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.