Hospital medicine arose within internal medicine but has recently spread to subspecialties, including gastroenterology (GI). GI hospitalists are gastroenterology fellowship–trained physicians who spend most of their clinical time on inpatient care.
Daniel J. Stein, MD, MPH, a GI hospitalist in the Department of Gastroenterology, Hepatology and Endoscopy at Brigham and Women’s Hospital, Ryan Flanagan, MD, a clinical research fellow there, and colleagues recently explored the prevalence and perceptions of the GI hospitalist model in academic GI departments across the United States. In Digestive Diseases and Sciences, they report GI hospitalists are relatively common and geographically diverse, and fellowship program leaders perceive them to have several benefits beyond improving the quality of inpatient care.
The researchers developed an online survey distributed to the directors of 201 accredited gastroenterology fellowship programs. There is no standard definition of a GI hospitalist, so they used two broad definitions for the types of faculty members:
- Academic GI hospitalist—Any faculty member who spends most (>50%) of their clinical time caring for inpatients, including time spent on inpatient GI primary services, inpatient consult service, and inpatient endoscopy
- Outpatient faculty—Those who spend most of their clinical time seeing clinic patients or performing endoscopy for outpatients and may (or may not) rotate on the inpatient service
Prevalence of GI Hospitalists
Leaders of 52 programs responded to the survey, including 42 tertiary medical centers, four Veterans Health Administration medical centers, and six community hospitals, representing all regions of the country.
12 respondents (23%) indicated their institution had a GI hospitalist. Ten of those hospitalists were at tertiary medical centers, and none were at community hospitals. However, the latter finding probably relates to surveying fellowship program directors rather than a lack of GI hospitalists in the community.
In nine of the 12 programs, both rotating outpatient faculty and hospitalists covered inpatient consults and procedures. Similarly, most GI hospitalists had supplemental outpatient responsibilities, including outpatient endoscopy in 10 programs and outpatient clinic in five programs.
Motivations For or Against Adopting the Hospitalist Model
A wide range of perceptions influenced whether a department had a GI hospitalist:
- 23 of 51 respondents (45%) said having a hospitalist would improve inpatient GI fellow education, 23 (45%) said it would have a neutral effect, and five (10%) said it would worsen education
- Among the 21 respondents who have added or are considering adding a GI hospitalist to their department, the most commonly endorsed reason was to reduce burnout and time on service for other faculty members (n=17, 81%)
- Among the 26 respondents who have not added a GI hospitalist, the most common reason was no perception of benefit (n=16, 62%)
- Most respondents indicated the ideal future of inpatient GI should be to alternate coverage between GI hospitalists and outpatient faculty (34/50, 68%)
Avenues for Future Research
The survey didn’t delve into the structure of each GI department, such as the amount of time outpatient faculty spend on the inpatient service or the size of the faculty pool. Both data types could partially explain why some program directors believed there would be no advantage to hiring a hospitalist.
Future research should also assess the effect of GI hospitalists on patient-centered clinical outcomes, longitudinal educational relationships with GI fellows, and the cost-effectiveness of impatient healthcare.