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The Rise of the Hospitalist in California

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The hospitalist field has become the fastest-growing specialty in the history of American medicine, skyrocketing from a few hundred physicians nationally in the mid-1990s to more than 20,000 today. To assess this important trend, the California HealthCare Foundation funded researchers at UCSF to perform a study of factors driving the growth of hospitalists in California. Having proven their ability to reduce costs and length of stay for medical patients, hospitalists' roles are expanding into surgical, intensive care, and emergency areas. In addition, they are being asked to assist with systemwide efficiency improvements, as well as quality and safety initiatives. Such expansion has increased the need to define training and certification requirements for hospitalists. At the same time, it has created a large demand for hospitalists, leading to sharp rises in salary and high turnover rates. This report illustrates that hospitalists will remain part of California hospitals for the foreseeable future, and that their fast growth is changing the way hospitals and primary care doctors do business, certify staff, and pay for services.