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Hospitalists, or specialists of hospital medicine, have long been practicing in Canada and Europe. However, it was not until the mid-1990s, when hospitals in the U.S. started widespread adoption of hospitalists. Since then, the number of hospitalists has grown exponentially in the U.S. from a few hundred to over 50,000 in 2016. Prior studies on hospitalists have well documented benefits hospitals gain from adopting this innovative staffing strategy. However, there is a dearth of research documenting predictors of hospitals’ adoption of hospitalists. To fill this gap, this longitudinal study (2003–2015) purposes to determine organizational and market characteristics of U.S. hospitals that utilize hospitalists. Our findings indicate that private not-for-profit, system affiliated, teaching, and urban hospitals, and those located in higher per capita income markets have a higher probability of utilizing hospitalists. Additionally, large or medium, profitable hospitals, and those that treat sicker patients have a higher probability of adoption. Finally, hospitals with a high proportion of Medicaid patients have a lower probability of utilizing hospitalists. Our results suggest that hospitals with greater slack resources and those located in munificent counties are more likely to use hospitalists, while their under-resourced counterparts may experience more barriers in adopting this innovative staffing strategy.

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Published In

Article first published online: October 21, 2020
Issue published: August 2021


  1. hospitalists
  2. market factors
  3. organizational characteristics
  4. resource dependence theory
  5. slack resources
  6. US hospitals

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© The Author(s) 2020.
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Published online: October 21, 2020
Issue published: August 2021
PubMed: 33085543



Josue Patien Epane
Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA
Robert Weech-Maldonado
Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, USA
Larry R Hearld
Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, USA
Bisakha Sen
Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, USA
Stephen J O’Connor
Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, USA
Luceta McRoy
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
Washington Adventist University, Takoma Park, USA


Josue Patien Epane, University of Nevada Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154, USA. Email: [email protected]

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