PROVIDENCE – Call it the power of convergence. When Dr. Elizabeth Goldberg published her goodbye to her stint serving in Emergency Medicine after 13 years, it caught the attention of the founders and editors of a new publication, the Brown Journal of Hospital Medicine, launched in February of 2022, focused on the research and scholarly activity among hospitalists and upcoming physicians. [See link below to ConvergenceRI story, “Farewell, Rhode Island.”]

The numbers from the last few years bear out this transition in the delivery of medical care: “In 2019 and 2020, 48,000 additional physicians left independent practice and became employees of hospitals or other corporate entities. Nearly half that growth occurred after the onset of COVID-19,” according to a story that was published in July of 2021 in HealthCareFinance.com.

Hospitalists are a new kind of growing medical specialty, it turns out, focused on providing inpatient care to patients in hospitals.

It appears to be one of numerous competing trends occurring at the same time in the disrupted world of health care delivery, perhaps part of the push-and-pull response to the move away from inpatient care in hospitals to more ambulatory care that is not hospital-centric.

The story by Dr. Goldberg, who had been a frequent contributor to ConvergenceRI, prompted Dr. Vijay Selvaraj MD, MPH, FACP, FHM, an Assistant Professor of Medicine at the Alpert School of Medicine at Brown University and one of the three co-founders at the Brown Journal of Hospital Medicine, to reach out to ConvergenceRI. He had not been aware of ConvergenceRI before reading Dr. Goldberg’s story, despite the fact that ConvergenceRI was about to enter its 10th year of publishing, having launched in September of 2013.

“We recently came across your article on Dr. Goldberg in your newsletter,” Dr. Selvaraj wrote. “We were wondering if you could write an article on our journal “Brown Journal of Hospital Medicine” in your newsletter.”

As Dr. Selvaraj explained in his letter, “There are around 44,000 hospitalists in the U.S. and around 75 percent of the hospitals in the U.S. employ hospitalists.” Yet, Dr. Selvaraj continued, “There exists only one or two journals for hospitalists, compared to the many journals that exist for other specialties. We hope the journal will promote more academic and scholarly activity among hospitalists.”

Intrigued, ConvergenceRI reached out to Dr. Selvaraj and conducted an interview by phone, eager to learn about the impetus behind launching a new medical journal based at Brown University, focused on publishing research by hospitalists, a growing field in medicine.

The basic facts about the Brown Journal of Hospital Medicine include: It is an online-only journal, published quarterly, founded by three hospitalists working within the Lifespan health care system, focused on inpatient care. The plan is to promote the journal to a broad national and international audience. [Dr. Goldberg will have an article published in an upcoming issue of the journal, focused on her research on geriatric care in hospitals.]

ConvergenceRI: Did you like the story by Dr. Elizabeth Goldberg?
SELVARAJ: I did. It was very good.

ConvergenceRI: Was this the first time you had seen – or read stories – in ConvergenceRI?
SELVARAJ: Yes. I had not heard about it before.

ConvergenceRI: That’s one of the problems, I believe, with the silos that exist in most other health care reporting.
SELVARAJ: I agree.

ConvergenceRI: I have been publishing going on 10 years now. ConvergenceRI has been extremely well received by the community. But it is always great to begin new conversations and to develop new relationships. What was the catalyst in deciding to launch a new medical journal focused on inpatient medicine at this time?
SELVARAJ: I am a hospitalist at Lifespan, a hospitalist and a physician whose focus is the general medical care of hospitalized patients.

There are approximately 45,000 practicing hospitalists in the U.S. About 75 percent of all hospitals in the U.S. employ hospitalists. But there are only one or two journals in the United States for hospitalists, compared to other medical journals for other specialties, like cardiology and clinical care.

For this reason, we felt that there was a need to start a journal focused on inpatient medicine. Also, Brown itself does not really have a medical journal of its own. We felt that it would be [advantageous] to launch the journal, for these reasons.

ConvergenceRI: Have you gotten support from the Brown medical school to do this?
SELVARAJ: Yes, we have gotten support from Brown medical school to do this. They are fully aware [of this endeavor].

