title: The positive impact of initiation of hospitalist clinician educators.
abstract: OBJECTIVE
  Although hospitalists have been shown to improve both financial and educational outcomes, their ability to manage dual roles as clinicians and educators has been infrequently demonstrated, particularly in the community setting where large numbers of residents train. We evaluated the impact of hospitalists on financial and educational outcomes at a mid-sized community teaching hospital 1 year after implementation.
  
  
  METHODS
  Two hospitalist clinician educators (HCEs) were hired to provide inpatient medical care while participating in resident education. Length of stay and cost per case data were calculated for all patients admitted to the hospitalist service during their first year and compared with patients admitted to private physicians. The hospitalists' top 11 discharge diagnoses were individually assessed. For the same time period, categorical medicine residents (N = 36) were given an anonymous written survey to assess the HCEs' impact on resident education and service.
  
  
  RESULTS
  Resource consumption: length of stay was reduced by 20.8% and total cost per case was reduced by 18.4% comparing the HCEs with community-based physicians. Reductions in both length of stay and cost per case were noted for 8 of the 11 most common discharge diagnoses. Resident survey: over 75% of residents responded, with all noting improvement in the quality of attending rounds, bedside teaching, and the overall inpatient experience. Residents' roles as teachers and team leaders were largely unchanged.
  
  
  CONCLUSIONS
  Hospitalist clinician educators as inpatient teaching attendings effectively reduce length of stay and resource utilization while improving resident education at community-based teaching hospitals.
authors.affiliation: Department of Medicine, Yale University School of Medicine, Norwalk Hospital, Norwalk, CT 06856, USA. Mark.Kulaga@norwalkhealth.org
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kulaga
authors.forename: Pamela
authors.initials: P
authors.lastname: Charney
authors.forename: Stephen P
authors.initials: SP
authors.lastname: O'Mahony
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Cleary
authors.forename: Timothy M
authors.initials: TM
authors.lastname: McClung
authors.forename: Donald E
authors.initials: DE
authors.lastname: Schildkamp
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mazur
mesh_terms: D000328:Adult; D003237:Connecticut; D020445:Hospitalists / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000458:organization & administration; D007396:Internship and Residency / Q000458:organization & administration; D007902:Length of Stay; D010819:Physician's Role; D017009:Professional Autonomy