Fellowships Available to Family Physicians Considering Hospital Medicine Career
I am in my final year of family practice residency. I discovered that I enjoyed hospital medicine much more than I thought I would. I am considering a hospitalist fellowship (one year) to add depth and breadth to my clinical skills. Do you view the clinical knowledge from a fellowship as beneficial to outpatient practice, and, with respect to hospitalist opportunities, are they available to an FP physician?
–Ward Harbin, MD
Dr. Hospitalist responds:
Congratulations on completing your residency. I know it has been a long and arduous journey, but you’re almost there!
I do believe HM fellowships are beneficial for anyone aspiring to become a hospitalist. Even though fewer than 5% of U.S. hospitalists are family practice graduates, there are many opportunities for FP residents to do a fellowship in hospital medicine. Many hospitalist programs limit their recruitment to board-certified internal medicine candidates, but this is probably more a reflection of internists having sustained a foothold in the HM movement and staking out their turf. Nearly all fellowships are one year in length, and most only offer one or two slots. As you can imagine, with such a limited number of positions, the competition is fairly keen, especially in the larger academic programs.
Most programs offer core rotations (similar to residency) but allow some flexibility in selection of electives. Some programs offer several different tracks. For example, Mayo Clinic in Rochester, Minn., offers clinical research, clinician educator, and quality tracks. These are becoming more popular, as they allow the fellow to focus early on a particular area of hospital medicine and, ideally, develop a niche, while becoming a much more attractive candidate for employment.
If I were considering the practice of outpatient adult medicine, I would think about a fellowship in general medicine and target a specific area (e.g., geriatrics or sports medicine). For many reasons, these tend to be less competitive, but as our population ages and current reimbursement strategies are challenged, this may soon change. While there are many clinical principles taught in an HM fellowship that are applicable to outpatient medicine, it would be best to choose the area of interest (inpatient vs. outpatient) and focus your efforts in that direction.
As hospitalists are increasingly being offered more administrative opportunities, several post-graduate degrees or areas of focus are becoming valuable. I would strongly consider pursuing a master’s degree in healthcare management (MHM) or healthcare administration (MHA). Those degrees are offered by a number of top-notch business schools. Nearly all are two-year programs with built-in schedule flexibility, basically geared toward the working professional. A master’s degree in public health (MPH) is also a valued degree and is offered by many outstanding programs. Although most programs attempt to emphasize and train healthcare professionals for the public health arena, there are opportunities to specialize in areas that can be used in hospital management.
As the hospitalist movement matures and the healthcare industry evolves due to market and governmental pressures, there will be many more administrative and clinical opportunities for hospitalists. The clinicians best positioned to take advantage of these opportunities will be those who have some form of post-graduate training supported by strong clinical skills.
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