But more recent data show that most patients accept the practice and understand that their physicians will not see them in the hospital, Pham said.

There is similar data to show that patient care has improved as hospitalists become more experienced caring for patients in the hospital, she added.

"I think part of it is a moving target," Pham said. "As time has evolved, it has become clear that this is not a system that is going to disappear. It will only grow in influence ... and patients have become accustomed to it."

Gabbard, who is board certified in internal medicine, said a drawback for physicians is not getting to know patients as well and following their care over a number of years. But he still enjoys getting to meet people and caring for them during their hospital stays, he said.

"I enjoyed (having a practice) and would still like to do both" inpatient and outpatient care, he says. "But, then again, it's hard to do either really well when you have to do both. And I really like what I am doing now."
A growing field

Gabbard still works about 12 hours per day about 20 days per month, seeing more than 20 patients each day, he said.

But his schedule now is more predictable because he and the other physicians work shifts to share the patient load.

He said he also can concentrate more on patients who need the most care and "see them in a timely manner," and he has gained a better understanding for complex medical conditions presented by patients in a hospital setting.

When necessary, Gabbard talks with a patient's regular physician to discuss decisions about their care. Otherwise, the doctors exchange information through patient charts and medical records that Gabbard reviews before and after seeing each patient.

Dr. Lynn Simon, chief medical officer for Jewish Hospital and St. Mary's HealthCare Inc., said that before hospitalist practices began, patients "either waited all day to see their doctor, or they had to wait for (the physician) to call in an order" or discharge patients.

"They would see them usually once a day," she said. "Now, they see somebody who can stay longer" and who will come back if necessary.

But in the early 1990s, many doctors began to take the approach that Gabbard has with a primary focus on hospital care.

According to information from the Society of Hospital Medicine, a Philadelphia-based nonprofit group that represents hospital-based physicians, the number of hospitalists practicing in North America has grown rapidly since the mid-1990s and has more than doubled since 2002 to about 15,000.