As Dr. Cate Ranheim enters the room, Anne Kloiber smiles.

"You're doing so much better today," Ranheim tells Kloiber, 85, at Meriter Hospital for pneumonia.

"I know, I'm like Lazarus," Kloiber says.

"I've started calling my cat Lazarus," replies Ranheim, whose feline recently recovered from kidney disease.

Ranheim isn't Kloiber's regular doctor. She's a hospitalist, a growing breed of physician who treats only hospitalized patients.

Meriter, St. Mary's Hospital, UW Hospital, Madison's Veterans Hospital and most hospitals around the country have been adding hospitalists, who take over for a patient's primary-care doctor during hospital stays.

The trend, which started a decade ago and has accelerated the past two years, is controversial.

Supporters say hospitalists, who are readily available to order tests, manage medications and respond to problems, make inpatient care more efficient and shorten hospital stays. Hospitalists also free up primary-care doctors from making hospital visits, giving them more time in their clinics and a better work schedule.

But hand-offs between primary-care doctors and hospitalists can lead to unnecessary tests and confusion when patients most need someone familiar, opponents say.

"In the hospital, in that time of increased need and anxiety, patients don't want to be suddenly taken care of by strangers," said Dr. Michael Goldrosen.

Goldrosen is a primary-care doctor at Associated Physicians, a Madison clinic that has withstood the hospitalist trend.

Kloiber's daughter, Joanne Berman, said she was skeptical when she learned that a hospitalist would manage her mother's care this month at Meriter.

But Ranheim kept in touch with Kloiber's primary-care doctor and checked in on Kloiber several times a day, Berman said.

"She's so focused on my mom's care, and she doesn't have to worry about patients at a clinic," Berman said. "I think I'm now a believer."

Hospitalists widespread

Meriter hired its first hospitalist in 1999, three years after the term was coined nationally. The hospital now has 15 of the inpatient specialists. Three more are coming in June and four more will be recruited soon.

St. Mary's has a dozen hospitalists. UW Hospital has 11, with two more coming in July. The Veterans Hospital, which has three, will soon add another.

St. Clare Hospital in Baraboo and Stoughton Hospital are looking at hiring hospitalists, said spokesman Steve Van Dinter.

Most large and medium-sized hospitals in Wisconsin now have hospitalists, and many small hospitals are considering adding them, said Dr. Charles Shabino, a medical adviser to the Wisconsin Hospital Association.

Nationally, according to the Society of Hospital Medicine, a hospitalist group, there are 20,000 of the doctors — and more than 30,000 will be working within two years, the society predicts.

Hospitalists trim about a half-day off an average four-day hospital visit and slightly reduce costs, according to a study published in December in the New England Journal of Medicine.

Continuity of care

The hospitalist programs in Madison are voluntary. Primary-care doctors can choose whether to use them or continue seeing their hospitalized patients.

At Meriter, most primary-care doctors have handed over the responsibility for inpatient care to hospitalists, said Ranheim, who directs the hospitalist program.

The traditional parade of clinic-based doctors visiting their patients in the morning and the evening has largely given way to a steady stream of hospitalists shuffling among rooms throughout the day.

"They're always here," said Dr. Joe Bellissimo, Meriter's medical director for cardiovascular services. "They're experts at taking care of complicated patients."

Hospitalists also help implement quality initiatives, such as making sure heart patients receive aspirin and beta blockers, said Dr. Julia Wright, head of the hospitalist program at UW Hospital.

Goldrosen and the six other internal medicine doctors at Associated Physicians have continued caring for their patients, mostly at Meriter.

Hospitalists, though well-qualified, don't always have ready access to a patient's medical records and personal history, Goldrosen said.

"You run the risk of repeating tests or trying things that have failed before," he said.

Associated Physicians might start using Meriter hospitalists this summer, but only at night. "I don't foresee us ever using them full time," Goldrosen said.

Dr. Karen Lentfer and the 10 other doctors at Wildwood Family Clinic in Madison also have kept seeing their hospitalized patients, mostly at St. Mary's.

"An illness or event does not happen in isolation. There's a psycho-social background to it," Lentfer said. "When you know the patient, you know what their family situation is like and what their emotional state is."

Dr. Elizabeth George, a primary-care doctor at UW Health, didn't initially like the idea of hospitalists. "I was concerned about continuity of care," she said.

But she started turning over her patients to hospitalists at Meriter more than a year ago and said the arrangement works well.

"I have more time in the office to see my patients, and it has helped me balance out my own life," said George, who has children ages 7 and 9.

Developing trust

Hospitalists don't have much time to establish a bond with patients, but it can be done, Ranheim said.

"You have to be trustworthy," she said.

On a recent day at Meriter, Ranheim was in charge of 16 patients, about average. She checked in on patients on a variety of floors.

With Peter Goodrich, a 54-year-old chef from Reedsburg in the hospital for a mini-stroke, Ranheim talked about the Harry Potter book on his bedside table. They also discussed medications and his need to eat better and drink less.

Curtis Phipps, 50, of Madison, was hospitalized with an infection. He also had some tissue surgically removed from a bed sore. A gunshot wound in his back years ago left him paralyzed.

"As long as they're experienced and know what they're doing," Phipps said of hospitalists, "I think they're OK."

Shirley Lau wasn't so sure.

"I prefer to have my own doctor see me," said the 73-year-old from Marshall, at Meriter for an ulcer and a blood clot. "Part of the healing process is having faith in the people who care for you."

But after several days of being cared for by Ranheim, Lau decided she was "great."

Patients and primary-care doctors usually warm up to the idea of hospitalists once they become more familiar with them, Ranheim said.

"It's a philosophical change," she said. "But this is the model of the future."