The first otolaryngology hospitalist position was created in 2011 at the University of California, San Francisco’s (UCSF) tertiary-level university medical center. Matthew Russell, MD, currently an instructor in the department of otolaryngology–head and neck surgery at Harvard Medical School and a physician and surgeon at Mass Eye and Ear in Stoneham, Mass., held the inaugural role.
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June 2026But that was really the second iteration of the hospitalist model at UCSF, explained Andrew H. Murr, MD, professor and chair of the department of otolaryngology–head and neck surgery at UCSF. He and David W. Eisele, MD, along with Dr. Russell and others, were instrumental in developing that first hospitalist model in otolaryngology. The initial model, said Dr. Murr, was to assign the faculty member on call for a given week to personally cover all inpatient, emergency department (ED), and acute care consultations. The rationale was based on the need for a dedicated otolaryngologist in the hospital to provide more efficient, timely, and quality care, given the logistical challenges of providing otolaryngologic hospital care when the department relocated miles from the hospital.
The success of that first model gave rise to the official creation of an otolaryngology hospitalist and was based on collected data showing the positive impact of specifically assigning a person on site to handle the high volume of otolaryngologic service needs in the hospital. This practice structure established significant interdepartmental collaborations that ultimately created more efficient throughput in the intensive care unit (ICU) and urgent care settings and resulted in demonstrably higher quality care while decreasing poor outcomes, especially in emergency airway events.
Dr. Russell said the key reason he took on the first hospitalist position was to elevate the level of inpatient care. “I wanted to redefine how we as ENT doctors thought about inpatient care,” he said. Instead of the classical model, in which otolaryngologists do hospital inpatient consults at the end of the day after their primary responsibilities, he said, the ability to be on site in the hospital to handle consults, do surgeries, and educate residents was successful in providing timelier, needed patient care and on-site teaching to residents.
The role also gave him the opportunity to integrate otolaryngology with other specialty care in the hospital. “The model is really team-based medicine and is highly collaborative with different specialties such as anesthesia, intensive care, internal medicine, and infectious diseases,” he said, adding that he took on both consults and surgery for inpatients with acute illnesses who needed pretty complex care.
What he learned from that role led to the third iteration of the model at UCSF, the one used today. Because of the level of care required for acute care patients, the work was highly stressful and unpredictable, leaving little time to do academic work. “I burned out” after several years on the job, he said.
His recommendation? Divide the hospitalist role among several rotating physicians, which is what is done today at UCSF. The model is to split the hospitalist time among three rotating faculty members, so that one physician takes two days, another physician takes another two days, and one physician has one day.
For departments and institutions that choose to make this a solo role, he recommends thinking carefully about the structure of the job if the person wants to do it long-term, because of the unpredictability. “Having some protected time is important,” Dr. Russell said.
He also highlights a key issue that may be one of the main challenges of creating and maintaining a hospitalist position—reimbursement.
Role of Otolaryngology Hospitalist
This opening story illustrates the evolution of a model within otolaryngology that is still changing and examines why an institution and department may see the need for an otolaryngology hospitalist, as well as issues that remain germane in considering whether or not an otolaryngology hospitalist is the right fit for a given institution.
Aside from UCSF, several institutions have otolaryngology hospitalists, including Louisiana State University, Houston Methodist, Emory, the University of California at Los Angeles, and Montefiore Einstein.
At a recent Society of University Otolaryngologists meeting, a panel of experts that included otolaryngology hospitalists from some of these institutions discussed the evolving paradigm of inpatient care and resident education that characterizes a hospitalist, provided insight into the day-to-day life of a hospitalist, and explored how to approach issues such as reimbursement.
Steven Pletcher, MD, professor and vice chair for education and director, residency training program, department of otolaryngology–head and neck surgery at UCSF, moderated the session. His own story is one of moving from the traditional role of otolaryngologist within this department for 20 years to becoming one of the three otolaryngology hospitalists at UCSF who rotate days each week. For the past three years, he has been working as the hospitalist on Mondays and Wednesdays, which allows him and his two fellow hospitalist colleagues to continue their current surgical and clinical practice.
While pointing out that the hospitalist model is much more developed and established in internal medicine and other surgical specialties, he underscored that a hospitalist is a surgeon. “That is one of the misconceptions about whether a hospitalist is the right role for otolaryngologists, because people don’t view it as involving performing surgery,” he said. “One of the main points of the panel was to underscore that otolaryngologists in this role have a fairly robust surgical component to their practice as well as the medical and patient evaluation aspect.”
