson, MD; Roger B. Davis, ScD; Russell S. Phillips, MD

Arch Intern Med. 2003;163:2330-2336.

Objective  To determine whether internists' attitudes toward the hospitalist model change after implementation of a new inpatient service.

Design  Cross-sectional surveys performed in 1998 and 2000.

Setting  Tertiary care hospital in Boston, Mass.

Subjects  A total of 236 internal medicine board-certified physicians affiliated with Beth Israel Deaconess Medical Center.

Main Outcome Measures  Responses to survey items regarding attitude toward inpatient care and the hospitalist model. We used multivariable models to determine factors associated with physician responses.

Results  Of physicians surveyed in 2000, 236 (69%) responded; 145 (61%) had also responded in 1998. The mean (SD) age of respondents was 46.4 (10.8) years; 157 (66.5%) were male; and 146 (61.9%) were primary care providers. In 2000, more physicians agreed that "caring for inpatients is an inefficient use of my time" (P<.001), and that "use of a hospitalist service improves quality of care" (P = .002). In 2000, more physicians disagreed that "use of a hospitalist service diminishes physician career satisfaction" (P<.001), and that "use of the hospitalist service adversely affects the physician-patient relationship" (P<.001). No differences were detected in responses to questions regarding patient satisfaction or overall career satisfaction. In multivariable models, older physicians were more likely to favor the hospitalist model; those with busier inpatient practices were more negative (P<.05 for each). Physician specialty or being a primary care provider was not associated with attitudes toward the hospitalist model.

Conclusions  Following experience with a hospitalist system, physician attitude, including concerns regarding career satisfaction and relationships with patients, toward a voluntary hospitalist model improved. Future research should investigate whether the hospitalist model affects patient satisfaction and quality of care.

From the Department of Medicine, University of California, San Francisco, (Dr Auerbach), and Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Mass (Drs Aronson, Davis, and Phillips). The authors have no relevant financial interest in this article.

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