THE HOSPITALIST movement is a fresh idea for America. But it is old news in Canada. North of the border here, I have practiced as a hospitalist for almost a decade. And some of my colleagues have been hospitalists well past their 60th birthdays. In the tradition of international health care comparisons, therefore, I offer my Canadian experience in hopes of informing the debate in the United States about hospitalists. The experience helps distinguish the problems due to transitions (switching from one system to another system) from the problems of working effectively when the system is stable. The experience also helps to separate issues inherent to American medicine (that will not necessarily improve or deteriorate with the advent of hospitalists) from issues innate to the new initiative. Finally, the experience helps to highlight pragmatic issues for clinicians who are removed from policy debates but devoted to individual patient care.
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