By Kim Maialetti
From left: Todd Hecht, MD, and Hospital Medicine chief S. Ryan Greysen, MD, are helping to train the next generation of hospitalists.
When Todd Hecht, MD, was asked if he wanted to become one of the first hospitalists at the Hospital of the University of Pennsylvania (HUP), he had one question: “Sounds good—what’s a hospitalist?”
That was in 1997. The Hospital Medicine program at HUP launched a year later, making history as one of the first programs in the field.
The program reached another milestone on July 1, 2023, when Penn Medicine established a new Division of Hospital Medicine, within the Department of Medicine.
The division’s inaugural chief, S. Ryan Greysen, MD, who served as section chief since 2016 and is an accomplished researcher, aspires to make Penn Medicine the premier academic hospital medicine program in the United States.
A win for everyone
But back to Hecht’s question: What is a hospitalist?
In simplest terms, hospitalists are physicians who specialize in providing care exclusively within the hospital environment. They typically undergo residency training in internal medicine, general pediatrics, or family practice and play a pivotal role in providing and coordinating care during a patient's hospital stay.
Just as quarterbacks are the leaders on the football field, calling the plays and driving their team forward to the goal line, hospitalists are the leaders on the hospital floor.
“Hospitalists are the captains of the ship, the quarterbacks of the team,” said Jennifer Myers, MD, a hospitalist for more than 20 years and associate chief for Faculty Affairs in the Division of Hospital Medicine, as well as creator and director of the Center for Healthcare Improvement and Patient Safety (PennCHIPS, a center that focuses on education and training in quality and safety). “We know what needs to be done and how to get it done in the most patient-centered and efficient way possible.”
Hospitalists see inpatients regularly, order tests and scans, write prescriptions, and work closely with their teammates—nurses, social workers, therapists, pharmacists, specialists, and primary care providers—to diagnose and monitor patients and execute the treatment plan. And when a patient is discharged, it’s a win for everyone.
To Greysen, the elevation of Hospital Medicine as a division at Penn Medicine recognizes hospitalists’ role in ensuring safe, high-quality patient care and their contributions to overall hospital operations.
“We often say the hospital is our second patient,” Greysen said. “When the hospital is functioning well, the patients get the best care.”
The value hospitalists bring was never clearer than during the COVID-19 pandemic. Hospitalists were key to providing bedside clinical care and were instrumental leaders in developing strategies to meet COVID-19 surges. Like an experienced quarterback who decides to call an audible, hospitalists quickly adapted to the rapidly evolving situation.
“Hospitalists were always there on the front lines of the pandemic,” Greysen said. “We took care of the most patients and had to become experts at how to manage COVID as a disease. When there were surges, we were able to move staff around, which enabled us to see more patients.”
In addition to HUP, the Division of Hospital Medicine at Penn Medicine also provides services at Penn Presbyterian Medical Center, Good Shepherd Penn Partners, and the Philadelphia Veterans Administration Medical Center. Today, the division includes more than 70 faculty members, including leaders in clinical operations, quality and safety, informatics, health services research, and medical education.
A brief history
The concept of hospital medicine and hospitalists began to take shape in the mid-1990s.
Before then, patients were typically treated by their primary care physician, even during hospital stays. That traditional model, however, had shortcomings.
Primary care physicians had busy practices, which made it challenging for them to see their patients in the hospital in a timely manner.
At the same time, with advances in medicine, inpatient care was becoming more complex, and there was a growing recognition that it required a different set of skills and expertise.
Also, the number of medical residents who cared for hospitalized patients was shrinking, largely due to new, mandated work-hour restrictions.
This combination of challenges, along with a growing focus on safety and quality, inspired medical professionals to look for an alternative structure.
“Hospitalists were the solution,” Greysen said.
Today there are 50,000 to 60,000 hospitalists in practice in the United States, according to the Society of Hospital Medicine.
Getting it right
The hospital is the “second patient” of hospitalists, according to Chief of Hospital Medicine S. Ryan Greysen, MD: “When the hospital is functioning well, patients get the best care.”
Hospitalists are also instrumental in managing patient flow, a major challenge in many hospitals. Because they monitor the capacity of different teams—cardiology, pulmonary, GI, for instance—they can direct patients to where they’ll get the most appropriate care in the most efficient manner.
“We get the patients the care they need, and we’re not keeping them in the hospital longer than they need to be,” Greysen said.
Put another way, hospitalists are in charge of getting the right patient the right care from the right team at the right time.
As an example, Greysen pointed to an initiative that placed hospitalists in the Emergency Department (ED) at HUP. The Division of Hospital Medicine is partnering with researchers in the Operations, Information and Decisions Department at the Wharton School at the University of Pennsylvania to dig into the data and further analyze the hospitalists’ impact. The study is being led by Assistant Professor of Health Care Management Hummy Song, PhD, whose research focuses on identifying ways to improve the performance of service systems, with a particular emphasis on the health care sector.
It’s research and partnerships like this that Greysen hopes to continue to expand and advance under the new Division of Hospital Medicine, with the goal of helping the field further develop the best ways to provide inpatient care.
“My three main goals for our division are to provide the best patient care possible, to be nationally known as the quality experts and the leaders in innovative hospital operations, and to disseminate knowledge through scholarship, including robust studies and publication of those studies,” Greysen said.
Faculty are at the forefront of quality and safety efforts, and faculty development is a priority, Greysen added.
“Fun to pass on knowledge”
The opportunity to teach and care for patients attracted Erik Tan, MD, to a residency in hospital medicine at Penn Medicine.
“My goal eventually is to practice hospital medicine as well as be an educator,” said Tan, who is an internal medicine resident at HUP and has a special interest in how medical education is delivered. “It’s fun to pass on knowledge.”
Tan noted that even though hospitalists may not have long-term relationships with patients like a primary care physician would, they can still form bonds with their patients.
“You really are able to develop close connections with patients in the short amount of time you’re with them,” Tan said. “You’re the face they see every day. You can develop a lot of fulfilling relationships from that too.”
A special team
During Hecht’s 25 years at Penn Medicine, he has treated thousands of patients and seen these special relationships develop many times. One recent example is colleague Veronica “Ronni” Elena, an award-winning unit secretary at HUP, whom Hecht had known for more than a decade. In March 2022, Elena landed in the Emergency Department at HUP after suffering with gastrointestinal discomfort, swelling, and other mysterious symptoms for months. Upon her admission, Hecht ordered a range of tests and worked with several specialists.
Ultimately, the team diagnosed a potentially life-threatening condition caused by a partial obstruction of Elena’s thoracic duct, the main vessel in the lymphatic system. They developed a treatment plan and today, Elena is feeling more like herself.
The case deepened Hecht’s relationship with Elena and renewed his pride in his work.
“Patients benefit because they have an inpatient expert advocating for them and managing their care, and you can really bond with people over that short period when they’re in the hospital,” he said. “To me, it’s really fulfilling.”