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One of the most interesting aspects of working as a moderator supporting primary marketing research studies in biopharma is having a front-row seat to how different physician specialties think about patient care.
Over time, you develop a keen appreciation for the way that each specialty has its own unique perspective. Cardiologists think differently than infectious disease specialists. Oncologists approach decision-making differently than primary care physicians. And that's in some respects because each has a different vista on the patient journey.
At ThinkGen, we've been doing a significant amount of work recently in cardiovascular disease, particularly in heart failure and anticoagulation. Across several studies exploring how patients are managed following heart failure exacerbations, ischemic stroke, myocardial infarction, and other acute cardiovascular events, one physician segment continues to emerge as an important source of insight: hospitalists.
In one recent study on an investigational heart failure medication, we were evaluating a therapy that would be initiated during hospitalization and then continued in the outpatient setting. Cardiologists were an obvious inclusion in the sample design. Nurses were as well. We also agreed with the client that incorporating hospitalists would be prudent.
What we discovered was not that hospitalists duplicated the perspectives of specialists. Quite the opposite.
While cardiologists focused understandably on disease management and treatment optimization, hospitalists consistently broadened the discussion. This set of respondents talked a lot about things like: discharge readiness, medication burden, care coordination, social determinants of health, readmission risk, and the practical realities of implementing treatment plans in complex patients.
The experience, and others like it, led us to take a closer look at the specialty itself and to appreciate how important hospitalists have become within today's increasingly complex healthcare ecosystem.
Hospital medicine is one of the most remarkable growth stories in modern healthcare.
The term "hospitalist" was first introduced in 1996 by physicians Robert Wachter and Lee Goldman to describe an emergent set of clinicians whose practice focused exclusively on the care of hospitalized patients. At the time, the concept was relatively novel.
Today, hospital medicine has become one of the largest and fastest-growing physician specialties in the United States. According to the Society of Hospital Medicine (SHM), there are now more than 60,000 hospitalists practicing nationwide. Research suggests the number of hospitalists grew by more than 50% between 2012 and 2019 alone.
The reasons behind this growth are not difficult to understand.
Healthcare has become increasingly specialized. Patients admitted to hospitals are often older, more medically complex, and managing multiple chronic conditions simultaneously. They may interact with a wide range of physician types -- cardiologists, nephrologists, infectious disease specialists, pulmonologists, pharmacists, social workers, and case managers -- during a single admission.
Someone needs to connect those pieces. Increasingly, that responsibility is owned by the hospitalist.
SHM defines hospital medicine as the specialty dedicated to the comprehensive care of hospitalized patients. In practice, hospitalists do much more than manage admissions and discharges.
They diagnose and treat acute illness, coordinate care across specialties, facilitate transitions of care, implement evidence-based protocols, support quality improvement initiatives, and increasingly serve in leadership positions focused on patient safety, operations, and health system performance.
One of the themes that emerged repeatedly in the articles and interviews I reviewed while researching this topic was that hospitalists see patients holistically rather than through the lens of a single organ system.
And that perspective is increasingly valuable.
As medicine has become more specialized (and compartmentalized), hospitalists have emerged as the HCPs responsible for integrating the recommendations of multiple specialists while balancing the realities of the individual patient sitting in front of them.
In many ways, they have become the coordinators of complexity.
Not every study requires hospitalist participation. But there are many situations where their perspective can add substantial value.
Heart failure is an obvious example. Hospitalists frequently manage acute decompensations, inpatient treatment decisions, discharge planning, and readmission prevention efforts.
The same can be said for anticoagulation, stroke, infectious disease, respiratory disease, sepsis, chronic kidney disease, and other conditions where inpatient management influences long-term outcomes.
Hospitalists can be particularly valuable when research objectives involve:
In these situations, hospitalists often provide a unique perspective that complements rather than duplicates that of other specialists.
For pharmaceutical marketers and I&A teams, it is also worth recognizing that hospital medicine has evolved into a highly organized and influential specialty.
SHM serves as the leading professional organization for hospitalists in the U.S., supporting education, research, quality improvement, and advocacy efforts. Hospital medicine divisions now exist within most major academic medical centers, and hospitalists increasingly occupy leadership roles across health systems.
Recent reporting has also highlighted the emergence of subspecialized hospitalists in areas such as obstetrics, pediatrics, neurology, and otolaryngology, reflecting the continued maturation and diversification of the field.
This is no longer an emerging specialty. It is a central component of modern healthcare delivery.
The lesson from our recent cardiovascular studies wasn't that hospitalists are more important than cardiologists, neurologists, or other specialists.
Rather, it was a reminder that every specialty contributes a different perspective to understanding the complexities of modern patient care.
Hospitalists inhabit a uniquely valuable vantage point within the healthcare system. They are often the HCPs who witness the entire arc of a hospitalization: from the uncertainty of admission, through specialist consultations and treatment decisions, to discharge planning and the transition back into the community. Few physicians have such a broad view of how care is actually delivered across the continuum.
For those of us in pharmaceutical I&A, those are often the moments where some of the most important insights can be cultivated.
As healthcare continues to become more complex and multidisciplinary, I suspect we will continue to hear more from hospitalists -- not simply because the specialty is growing, but because their perspective helps us better understand how care is actually delivered in the real world.