As the director of residency training, Dr. Pletcher also strongly advocates that residency teaching be a part of the hospitalist’s job. Alexandra Bourdillon, MD, resident in otolaryngology–head and neck surgery at UCSF, spoke on the panel about her experience as a trainee. She said that having three hospitalists covering the entire week in the hospital is a favorable situation for trainees like her because it reduces the burden of having to identify an attending to staff things with and also minimizes the need to balance or negotiate timing based on other outpatient duties that occur if the attending is not a dedicated hospitalist.
“Generally, these three hospitalists function as a very formidable unit, signing out to each other and discussing things together, so that minimizes having to repeat sign-outs or potentially change plans/management styles that would inevitably occur in a rotating coverage system,” she said, adding that the hospitalist is a great role for anyone dedicated to resident education.
Along with the satisfaction of working closely with residents, Dr. Pletcher cited other attractive aspects of the hospitalist role, such as having a more predictable schedule and engaging in interesting work with lots of complex patients coming in or through transfers from the emergency rooms. “Like any job, it has its pros and cons, and how that fits the balance with an individual’s goals is the key aspect of whether it is the right role for someone,” he said.
It was and is the right role for Elizabeth S. Willingham, MD, associate professor in the department of otolaryngology–head and neck surgery at Emory University School of Medicine in Atlanta, who spoke on the panel about her experience of becoming the inaugural otolaryngology hospitalist at Emory in 2014.
Like UCSF, Emory’s hospital system is geographically diverse, and the relocation of the otolaryngology department away from Emory’s flagship location occasioned the need to develop a consistent otolaryngology presence at this site.
During her first year, she established the hospitalist paradigm at Emory, based in part on the successful program at UCSF and a subsequent one at Louisiana State University. She and another faculty member shared hospital coverage Mondays through Fridays from 8 a.m. to 5 p.m. The work included seeing all hospital consults, emergency department issues requiring otolaryngology expertise, acute consults in the operating room for airway bleeding or difficult intubations, head and neck infections, and basically anything otolaryngology-related on the floor, in the ICU, and in the ED.
After two years, Emory hired an advanced practice provider (APP) to support the high demand for the service. Over four years, the clinical activity of the service was tracked with an average of nearly 1,000 evaluation and management (E&M) encounters each year and close to 450 procedures performed per year.
“I think that model is really the way to go,” Dr. Willingham said. Calling it a hybrid model, she suggests that it decreases burnout, provides seamless outpatient follow-up, and allows the provider to keep up their outpatient skills.
In 2016, with the addition of an APP and a PGY-1 otolaryngology resident, the Emory otolaryngology hospitalist model morphed into a formal consult service. The resident rotation allows one-on-one teaching to educate new interns on how to apply critical otolaryngology skills, how to be a helpful consultant, and how to handle emergency ENT procedures. It is consistently a highly rated rotation.
Referring to a presentation at a recent meeting of the five mature programs with a hospitalist, Dr. Willingham said that the hospitalists tended to see similar types of consults (e.g., airway evaluation, epistaxis, sinusitis, dysphonia, tracheotomies, head and neck infections, neck masses, and ear complaints) and perform similar procedures (e.g., direct laryngoscopy, epistaxis control, incision and drainage, sinus surgery, tonsillectomy, tracheotomies, vocal cord injection, and biopsy).
When discussing the otolaryngology hospitalist role, most panel members said they liked working with complicated patients who require creative solutions, collaborating with multidisciplinary teams and colleagues, feeling they were helping very sick patients, and being able to do complex, interesting work during established workday hours.
What they found dissatisfying about the role was the lack of control over the day (i.e., some days slow, some busy), the lack of others’ understanding of the role, and coverage issues (i.e., when the hospitalist is out of town).
Like Dr. Willingham, Ran Wang, MD, an otolaryngologist at Houston Methodist, became its first otolaryngology hospitalist in 2023. She practices as a solo general ENT with subspecialty colleagues, structured between 6 a.m. and 3 p.m. Monday through Friday, and she consults, performs surgeries, and educates residents like the other hospitalists.
For Dr. Wang, one big benefit of the role is the ability to improve patient-focused care for both inpatients and outpatients, thus helping the department. “We know pivoting between inpatient and outpatient care can be hard throughout the day because each side has specific and urgent needs,” she said. “When there are multiple requests that need to be urgently addressed, I handle them with the flexibility built into my schedule, and it gives my partners their time back because they do not have to make time for inpatient tasks between or after their outpatient schedule.”
She said the role also gives the surgery service more flexibility in scheduling inpatient surgeries, and that benefits patients and their families in that a set surgery time can be scheduled.
