The structure of hospital care is evolving. With patient safety, quality of care, and sustainable healthcare systems becoming increasingly important, a paradigm shift is underway from a model relying heavily on trainee doctors to a “specialist-oriented hospital.” At the center of this shift is the “hospitalist.” The introduction of the hospitalist system, which manages hospitalized patients, has ensured continuity of care and increased patient satisfaction.

Nevertheless, hospitalists are still often perceived primarily as substitutes for trainee doctors, which is why their role has often been linked to improving the training environment for residents. With the reduction of residents’ workweeks to 80 hours, hospitalists have faced staffing gaps on night and weekend shifts and have been viewed as “relieving residents’ workload” rather than as inpatient care specialists.

However, a growing consensus is emerging within the medical community that this perception needs to change. Changes in government policy, the shift to specialist-centered hospitals, and improvements in trainee doctors’ education are contributing factors. Yet, the reality remains challenging—there is no system in place to support the full establishment of the hospitalist model.

Several issues must be addressed for hospitalists to effectively function as a pillar of the healthcare system. Ultimately, hospitalists are expected to act as coordinators of care for patients with severe and complex diseases, leading collaborative efforts and working closely with nursing staff to provide inpatient care. This team-based approach is essential to improve the quality of junior doctors’ training and ward operations. Educational programs should be established to help trainee doctors develop competencies in inpatient care within a quality training environment.

These concerns led to the creation of the Korean Association of Hospital Medicine (KAHM), officially launched on June 21. The first president is Dr. Kyong Tae-young, director of the Department of Hospital Medicine at Yongin Severance Hospital. Kyong recently met with Korea Biomedical Review to discuss establishing the academic identity of hospital medicine and creating a system to stabilize hospitalists’ roles in the evolving medical landscape.

Question: What is the background behind launching the Korean Association of Hospital Medicine (KAHM)?

Answer: I have been practicing as a hospitalist since 2017. I became convinced of the value of inpatient management after observing high patient satisfaction and the positive feedback from colleagues in departments benefiting from improved patient safety and quality of care. After a meeting of like-minded hospitalists in February, the association officially launched last month.

For three years, we have been encouraging members of the Hospitalization Research Society—previously divided into internal medicine and surgery—to unite. Korea’s hospitalist regulations do not limit specialties, and in practice, some hospitalists are not specialists in either internal medicine or surgery. There are only about 370 hospitalists in Korea.

The division between internal medicine and surgery hospitalists is problematic because it prevents unified representation in government negotiations and policy proposals. Since hospitalist services became a regular business, inpatient medicine development has stagnated due to the government’s passive attitude, and few consider hospital medicine a specialty or lifelong career. However, the hospitalist system is essential for realizing specialist-centered hospitals.

Q: The importance of hospitalists is growing, but recruitment remains challenging. Why is hospital medicine not seen as a “lifelong career”?

A: There is one main reason: hospitalists are not regarded as specialists. Although hospitalists are experts in managing hospitalized patients, they are often viewed as substitutes for trainee doctors rather than recognized as specialists. The environment is difficult. Yonsei University College of Medicine employs hospitalists as faculty members who can apply for research grants and participate in hospital committees. However, Yonsei is the only university with a Department of Hospital Medicine operating accordingly.

Support cannot be limited to financial incentives alone. No one wants to become a hospitalist, even if offered 400 million won ($296,000) annually, if they are seen as replacements for trainee doctors. Yongin Severance Hospital doesn’t offer high pay, but turnover and resignation rates are very low—almost negligible. This proves that money alone cannot solve the issue.

Ultimately, we need an environment that supports continued academic growth, allowing hospitalists to take pride in their field and advance their careers. The government should designate hospital medicine as a specialty and build a foundation for academic development. Only then will a virtuous cycle emerge where medical schools can establish hospital medicine departments, recruit qualified personnel, and support professionals.

The era of simply introducing hospitalists is over; now the system is evolving. At the academic level, we plan to lay a foundation for stable hospitalist career paths by providing clinical competency improvement programs, academic growth opportunities, and faculty appointment models. It is also time for the government to provide institutional support to recognize and enhance their specialty.

Q: You emphasize collaboration with advanced practice nurses (APNs), nurse practitioners (NPs), and physician assistants (PAs). Why is a team-based care model important?

A: Team-based care is essential for hospital medicine. APNs and NPs are hospitalists’ closest care partners. Their competencies must be recognized and nurtured, and a collaborative model based on mutual respect established. This requires a clear division of roles, regular feedback, and capacity-building training for nursing staff to ensure effective collaboration.

Yongin Severance Hospital has made significant efforts to train PAs. Since 2021, the hospital has provided customized training programs tailored to nursing staff needs, continuously gathering feedback to guide the curriculum.

Recently, debate has arisen over who should provide education for PAs, but the focus should be on the quality and management of education rather than on who delivers it. Above all, providing necessary practical training is essential. The education debate is not about privilege—it should center on improving patient safety and care quality.

Q: There are concerns that institutionalizing PAs might reduce trainee doctors’ working hours and compromise training quality. What’s your view?

A: Training trainee doctors is critical to the transition toward specialist-centered hospitals. Hospitalists, focused solely on inpatient care, can dedicate more time to training residents on the wards. They can assign an appropriate patient load to residents, conduct teaching rounds, and instruct on bedside ultrasound and other clinical skills. With an immediate backup system in place, residents can safely manage deteriorating patients. This setup fosters an environment conducive to resident education.

The hospitalist role can be divided into two: professors focused on teaching and professors focused on patient care. Patient care professors manage large inpatient loads with PA assistance, while teaching professors oversee fewer students, dedicating more time to education and providing backup support. This dual approach effectively teaches comprehensive patient care and bedside skills.

Q: What government support is essential for establishing the hospitalist system?

A: The government emphasizes outcomes-based compensation, such as patient outcomes, rather than volume-based metrics. The framework should support hospitalists demonstrating team-based performance with PAs. However, performance indicators remain vague. We have recommended establishing a council to consult hospital medicine departments on related issues. Above all, hospital medicine must be designated a specialty to secure its expertise.

Q: What goals do you hope to achieve during your term as KAHM’s first president?

A: To have hospital medicine designated a specialty, KAHM’s first step is to become a full member of the Korean Medical Association. We plan to publish a journal this year and establish systems recognizing hospitalists as full professors in hospitals. We also aim to secure recognition for hospitalists as specialists, not mere substitutes for trainee doctors.

Improving hospitalists’ status will enable them to play essential roles in medical education, PA and nursing training, and medical research. KAHM will serve as a strong voice advocating for these advances and lead efforts to improve inpatient care quality. Our goal is to provide hospitalized patients with timely, safe care that facilitates faster discharge. By placing hospitalists at the core, we aim to build patient-centered, specialist-focused hospitals. We will maintain communication channels with the government to address night and weekend staffing, overhaul the system, and propose policies to revitalize inpatient medicine.