The hospitalist movement and the future of academic general internal medicine.

Abstract

The field of academic general internal medicine has enjoyed a long and distinguished history of health care, education, and research in the hospital. Increasingly, however, its attention is focused on the outpatient setting. The reasons for this trend correspond roughly to the three legs of the academic stool.1 First, as economic and technological change narrowed the gate to hospitalization over the past decade, we found ourselves caring for more and sicker patients in our outpatient practices. At the same time, many academic medical centers embarked on a strategic path of growing their primary care bases,2 leaving divisions of general internal medicine scurrying to increase their ambulatory clinical capacity. Second, we have recognized that the training of those students and housestaff destined to practice general internal medicine (and many medical specialties) needs to be based primarily on ambulatory care.3 Finally, the research agenda of general internal medicine has increasingly focused on ambulatory disorders and preventive practices long neglected by academia.4 As a result of those forces, many academic divisions of general internal medicine have, to a large extent, changed into divisions of primary care.