Partners: Early on there was clearly some resistance to the concept of hospital medicine from other internists and other specialties. Do you find that is still the case today?
Wachter: Sure, and I actually would have been disappointed in my field had there not been. In order to achieve the advantages of having a hospitalist — and those advantages really are focused practice where this person becomes an expert in the management of sick hospitalized patients, available throughout the day and often the night, with on-site presence, and a level of coordination of hospital care that can’t be achieved by a primary care doctor trying to manage a hospitalized patient — in order to achieve those advantages there is a cost. That cost is a purposeful discontinuity of care, with the primary care doctor no longer maintaining the responsibility to manage a hospitalized patient. If I was a primary care doctor and I was being confronted with a model in which a different doctor would take care of my patient when he or she were very sick, that would bother me too. It’s really the reason why, in the early years of the field, our professional society, and our whole field really, came down very strongly against programs that were mandatory. We really felt that if the model develops and grows organically, and some primary care doctors see why there may be advantages to them and their patients in doing things this way, that over time it would grow of its own momentum. I think that has largely been what has happened.
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