Raja M. Chakrapani, MD, Instructor and Associate Program Director for Inpatient Care, Department of Medicine, Western Pennsylvania Hospital, Temple University School of Medicine Clinical Campus, Pittsburgh, PA; and Herbert S. Diamond, MD, Professor and Chairman, Department of Medicine, Program Director, Internal Medicine Residency, Western Pennsylvania Hospital, Temple University School of Medicine Clinical Campus. provide primary coverage, or on a nonteaching service, where primary coverage is by nursing staff, other nonphysician health care providers, or house doctors. A house doctor is defined here as a physician who substitutes for house staff coverage but does not serve as the patient’s primary attending physician during hospitalization, as does the hospitalist. The movement toward the hospitalist model is a recent phenomenon stimulated by a common interest of hospitals and physicians to improve the quality and efficiency of the care they provide as well as a concern for cost containment. With these goals in mind, provider organizations increasingly are replacing their traditional practice of all primary care physicians managing their own hospitalized patients with a voluntary or mandatory system in which patients are referred to the care of a hospitalist.

The number of hospitalists practicing in the United States has increased dramatically in the past few years. For example, although the National Association of Inpatient Physicians (NAIP) included just 12 members when it was founded in 1996 [2], paid membership within this organization totalled 2300 as of December 2001, up 500 from the total of 1800 just 3 months earlier. At this rate of growth, the NAIP likely represents the fastestgrowing medical professional organization in the United States [2]. The NAIP estimates that between 5000 and 6000 physicians were practicing as hospitalists at the end of 2001 [Lisa Freeman, National Association of Inpatient Physicians, personal communication]. Little published data exist regarding the personal and work-related characteristics of hospitalists, but some insight can be drawn from recent surveys. A 1999 survey of 820 NAIP members revealed that most trained in general internal medicine, with pulmonary or critical care medicine the next most frequently cited specialty, and a variety of other specialties and subspecialties (eg, general pediatrics, family medicine, internal medicine and pediatric subspecialties) identified by the remainder of the group [ 3]. Most respondents were men who were early in their career and younger in age than the average physician. Finally, the NAIP survey respondents reported generally high levels of job satisfaction and autonomy, low levels of a sense of burnout, and a long-term commitment to remaining in practice as a hospitalist [ 3]. For those seeking a career as a hospitalist, it is important to understand the specifics of the position being offered. For those who do not pursue this career track, it is useful to understand how patient care is affected when a hospitalist is involved. In this paper, the authors seek to provide a basic understanding of the hospitalist role in patient care, including the typical