SHM has benefited by this recruitment feeding frenzy. Just look at the ads in this issue of The Hospitalist, surf SHM’s Online Career Center, or visit our meeting’s Exhibit Hall to see the tangible expression of the need to find more hospitalists. This cannot be solved by hospitalists jumping from one place to another. We need to find a way to attract a new wave of qualified hospitalists into our specialty.
Where will these new hospitalists come from?
Right now about 8% of internal medicine residency graduates enter hospital medicine. While this is a steady stream of new hospitalists, the flow is but a trickle and we need a rapid current. Is it time for hospital medicine to develop a more aggressive recruitment strategy geared to third-year medical students to pull them into hospital medicine with offers of a job or loan repayment?
In addition, some general internists move into hospital medicine each year, but this is a shrinking pool of potential new hospitalists. While 3% of hospitalists have been trained as family practitioners, there are no good statistics on how many family practitioner residents select hospital medicine as a career or how many family practitioners in practice come to hospital medicine. While the guess is that the pool of family practitioners presents an opportunity for future hospitalists, there are some concerns about how well today’s family practitioner residency training prepares young physicians to step right into the role of a hospitalist.
There are other sources for hospitalist physicians from overseas. Currently 25% of the U.S. physician workforce is made up of international medical graduates (IMGs).1 Further, 35% of internal medicine residents and fellows are graduates of medical schools outside the United States.2 SHM’s surveys indicate that approximately 26% of hospitalists are IMGs. That said, hiring physicians from outside the U.S. can present residency and visa issues that complicate employment. Will hospital medicine employers need to look abroad in the same way the U.S. has become a major importer of RNs and other health professionals?
Speaking of nonphysician providers, 5% of hospitalists are PAs and NPs, and this segment appears to be growing. Are there strategies that allow for increased use of nonphysicians in the hospital medicine workforce that can allow a group of hospitalists to be more productive and meet all their stretch goals?
While the question is clear—where will the next 20,000 to 30,000 hospitalists come from?—the answer is somewhat muddled. With this in mind, SHM will hold the National Summit on Hospital Medicine Workforce Issues in late 2007. This will be a practical work group made up of the key national leaders of hospital medicine employers along with key decision makers from medical schools, family practice, pediatrics, internal medicine residency programs, the nonphysician provider community, and others who can help set a direction to solve what is rapidly becoming a crisis in manpower. From this summit SHM hopes to have clear, actionable strategies to create an environment for continued growth and maturation of hospital medicine and deliver on the promise of better healthcare for the patients and the communities we serve. TH
Dr. Wellikson is the CEO of SHM.
- Mullan F. The metrics of the physician brain drain. N Engl J Med. 2005 Oct 27;353(17):1810-1818.
- Brotherton SE, Rockey PH, Etzel SI. US graduate medical education, 2004-2005: Trends in primary care specialties. JAMA. 2005 Sep 7;294(9):1075-1082.