Each career path within hospital medicine offers distinct responsibilities, opportunities, and rewards. One of the biggest decisions you’ll make as a hospitalist is whether to enter an academic or a community-based hospital medicine field—but there are additional factors to take into account. Here’s an overview of the career paths within these two areas that may help you with your decision.
Choices in Academic Hospital Medicine
Only a small percentage of hospitalists go into academic jobs, and residents are—obviously—most familiar with these choices.
“[The environment] is familiar to you, and you’re able to grow professionally because … people are always asking you questions,” says Sanjay Saint, MD, MPH, hospitalist and professor of internal medicine at the Ann Arbor Veterans Affairs Medical Center and the University of Michigan Medical School. “The opportunity to be around learners—residents and medical students—is very exciting to residents.”
There are other reasons you may prefer academic over community-based hospital medicine. “The types of patients you treat are different,” says Dr. Saint. “They may be more complicated, and thus you can improve your clinical skills. Also, there’s prestige in being associated with an academic medical center. That appeals to some people.”
The rigorousness of the schedule varies with the institution. “Theoretically, you have residents, so you don’t have to take calls,” explains Dr. Saint. “But when you’re on, say, for a month there’s often no attending coverage on weekends or holidays.”
Hospital medicine work in an academic setting falls into four categories:
1) Hospitalist clinician-investigator: “These hospitalists typically spend the minority of their time doing clinical work—maybe 20% to 40% of their time,” says Dr. Saint. “The rest is spent developing their research agenda, applying for and obtaining grants to fund their research. The investigative focus is usually inpatient-oriented to provide synergy between their clinical work and their research.” This track typically leads to tenure, and usually requires some type of fellowship.
2) Hospitalist-educator: “There are a large number of these positions in academic medical centers,” says Dr. Saint. “These hospitalists spend about 80% of their time seeing patients and teaching residents and medical students.”
Typical hospitalist-educator activities include ward attending, medical consultation, and preoperative evaluations. “They spend about 20% of their time doing some type of scholarly activity, whether writing articles or developing educational curricula that can be disseminated,” estimates Dr. Saint.