Coordination, Switching Costs and the Division of Labor in General Medicine: An Economic Explanation for the Emergence of Hospitalists in the United States
General medical care in the United States has historically been provided by physicians who care for their patients in both ambulatory and hospital settings. Care is now increasingly divided between physicians specializing in hospital care (hospitalists) and ambulatory-based care primary care physicians. We develop and find strong empirical support for a theoretical model of the division of labor in general medicine that views the use of hospitalists as balancing the costs of coordinating care across physicians in the hospitalist model against physicians' costs switching between ambulatory and hospital settings in the traditional model. Our findings suggest opportunities to improve care.
Financial support for this work was provided by Robert Wood Johnson Investigator Program, (RWJF Grant ID 63910 Meltzer, Principal Investigator), a Midcareer Career Development Award from the National Institute of Aging (1 K24 AG031326-01, PI Meltzer and the Agency for Healthcare Quality and Research through the Hospital Medicine and Economics Center for Education and Research in Therapeutics (CERT) (U18 HS016967-01, Meltzer, PI). The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.