LETTERS TO THE EDITOR

Abstract

In Reply:—Although Dr. Khaliq and his colleagues did not find an appreciable difference in resource utilization or length of stay through the use of hospitalists at an academic community hospital, the evidence continues to overwhelmingly favor the use of hospitalists at both university and community hospitals. There are several factors which may be contributing to the results reported. Hospitalist programs come in all shapes and sizes; there may be some models that are more conducive to achieving efficiency than others. Our hospitalists, for example, have been buoyed by strong support from the chairman of medicine and hospital case management. Our patients were also on average younger than those cared for by Dr. Khaliq. In addition, the residency training of individual hospitalists may influence their ability to deliver more efficient care. Our hospitalists were trained at large university-based hospitals where inpatient medicine is heavily emphasized rather than a residency with a primary care focus. Finally, the phenomenon of “getting better with age” may apply to hospitalists. Though our article demonstrated a benefit of hospitalists after only one year, Auerbach et al. reported that two years were required for hospitalists to make a difference.1 Perhaps Dr. Khaliq's group will see more of a difference over time. The benefits of the implementation of hospitalist programs in a variety of settings were nicely summarized by Wachter and Goldman in 2002 with a 13.4% reduction in hospital costs and a 16.6% reduction in length of stay.2 Our findings further supported the use of hospitalists in an academic community teaching hospital by demonstrating a 20.8% reduction in length of stay and an 18.4% reduction in cost per case while providing residents with greatly improved teaching on the inpatient service.3 Though our findings differ from those of Khaliq et al., we agree that more work needs to be done to evaluate the impact of hospitalists, particularly in community settings where resources are fewer. It is still unknown how well hospitalist systems hold up over time, and what the keys to success truly are. It is also unclear how hospitalists achieve their documented benefits. These and other questions must be answered as the “hospitalist express” rolls on.