David Meltzer, MD, PhD; Willard G. Manning, PhD; Jeanette Morrison, MD; Manish N. Shah, MD; Lei Jin, MA; Todd Guth, MD; Wendy Levinson, MD
Acknowledgments: The authors thank Adriana Hernanadez, MA; Asif Dhar, BA; Corrinna Weckerle, BA; Catherine Humikowski, BA; Sharleen Suico, BA; and Johnny Lee, BA, for excellent research assistance. They also thank Dr. Scott Stern, Dr. Alex Lickerman, other attending physicians on the general medicine service, and the medicine housestaff.
Grant Support: By the University of Chicago Hospitals, Chicago, Illinois; the Charles E. Culpeper Foundation, New York, New York; the National Institute of Aging, Bethesda, Maryland; and the Robert Wood Johnson Foundation, Princeton, New Jersey.
Requests for Single Reprints: David Meltzer, MD, PhD, Section of General Internal Medicine, the University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637; e-mail, email@example.com.
Current Author Addresses: Dr. Meltzer: The University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637.
Dr. Manning: The University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637.
Dr. Morrison: 6814 North Oriole Street, Chicago, IL 60631.
Dr. Shah: University of Rochester, 601 Elmwood Avenue, Box 655, Rochester, NY 14642.
Dr. Jin: University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637.
Dr. Guth: Naval Aero-medical Medical Institute, 220 Hovey Road, Pensacola, FL 32508.
Dr. Levinson: St. Michael's Hospital, 30 Bond Street, Queen Wing 4036, Toronto, Ontario M5B 1W8, Canada.
Author Contributions: Conception and design: D. Meltzer, W. Levinson.
Analysis and interpretation of the data: D. Meltzer, W.G. Manning, M. Shah, L. Jin, T. Guth, W. Levinson.
Drafting of the Article: D. Meltzer, W.G. Manning, M.N. Shah.
Critical revision of the article for important intellectual content: D. Meltzer, W.G. Manning, J. Morrison, M.N. Shah, L. Jin, W. Levinson.
Final approval of the article: D. Meltzer, W.G. Manning.
Provision of study materials or patients: D. Meltzer, J. Morrison, M.N. Shah.
Statistical expertise: D. Meltzer, W.G. Manning, L. Jin.
Obtaining of funding: D. Meltzer, J. Morrison, M.N. Shah, W. Levinson.
Administrative, technical, or logistic support: D. Meltzer, M.N. Shah, T. Guth.
Collection and assembly of data: D. Meltzer, J. Morrison, M.N. Shah, L. Jin, T. Guth.
Meltzer D., Manning W., Morrison J., Shah M., Jin L., Guth T., Levinson W.; Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists. Ann Intern Med. 2002;137:866-874. doi: 10.7326/0003-4819-137-11-200212030-00007
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Published: Ann Intern Med. 2002;137(11):866-874.
In many countries, patients hospitalized with general medical problems are usually cared for by physicians who specialize in inpatient care (1-3). In the United States, primary care physicians have often served this role historically. However, in recent years, there has been a surge of interest in the care of inpatients by “hospitalists”—physicians who devote at least 25% of their time to the care of hospitalized patients (4).
Key to the growth of hospitalist medicine has been the belief that hospitalists are better suited to contain costs and maintain or improve patient outcomes. Although several recent studies support this belief (5-7), only two had research designs that assigned patients to hospitalists or nonhospitalists without taking into account clinical criteria. Wachter and colleagues showed cost savings but could not demonstrate improved outcomes (5). Moreover, many of the “hospitalist” physicians in that study practiced inpatient medicine for only 1 or 2 months per year. Kearns and colleagues found no effect on either costs or outcomes (8).
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