Many hospitalists have added value as local leaders in quality improvement, safety, and innova-tion, but some have functioned more as shift workers. For exam-ple, many community hospital-ists have a 7-days-on, 7-days-off schedule that focuses mainly on high-volume clinical work and sends an unspoken but clear mes-sage that, at the end of an inten-sive clinical “on” stint, one is “off ” and uninvolved. Our impression is that hospitalist programs pro-vide more value when hospital-ists’ inpatient assignments (clini-cal “systole”) are complemented by a systems-oriented “diastole,” dur-ing which clinical activity is limit-ed but they contribute to key in-stitutional programs. Productive diastole is more likely when hos-pitalists have strong leadership, a robust professional-development curriculum, and a mutual hospi-tal–hospitalist commitment to adding value during specified and structured nonclinical time.

In the academic setting especially, a premium will beplaced on clinical quality improvement, the develop-ment of practice guidelines, and outcomes research,not only to provide the physician with a creative out-let and a potential source of funding during thenonclinical months but also to give the academiccenter a practical research-and-development arm

Oneof the advantages of the hospitalist model is that itcreates a core group of faculty members whose in-patient work is more than a marginal activity andwho are thus committed to quality improvement inthe hospital.