Dr. Wang, who will be publishing results from her single-site practice in a forthcoming study, shared some statistics that quantify some of the benefits. For example, she said the rate of her service reliably performing bedside tracheotomies within three working days of consult has improved from 75% to 85%, and their rescheduling rate for tracheotomies has gone from one in three to fewer than one in eight.
She also underscored the collaborative benefit and specifically mentioned close relationships with the ICU and gastrointestinal (GI) service line. With the latter, she coordinates joint bedside tracheostomies and percutaneous endoscopic gastrostomy (PEG), which allows the patient to undergo only one round of anesthesia for two procedures and improves service line efficiency for all departments involved.
For Dr. Wang, the key to being a hospitalist is the delivery of care and how much more she can impact the care of patients in the hospital because of her consistent presence and good collaboration with other specialty colleagues. “It is absolutely wonderful,” she said.
Richard Vance Smith, MD, professor and chair of the department of otorhinolaryngology–head and neck surgery at Montefiore Einstein, in the Bronx, N.Y., the final panelist to speak, described a slightly different model.
In 2021, his institution implemented the program with one dedicated otolaryngology hospitalist who provides consulting services four days of the week. During that time, they are responsible for consults from 8 a.m. to 5 p.m.; whatever happens after that time goes to the person on call. The hospitalist typically sees consults half of the days and does surgeries when needed, with the resident often seeing the consults first. Typically, he said, the hospitalist will meet with the resident in the afternoons, and in the mornings will work with ambulatory patients in the office. The hospitalist retains an active subspecialty.
Today, Montefiore is now on its second otolaryngology hospitalist in this role. Dr. Smith said most people hired for this position will ultimately get into subspecialty care, so it is a great way to get their name out. “The benefit of the person doing this is that they can develop a very full practice from getting to know everyone in the area,” he said. “It is a good way to build your practice, as people you get to know will refer patients to you. The hospitalist role is set up to last three to five years.”
Like the other panelists, Dr. Smith said the advantages of having a hospitalist on staff who can provide significant improvement and improve the timeliness of attending oversight of consultation are instrumental in inpatient care. “So attending oversight happens faster and more completely,” he said. “Overall, the quality of care is elevated by the consults managed this way.”
Unlike the other hospitalists on the panel, the hospitalist at his institution does not do inpatient bedside tracheotomy, as there is already a decades-old service that does this. “Our hospitalist is outside that service,” he said.
Big Issue: Payment
All of the panelists spoke on the financial aspects of paying for a hospitalist role.
At UCSF, reimbursement is handled through what is called Tier 4 payment. “This means you are paid a fixed salary for the person to do that work,” Dr. Murr said, adding that the health system pays the department to pay the hospitalist. “Payment is not an issue,” he said. “At UCSF, the payment model is a staffing payment paradigm.”
He said that UCSF has a strong history of support for hospitalists following the model set years ago in the department of internal medicine, so setting up reimbursement for the otolaryngology hospitalist was not difficult. However, he cautioned, not all institutions will see the value of paying a hospitalist. “I can understand that at some centers, the CEO, COO, or chief medical officer will need to be persuaded of the value of the role,” he said.
Dr. Pletcher added that despite a lot of efficiency benefits to the hospital, it can still be challenging to convince hospital administrators to dedicate funding for this position. “Funds flow systems vary across hospital systems (RVU-based versus collections-based) and can influence institutional and departmental financial risk when creating a funding line for an otolaryngology hospitalist,” he said.
At some medical centers, reimbursement comes through surgeries that generate relative value units (RVUs), while other medical centers receive monies and transfers to departments; hospitalists get a cut of that, and the rest goes to the department, which in turn can use that to pay for the physician’s salary. “Insurance status is very important in how the department receives revenue,” he said. “Frequently, patients in the inpatient setting have less favorable insurance, so that can determine how excited management will be to fund a role like this.”
Dr. Willingham also underscores that the precedent for the hospital system to support a hospitalist is well established in hospital medicine. “The hospital subsidizes the role because it sees that it greatly benefits the hospital,” she said.
By definition, a hospitalist can’t be paid through the traditional RVU-based reimbursement, she said, given that the hospitalist can’t control their volume. In addition, a large part of the hospitalist’s value is in increasing efficiency for the hospital (e.g., shorter wait time in the ED, quicker turnaround from consult to surgical intervention). “There has to be some understanding of the value of the role beyond the RVU generation,” she said.
Dr. Wang said that she is paid a base salary, with RVU bonus potential paid by a physician specialty group within which the otolaryngology department operates.
“Every contract will be unique, however, in terms of reimbursement,” she said.
Mary Beth Nierengarten is a freelance medical writer based in Minnesota.
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