Practice Management

Hospital medicine around the world

Similar needs, local adaptations


Hospital medicine has evolved rapidly and spread widely across the United States in the past 25 years in response to the health care system’s needs for patient safety, quality, efficiency, and effective coordination of care in the ever-more complex environment of the acute care hospital.

But hospital care can be just as complex in other countries, so it’s not surprising that there’s a lot of interest around the world in the U.S. model of hospital medicine. But adaptations of that model vary across – and within – countries, reflecting local culture, health care systems, payment models, and approaches to medical education.

Other countries have looked to U.S. experts for consultations, to U.S.-trained doctors who might be willing to relocate, and to the Society of Hospital Medicine as an internationally focused source of networking and other resources. Some U.S.-based institutions, led by the Cleveland Clinic, Johns Hopkins Medicine, and Weill-Cornell Medical School, have established teaching outposts in other countries, with opportunities for resident training that prepares future hospitalists on the ground.

SHM CEO Eric E. Howell, MD, MHM, said that he personally has interacted with developing hospital medicine programs in six countries, who called upon him in part because of his past research on managing length of hospital stays. Dr. Howell counts himself among a few dozen U.S. hospitalists who are regularly invited to come and consult or to give talks to established or developing hospitalist programs in other countries. Because of the COVID-19 epidemic, in-person visits to other countries have largely been curtailed, but that has introduced a more virtual world of online meetings.

Dr. Eric E. Howell, chief, division of hospital medicine, Johns Hopkins Bayview Medical Center, Baltimore

Dr. Eric E. Howell

“I think the interesting thing about the ‘international consultants’ for hospital medicine is that while they come from professionally diverse backgrounds, they are all working to solve remarkably similar problems: How to make health care more affordable and higher quality while staying abreast of up-to-date best practice for physicians,” he said.

“Hospital care is costly no matter where you go. Other countries are also trying to limit expense in ways that don’t compromise the quality of that care,” Dr. Howell said. Also, hospitalized patients are more complex than ever, with increasing severity of illness and comorbidities, which makes having a hospitalist available on site more important.

Dr. Howell hopes to encourage more dialogue with international colleagues. SHM has established collaborations with medical societies in other countries and makes time at its conferences for international hospitalist participants to meet and share their experiences. Hospitalists from 33 countries were represented at SHM’s 2017 conference, and the upcoming virtual SHM Converge, May 3-7, 2021, includes a dedicated international session. SHM chapters have formed in a number of other countries.

Flora Kisuule, MD, MPH, SFHM, director of the Division of Hospital Medicine at Johns Hopkins Bayview Medical Center in Baltimore, said her international hospital medicine work1 started 7 years ago when she was invited to the Middle East to help Aramco, the Saudi Arabian Oil Company, develop a hospital medicine program based on the U.S. model for its employees. This was a joint venture with Johns Hopkins Medicine. “We went there and looked at their processes and made recommendations such as duration of hospitalist shifts and how to expand the footprint of hospital medicine in the hospital,” she said.

Dr. Flora Kisuule, hospitalist and Director of the Division of Hospital Medicine at Johns Hopkins Bayview Medical Center in Baltimore

Dr. Flora Kisuule

Then Dr. Kisuule was asked to help develop a hospital medicine program in Panama, where the drivers for developing hospital medicine were improving quality of care and ensuring patient safety. The biggest barrier has been remuneration and how to pay salaries that will allow doctors to work at only one hospital. In Panama, doctors typically work at multiple hospitals or clinics so they can earn enough to make ends meet.


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