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Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists

David Meltzer, MD, PhD; Willard G. Manning, PhD; Jeanette Morrison, MD; Manish N. Shah, MD; Lei Jin, MA; Todd Guth, MD; and Wendy Levinson, MD
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From the University of Chicago, Chicago, Illinois.


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, dmeltzer@medicine.bsd.uchicago.edu.

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.


Ann Intern Med. 2002;137(11):866-874. doi:10.7326/0003-4819-137-11-200212030-00007
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In July 1997, a hospitalist service was established within the general medicine service at the University of Chicago. The goals of the service were to improve the educational environment and contain costs. Two general internists in practice for 2 and 10 years, respectively, agreed to serve as an inpatient attending physician for 6 months of the year, alternating with each other every month between the inpatient service and a shared ambulatory general medicine practice. The 58 nonhospitalist physicians had an average of 9 years of experience after residency (median, 7 years [range, 0 to 34 years]), and 24 had subspecialty training. The hospitalists were not given specific instructions or incentives to alter their practice patterns but were aware that resource utilization, patient outcomes, and housestaff satisfaction were being studied. The hospitalist team alternated in a 4-day call cycle with 3 teams led by traditional academic internists who served as inpatient attending physician 1 or 2 months per year. The 4-day call cycle was arranged so that all patients admitted on each day were assigned to the on-call team (except for the first four patients admitted on weekdays before 5 p.m.). The four excluded patients were assigned to the “short-call” team for that day, which was on day 3 of its call cycle at the time. Thus, all patients were assigned to teams according only to their position in the call cycle, without regard to whether the attending physician was a hospitalist or nonhospitalist.

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Figure.
Kaplan–Meier survival curves for patients cared for by hospitalists and nonhospitalists.
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Summary for Patients

Hospitalists and the Costs and Outcomes of Hospital Care

The summary below is from the full report titled “Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists.” It is in the 3 December 2002 issue of Annals of Internal Medicine (volume 137, pages 866-874). The authors are D Meltzer, WG Manning, J Morrison, MN Shah, L Jin, T Guth, and W Levinson.

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