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MedPac study finds jump in hospitalist numbers, dip in primary care physicians


Training, salary, and schedule may be pushing more students toward being hospitalists rather than general internists.

There is an increase in third-year internal medicine residents planning to become hospitalists rather than general internists, according to a new study from the Medicare Payment Advisory Commission (MedPac).

The study shows a 10 percent increase in students planning to become hospitalists between 2010 and 2018, bringing the total to 19 percent. During the same period, general internal medicine saw a drop from 23 percent to 11 percent.

MedPac pegs the estimated number of hospitalists growing from 32,417 in 2010 to 48,407 in 2017 and found that, after the commission created a new specialty designation for hospitalists in 2017, about one in five physicians they previously considered primary care physicians are in fact hospitalists. This takes their previous estimate that in 2017 there were 186,193 primary care physicians down to 140,290.

Hospitalists are physicians whose main focus is on the general care of patients in hospitals. The first structured hospitalist program was created in 1994, and hospitalists monitor the progress and tend to the needs of hospital inpatients to allow primary care physicians to focus on office-based care, the study said.

The study identifies three factors that may be influencing medical students’ decision to pursue careers as hospitalists:

• Training: hospitalists are usually board certified in internal medicine and do not need a sub-specialization.
• Salary: hospitalists earn substantially more than primary care physicians.
• Schedule: hospitalists’ schedules are more predictable and may be better for a work-life balance.

Despite the changes in classification, MedPac found that the lower absolute number of primary care physicians did not change their previous conclusion that Medicare beneficiaries maintained adequate access to care.

In fact, MedPac’s annual beneficiary survey showed patients were less likely to wait longer than they wanted for routine care than those with private insurance, no large change in trouble accessing primary care physicians, and access to primary care doctors has remained as good or better than with private insurance.

But, the trend of increased hospitalists over primary care physicians does reinforce the committee’s concern about the future pipeline as the separation of the two focuses has dropped the growth rate for primary care physicians.

While primary care saw a 0.7 percent growth between 2016 and 2017 when including hospitalists, that number drops to -0.6 percent without hospitalists added into the count.

The commission is continuing to study the primary care physician pipeline.

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Jennifer N. Lee, MD, FAAFP
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