Dr. Alexander and his colleagues say they are in favor of efficiency gains. It’s the particular way the hospital has interpreted this mandate that has left them feeling demoralized. If you talk to them for long enough, you get the distinct feeling it is not just their jobs that hang in the balance, but the loss of something much less tangible — the ability of doctors everywhere to exercise their professional judgment.

A Job Born of Efficiency

As recently as the mid-1990s, there was no one called a hospitalist. Most doctors would simply scramble from their offices to the hospital when they had to tend to patients there. But the discipline grew rapidly thereafter — to roughly 50,000 hospitalists nationwide in 2015 from about 11,000 in 2003, according to industry estimates.

The hospitalist boom was itself a response to economic pressures and a push for efficiency in health care. Internists were seeing more patients in their offices in a day, partly thanks to the rise of managed care and smaller margins, making it less practical to run to the hospital. “It became difficult to plan your day,” said Dr. Frank Littell, a Sacred Heart hospitalist who has been practicing in the area since the 1980s. “If a patient needed to be admitted to the E.R., you had to cancel all your afternoon appointments.”

Gradually, it became clear that it would make more sense for a subset of internists to be based at each hospital, where they would handle the care of all the patients on site. The other internists could end their periodic hospital visits altogether.

Hospitalists could also increase hospital profits. They were on hand to discharge people throughout the day, emptying beds that could generate revenue again. And while paying the doctors was a new cost, hospitals at first found the efficiencies so advantageous that hospitalists were afforded the rare privilege of spending more time with patients. The doctors spent the time diagnosing and treating what were often highly complicated conditions — chronic health problems stacked on top of one another, or multiple organ failures.

This reprieve from the economic forces bearing down on the medical profession didn’t last long, however. “A consequence of how much the health care market has changed is that everybody has to be more efficient,” said Adam Higman, who specializes in hospital operations at Soyring Consulting in St. Petersburg, Fla. He noted that the increasing focus on metrics like readmission rates and hospital-acquired infections had created more work for hospitalists, who are responsible for a lot of documentation. “In some sense that comes to the detriment of the patient, there’s not as much quality time,” he said. “In some sense, that’s to their benefit — there’s a system to manage them.”

Asked if health outcomes had improved as a result, Mr. Higman said, “Readmission rates have been reduced — we can show it.” Costs are rising more slowly too, he said, no small thing in a country where many people are bankrupted by medical expenses. But, he added, “as to whether you as an individual are seeing better quality in health care — I think there’s some question there.”