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Hospital medicine educational pathway and career opportunities

Potential advantages of working for a hospital-based practice include a stable income, flexible hours and an ability to have leadership and administrative responsibilities. Disadvantages include vulnerability to the financial status of the hospital and discrepancies between financial support and expectations.

Academic Hospitalists

The academic setting offers a wide variety of career options for hospitalists. Typically, academic hospitalists are employees of the university and hold faculty positions, generally beginning at the clinical instructor or assistant professor level. Academic hospitalist positions can be loosely grouped into the following three categories, although there is often considerable overlap between these job descriptions.

Hospitalist-educator

Also known as clinician-educators, these positions focus on providing direct inpatient care while teaching and supervising residents and medical students. Staffing models vary, and are generally specific to individual institutions, but hospitalists primarily function in a fashion similar to the traditional internal medicine ward attending. Published research has demonstrated that residents and students feel they learn more, and are more satisfied with their ward rotations, when the attending is a hospitalist. Many academic medical centers are now introducing non-teaching or (uncovered) services, in which hospitalists provide care without house staff in a manner similar to a private practice setting. Early-career hospitalist-educators generally spend 60 to 80 percent of their time in direct clinical care and teaching, with the remainder allotted for educational, research and administrative activities.

Hospitalist-researcher

Some academic hospitalist careers have a research focus. Although the area of research can vary from basic science to a specific disease state, many hospitalists focus on linking evidence-based medicine with quality improvement by systematically studying hospital care. The outcomes are used to optimize healthcare delivery at the level of both the individual patient and the hospital. Also known as clinician-researchers, these positions often require formal research training (i.e., through general medicine fellowships, hospital medicine fellowships or the Robert Wood Johnson Clinical Scholars program). These hospitalists spend less time in direct clinical care, and devote the majority of their time to research activities often funded by extramural grants.

Hospitalist-administrator

The field of hospital medicine has become well established and continues to mature. Consequently, hospitalists are notably acquiring an increasing number of administrative roles. Examples include managing hospitalist programs, directing perioperative and consultative services, and leading various multidisciplinary hospital committees. Furthermore, hospitalists are naturally positioned to take the lead in quality improvement (QI) efforts, particularly those focusing on patient safety and hospital systems improvement. With the increasing focus on measuring the quality of care, many hospitalists are assuming leadership roles to ensure their institution provides high-quality evidence-based care. Examples of QI efforts include reducing healthcare-associated infections, increasing DVT prophylaxis, and optimizing care coordination between the inpatient and outpatient setting.