ConvergenceRI: At a time when there seems to be a trend in health care moving away from inpatient care and more toward ambulatory approaches to health care delivery, why do you think it was important to create this journal to serve as a voice for inpatient medicine?
SELVARAJ: I don’t think inpatient medicine is going to go away any time soon. Patients still need to go the hospital if they are sick, or for management of their conditions and their morbidities. Even though there is a trend toward an ambulatory approach, I believe there is a need for inpatient medicine, because patients with diabetes and hypertension, when they get sick, they can get really sick, and [their conditions] cannot be managed at home.

That is why we feel there is this need for a voice to be there for inpatient medicine, so others can be read about it, and be motivated to do more research and to promote the field.

ConvergenceRI: Do you know how many hospitalists are employed in Rhode Island?
SELVARAJ: No.

ConvergenceRI: How would you go about finding that number? Is anyone keeping that data?
SELVARAJ: I would have to go find the number of active physicians in Rhode Island by specialty and then try to find out how many of them are hospitalists.

ConvergenceRI: How about the R.I Medical Society? Would they keep such a database?
SELVARAJ: They might. Off the top of my head, I would say there are about 500 or 600 hospitalists.

ConvergenceRI: I looked over the most recent issue of your journal. Many of the articles seem to be coming out of the Lifespan health system. Is that an accurate observation?
SELVARAJ: We have received and published research submitted from outside Lifespan, from health systems in Iowa, Texas, and New Jersey, as well as from India and Indonesia. We are open to submissions from hospitalists working in any health care delivery system in Rhode Island, not only at Lifespan but also from Kent Hospital and the VA as well.

ConvergenceRI: How would evaluate the research enterprise in Rhode Island today? Is it thriving? Are there ways that it needs to grow?
SELVARAJ: I wouldn’t say research is thriving, it needs to grow; and there are ways to grow.

In turns of competition, there is only one other major journal for hospitalists, and that’s the Journal of Hospital Medicine. The topics that they publish are not very relevant for hospitalists or inpatient medicine itself; it’s a little too high-level, [in my opinion].

The journal we created is meant for day-to-day practicing physicians and hospitalists to have a resource to help them find guidance for patient care.

Our goal is to promote the Brown Journal of Hospital Medicine as a resource for hospitalists, and to encourage more physicians and medical students and residents to submit their research.

ConvergenceRI: It may be because of my own lack of knowledge about hospitalists and inpatient care, but is there was an opportunity for nurses to participate and submit and publish research in your journal, because clearly, they are such an important part of inpatient care for patients at hospitals? Or, is the journal exclusively for doctors?
SELVARAJ: No, it is not exclusively for doctors. We welcome participation from nurses. We are also encouraging physical therapists and occupational therapists to become involved and to submit research and stories, because they also deal with patients on a day-to-day basis. And, [for example], they have a lot of knowledge about encouraging mobility in patients and preventing falls.

It is not limited to physicians; nurses, therapists, and other health providers, like nurse practitioners and physician assistants, are also welcome to submit research and contribute articles to the journal.

ConvergenceRI: That’s good to know. So, a physical therapist who works outside of the hospital system would be able to submit research?
SELVARAJ: Yes, absolutely.

ConvergenceRI: Are your research papers peer reviewed?
SELVARAJ: Yes, they are reviewed by two peer reviewers, and double-blinded.

ConvergenceRI: Last year, I interviewed the new head of Pediatrics at Women & Infants Hospital, Dr. Jill Maron, she’s leading two major national clinical trials about using a saliva assay for rapid whole geonomic testing on newborns, which seems to me could lead to changes in the diagnosis of infants and also in terms of inpatient hospital care for newborns. [See link below to the ConvergenceRI story, “On the cusp of a revolution in the care of newborns.”]

Would that be something that would be appropriate for submission to your journal, if she was looking to publish information about the research conducted as part of the clinical trials?
SELVARAJ:: Yes, absolutely. There are also hospitalists on the pediatric side, who take care of kids in the inpatient setting. That research would be very much applicable and well received by the audience that reads our journal.