Blog | Tuesday, April 21, 2015

Should the word 'hospitalist' be more protected?

Our specialty of hospital medicine has grown exponentially over the last decade and now finds itself at the forefront of American medicine. I'm proud to be part of such a growing movement and must say that I find the job just as rewarding as when I first became an attending physician when the specialty was still in its fledgling stage. As the number of us soars towards the 50,000 mark, the vital work we do across the country every day is rightly becoming more widely known and recognized.

The term “hospitalist” was first coined in 1996 in a New England Journal of Medicine article and has now become our job title. But at this point let me break from my esteemed colleagues who champion the phrase. I've written previously about my personal dislike of the word “hospitalist,” including in this article published last year on a top social media site entitled “Please don't call me a hospitalist.” I received a lot of emails after writing this—both positive and negative. I know a lot of our colleagues right now are celebrating the fact that the head of the Centers for Medicare and Medicaid Services and the new surgeon general are “hospitalists.” Isn't this great for the specialty?

Don't get me wrong, I mean no personal disrespect to our founding fathers who first came up with the job title or the thousands of hard working hospital doctors, but I've personally never used that word to describe myself, find it a slightly ridiculous term, and have always gone an extra mile to avoid putting the word on my business cards or even my name badge. For me, being known to my patients as their “attending physician” or “internal medicine doctor” is all I want.

But I will move on from the points I raised previously to another central question: If this is the name that we've adopted, should it be more protected? This question arises because over the last few years on my travels up and down the East Coast, I've noticed more and more people banding around the word “hospitalist” to describe what they do. For instance I've heard many specialty colleagues such as nephrologists and endocrinologists who find themselves working mainly in the hospital describe themselves as functioning as a “hospitalist.” I've heard final year residents and even medical students on-call openly say that they are working as the “hospitalist.” Nurse Practitioners and PAs frequently describe themselves as the “covering hospitalist.” I've even heard respiratory therapists and wound care nurses who are covering multiple floors describe themselves as the “respiratory therapy hospitalist” and “wound nurse hospitalist!”

Not to get stuck on names, but this situation would never occur with most other specialties. For example, neither a resident, respiratory therapist, nurse practitioner or physician assistant would boldly describe themselves as the “cardiologist” or “nephrologist” on-call.

I understand that this may not be a big issue to lots of our colleagues, but remember that you have gone through medical school and residency to call yourself an attending physician—why make yourself anything else? Without sounding arrogant, there isn't a professional out there who would ever describe themselves as anything of less magnitude than their true job title. A chief executive officer of a company wouldn't introduce him or herself as “one of the managers” and a 747 pilot would never describe him or herself as “one of the airline staff.”

We belong to an ancient profession. The word “doctor” is more than 2,000 years old, aptly derived from the Latin doctus meaning teach or instruct. Physician was used traditionally to describe a medical doctor, and King Henry VIII granted the first charter to form the Royal College of Physicians in 1518. In almost every country in the world, a medical doctor is considered to be among the most noble and prestigious professions, the title only conferred after 1 of the most rigorous university courses in existence. It is a privilege and honor to be 1.

I'm afraid to say that in my own experience, whether we like it or not, “hospitalist” in the eyes of many says “I am a shift worker,” or “I am transient,” or “I am some type of resident,” or I am “owned by the hospital.” If you are the attending physician—now that's something a lot more meaningful.

So should the word “hospitalist” be protected like a cardiologist or radiologist, and specifically is a hospitalist always a physician practicing hospital medicine? That's a question for the wider community. For me personally, as someone who doesn't use the word, it doesn't matter! But if any Tom, Dick or Harry who works in a hospital and is employed in shift work, physician or not, now feels able to call themselves a “hospitalist,” what does it mean for you to primarily use that as your job title?

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.