Charlie Amico has two primary care doctors, and he thinks that is just fine.        One is Terry Cantlin, who see Amico at the health center near Amico's home in Bethel. The other is Martin Johns, who, along with a team of three physician assistants, looks out for Amico while he stays at Gifford Medical Center in Randolph, which lately, as a result of complications from colon surgery, has been happening more than Amico would like.

“They've been right here since the time I got into the emergency room,” Amico said of Johns and his team while at the hospital last month.

Gifford hired Johns, a hospitalist, over two years ago to start what was a new model of inpatient care for the 25-bed center. Prior to that, the well-being of patients in the hospital was monitored by their primary care physicians, who traveled from their clinics to do rounds, or by a rotating cast of on-call internists.

Now Johns leads a team of three physician assistants. Together they watch and treat patients at the hospital around the clock. Their goals are to provide stable, continuous care and to stay in close contact with their patients' primary doctors.

Amico said he is comfortable with Johns and the care the in-hospital team provides. “You are kept very informed about what is going on,” he said. “And Terry sees everything (Johns) writes.”

Hospitalists are doctors who specialize in providing general medical care inside a hospital. The role has evolved over the last two decades. During that period, more and more patients could be treated in outpatient clinics. Simultaneously, the cases of those patients who were admitted to the hospital became more and more serious and complex.

The concept was given a formal name in an article published in 1996 in the New England Journal of Medicine. Since then, hospitalist programs have proliferated across the country.

The Society for Hospital Medicine puts the current number of practitioners at 22,000 nationwide. According to the most recent survey by the American Hospital Association, hospitalists practice in 40 percent of all hospitals and in more than 70 percent of hospitals with 200 or more beds.

The specialty has also gained an institutional foothold. Several residency programs in internal medicine have a hospitalist track and the American Board of Internal Medicine is developing a certification program.

The trend toward employing hospitalists has come to rural areas more recently. Yet in quick succession over the last five years, most hospitals in the Upper Valley have hired them.

Dartmouth-Hitchcock Medical Center had formalized its program by 2004. Now there are 18 physicians on staff filling 14 full-time hospitalist positions. They are all faculty at Dartmouth Medical School and both train and oversee residents as well as provide direct care for DHMC patients.

Smaller medical centers in the region followed soon afterward. New London Hospital hired one of its primary care physicians as a hospitalist in 2005; Mount Ascutney Hospital in Windsor did the same, hiring two of its own doctors in 2006. Gifford went with an outside hire in 2006, as did Valley Regional Hospital in Claremont in 2007.

Alice Peck Day Hospital in Lebanon created a hospitalist program two years ago that has been staffed by primary care doctors from its outpatient clinic on a rotating basis. The hospital expects to hire two full-time hospitalists early this year, said Ann Marchewska, vice president of patient care services at the hospital.

In New London, the reasons for hiring a hospitalist had as much to do with improving patient service at their affiliated outpatient primary care clinics as with needs inside the hospital, said Susan Bryant, director of community relations for the hospital. When outpatient doctors had to come to the hospital to admit patients, “that resulted in a backlog of patients in their office causing rescheduling or cancellations,” she said.

Hiring primary care doctors already affiliated with the hospital has helped in the transition at several area hospitals. “In retrospect, it was very positive we had our own primary care physicians developing the program,” said Marchewska. “They know the hospitalist work and they also know our patients.”

At Gifford, clinic providers were initially skeptical of the hospitalist model, said Marcus Coxon, a doctor with Gifford Family Practice for a dozen years. But today most back it and want it to grow. It has increased their ability to serve their patients in the clinic, and the consistency of care in the hospital has been better for patients, he said. There is also less of a chance for errors in medication to occur “now that there is one chef in the kitchen, so to speak,” said Coxon.

Also, most patients, particularly those with chronic diseases that bring them to the hospital frequently, seem to appreciate it. “There is happiness that the same faces and the same approaches are taken to their problems each time they come in,” he said.

But the transition is not always smooth. Central Vermont Medical Center in Barre contracted with a national physicians group, Apogee Physicians, in 2007 to operate a hospitalist program, but ended the relationship within a year. After that rough start, the hospital had to rebuild, hiring three full-time physicians within the last six months, said its new director, Sameer Shetty, who started in the summer.

The explosive growth in the field is occurring as the added value of hospitalists is still being quantified. The largest study done so far, a comparison of doctors at 45 hospitals over three years published in the New England Journal of Medicine in December 2007, found that hospital patients did similarly well when cared for by a hospitalist or an outside family practitioner or internist.

However, patients spent less time in the hospital by a half-day on average (a roughly 12 percent reduction in the length of a visit) under a hospitalist, which suggested to researchers that with hospitalists patients get services faster and hospitals save money.

At Gifford, the administration wants to expand the hospitalist program. Johns hopes to hire an additional physician in the coming year. Although there is currently a shortage of hospitalists, he hopes that the ability to have a closer relationship with patients will draw candidates to the rural setting.

“A rural hospitalist almost becomes a primary care hospitalist,” Johns said. “I become familiar with them (patients) and they look for me when they come.”

Kristen Fountain can be reached at kfountain@vnews.com or (603) 727-3209.