Assessing the Prevalence, Penetration and Performance of Hospitalist Physicians in Ontario:

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Implications for the Quality and Efficiency of Inpatient Care

Heather L. White

PhD Candidate, IHPME, University of Toronto

The rising cost of health care, competitive market pressures and the emergence of new technologies have changed the nature of hospital care provision in Canada. Acute care hospitals aim to increase operating efficiency by reducing length of stay and substituting outpatient for inpatient care, yet an aging population requiring critical and complex disease management has continued to increase overall hospital expenditures. Faced with a growing need for cost-effective delivery, hospitals are exploring new methods of inpatient care provision including the use of hospitalists, which seek to enhance institutional flow and lower operating costs while improving the clinical quality of care provided to hospitalized residents.

Defined as physicians who spend the majority of their professional time providing general medical care to hospitalized patients, hospitalists have emerged as the fastest growing medical specialty in North America with more than 300 practitioners and 62 programs operating in Ontario hospitals today. Yet hospitalist models continue to be a source of controversy and debate. While the majority of studies have demonstrated that hospitalists are efficient providers of inpatient care, concerns have been expressed regarding the financial sustainability of hospitalist programs, satisfaction amongst patients and providers and perhaps most importantly, whether patient outcomes are adversely affected by the transfer of responsibility between providers.

My doctoral dissertation describes the prevalence, penetration and practice characteristics of hospitalist physicians working in Ontario hospitals between 1996 and 2011, and assesses the current performance of these physicians with regards to their clinical effectiveness and operating efficiency.