Are you attracted to research but not sure if it’s your sole calling as a prospective hospitalist? Whether you think you might want to steer quality improvement (QI) studies in the community setting or veer toward an academic/research career, hospital medicine offers an array of paths to career satisfaction.
“There is so much room in hospital medicine to find your research niche,” says Luci K. Leykum, MD, MBA, MSc, SFHM, hospital medicine division chief and associate dean for clinical affairs at University of Texas Health Science Center in San Antonio. As chair of SHM’s Research Committee, Dr. Leykum can attest to the range of hospitalists’ research pursuits: from basic science (what biomarkers best predict poor outcomes in patients with acute lung injury?) to care organization (are hospitalist schedules and workload associated with patient outcomes?) to implementation (how do we most effectively implement best practices for care transitions?) studies.1-6
In addition to Dr. Leykum, The Hospitalist consulted Vineet Arora, MD, MPP, FACP, SFHM, associate professor of medicine at the University of Chicago and chair of SHM’s Physicians in Training Committee, and Margaret Fang, MD, MPH, FHM, associate professor and clinician-investigator in the department of medicine at University of California San Francisco (UCSF) Medical Center and a member of the SHM Research Committee. Critical to research success, they agree, is acquiring skills in research methodology and project design, finding the right mentor(s) to help guide your career, and committing to and preserving time to focus on your research.
“After residency,” Dr. Arora notes, “you have accumulated the clinical skills to become a hospitalist, but you usually have not accumulated the skill it takes to be a researcher, which is why you need to do additional training.”
Is a Fellowship Necessary?
The paths to incorporating research into one’s HM career can be diverse. Although a fellowship is often the recommended route, there are other ways to acquire research methodology and experience with project design. Dr. Leykum began her career as a clinician-educator at Columbia University in New York. Although she found the QI work enjoyable, she realized she wanted to understand how to create more meaningful and sustainable changes in inpatient care delivery. She later acquired a master’s degree in clinical investigation. She has published more than 25 journal articles, several in collaboration with other SHM colleagues.
As a result, perhaps, of her own experience—and the fact that HM is still a young subspecialty with limited HM-specific fellowship opportunities—Dr. Leykum says that she would consider hiring a junior faculty member who had not yet completed a fellowship. “I think you have to consider people who might be talented candidates that you are willing to groom,” she says. However, she says she would structure the position so that the faculty member could immediately pursue additional research training.
“If you’re interested in antimicrobial stewardship, for example, your institution’s division of infectious disease might be a logical choice for your mentorship and collaboration search.”
Dr. Fang completed a two-year, general medical research fellowship right after her residency and obtained her master of public health degree at that time. “I do agree,” she says, “that the fastest way to doing research well is to get some additional training.”
Even if you are not aiming to become a full-time investigator, Dr. Arora says a research fellowship “gives you very marketable skills. You will still gain skills that will be helpful to your career—and not all research is done by clinician investigators in academic settings.”
Another advantage of a fellowship, Dr. Arora says, is that it allows you to explore whether you are truly suited for a research career. All three hospitalists agreed that researchers share many of the same abilities: to focus, accept uncertainty, persevere, work in teams, and handle rejection.