&gt; The basic accounting problem for hospitalists is that they are not a profit center. That is, when they treat patients, the amount a hospital can bill Medicare and insurance companies is typically less than what the hospital must pay them. The opposite is true for other specialists, like surgeons.<p>The rest of the article focused on peoples&#x27; emotional reactions, but that paragraph is key. Medicare, Medicaid, and the insurance companies will pay more than enough for tests and surgeries, but not for the diagnoses and treatments that hospitalists and GP&#x27;s perform themselves. So the folks running the hospital budgets are naturally trying to change the model so that the hospitalists quickly refer patients to the more profitable departments.<p>The only actor able to change this model is the US Congress, which makes the legislation that sets the Medicare and Medicaid reimbursement rates. There were major improvements with the ACA&#x2F;Obamacare, but it&#x27;s a dysfunctional system that can only be fixed by an even more dysfunctional system.