According to the Society of Hospital Medicine (SHM), hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their duties include patient care, teaching, research, and leadership related to hospital medicine. The term hospitalist was coined in a 1996 article published in the New England Journal of Medicine by Wachter and Goldman, entitled “The Emerging Role of ‘Hospitalists’ in the American Healthcare System.”¹ Therefore, the field of hospital medicine is said to be just over 20 years old at the time of this writing, even though some physicians were known to be practicing hospitalists long before the specialty was formally established.

Hospital medicine is the fastest-growing specialty in the medical field, with over 50,000 hospitalists in the United States (Fig. 1-1). It is now the second-largest specialty in the United States, behind primary care. American Hospital Association recently reported the total number of US-registered hospitals is 5564; the number of staffed beds in all US hospitals is 897,961, with about 35,061,292 admissions annually. Hospitalists now manage over 50% of all Medicare inpatients. The majority (over 80%) of hospitalists have an internal medicine background. The remainder come from other specialties, including internal medicine subspecialties (infectious disease, pulmonary critical care, geriatrics, palliative care, cardiology, GI, nephrology, etc.), pediatrics and pediatric subspecialties, family medicine, neurology, psychiatry, surgery, and OB/GYN.

Hospital medicine is a location-based specialty. In healthcare, we have traditional organ-based specialties (e.g. cardiology, nephrology), disease-based specialties (e.g. infectious disease, oncology), procedure-based specialties (e.g. electrophysiology), population-based specialties (e.g. pediatrics, geriatrics, women’s health), and now location-based specialties (e.g. hospitalist, emergency medicine, critical care). Location-based specialties developed because there is something unique about particular settings that allows us to optimize the care of patients and facilitate a safe transition to the next care setting. From an evidence-based practice standpoint, a patient with acute decompensated heart failure is different than a patient being managed for chronic heart failure. The same is true for an acute chronic obstructive pulmonary disease (COPD) exacerbation vs. chronic COPD, diabetic care in the acute setting vs. chronic diabetes in the ambulatory setting, etc.

What creates a specialty? It requires the existence of a unique set of knowledge, skills, and attitudes, as defined by the specialty’s core competencies. In 2006, the SHM published an article called “The Core Competencies in Hospital Medicine: A Framework for Curriculum Development,” by Pistoria et al,² in the Journal of Hospital Medicine (Fig. 1-2). This document helped (1) define hospital medicine; (2) standardize the expectations for knowledge, skills, and attitudes of hospitalists; (3) promote the participation of hospitalists in system and process improvements; (4) encourage innovative curriculum development; and (5) serve as a key resource for the Focus Practice in Hospital Medicine board certification from the American Board of Internal Medicine (ABIM).

In addition to the core competencies, a specialty has a professional society where like-minded people congregate to advance and disseminate knowledge pertaining to that specialty. In hospital medicine, for example, there is the SHM,³ the Society of OB/GYN Hospitalists (SOGH),⁴ the Neurohospitalist Society (NHS),⁵ and the American Academy of Pediatrics Section on Hospital Medicine.⁶ A specialty also features textbooks (e.g. Hospital Medicine,⁷ Hospital Medicine Secrets,⁸ Comprehensive Hospital Medicine: An Evidence-Based Approach,⁹ Principles and Practice of Hospital Medicine,¹⁰ and Comprehensive Pediatric Hospital Medicine¹¹) and journals that help spread scientific, educational, and thought-provoking information to continue to advance the field; examples include the Journal of Hospital Medicine (JHM), Hospital Practice, and Neurohospitalist. As specialized knowledge, skills, and attitudes have developed for hospital medicine, many places have developed fellowships in the area. These¹² are currently non–Accreditation Council for Graduate Medical Education (ACGME) accredited fellowships with unique elements that include advanced skills in hospital medicine, such as preoperative and consultative medicine, quality/process improvement, leadership skills, teaching skills, teamwork, and patient safety.