It’s fall. I know that because the leaves are turning, the nights are chillier, and my dogs have migrated back to the bed from a hot summer on the floor. Oh, and I again need to fill four positions for my hospitalist group.
A lot has changed in HM recruiting in the past few years. There was a feeding frenzy in the early part of the century, when I often joked that group leaders were so desperate for boots on the ground that my mom (who is not a physician, is retired, and struggles somewhat with the triple acid-base disorder) could have gotten a job as a hospitalist. I saw it in the number of reference calls for the residents in our program, their ever-increasing salary offers, and the breathless e-mails I’d receive from headhunters. Improbably, on occasion, their froth would even boil over to an offer for me, an academic. Now that’s desperation.
But things seem to be changing. The number of calls per resident is down and my inbox is filled with slightly less-winded recruiters. Maybe groups have finally matured and don’t need to hire; maybe the recession has induced an air of caution around growth; or maybe groups have uncovered the secret tonic to seeing more patients with fewer providers. Whatever it is, it seems that the job market has tightened ever so slightly.
And the job market has changed, especially on the academic side.
Work Harder for Less
In academics, we hire into jobs we describe as “clinician-something,” with the something reflecting what you do when you are not seeing patients, the thing that in most cases will get you promoted from instructor to assistant to associate to professor. Because HM is not a fellowship-driven field, primary researchers, called clinician-researchers, are rare. Most of the folks we hire fall into the clinician-educator mold—that is, they see patients and teach, develop curriculums, and produce scholarship, often around education.
And therein lies the problem.
We’re running out of educational opportunities. The demand for clinical work long ago outstripped the supply of teaching opportunities, resulting in many academic HM groups hiring hospitalists for clinical jobs without residents to teach. Much like a deep-sea diver miles below the surface who finds his oxygen tank is running low, we now find ourselves looking up at an ocean of patients and realize that our educational lifeline has been severed. And the dyspnea is becoming ever more uncomfortable.
Increasingly, here is the sell for many academic HM groups: “Come work for us, do the same work you’d do at a community hospital, in a less-efficient system, without residents, for a lot less money.” And because you are primarily a clinician, you probably won’t have protected time to develop an academic interest and, therefore, you won’t get promoted beyond the “instructor” level because you haven’t contributed to advancing your field of medicine.
Even my mom wouldn’t apply for that job.
Failure Does Matter
The academic hospitalist job circa 2010 is heavy on the hospitalist and light on the academic. This is bad. And it matters to all of us, community hospitalists included. Without a strong frontline of academic hospitalists, we will not develop this field beyond “doctors who work in a hospital.”
There is a science to our field and it needs to be further developed. It can be seen in the comparative-effectiveness research, which tells us the best way to manage common diagnoses, the translational research (i.e. getting that new drug from the bench to the bedside), and the systems-based improvements (e.g. ensuring every stroke patient gets thrombolytics within three hours).