Medicolegal Issues

Seek Work Wisely


Hospital medicine has come a long way since the term hospitalist was coined slightly more than a decade ago. SHM estimates the need for 30,000 practicing hospitalists within the next decade.

Filling an available hospitalist position is a two-way process that involves considerations and negotiations at various levels. When looking for the suitable hospitalist job, it is critical that you think both about what your potential employer needs and what you expect from the role you seek. The following insights provide a gauge of what an employer is looking for in a hospitalist applicant.

1) Clinical and procedural skills. Good clinical acumen is fundamental to being a successful hospitalist. As you complete residency training, your professional references are a reliable means for others to judge clinical skills. It’s important that your references comment on your clinical proficiency in their letters. Procedural skills always are welcome but by no means mandatory.

In larger facilities, where residents in training or specialists do many procedures, the program may not insist on procedural skills. On the other hand, some hospital medicine programs may require a proficiency in ICU procedures, which include intubations, central line placement, and A-line placements to mention a few. The SHM publication The Core Competencies in Hospital Medicine: A Framework for Curriculum Development is a great resource for understanding the knowledge and skills expected of a hospitalist physician.

A commitment to and active interest in quality improvement is highly desirable. Prior participation in and/or research for programs such as venous thromboembolism (VTE) prophylaxis, inpatient glycemic control, fall preventions, CHF optimization, medicine reconciliation pathways, and other evidence-based measures are a definite plus.

2) Professionalism and teamwork. There are an extraordinary number of healthcare providers a hospitalist needs to work with. In addition to establishing a courteous rapport with patients and their families, good communication with primary care physicians, specialists, nursing staff, case managers, midlevel providers, and administrative and secretarial staff is essential. With this diversity of interactions, professionalism and teamwork are highly regarded and go a long way in establishing you as proficient hospitalist. An applicant’s professionalism is not only judged during the interview period but also confirmed by references. An unwavering positive attitude and commitment to a healthy work environment also are attributes that are recognized by a potential employer.

3) Quality improvement focus. Quality improvement activities and participation in such programs have rightly received unprecedented attention. SHM data indicate that 86% of hospitalist groups are active in quality improvement initiatives. Many hospital medicine programs participate in some form of Medicare pay-for-performance initiatives in order to ensure evidence-based patient care, better health outcomes, and reduce preventable complications.

A commitment to and active interest in quality improvement is highly desirable. Prior participation in and/or research for programs such as venous thromboembolism (VTE) prophylaxis, inpatient glycemic control, fall preventions, CHF optimization, medicine reconciliation pathways, and other evidence-based measures are a definite plus. In addition, specific training in areas such as perioperative care, improving safety of transitions of care, and stroke management are beneficial. Elaborating on any systems enhancement projects undertaken especially during hospital medicine clinical rotations/electives and/or fellowships will be invaluable.

4) Leadership skills. Nonclinical and administrative responsibilities are an important element of many hospitalist programs. Interest in various committees and an ability to assume leadership roles reflect favorably on your application. A good hospital medicine program will often encourage your interest in fostering the program and invite your involvement in initiatives to promote good patient care and facilitate fiscal strength.

An applicant should inquire about opportunities to participate in organizational committees and develop leadership skills, as this will be important for your professional growth. Take the time to point out any previous committee involvement in national healthcare organizations such as SHM.

5) Workflow efficiency. The ability to multitask and be organized are great skills to have as a hospitalist. Hospitalist work often involves managing several things during a short time span (i.e., rounding, admitting, teaching, holding family conferences, answering pages, and running codes). Successfully completing these responsibilities involves patience, structure, and resourcefulness during the course of any given day.

6) Teaching and research skills. In academic hospital medicine programs, good teaching and research skills can be very desirable. Chief residency or assistant chief residency experience is a good sign of teaching experience. Participation in research projects will boost your chances when looking for an academic hospitalist job. In non-academic practices, the employer may not focus much on these skills. Nevertheless, it is of significant value when the practice also hires midlevel practitioners like nurse practitioners or physician’s assistants or is thinking about how to evaluate the effects of a new program or intervention.

7) Local ties and durability. In view of the significant demand for hospitalists, recruiting can be challenging for any program. Another important aspect an employer looks at is whether you have any local ties or other compelling reasons to stay in the area for a long time. If you do have some geographic attachments or other reasons to be in the area for an extended duration, it will make the program more receptive toward you. Also, obtaining or applying for state licensure will save significant time and put you ahead of the curve.

8) Board certification. Most programs require you to be board certified or eligible when hired. Many programs expect you to obtain board certification within one to two years of starting your job. The sooner this is accomplished the more beneficial for the applicant.

Other Considerations

The diversity of hospital medicine programs provides an array of opportunities to choose from. Broadly speaking, the practice type could be academic or community based. The choice would depend upon your interest and proficiency in teaching.

In terms of schedules offered, several models exist. Many hospitalist programs are increasingly becoming 24/7, and it may be expected that you work different shifts. Also look into the licensure requirements of the state where you want to practice and be prepared with the required documentation, as some states may take longer to issue the license.

Above all, always remember: As much as it is important for you to find a befitting job, it is similarly essential for hospital medicine programs to hire worthy and valuable physicians. TH

Dr. Asudani is assistant clinical professor of medicine and a hospitalist at Baystate Medical Center, Tufts School of Medicine. Dr. Gandla is program medical director, Cogent Healthcare, High Point Regional Health System.

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