Hospital Medicine is the medical specialty dedicated to the delivery of comprehensive medical care to hospitalized patients and is the fastest growing medical specialty due to the increasing demand for hospitalists throughout the nation.
Armed with the understanding of different practice options, a prospective hospitalist will be able to choose a program that best meshes with individual, family and career goals. There are many practice options ranging from working directly for a hospital or academic institution, to working for a large national group. Hospital Employed:
About 40 percent of hospitalists are employed directly by the hospital. The hospital usually provides either complete salary support, or base pay with supplemental income based on performance. Because hospitalists will not often generate enough revenue from patient care alone, their value to hospitals can be measured by their assistance with different challenges, including:
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
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.
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.
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.
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.