Rotating hospitalists to specialty and subspecialty services for 25% of their time in the hospital, as the UCSF Neurosurgery hospitalists do, might be one way to preserve the traditional general medical model to which many internal medicine hospitalists still gravitate. “This could be an interesting, specialized niche practice, but would not be the bulk of what they do,” says Dr. Wachter.
Dr. Frost agrees that the key to addressing the challenge of subspecialization lies in building this type of work into the context of a larger hospital medicine program. “Rotating all members of a hospital medicine group through a subspecialty experience for a portion of their overall time may be the way to go,” he notes.
Dr. Friedly cautions that certain subspecialist services, such as liver transplant, may not embrace the multidisciplinary hospital medicine model, so it remains to be seen if the effort can evolve to be truly collaborative. Her advice to younger residents just entering hospital medicine? “Hospitalist medicine has unlimited possibilities as a career choice, especially if you enjoyed being an internal medicine resident. Be careful, however, to avoid a setting where you risk losing your hard-earned skills while also being treated like a ‘perma-resident.’ Starting out in a more traditional hospitalist program to learn solid hospitalist ‘tricks of the trade,’ then transitioning to a subspecialty program where you can offer your skills, rather than the other way around, may be the more sustainable, long-term option.” TH
Gretchen Henkel is a frequent contributor to The Hospitalist.
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- Melzer SM, Molteni, RA, Marcuse EK, et al. Characteristics and financial performance of a pediatric faculty inpatient attending service: a resource-based relative value scale analysis. Pediatrics. 2001 Jul;108(1);79-84.