LAUSR

Hospitalists are dedicated to the delivery of comprehensive medical care to hospitalized patients. They engage in clinical care, research, and medical education in the broad field of general hospital medicine. Hospitalists are very important, as they manage and treat a significant range of complex and comorbid disease conditions, especially in an aging society. In addition to improving care for each hospitalized patient, hospitalists support the implementation of evidencebased practices to facilitate optimal continuity of care and enhance the performance of hospitals and healthcare systems, including quality improvement, patient safety, infection control, and proper allocation of medical expenditures. More importantly, they act as leaders in the hospital care system (1). Their activities have been spotlighted during the coronavirus disease 2019 (COVID-19) pandemic (2). In the US, the number of hospitalists rapidly increased from 10,000 in 2003 to more than 50,000 in 2016, and 75% of all university hospitals have established hospitalist systems (3). Although internists used to practice in ambulatory care settings and wards, more senior physicians chose to dedicate themselves to only the outpatient setting, while younger physicians engaged in hospitalist care (4). Asian countries have now also chosen to adopt the hospitalist model to supplement the already established specialty-driven inpatient care systems (5). The Japanese Society of Hospital General Medicine (JSHGM) was established in 2010 and currently has 2,100 members from 245 affiliated medical institutions. In 2022, the JSHGM started its certification system for hospitalist as a subspecialty. It is worth noting that this certification focuses on not only clinical ability (e.g., diagnosis, clinical procedures) but also hospital management (e.g., leadership, patient safety, communication). On the practical side, Hamada et al. showed that hospitalists improve the care of patients with urinary tract infection (6). Other research from Japanese groups also demonstrated that the length of hospital stay was significantly shortened after the introduction of a hospital medicine department (adjusted difference -0.659 days; 95% confidence interval -1.118 to -0.136; p=0.01) (7). These studies further showed that the research interests of hospitalists include not only clinical research (38%) but also health service research (22%), medical quality and improvement (18%), and medical education (17%) (8). Although Japanese general medicine physicians have historically been less involved in research than specialists and do not consider research skills to be important (9), some eager hospitalists have started a movement to disseminate information regarding conducting research and publishing papers aimed at other hospitalists (10, 11). Concurrently, collaboration between the Japanese Society of Internal Medicine and the JSHGM will help improve the research abilities of young hospitalists. Evidence-driven quality improvement by hospitalists is sure to facilitate specialists’ understanding of the role of hospitalists in Japan.