A hospitalist could be an internist, but an internist is not necessarily a hospitalist. These two medical specialties are more similar than different. Hospitalists and internists both practice medicine and treat patients, provide the same level of care to hospitalized patients, diagnose and treat acute illnesses or perform various medical procedures while the patient is hospitalized. Hospitalists, however, confine their practice exclusively to the hospital and often have specialized training in nonmedical subjects related to that field.
Internal medicine is a primary care field. Although some internists specialize in adolescent medicine, most internists care only for adult patients who have a variety of diseases, including chronic medical problems such as diabetes or acute problems such as pneumonia. Internal medicine has a number of subspecialties, such as infectious disease, rheumatology, gastroenterology and cardiovascular disease. Internists might see patients in the hospital or perform procedures there, but they spend most of their days in an office or clinic, where they see multiple patients, many of whom they care for over an extended period of months or years.
Hospital medicine developed in response to changes in reimbursement practices and demands on primary care physicians. Many physicians are unwilling to care for uninsured patients or take hospital calls, and teaching hospitals have restricted the hours that medical residents are allowed to work. The combination of these factors created a demand for physicians who could manage hospitalized patients and be available for emergencies. A hospitalist might see a patient only once in her lifetime and is more likely to be responsible for hospital-wide quality improvement efforts. William T. Ford, Ph.D., a hospitalist at Temple University Health System in Philadelphia, writes in the August 2009 issue of Today’s Hospitalist that in many respects, the hospital itself is his “patient.”
Hospitalists and internists receive essentially the same education through college and medical school. Hospitalists often receive post-residency training in extended training programs called fellowships that focus specifically on the practice of hospital medicine. Although pediatric, family practice and internal medicine fellowships are available, not all primary care physicians take advantage of the extended training.
Work Settings and Salaries
Internists see patients both in the hospital and in the outpatient setting, in clinics or medical offices, while hospitalists may not even have a private office. Internists are focused strictly on patient care, but hospitalists are expected to enhance the performance of healthcare systems and hospitals in addition to their direct clinical work. Internists earned $219,500 in 2011, while hospitalists who specialize in internal medicine earned $229,294, according to the American Medical Group Management Association.
One of the most significant differences between hospitalists and internists is the length of the physician-patient relationship. An internist might care for the same patient from early adulthood until old age. Hospitalists, on the other hand, often see a patient only during the course of a single hospitalization. Hospitalists might see some patients with severe chronic medical problems more frequently, but the focus is strictly on the problems related to the hospitalization, not ongoing patient management. Someone who values the long-standing relationships might prefer a career as an internist.