I well remember reading the landmark article by Wachter and Goldman entitled "The emerging role of 'hospitalists' in the American health care system," published in the New England Journal of Medicine in 1996.1 In this article, the authors recognized the need for "a new breed of physicians… specialists in inpatient medicine" and coined the term "hospitalist" to refer to this new type of physician specialist. Since then, the specialty of hospital medicine has become an increasingly popular and successful career pathway, and has expanded beyond its roots in internal medicine to other disciplines, such as pediatrics, family practice, and obstetrics. The Society of Hospital Medicine estimated there were approximately 44,000 hospitalists in the United States in 2014, and predicted that number will continue to grow.2
When hospital medicine started, the expertise of hospitalists was focused on the clinical issues surrounding care of the hospitalized patient. More recently, there has been increasing emphasis on the hospitalist's role in designing and improving the systems of care in the hospital. These added responsibilities have necessitated an expansion of the hospitalist's skills set beyond just a clinical knowledge base to an understanding of such topics as teamwork, transitions of care, quality metrics and improvement, and patient safety, among many others. A consequence of this proliferation of specific competencies has been the creation of an optional pathway for internal medicine hospitalists to maintain their certification with the American Board of Internal Medicine, officially referred to as Focused Practice in Hospital Medicine.
In the first edition of Principles and Practice of Hospital Medicine, McKean and her co-editors took on the herculean task of assembling an outstanding group of contributing authors and putting together a superb, comprehensive textbook of hospital medicine that was published in 2012. In this second edition, the editors have not only updated content but have also added a number of important topics in both clinical and nonclinical areas, ranging from value-based medicine to transplant surgery consultation. The section on billing, coding, and clinical documentation has been greatly expanded, as has coverage of a wide host of malignancies. Because of the importance of the recovery period and transitions to a variety of settings after hospital discharge, a welcome new section on rehabilitation and skilled nursing care has also been added.
The editors and authors are to be congratulated on again having made a major contribution to the care of hospitalized patients and to those physicians, whether or not they formally identify themselves as hospitalists, who care for these patients. Given the breadth and the depth of this text, there are few questions that clinicians will not be able to answer or guidance that they will not be able to obtain about how to provide the best care for the wide spectrum of their hospitalized patients.
Steven E. Weinberger, MD, MACP, FRCP
Executive Vice President and Chief Executive Officer
American College of Physicians
Adjunct Professor of Medicine
Perelman School of Medicine at the University of Pennsylvania
Senior Lecturer on Medicine
Harvard Medical School
L. The emerging role of "hospitalists" in the American health care system. N Engl J Med.