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AbstractObjectiveTo investigate whether the US News & World Report (USNWR) ranking of the medical school a physician attended is associated with patient outcomes and healthcare spending.DesignObservational study.SettingMedicare, 2011-15.Participants20% random sample of Medicare fee-for-service beneficiaries aged 65 years or older (n=996 212), who were admitted as an emergency to hospital with a medical condition and treated by general internists.Main outcome measuresAssociation between the USNWR ranking of the medical school a physician attended and the physician’s patient outcomes (30 day mortality and 30 day readmission rates) and Medicare Part B spending, adjusted for patient and physician characteristics and hospital fixed effects (which effectively compared physicians practicing within the same hospital). A sensitivity analysis employed a natural experiment by focusing on patients treated by hospitalists, because patients are plausibly randomly assigned to hospitalists based on their specific work schedules. Alternative rankings of medical schools based on social mission score or National Institute of Health (NIH) funding were also investigated.Results996 212 admissions treated by 30 322 physicians were examined for the analysis of mortality. When using USNWR primary care rankings, physicians who graduated from higher ranked schools had slightly lower 30 day readmission rates (adjusted rate 15.7% for top 10 schools v 16.1% for schools ranked ≥50; adjusted risk difference 0.4%, 95% confidence interval 0.1% to 0.8%; P for trend=0.005) and lower spending (adjusted Part B spending $1029 (£790; €881) v $1066; adjusted difference $36, 95% confidence interval $20 to $52; P for trend <0.001) compared with graduates of lower ranked schools, but no difference in 30 day mortality. When using USNWR research rankings, physicians graduating from higher ranked schools had slightly lower healthcare spending than graduates from lower ranked schools, but no differences in patient mortality or readmissions. A sensitivity analysis restricted to patients treated by hospitalists yielded similar findings. Little or no relation was found between alternative rankings (based on social mission score or NIH funding) and patient outcomes or costs of care.ConclusionsOverall, little or no relation was found between the USNWR ranking of the medical school from which a physician graduated and subsequent patient mortality or readmission rates. Physicians who graduated from highly ranked medical schools had slightly lower spending than graduates of lower ranked schools.

To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput. Randomised, multicentre clinical trial. Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit. 88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training; 12 scribes trained at one site and rotated to each study site. Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018. Physicians' productivity (total patients, primary patients); patient throughput (door-to-doctor time, length of stay); physicians' productivity in emergency department regions. Self reported harms of scribes were analysed, and a cost-benefit analysis was done. Data were collected from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23 838 patients). Scribes increased physicians' productivity from 1.13 (95% confidence interval 1.11 to 1.17) to 1.31 (1.25 to 1.38) patients per hour per doctor, representing a 15.9% gain. Primary consultations increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to 1.11) patients per hour per doctor, representing a 25.6% gain. No change was seen in door-to-doctor time. Median length of stay reduced from 192 (interquartile range 108-311) minutes to 173 (96-208) minutes, representing a 19 minute reduction (P<0.001). The greatest gains were achieved by placing scribes with senior doctors at triage, the least by using them in sub-acute/fast track regions. No significant harm involving scribes was reported. The cost-benefit analysis based on productivity and throughput gains showed a favourable financial position with use of scribes. Scribes improved emergency physicians' productivity, particularly during primary consultations, and decreased patients' length of stay. Further work should evaluate the role of the scribe in countries with health systems similar to Australia's. ACTRN12615000607572 (pilot site); ACTRN12616000618459.

In the past 20 years, the number of hospitalists in the United States has grown from a few hundred to more than 50,000. Although challenges remain, many stars have aligned to enable the model to thrive and contribute to high-quality, efficient inpatient care. Twenty years ago, we described the emergence of a new type of specialist that we called a “hospitalist.” 1 Since then, the number of hospitalists has grown from a few hundred to more than 50,000 (see graph) — making this new field substantially larger than any subspecialty of internal medicine (the largest of which is cardiology, with 22,000 physicians), about the same size as pediatrics (55,000), and in fact larger than any specialty except general internal medicine (109,000) and family medicine (107,000). Approximately 75% of U.S. hospitals, including all highly ranked academic health centers, now have hospitalists. The field’s rapid growth . . .

Although there is a plethora of literature on patients leaving against medical advice, across Canada there is a lack of similar guidance when patients with cognitive impairment, who are medically stable but have ongoing personal care needs (i.e., \"at-risk patients\") seek discharge when their care team recommends they remain admitted. With the population aging and the continued lack of community resources, the legal and ethical considerations, such as patient autonomy, professional responsibility and liability, authority to detain or restrain, and defining and managing risk are nuanced and the best course of action is not always clear. This can cause significant moral distress for all involved. In an attempt to fill this gap, a quality improvement project was initiated with a core change team which included a hospitalist, a psychiatrist, a lawyer, a bioethicist, and a bioethics research student. A practical framework to facilitate in-the-moment decision-making when an at-risk patient is expressing a desire to leave an in-patient setting and return to community was developed and piloted with a range of stakeholders. This framework is based on Ontario law, but its principles are applicable broadly across Canada. It outlines four options that health care teams can use, alone or in combination, to help determine what to do. When evaluating options, it is important to consider the patient's specific circumstances, values and wishes. This workshop will be facilitated by the hospitalist physician and bioethicist from Sinai Health who, with colleagues, developed this framework. The framework which includes guiding legal and ethical principles, along with considerations for communication strategies and internal resources will be reviewed and applied to a case. Participants in this workshop will then have an opportunity to work in groups on a variety of provided cases and apply the framework in real-time. They will then present their case review to the entire group to facilitate further discussion and learning.

Although the roles and responsibilities of hospitalists have grown considerably in recent years, research on the current job status and satisfaction levels of Korean hospitalists is lacking. We investigate the present state of Korean hospitalists and the factors influencing their job satisfaction 6 years after the pilot program's launch. This cross-sectional analysis was based on an online survey conducted from January 30 to February 18, 2023. Korean hospitalists (N = 303) MAIN MEASURES: The survey encompassed participant demographics, hospital information, education, clinical practice, research involvement, and job satisfaction. We employed multiple logistic regression analyses to identify determinants of satisfaction as a hospitalist. The analysis was based on 79 hospitalists' responses (response rate 26%). Respondents had a median age of 39 years; approximately half were male internal medicine specialists, possessing over 3 years of hospitalist experience. Most respondents were interested in clinical work (94.4%), with only 21.5% interested in research and evidence-based medicine. Over two-thirds indicated that non-clinical duties occupied less than 20% of their time. Overall, job satisfaction among hospitalists averaged 51.9%. Notably, the availability of a research mentor was significantly associated with job satisfaction (P = .011). While hospitalists with more than 3 years of experience, more hospitalists per facility, and autonomy were associated with increased job satisfaction, these associations were not statistically significant. Furthermore, there was no association between night shift work, work type, or work hours and job satisfaction. Although Korean hospitalists primarily focus on clinical practice, our study underscores the positive impact of mentorship from research mentors on job satisfaction, supported by comprehensive univariate and multivariate analyses. These findings signal a progressive transformation in the role of Korean hospitalists, as they increasingly engage in research alongside patient care.