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Multiple Choices


 

Seven on, seven off. That’s what you can expect as a hospitalist, right? Maybe. As you consider an HM career, your first thought should be just that—is this a career or a job? Is this a year between residency and fellowship, clinical shifts that allow you to have 26 weeks off every year, or is it something else?

Either way, HM offers abundant opportunities conducive to work-life balance and career satisfaction. HM careers reside in clinical, academic, and administrative settings.

Clinical

As a physician entering the workplace, clinical practice often is the most familiar, but it does not have to be an extension of your residency floor rotation. Your individual schedule and employer will play a role in determining when you provide clinical service. Some employers, whether hospital-based, a private physician practice, or a national hospitalist company, utilize fixed schedules, which might include night shifts. The popular seven-on, seven-off model allows you to provide direct patient care every other week, creating personal or administrative time in between. You can opt to become a nocturnist and limit yourself to clinical service at night. Some hospital-based programs implement individualized schedules to meet the nonclinical demands of academic or administrative hospitalists. These schedules might combine Monday-through-Friday weeks, weekends, and nights to create flexibility within your group.

Hospitalists are perfectly positioned to identify areas within patient care where existing practices need improvement.

Clinical service can be carved out to fit both your interests and the setting in which you provide care. If placing central lines is your thing, a career as a proceduralist might be for you. Other hospitalists find themselves in clinical niches in specialty collaboration and specific care settings, including surgical comanagement, intensive care, emergency, clinical decision or observation units, or pre-admission and post-hospitalization clinics.

Hospitalists can improve quality, patient safety, and efficiency when working in specialized areas like a clinical decision or observation unit. In these settings, hospitalists often collaborate with midlevel providers, such as nurse practitioners or physician assistants, to provide observation or outpatient care to patients with medical conditions that require more than an ED visit. For example, many patients who present to the ED with chest pain are ideal patients for these settings to evaluate their symptoms and provide an optimal care transition out of the hospital or to an inpatient unit, if needed.

Perhaps you enjoy patient care, but just not all the time involved: You might find a fulfilling career that blends clinical service with research, teaching, or administrative work.

Academic

As an academic hospitalist, you have various options. Hospitalists provide education and oversight to trainees, both medical students and residents, in academic medical centers and community teaching hospitals. You might join an academic center and receive a faculty appointment, either as clinical instructor or assistant professor for first-time candidates.

Clinician educators generally serve as internal-medicine-ward attendings, teaching inpatient care to house staff and students in a traditional sense. Studies have demonstrated that students and house staff are more satisfied and feel they learn more when their ward attending is a hospitalist.1 Academic hospitalists foster career development by serving as mentors or residency program directors. Academic hospitalists also educate fellow physicians through faculty development series and programs.

Hospitalists can have roles in academics as clinician-researchers, usually following formal research training. Hospitalist researchers focus on numerous areas, including basic science, specific disease states, and hospital outcomes. A focus on hospital outcomes allows clinician-researchers to link “evidence-based medicine with quality improvement by systematically studying hospital care. The outcomes are used to optimize healthcare delivery at the level of both the individual patient and the hospital.”2

Administrative

Hospitalists can pursue leadership opportunities in academic, hospital-based, or community-based settings. Administrative hospitalists develop and guide programs: hospitalist, hospital-based, and multidisciplinary. Hospitalist-leaders serve as program managers, division heads, and medical directors in operational leadership. Aside from running the day-to-day operations of physician groups and hospital units, hospitalists lead in other arenas, such as utilization management, QI and patient safety, medical informatics, and hospital operations.

When serving as physician advisor or utilization management director, it is an opportunity for the hospitalist to lead care coordination within an organization and identify where opportunities related to hospital utilization exist. Many hospitalists lead multidisciplinary hospital committees in QI and patient safety. Hospitalists are perfectly positioned to identify areas within patient care where existing practices need improvement. As quality leaders, hospitalists facilitate the process changes necessary to implement evidence-based care. Some of the hospitalist-led QI areas include care transitions (patients moving from one setting to another; for example, inpatient to outpatient), VTE prophylaxis, inpatient glycemic control, and reduction of hospital-associated conditions.

Directing or guiding medical informatics as health systems across the country implement electronic health records (EHR) is an area where hospitalists can impact both quality and efficiency of care. Medical informaticists can guide clinical-decision support systems within an EHR, easing evidence-based, disease-specific care for other clinicians. As EHR becomes more available, this opportunity for hospitalists will grow.

In addition to these areas, hospitalists can manage or direct a hospital’s patient flow or throughput. Considering that more EDs and hospitals are overcrowded, improving patient flow is an area where hospitalists can join or lead a hospital’s throughput initiative. Evidence has shown that hospitalist-driven active bed management can improve ED crowding and overall hospital flow.3

So now that you know there is more to an HM career than the seven-on, seven-off job that you get between residency and fellowship, determining how and where to find that just-right combination is up to you—with a little help from your local hospitalist mentor. TH

Dr. McAllister is assistant professor in the division of hospital medicine at Cooper University Hospital/UMDNJ-Robert Wood Johnson Medical School in Camden, N.J. Dr. Kupersmith is assistant professor of medicine, UMDNJ-Robert Wood Johnson Medical School, division head, hospital medicine, medical director throughput, Cooper Health System.

References

  1. Hauer KE, Wachter RM, McCulloch CE, Woo GA, Auerbach AD. Effects of hospitalist attending physicians on trainee satisfaction with teaching and with internal medicine rotations. Arch Intern Med. 2004;164(17):1866-1871.
  2. Career options. SHM website. Available at: www.hospitalmedicine.org/AM/Template.cfm?Section=Young_Physicians&Template=/CM/HTMLDisplay.cfm&ContentID=22474. Accessed Dec. 28, 2010.
  3. Howell E, Bessman E, Kravet S, Kolodner K, Marshall R, Wright S. Active bed management by hospitalists and emergency department throughput. Ann Intern Med. 2008;149(11):804-811.

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