It seems like just yesterday that we started hearing about Hospitalists and now 35,000 physicians consider themselves part of this specialty.  This group is so new that the spell check on my iPad doesn’t even recognize the term, although it is in the dictionary. Take a look at the attached article about the growth of this specialty and note several trends.  First, in response to last week’s blog on physician burnout this may be one defense mechanism for both office-based physicians and those going into this new area.  It is also interesting that the specialty is going beyond just FP and IM work.  Note that these physicians are often employees of hospitals or hired as independent contractors.  Also note the growth.  Is there any other medical specialty that has tripled in size over the last nine years?

The obvious question I always like to start with is what does this mean for the pharmaceutical industry?  First, it is rare that without “aided” questions, that this specialty group ever comes up in strategic or tactical discussions.  How many marketers have thought of attending their meetings or trying to figure out how to best work with this group?  How many companies have thought about tracking the continuity of care issue from a large office practice to the hospitalists who cares for their patients outside the office?

Meeting with lots of physicians over the last five years, it is clear that this trend is here to stay.  The office based physicians are extremely glad to have the hospital burden off their plate as it allows them to totally concentrate on their office work.  They feel this is not only better for their personal life but may also be a financial benefit as well.  When pressed they often feel the hospitalist may even provide better care as they work in that setting all day every day.  It is also interesting that when talking to a young internist who recently completed his residency at a major NY city teaching hospital that he stated he was the only one out of thirty who did not become a hospitalist.  There seems to be a trend that the young and the brightest in primary care are drawn to the action of the hospital and perhaps to the financial security in these difficult times.

A key point for the industry to consider is the impact this trend has on the sense of community among physicians.  In days past the hospital was a meeting place for physicians within a local area.  They would meet there early in the morning, perhaps at lunch and after work to see their patients.  Inevitably that meant spending some time with other physicians in the doctor lounge where difficult cases were discussed.  Specialists talked with PCPs about the latest drugs and community standards of care were often determined around coffee and donuts.  Pharmaceutical companies provided money and speakers for grand rounds and other hospital talks where appropriate.  Again in this setting, debate and discussion led to community consensus.  This link is now gone as one doctor told me, somewhat jokingly, that the only chance he gets to talk to other physicians is if their kids are on the same little league team.  This community has been replaced by another, the Internet.

Note in the article the discussion about protocols and the need to “institutionalize” care.  Everyone in the “care chain” needs to be on the same page and the role of formularies can not be overstated.  Outliers get noticed as they tend to confuse things.  This is somewhat accepted if the benefits are clear and based on solid evidence.  It is tough to explain within the system that a particular new drug is being used because the physician likes a rep or saw some obscure piece of data that made the product look interesting.  Widespread consensus is needed before a new drug can enter the system.

It is critical that marketers pay attention to the fringe things that are taking place in medicine.  A few years ago it was the hospitalist and today it might be the accountable care expert.  You can’t stay ahead of competition if you are not ahead of the trends that are reshaping the medical environment.  If you think hospitalists are just important for hospital products, you may want to reconsider.

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