Hospitalists have taken over the hours that allow the residents and primary care physicians (PCP) to sleep but the effect on the patient and patient care and psychological response to care is disastrous. If the solution to tired residents was to graduate them to hospitalists, then the system has failed. Note the recent study showing improvement in care, just happier insurance companies due to shorter stays: <link>

But also note the comments of MDs and patients from the WSJ health blog:

"Hospitalists are generally a second class substitute for the patient’s real doctor. If the PCP chooses not to go to the hospital, or is doesn’t have expertise managing hospital patients, then what choice does the patient have? Hospitalist.
At our hospitals, the communication between the hospitalists and the PCP is next to zero. Several days after the patient is discharged, we might (or might not) get a faxed discharge summary. We don’t get the courtesy of a phone call…once the patient is admitted the hospitalists DO NOT WANT THE PCP INVOLVED. They are acutely aware that if the patient was choosing, they would choose the PCP. This avoidance of communication is pathetic and does the patient a disservice, since tests get repeated, old problems get worked anew; all exposing the patient to more cost and morbidity. It is a pretty bizarre experience to be making rounds seeing my patients, when another of my patients sees me in the hallway and asks why wasn’t I seeing them too?? Their request was going in one ear and out the other of the hospitalist. But the patient is pissed at me for not coming to see them when I wasn’t even contacted. This may be the wave of the future, but I’m doubt it is an improvement…."

Comment by RealDoc - June 24, 2008 at 9:15 pm <link> Having just completed a stay at a University hospital that requires a hospitalist and precludes contact with your own MD, I experienced a terror not unlike what one might see in the movies. One doctor did not know why I had been admitted; the next doctor was only on for a day and would not review my medications with me to make sure the proper medications and doses were being administered, the third hospitalist refused to answer my questions and when she didn't know an answer, would turn around without a word, leave the room and slam the door behind her. She waited two weeks to provide a discharge summary to my doctors telling me "I do my paperwork last" leaving me and my doctor of choice with no information about meds upon discharge or doses administered during the hospital stay. The doctor should be before the licensing commission explaining her conduct, not in charge of a floor of patients ill enough to be hospitalized. I'll take a tired resident that calls my doctor in the middle of the night anytime over this system, at whatever cost I must pay, since, btw, the insurance company has shifted most of the hospital cost to me anyways.

Having worked as a hospitalist for nearly six years and in a couple of different systems, I can tell you that none of the above is true about the hospitals where I have worked. A competent hospitalist is better for a hospitalized patient than an equally competent primary doctor who has to fit seeing inpatients around his/her clinic hours. And a competent hospitalist communicates on a daily or near-daily basis with each patient's primary doctor. Perhaps it's different in the adult-medicine world, but what you described above doesn't happen where I've worked - that shit doesn't fly when it's somebody's child involved.

I think the key phrase here is that the primary care physician is NOT going to be making calls at night to the hospital, for his patient. Primary care physicians really WANT the day to end at 5. If this were NOT true, there would be no need for hospitalists.