The rapid growth of the hospitalist movement has dramatically changed the delivery of inpatient care in the United States over the last two decades. Hospital medicine has an increasing presence within general internal medicine in academic and community hospitals.
Historically, the hospitalist movement attracted a number of recent internal medicine residency graduates who were seeking a transitional period before entering subspecialty fellowship training. With the growing financial burden of medical school education, several physicians also entered into short-term hospitalist practices to help repay debt prior to further training. Consequently, in its infancy, a substantial percentage of hospital medicine was populated with this transient physician population, leading to a paucity of investment in hospitalist career development and leadership. Excessive patient workloads, long hours, a shortage of mentorship and other factors have led to high attrition rates and significant physician burnout. See Chapter 41: For the Individual: Career Sustainability and Avoiding Burnout.
The site where hospitalists practice defines their area of expertise. Distinguishing between academic and community hospitalists is often based on the type of institution in which they practice (academic medical centers vs community hospitals). This definition may lead to an oversimplification of the differences between these physicians, as some hospitalists in the community do have academic responsibilities in addition to clinical care. Academic hospitalists typically hold a faculty appointment conferred by a hospital-affiliated university. When community hospitals become affiliated with universities, or merge with academic medical centers, the role of their staff may change accordingly to include an academic component. In addition to community and academic hospitals providing salary support, companies have been developed to outsource hospitalists and related services to multiple hospitals. In any of these settings, hospitalists have opportunities to acquire additional skills and leadership that will provide them with the option of transitioning from one setting into another. This chapter offers strategies for professional development for early-career hospitalists.
Achieving traditional academic success in hospital medicine has many challenges. Increasing demands of clinical work is due to a number of factors, including:
Expansion of patient care into specialty areas
Increased on-site coverage (nights, weekends)
Lack of funding for protected time to pursue scholarly activities
Restricted resident work hours and availability
Many academic clinicians build careers that follow a classic triad of clinical care, research, and teaching in the inpatient setting. In the inpatient setting career-hospitalists may specialize in acute general medicine, one of the medical specialties, general medical consultation, or comanage a specialty such as orthopedic surgery and neurosurgery. Each of these clinical areas provides opportunities for hospitalists, including acquiring new skills, leading a program, performing quality improvement, and education. In addition, some hospitalists may expand their clinical duties to involve some outpatient care.
Many hospitalists cite higher job satisfaction when able to complement inpatient clinical duties with other nonclinical activities (...