To the Editor:

In the debate over the implications of the hospitalist movement for family physicians (“What the Hospitalist Movement Means to Family Physicians,” November/December 1998), one point has been overlooked: An ambulatory-only practice may not be in our patients' best interests.

Without the inpatient experience and the interaction with specialist colleagues, real continuing medical education will decline. How can this be replaced? Lectures in a darkened hotel ballroom will not keep me abreast of changing approaches to the management of, for example, ischemic heart disease — therapies that will carry over into my office practice. The longer we are away from inpatient medicine, the more likely we will lose the ability to recognize truly ill patients.

Without the inpatient experience, we will truly be indistinguishable from midlevel providers. The choice of hospital-only versus ambulatory-only care is about more than personal satisfaction or economics; it is about the quality of care we will provide for our patients.