Friend or foe? How primary care physicians perceive hospitalists

Background: increased use of hospitalists is redefining the role of primary care physicians. Whether primary care physicians welcome this transition i s unknown. We examined primary care physicians' perceptions of how hospital ists affect their practices, their patient relationships, and overall patie nt care. Methods: A mailed survey of randomly selected general internists, general p ediatricians, and family practitioners with experience with hospitalists pr acticing in California. Main Outcome Measures: Physicians' self-reports of hospitalists' effects on quality of patient care and on their own practices. Results: Seven hundred eight physicians were eligible for this study, and t here was a 74% response rate. Of the 524 physicians who responded, 34% were internists, 38% were family practitioners, and 29% were pediatricians. Of the 524 respondents, 335 (64%) had hospitalists available to them and 120 ( 23%) were required to use hospitalists for all admissions. Physicians perce ived hospitalists as increasing (41%) or not changing (44%) the overall qua lity of care and perceived their practice style differences as neutral or b eneficial. Twenty-eight percent of primary care physicians believed that th e quality of the physician-patient relationship decreased; 69% reported tha t hospitalists did not affect their income; 53% believed that hospitalists decreased their workload; and 50% believed that hospitalists increased prac tice satisfaction. In a multivariate model predicting physician perceptions , internists, physicians who attributed loss of income to hospitalists, and physicians in mandatory hospitalist systems viewed hospitalists less favor ably. Conclusions: Practicing primary care physicians have generally favorable pe rceptions of hospitalists' effect on patients and on their own practice sat isfaction, especially in voluntary hospitalist systems that decrease the wo rkload of primary care physicians and do not threaten their income. Primary care physicians, particularly internists, are less accepting of mandatory hospitalist systems.