Jane Jerrard covered some potential career paths for academic hospitalists in her article “How to Navigate Hospital Medicine” (May 2007, p. 9). But I believe her account was incomplete. I would like to add detail to the opportunities in community-based and other programs.

Community-based medical groups offer a number of opportunities in hospitals or hospital systems. These include:

• Committee chairman. Most hospitals want interested, dedicated individuals to chair traditional medical staff committees. Hospitalists are well suited because our unique perspective lets us identify processes or products that can help many patients. Begin by serving on a committee, such as ethics, pharmacy and therapeutics, IRB, or departmental peer review. As you get comfortable, discuss potential chairmanships with the chief of staff or the vice president of medical affairs (VPMA). Don’t expect to advance if you don’t show up or don’t come prepared to committee meetings.
• Department chairperson. These positions are often elected and may allow one to serve on the credentials committee and the medical executive committee.
• Medical staff officers. Hospitalists often are elected to these key positions and gain access to administration and various committees.
• Project manager. Installing and using electronic medical records and devices calls for physician involvement in design and support. These are great chances to work on interesting projects and affect the tools you work with.
• Hospital administrative positions. Many hospitals have a VPMA or a chief medical officer (CMO), and some are developing the role of vice president of quality. These can be full- or part-time positions. You will be expected to help members of the medical staff implement change, and you should have experience and proven effectiveness in prior roles. Several predict that hospital COOs and CEOs of the future will be hospitalists.

Another path of opportunity is within your organization, depending on your employer. These roles may overlap with hospital positions:

• Group leader. Generally responsible for working on scheduling, recruitment, and organizational structure. The job may involve responsibility for one or more facilities.
• Compliance officer. Someone in the group must understand billing, coding, and proper use of rules and legislation.
• Quality and safety officer.
• Group president.

Hospitalists can also participate on committees that deal with such areas as pension plans, contracts, or other business.

Health insurance companies provide opportunities for individuals to practice part-time and serve as medical directors. They also have career paths for VPMAs and CMOs.

Also, many healthcare companies have been started and run by physicians. Invent something; start a company. The opportunities are endless.

Some other tips:

• Educate yourself. Take courses like the SHM Leadership Academy. Learn how to interact in a businesslike manner. Some on-the-job training is OK, but management and leadership are new fields that require new learning.
• Read. There are many great books on being an executive. Learn how to run a meeting, make an agenda, work with other professionals, and delegate.
• Ask for help. Find an individual or individuals with whom you can discuss ideas. Some of your best mentors will be managers in other fields.

Mary Jo Gorman, MD, MBA

Immediate Past President, SHM

Consequences of Locum Tenens Work

I feel one piece of advice in the Career Development section in the May issue of The Hospitalist (“How to Navigate Hospital Medicine,” p. 9) is not complete and may adversely affect a new hospitalist’s career.

The article recommends exploring locum tenens work. We have found two unintended consequences of such action. First, the locum companies usually have a buyout clause for the physician. Should he decide he likes a location and wishes to stay, the potential employer faces an additional cost in the $20,000-$30,000 range. It makes budgeting difficult. Also, there is usually a clause in the locum contract that this policy is in place for two years after leaving the locum company.