U.S. Trends in Hospitalization and Generalist Physician Workforce and the Emergence of Hospitalists

General internists have traditionally cared for their patients during both ambulatory visits and hospitalizations. With the rise of hospitalists since the mid-1990s, some have suggested that primary care physicians have been crowded out of inpatient care. This study of discharge data from 1980 to 2005 from the National Hospital Discharge Survey, and physician manpower data from the American Medical Association, examines trends in hospital use by the generalist workforce before and after the rise of hospitalists, and investigates factors contributing to those trends.

Key Findings:

  • Inpatient encounters relative to the number of generalists declined steadily even before the emergence of hospitalists.
  • Declines in inpatient encounters relative to the number of generalists were driven primarily by reduced hospital length of stay and an increased number of generalists.

The trends observed in inpatient activity relative to the size of the generalist workforce suggest that the inpatient activity of generalist physicians declined tremendously after 1980 but flattened in the post-hospitalist era. This decline likely weakened incentives for generalists to provide inpatient care. Care models that seek to preserve generalist care spanning ambulatory and inpatient settings are most likely to be viable if they focus on patients at high risk of hospitalization.