Hospital medicine grows globally


Hospital medicine is growing in popularity in some foreign countries, speakers said during Monday afternoon’s session, “International Hospital Medicine in the United Arab Emirates, Brazil and Holland.” The presenters discussed some of the history of hospital medicine in each of those countries as well as some current challenges.

Dr. Marjolein de Boom of Haaglanden Medical Center, the Netherlands

Dr. Marjolein de Boom

Hospital medicine in the Netherlands started in about 2012, said Marjolein de Boom, MD, a hospitalist at Haaglanden Medical Centre. The country has its own 3-year training program for hospitalists, who first started to work in hospitals in the country in 2015. “It’s a relatively new and young specialty,” said Dr. de Boom, with 39 hospitalists in the country working in 8 of the 80 Dutch hospitals. Another 25 or so hospitalists are in training, “so it’s a growing profession,” she said. A Dutch chapter of SHM has been in place since 2017.

Hospitals in the Netherlands permit physicians to serve as hospitalists in different specialties depending on their needs. For example, Dr. de Boom works in the oncology department, as well as the surgical and trauma surgery units. One challenge has been to get more physicians interested in the hospitalist program because it’s newer and not as well-known, she said.

Hospital medicine in the United Arab Emirates also is a newer concept. The American model of hospital medicine was first introduced to the region in 2014 by the Cleveland Clinic in Abu Dhabi, said Mahmoud Al-Hawamdeh, MD, MBA, SFHM, FACP, chair of hospital medicine at the medical center. “Before that, inpatient hospital care was done by traditional family and internal medicine physicians, general practitioners, and residents,” he said.

Dr. Mahmoud Al-Hawamdeh of Cleveland Clinic in Abu Dhabi, UAE

Dr. Mahmoud Al-Hawamdeh

There are 43 hospitalists at Cleveland Clinic, Abu Dhabi, said Dr. Al-Hawamdeh. They cover about 50%-60% of inpatient services, as well as handle admissions for vascular surgery, ophthalmology, and some general services; they also comanage postcardiac surgery care, he said. “It has been a tremendous success to implement hospital medicine in the care for the inpatient with improved quality metrics, reduced length of stay, and improved patient satisfaction.”

However, there are some challenges, such as educating patients and families about the role of hospitalists, cultural barriers, and the lack of a postdischarge follow-up network and institutions such as skilled nursing facilities. Dr. Al-Hawamdeh worked with physicians from Johns Hopkins Aramco Healthcare and Hamad Medical Corporation to establish an SHM Middle East chapter in 2016.

In Brazil, hospital medicine started to take hold in 2004, said Guilherme Barcellos, MD, SFHM. At that time, just a few doctors were true hospitalists. Dr. Barcellos helped create two hospitalist societies in the country. Hospitalists balancing multiple jobs is still very common, but decreasing, he said, while hospital employment and medical group participation is increasing.

“It was a high-pressure environment, crying out for efficiency, that drove forward Brazilian hospital medicine,” Dr. Barcellos said, “together with new reimbursement models, surgical redesigns, primary care recognition and structure.”

Some challenges remain in Brazil as well, he said. Fancy private hospitals announce they have hospitalists when they may not. In addition, the role of generalists and subspecialists, and the role of certifications, is not always clear. But hospitalists are gaining a foothold, participating in a Choosing Wisely initiative in the country and organizing several conferences.

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