Gone are the days when a doctor toting a black bag would ring your doorbell and take your vitals with a mercury thermometer. In the digital age, your physician might pop up on your laptop screen while your wearable device reads your temperature. And if you go to an office for your annual physical, you’re as likely to see a nurse practitioner as a doctor.
A national shortage of primary care physicians, along with increasing healthcare costs, has created a demand for new types of specialists, as well as innovative uses of technology in healthcare. Here are five types of medical specialists on the rise — what they do, what makes them distinct and when you might see one.
1. Hospitalists
What they do: Hospitalists work exclusively in hospitals and specialize in treating hospital patients. Most are internists, who treat a wide range of conditions commonly seen in hospital patients, such as kidney disease and heart failure. Ob-gyns, pediatricians and neurologists are also drawn to the specialty. “Being a hospitalist is really defined by being a great generalist,” says Dr. Andrew Dunn, chief of the division of hospital medicine at Mount Sinai Health System in New York City. Hospitalist subspecialities include nocturnists, who practice only at night, and intensivists, which are pulmonary specialists who tend to patients in the intensive care unit.
Training and bonafides: Hospitalists must be board-certified in internal medicine, family medicine, pediatrics or, in the case of intensivists, pulmonary medicine.
Why you might see one: About 3 out of 4 U.S. hospitals employ hospitalists, so it’s highly likely that one will helm your care if you’re hospitalized.
Reason their popularity is growing: The term hospitalist was only coined in 1996. Now it’s among the fastest growing medical subspecialties. Hospitalists know their hospital’s staff well and are able to provide more streamlined and efficient care, which decreases the length of a patient’s stay and reduces readmissions, as well as hospital costs.
2. Lifestyle medicine physicians
What they do: Lifestyle medicine doctors focus on preventing, reversing and treating chronic diseases, such as diabetes and high blood pressure, using evidence-based lifestyle modifications. Prescribed modifications can include eating a plant-based diet, increasing physical activity, getting sufficient sleep, maintaining social connections and avoiding substances.
Training and bonafides: The American College of Lifestyle Medicine just began offering certification in lifestyle medicine in October 2017. So far, 700 medical professionals have been certified. To sit for the exam, you must already be board-certified in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association.
Why you might see one: Doctors who practice lifestyle medicine are typically in primary care and family medicine, with the lifestyle piece folded into their overall practice. Increasingly, specialists such as cardiologists and endocrinologists are getting on board as well. There are also one-week programs at dedicated lifestyle medicine clinics that offer “boot camp” for those who need it.
Reason their popularity is growing: It’s just math. Six in 10 Americans have at least one chronic disease; 80 percent of healthcare costs are related to chronic disease; 80 percent of chronic disease is related to lifestyle choices. According to the World Health Organization, 80 percent of heart disease, stroke and type 2 diabetes, as well as 40 percent of cancers, could be prevented, primarily with improvements in diet and lifestyle. “Lifestyle medicine is both the oldest form and the newest form of managing disease,” says Susan Benigas, executive director of the ACLM. “For many healthcare providers, it reignites why they went into medicine in the first place — to become true healers.”
3. Telemedicine providers
What they do: Telemedicine is healthcare furnished via video conferencing, or with the help of an app designed for patients to track their health data. Practitioners include doctors from a variety of specialties who typically see patients in brick-and-mortar offices.
Training and bonafides: There is currently no official accreditation required beyond being board-certified in a medical specialty, but medical schools are increasingly incorporating telemedicine training into their curricula. As all forms of digital healthcare delivery expand, it’s more than likely their ranks will increase.
Why you might see one: A big draw of telemedicine is convenience. Say you’re far from the nearest hospital and you have a standard post-surgical follow-up with your surgeon. You might do it via video to avoid driving into the city or enduring a long wait at a doctor’s office for such a routine matter. “We also use the technology to see patients in skilled nursing facilities, who otherwise might need an ambulance to get to a hospital or doctor’s office,” says Marcy Simoni, director of virtual visits at the Massachusetts General Hospital Center for Telehealth.
Reason their popularity is growing: The telehealth market is expected to rise 30 percent each year between 2017 and 2022. “Telehealth and virtual tools just give us another way to provide care,” Simoni says.
4. Nurse Practitioners
What they do: Nurse practitioners follow a patient-centered model in which they focus on disease prevention and health education. They also handle assessment, diagnosis and treatment.
Training and bonafides: NPs are registered nurses who have earned a master’s degree or doctorate in a specialty area of nursing.
Why you might see one: NPs often pick up the slack for doctors to reduce patient waiting times and staff expenses for the practice. NPs frequently work in hospital outpatient and inpatient settings, at community health centers, and with doctors in private practice. NPs are also qualified to have their own private practices, and see patients without any MD supervision.
Reason their popularity is growing: The number of NPs in the U.S. has grown substantially in the last decade, according to a survey from the American Association of Nurse Practitioners, with an estimated 270,000 licensed and practicing NPs nationwide. Their role within the increasingly costly medical system is part of what makes them valuable, as their services are more cost-effective than those of physicians.
5. Physician Assistants
What they do: Compared to NPs, physician assistants follow a more medical, disease-centered model of care, focusing on the biologic and pathologic components of health. They are also able to prescribe medication with the approval of a physician.
Training and bonafides: PAs must earn a master’s degree or a combined bachelor’s/master’s, complete a clinical rotation, pass a certifying exam and receive a license in their state.
Why you might see one: PAs tend to be interested in certain specialized practice areas. For example, more than 25 percent of physician assistants have a surgical specialty that allows them to perform duties associated with surgical procedures. Other popular specialties are dermatology, pathology and emergency medicine. Doctors always supervise PAs — they cannot practice independently.
Reason their popularity is growing: According to the Bureau of Labor Statistics, employment of physician assistants is projected to grow 37 percent from 2016 to 2026. The high demand for PAs is driving the creation of new physician assistant programs. As with NPs, they are valuable because of their expertise, as well as the cost-effectiveness of their care.
Hospitalists, as well trained as they may be, are seeing patients for the first time., essentially as an extension of charts and lab tests. They exist to enhance efficiency and bottom line where, as hospital employees, all payments go to the hospital corporation.
The client is given no choice, their primary care physician being denied access to the hospital, thereby cutting out what may be a major component of the client’s recovery.
Hospitalists are intermediary’s in the hospital. What your primary care physician used to be able to do, be the point person for the various specialists, is now taken over by the hospitalists. However, hospitalists rarely know the intricacies of their assigned patients in their care and in many regards are nothing more than the go between for departments without knowing the patient history.
Bottom line….one must always be or have with you, someone, to be YOUR case manager at all times.
I have to agree with the above messages. The Hospitalist doesn’t know anything about the patient and I find that disconcerting. My husband has been hospitalized 4 times since June 2016 and was taken care of by the hospitalists who, not knowing anything about him and bad things happened. Medications were not ordered, no one checked the level of his bladder when told he had urinary retention and as a result his bladder was expanded with more than 2600 cc of urine. I’m a nurse and his main caregiver and advocate or he’d but up the creek without a paddle. I’m not in favor of the hospitalist at all.