Hospitalists "Contributed to Patient Safety, but Sustainability Remains a Challenge"

Korean Society of Hospital Medicine Publishes White Paper on the Korean Hospitalist System

Proposes Seven Core Policy Directions including Realistic Reimbursement and Specialty Recognition

Although it has been 10 years since the introduction of the hospitalist system in Korea, concerns have been raised that the system may stagnate due to an irrational compensation structure and the lack of a professional workforce training system, despite its clinical achievements.

The Korean Society of Hospital Medicine announced on the 1st that it has published a white paper titled “10 Years of Patient Safety and Improvement in the Quality of Care: The Korean Hospitalist System White Paper (2016~2026),” analyzing the achievements and limitations of the system over the past decade.

A hospitalist is a physician who is stationed in the hospital ward and is responsible for the specialized care of inpatients. The system began as a pilot project in September 2016 with 11 board-certified physicians participating across six medical institutions nationwide. Since then, the number of participating hospitalists has steadily increased, reaching 250 in 2020 and peaking at 385 in 2023.

Wards with assigned hospitalists have accumulated notable clinical outcomes, such as shortened length of stay, reduced rates of emergency events, and increased patient satisfaction. Since the hospitalist program became an official policy in 2021, its roles have expanded to ensure continuous care for inpatients and enhance ward safety management.

The society noted that the importance of hospitalists became increasingly evident during the COVID-19 pandemic in 2020 and the mass departure of medical residents in 2024, which led to medical staff shortages. In situations where it became difficult for resident-centered ward care to continue, hospitalists played a core role by continuously caring for inpatients and managing ward operations as key professional staff members.

However, as of March this year, the nationwide number of hospitalists had decreased to 310, reflecting a slowdown in the system’s growth over the last two to three years. Some hospitals have reduced the size of their hospitalist wards or halted new recruitment altogether.

The society identified the weakening of policy incentives as a primary reason for these trends. For example, in the sixth round of the “Advanced General Hospital Designation and Evaluation” announced this year, the indicator for the level of hospitalist placement—previously included in the fifth round—was omitted. As a result, medical institutions have less incentive to increase their number of hospitalists. Furthermore, the current hospitalist management fee does not sufficiently account for actual personnel costs, discouraging hospital management from hiring hospitalists proactively.

From the perspective of hospitalists, the lack of recognition of hospital medicine as an independent specialty, combined with a heavy workload, job insecurity, and unresolved issues regarding the adjustment of roles and authority with clinical departments, has made long-term career development difficult. While some large hospitals operate independent hospital medicine departments or hospitalist centers and have developed collaborative models with existing clinical departments, standardized operating systems have yet to be established, as each medical institution differs in workforce scale, work patterns, support staff, and collaboration methods. Consequently, the scope of clinical authority and responsibility for hospitalists varies significantly by institution.

In response, the society presented seven key policy directions to establish the hospitalist system as a sustainable healthcare infrastructure: (1) making reimbursement and compensation systems more realistic; (2) developing hospital medicine as a recognized specialty and establishing professional training systems; (3) overhauling ward operating systems to transition to specialist-centered hospitals; (4) mutually redesigning the residency training environment; (5) reducing the gap in regional and public healthcare; (6) standardizing inpatient care infrastructure and improving caregiver systems; and (7) building collaborative governance with the government and related agencies.

Taeyoung Kyung, president of the Korean Society of Hospital Medicine and chief of hospital medicine at Yongin Severance Hospital, stated, “The hospitalist system is not just about expanding a specific healthcare workforce; it is a core infrastructure to improve the quality and safety of inpatient care and establish a specialist-centered hospital operating system. Based on the clinical outcomes verified over the past 10 years, we must now establish sustainable compensation and workforce development, and create stable ward operating systems.”

This content was produced with the assistance of AI translation services.