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Without question, much of the growth of the hospital-ist movement has been generated by hospitals anxious tocut inpatient costs. However, the Davis study’s findingsregarding the diverse motivations for these programs aretypical. For example, in the Mississippi hospital, the mo-tivations included a desire to improve outpatient effi-ciency (and ambulatory care efficiency did increase by56%), a motivation shared by many other large multispe-cialty groups. The availability of primary care providersto their outpatients probably improved as well (althoughthese results were not reported). Freese (14) found that asimilar desire to make certain that primary care providerswere predictably available to their office patients was amajor driver of the hospitalist program at the Park Nicol-let clinic, and the program did lead to improved outpa-tient satisfaction. Other common motivations includethe desire to improve physician availability to inpatients,to have hospitalists care for unassigned patients admittedthrough the emergency department, to invest physiciansin hospital quality improvement activities, and to allowprimary care practitioners to have more predictable life-styles (15)

Hospitalists are often referred to as the quarterbacks of the hospital. But even the best QB needs a good team to succeed. For HMGs, that roster increasingly includes nurse practitioners (NPs) and physician assistants (PAs).

“Any time when nurse practitioners and other providers get together, there is always this challenge of professions,” he says. “You’re doing this or you’re doing that, and once you get people who understand what the capabilities are past the title name and what you can do, it’s just amazing.”

Recent State of Hospital Medicine surveys showed that 83% of hospitalist groups are utilizing NPs and PAs, and SHM earlier this year added Tracy Cardin, ACNP-BC, SFHM, as its first non-physician voting board member