How physicians perceive hospitalist services after implementation: anticipation vs reality.

OBJECTIVE: To determine whether internists' attitudes toward the hospitalist model change after implementation of a new inpatient service.

DESIGN: Cross-sectional surveys performed in 1998 and 2000.

SETTING: Tertiary care hospital in Boston, Mass.

SUBJECTS: A total of 236 internal medicine board-certified physicians affiliated with Beth Israel Deaconess Medical Center.

MAIN OUTCOME MEASURES: Responses to survey items regarding attitude toward inpatient care and the hospitalist model. We used multivariable models to determine factors associated with physician responses.

RESULTS: Of physicians surveyed in 2000, 236 (69%) responded; 145 (61%) had also responded in 1998. The mean (SD) age of respondents was 46.4 (10.8) years; 157 (66.5%) were male; and 146 (61.9%) were primary care providers. In 2000, more physicians agreed that "caring for inpatients is an inefficient use of my time" (P<.001), and that "use of a hospitalist service improves quality of care" (P =.002). In 2000, more physicians disagreed that "use of a hospitalist service diminishes physician career satisfaction" (P<.001), and that "use of the hospitalist service adversely affects the physician-patient relationship" (P<.001). No differences were detected in responses to questions regarding patient satisfaction or overall career satisfaction. In multivariable models, older physicians were more likely to favor the hospitalist model; those with busier inpatient practices were more negative (P<.05 for each). Physician specialty or being a primary care provider was not associated with attitudes toward the hospitalist model.

CONCLUSIONS: Following experience with a hospitalist system, physician attitude, including concerns regarding career satisfaction and relationships with patients, toward a voluntary hospitalist model improved. Future research should investigate whether the hospitalist model affects patient satisfaction and quality of care.