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Am Fam Physician. 2003;67(5):online-only-

to the editor: The practice of primary care physicians assigning their patients who need hospital care to hospitalists is gaining momentum. Some are solely hospitalists and some also maintain their private medical practices. It is much more economical for a busy family physician to assign their in-hospital patients to the care of a hospitalist. Although the family physician typically has only a few of these patients, they are usually at several hospital locations. Assigning these patients to a hospitalist allows the family physician to treat more patients in the office where they can be examined and treated more efficiently and more cost-effectively.

As a retired private practice family physician, I submit that this practice of assigning hospitalists will negatively impact the care of these patients, because it results in fragmentation of their care; it also belittles the work of family physicians by making them assistants in the medical care of these patients.

I graduated from the University of Pennsylvania in 1940. My generation of family practice physicians worked long and hard over many years to secure privileges in most of our hospital clinical departments. I am saddened to see that today many family physicians rush to divest themselves of the privileges and responsibilities of the hospital care of their patients. In the long run, this will demean their practices and family practice in general. Even at this early stage of the hospitalist movement, the effect is showing up in lowered interest among medical students to enter family practice residencies.

I urge that family physicians rethink the collective wisdom of giving up the responsibility of the hospital care of their patients. Continuing such care will be for the benefit of the patient, and for the benefit of the doctor to keep him or her whole. Presently, the use of hospitalists by family physicians is purely voluntary; however, it may work so well that the practice will become mandatory.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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