The status of adult inpatient care by family physicians at US academic medical centers and affiliated teaching hospitals 2003 to 2012: the impact of the hospitalist movement.

BACKGROUND AND OBJECTIVES: Over the past 10--15 years, the number of hospitalists has grown from a few hundred to over 30,000, and hospitalists have assumed a greater proportion of the care of hospitalized patients. No existing studies report on the impact this movement has had on the characteristics of the hospital practice of family physicians in teaching hospitals. To explore this impact we examined the volume and scope of discharges by family physicians at teaching hospitals in 2003 and 2012, the most recent decade of hospitalist growth. We also compared the characteristics of family physicians' hospital practices in 2012 with hospitalists in 2012 to assess for differences in hospital performance. METHODS: We used the University Health Consortium (UHC) Clinical Database to capture adult non-pregnancy-related inpatient discharges in US teaching hospitals by family physicians and hospitalists in 2003 and 2012. We calculated the proportion of inpatient discharges by specialty in all UCH hospitals; did a qualitative comparison of frequent discharge diagnoses; and analyzed length of stay, case mix index, 7- and 30-day readmission rates, and mortality by specialty using UHCs risk adjustment methodology. RESULTS: The proportion of all inpatient discharges by family physicians in UHC hospitals was stable between 2003 and 2012 (2.7% versus 2.6%) though the volume increased. Over the same time, the proportion of discharges attributable to hospitalists increased (0.0% to 13.9%) with a concomitant decrease in proportion of discharges from general medicine (18.4% to 13.9%) and all other specialties (78.9% to 73.2%). Fourteen of the top 20 discharge diagnoses by family physicians from UHC hospitals were the same between 2003 and 2012. Family physicians and hospitalists shared 17 of the top 20 discharge diagnoses in 2012. Length of hospital stay was stable for family medicine across time and lower than that of hospitalists (4.5 versus 5.5 days; P<.001). Seven- and 30-day readmission rates for any cause were lower for hospitalists but there was no difference in either rate when limited to readmission for the same DRG. Hospitalists cared for a somewhat more complex patient mix. CONCLUSIONS: The growth of hospitalists has had little to no impact on the proportion of inpatient discharges in teaching hospitals by family physicians. Quality of care as judged by length of stay, mortality, and readmission rates was comparable between family physicians and hospitals in 2012.