Health reform leading to new specialties

Health reform — not the political issue but the ongoing effort by insurers to control costs — is solving medical labor shortages by creating new specialties.

The New York Times recently focused on one such specialty, the hospitalist.

The discipline combines elements of general practice, systems analysis, and nursing, the job being to learn about patients and get them out of the hospital as quickly and safely as possible.

Discharges used to be the purview of internists. Hospitalists help with that labor shortage, but they do more.

That’s because a hospital isn’t just beds, machines and specialists. It’s a complex bureaucratic system, with many services and departments, ever changing, and some specialization is needed to get the most from it.

The Society of Hospital Medicine represents hospitalists, and a quick glance at their Web site shows you quite a different agenda from that of, say, family medicine. The hospitalists’ blog attacks this directly, asking where are the generalists.

(You may benefit at this point from reading this 1998 American Academy of Family Physicians article on the new field of hospitalism, to see how far we’ve come. The illustration is from that story.)

The new specialists are not all doctors. The fastest-growing group of American generalists today is the American Academy of Physicians Assistants. PAs are not only commonplace in family practice offices, they are taking the lead in doc-in-a-box operations, alongside nurse practitioners, another growing specialty.

Yet another such specialty, one we cover often here, is medical informatics. Scot Silverstein, whom I’ve mentioned here in the past, is a noted practitioner of biomedical informatics. That is, he practices computer science as applied to medicine. He’s both a doctor and a geek.

Writing as MedinformaticsMD, he is one of the contributors to the popular Health Care Renewal blog, where he often cautions health IT enthusiasts (like myself) against thinking IT is a silver bullet in health care, and advocates for a marriage between IT expertise and medical expertise, such as he represents.

These are just a few examples. Whenever you read in the next months or years about a labor shortage in health care, it may pay you to think that one man’s shortage is another man’s growth opportunity.

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