Since the advent of managed care in the United States, the social and cultural impact of the economic restructuring of the practice of medicine, and the reorganization of health care, has been profound (Starr 1982, Stevens 1998). Today, the rapidly changing political economy of health has engendered a heightened awareness and understanding of the social consequences of the transformations in the practice of medicine and science. The emergence of """"""""hospitalist medicine"""""""" is one of these transformations. Hospitalists are both a response to, and constitutive of these changes, and the hospitalist model represents a major change in the provision of inpatient care in the United States. The underling goal of hospitalist medicine is to deliver efficient, quality patient care while decreasing costs. In 1996 Robert Wachter and Lee Goldman coined the term """"""""hospitalist"""""""" to describe this new """"""""breed of doctor"""""""" and emerging system of health care (Wachter and Goldman 1996: 37). Whereas in the """"""""traditional model,"""""""" primary care physicians are responsible for """"""""their"""""""" patients, both in the outpatient setting and in the hospital, in the hospitalist model, primary care physicians """"""""hand off"""""""" patients requiring hospitalization to their """"""""inpatient"""""""" counterparts, hospitalists, who work full time in the inpatient setting and specialize in caring for acutely ill patients. The fundamental innovation of this system is the institutionalization of a discontinuity between the outpatient setting and the inpatient setting. The hospitalist model is rapidly becoming the pervasive model of inpatient health services delivery, but its impact on, and consequences for, patients and physicians have yet to be examined and its cultural, political, social, and ethical implications addressed. This proposal requests funding to conduct a """"""""multi-sited"""""""" (Marcus 1995) phenomenological examination of the emergence of """"""""hospitalist medicine"""""""" to explore this impact and these consequences for patients and physicians a from a cultural perspective at: * the local level, by exploring the web of relations that both constitute and are impacted by the transition to this system in a community hospital in Northern California, and * at the national level, by investigating the academic, professional, and political activities geared towards legitimizing hospitalists.
