I recently spoke at two hospital medicine meetings, one in Tucson, Ariz., the other in Porto Alegre, Brazil. The former was a Mayo Clinic College of Medicine event while the latter was sponsored by Sindicato Médico do Rio Grande do Sul (SIMERS), a Brazilian medical union. I was struck by how the development of both meetings parallels the development of the field of hospital medicine.
The Mayo Update in Hospital Medicine course began in Rochester in 2004 but moved to Tucson the following year. Registration for the meeting has quadrupled since the first year, according to Ellen Willis, the course director. The conference emphasizes perioperative and inpatient management, as well as ethics, legal issues and medical history.
Of this year's 210 attendees, 60% identified themselves as hospitalists and 30% as traditional internists. The remaining participants were allied health providers—nurse practitioners and physicians' assistants—as well as several family practitioners. The preponderance of hospitalists and allied health providers reflects the acceptance of hospital medicine as an established field. There is no doubt in this audience that hospital medicine is here to stay.
But hospital medicine is not limited to the U.S. Programs in Canada, Europe and recently Australia are up and running. Hospital medicine has come to Brazil, but is in its formative period. In October 2007, SIMERS sponsored the first Brazilian hospital medicine conference. SIMERS, a well-organized physician union, was founded in 1931 as a professional organization and now has over 13,000 active members. The union provides a wide variety of services to its members, including legal services, insurance and office support, and over the last few years has been developing its educational activities.
October's two-day meeting in the bustling town of Porto Alegre featured both American and Brazilian speakers. Topics included the hospitalist model of care, the hospital medicine movement in Brazil, financial issues for charity hospitals, perioperative care and quality control in private hospitals.
Although several of the lectures covered clinical content, the overall purpose of the meeting was to present the benefits and advantages of a hospital medicine program to the audience of 200 physicians and administrators. Financial, quality and safety issues in both public and private hospitals—forces quite familiar to the American hospitalist—are propelling the hospitalist movement forward in Brazil. Length of stay in public-sector hospitals can average over 16 days and is adversely affected by access to resources and the transition from inpatient to outpatient status.
The number of hospitalists in Brazil is currently limited, but a rapid expansion is predicted. Many physicians must hold down several jobs to maintain a comfortable income. Government regulations involving which physicians can provide outpatient care will likely push more internal medicine providers, especially recent graduates, into an inpatient career. As in the U.S. several years ago, the case for hospitalists in Brazil is still being made.
The October meeting led to the formation of the Brazilian Society of Hospital Medicine (SOBRAMH). SIMERS, with support from the Mayo Clinic and other organizations, will sponsor the Brazilian Congress of Hospital Medicine (I Congresso Brasileiro de Medicina Hospitalar) in Gramado, Rio Grande Do Sul, this May. The congress will include a poster session, and posters from the U.S.—especially those related to the development and promotion of hospital medicine—are welcome. With an expected attendance of over 500 physicians, it is certain that interest in hospital medicine is growing in Brazil.
These were two conferences in very different cities within very different countries. The Tucson meeting showcased an established discipline, while the Brazilian conference represented a field in its infancy, one that will expand using the U.S. experience as a template but adapt to the unique financial and resource-driven aspects of the Brazilian medical environment. Both share the excitement of a developing and rapidly growing field.