Response to David Meltzer's paper "Hospitalists and the doctor-patient relationship".

The hospitalist movement, in which a generalist physician assumes the physician-of-record role for hospitalized patients in place of the patients' own primary physician is transforming American hospital care. Studies, including those by David Meltzer, support the premise that hospitalist care is less expensive and possibly of higher quality than inpatient care provided by primary physicians. Meltzer's survey of randomly selected individuals indicates that, although many would prefer that their own physician orchestrate their inpatient care, relatively few would pay more than $100 for this privilege. This indicates that patient dissatisfaction with the hospitalist model is unlikely to impede its widespread implementation. Hospitalists are just the latest example of the ongoing tension between generalism and specialization in American medicine. The hospitalist--unlike most traditional medical specialists--is actually a generalist by nature whose specialty is defined by the the site of the care rather than by organ, disease, patient population, or procedure.