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To the Editor: Drs Wachter and Goldman¹ acknowledge that the growth of the hospitalist movement may result in more discontinuity of care. In addition, physicians may lose some of their clinical skills after prolonged absence from the hospital setting.

In my experience, a hybrid program of rotating hospitalists from a group practice can provide an effective alternative. A group of 5 or 6 primary care physicians can generally maintain a hospital service of sufficient size to warrant at least a half-time hospital presence by one member of the group. This approach not only improves information flow throughout and after the hospitalization, but also allows physicians to maintain their inpatient skills.

This hybrid system is even more valuable in a geriatric practice, where hospitalizations often focus on decisions regarding appropriateness of invasive diagnostic tests and interventions. End-of-life decisions are often discussed. I suspect that these issues are best handled by physicians . . . [Full Text of this Article]

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