It’s no secret that primary care is in need of a lot of clinicians. In the grand scope of our current physician shortage, primary care seems to be suffering the most. So it’s no surprise that data shows primary care losing ground as the first choice for medical students. Surprisingly though, hospitalist employment is gaining ground.

A new study from the Medicare Payment Advisory Commission (MedPAC) looked at third-year internal medicine students and their proposed career paths between 2010 and 2018. Students were asked what they planned to pursue upon completion of their educational careers.

Needless to say the survey results were surprising. Even while fewer internal medicine students are choosing to become primary care providers, more are content to seek out hospitalist work. Equally surprising is how the numbers change when you account for MedPAC not having created a special designation for hospitalists until just a couple of years ago.

Data by the Numbers

A great Medical Economics piece published in early October 2019 lays out the most interesting details of the MedPAC study. According to author Keith Reynolds, the number of third-year internal medicine students planning to become hospitalists increased by 10% between 2010 and 2018. The total number came in at 19%. Meanwhile, those planning to become primary care provisions fell by 23%, for a total of 11% of the surveyed students.

If you’re not into percentages, raw numbers also tell the story. MedPAC estimated the total number of hospitalists in the U.S. would grow from just over 32,400 in 2010 to 48,400 in 2017. They created a special designation for hospitalists in 2017, forcing them to reclassify some of the doctors previously recorded under primary care.

Factoring in the change increases the total number of hospitalists. It also reduces primary care physicians from just over 186,000 to approximately 140,000. MedPAC said that creating the new hospitalist designation resulted in reclassifying roughly 20% of the physicians previously classified as primary care providers.

What It All Means

MedPAC’s numbers are certainly intriguing. But what does it all mean? Why are internal medicine students gravitating toward hospitalist work and away from primary care? And in the grand scheme of things, does it really matter in terms of quality of care?

Reynolds contends that there are three factors responsible for the growth of hospitalist practice. Training is the first one. Reynolds explains that, because hospitals are normally board certified in internal medicine, hospitalists do not need a sub specialization to work.

Compensation is another factor. By and large, hospitalists earn more than their primary care counterparts. Locum tenens hospitalists earn even more. When it is a matter of simple economics, hospitalist employment wins.

Finally, Reynolds says that hospitalist employment is attractive because schedules are more predictable. A hospitalist works a defined shift and goes home. Primary care physicians generally don’t enjoy that level of predictability in their schedules. They are often at the mercy of patient loads.

Quality of Care

One could probably argue that a shortage of primary care physicians is affecting quality of care. Still, any such assumptions would need to be measured against data showing how and when people access primary care. If patients are turning to hospitals rather than private practices, it would seem that they are still getting quality care provided by hospitalists. If, on the other hand, they are neglecting primary care altogether, then we have an entirely separate problem to deal with.

At any rate, hospitalist employment is gaining ground in America. Primary care is losing ground. It is safe to say that the healthcare landscape in this country is changing.

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