Although the term “hospitalist” was coined in 1996 in a New England Journal of Medicine article, the field of HM grew organically from pressure to optimize hospital economics and improve efficiency in economically pressed healthcare markets.1
Scholarship in HM has also grown and now includes regular publications of investigations exploring optimization of efficiency and quality, many with an emphasis on patient safety. In this way, HM is a unique field, with tools for approaching problems that aren’t commonly used in other branches of medicine.
In parallel to the emergence of HM as a field distinct from general internal medicine (IM), the HM fellowship is similar but distinct. Such fellowships serve multiple purposes.
HM fellowships can add clinical expertise and scholarship skills for a career in HM. While early HM research focused on proving the value of the hospitalist model, the field has expanded greatly for those interested in an academic career. The molding of a safer, more efficient hospital of the future depends on the creativity and scholarship of HM leaders. Further, experts suggest that with its unique emphasis on quality, safety, and efficiency, the field will be a key player in healthcare reform.2 Its strength lies in traditional clinical research, as well as further adoption of lessons from other fields including industry, ethnography, and public health.3 As such, fellowships to train future leaders and researchers is essential.
SHM’s website (www.hospitalmedicine.org/fellowships) lists dozens of IM hospitalist fellowships, as well as programs in family practice, pediatrics, and psychiatry. These programs last from one to three years, accept from one to six fellows per year, and exist in locations throughout the U.S. and Canada.
An excellent description of the nature and scope of pediatric HM fellowships was published last year in the Journal of Hospital Medicine.4 Descriptions of IM and HM fellowships also have been published.3,5
Hospitalist fellowships, like IM fellowships, aren’t credentialed by a governing body. In contrast to subspecialty fellowships, no separate specialty board exam is required for admittance to the field after completion of fellowship. HM positions do not require training after residency, and HM job opportunities continue to outpace the available workforce. This is the basis for the most important question confronting anyone considering such a fellowship: How is a fellowship of benefit to a career as a hospitalist?
Ranji and colleagues wrote that the “goal of hospital medicine fellowship training is to produce clinicians who are trained explicitly in studying and optimizing medical care of the hospitalized patient and in disseminating that knowledge for the advancement of patient care.”3 A review of information available for the different programs reveals two distinct approaches to this goal, with much overlap but distinct emphases:
Clinical programs usually last one year with a majority of time spent filling clinical responsibilities. In addition to providing focused exposure to HM with an emphasis on the Core Competencies in Hospital Medicine as outlined by SHM, such a program generally expands a trainee’s clinical scope. Additional training in palliative care, the management of neurologic emergencies, and comanagement of surgical patients are likely to be a part of clinical practice but often are underemphasized during residency. Research expectations vary, but most clinical programs allot some time for quality-improvement (QI) projects.
Clinical fellowships also afford more leadership training than most jobs would offer in the period immediately following residency. It also offers the possibility of refining clinical skills and developing a clinical niche.
Academic programs last two years and are characterized by two to four months of clinical responsibility per year. They offer a formal teaching curriculum and provide dedicated training in research, health policy, or health economics.3 Research training varies from program to program. Most include basic biostatistics and research-method coursework at a minimum; others offer the option to pursue a graduate degree in clinical research or public health.
Academic programs also offer dedicated research mentorship.
The value of an HM fellowship lies in career development. The decision to commit to a relatively low-paying fellowship can be a difficult one, especially given the debt burden most graduating residents bear and the abundance of high-paying HM jobs. It also is important for those interested in a career as an academic hospitalist to consider not only HM fellowships, but other programs as well, such as the Robert Wood Johnson Clinical Scholars Program (rwjcsp.unc.edu/about/index.html).
While all of the fellowship programs aren’t geared specifically toward the hospitalist, they often incorporate faculty with expertise that would benefit a future academic hospitalist. Of course, the best fit for an individual depends on their particular interests and needs.
Fellowship in HM can offer training in clinical skills, clinical research, teaching, and quality and patient safety. Anyone interested in an HM career should consider a fellowship an opportunity for career development in a young specialty entrenched in revolutionizing the care of hospitalized patients. Academic HM fellowships hold the promise of empowering tomorrow’s academic leaders with the tools to continue to move the field forward. TH
Dr. Mann is a fellow in the division of hospital medicine, Department of Medicine, at Mount Sinai School of Medicine in New York City. Dr. Markoff is associate division chief and fellowship director in the division of hospital medicine, Department of Medicine, at Mount Sinai School of Medicine in New York City.
- Wachter RM. Reflections: the hospitalist movement a decade later. J Hosp Med. 2006;1(4):248-252.
- Wachter RM. Keynote presentation. SHM national meeting. National Harbor, Md.: May 2010.
- Ranji SR, Rosenman DJ, Amin AN, Kripalani S. Hospital medicine fellowships: works in progress. Am J Med. 2006;119(1):72.e1-e7.
- Freed GL, Dunham KM, Research advisory committee of the American Board of Pediatrics. Characteristics of pediatric hospital medicine fellowships and training programs. J Hosp Med. 2009;4:157-163.
- Arora V, Fang MC, Kripalani S, Amin AN. Preparing for “diastole”: advanced training opportunities for academic hospitalists. J Hosp Med. 2006;1(6):368-377.