Hospital medicine is often synonymous with internal medicine, but as Bob Dylan famously said, the times they are a-changin’.
Family-medicine-trained hospital medicine practitioners may only represent 10 to 15% of practicing hospitalists, but they are a growing subgroup in the specialty, and the leaders of SHM’s Family Medicine Special Interest Group (SIG) aim to make that known as often and as loudly as they can.
“Family medicine historically has been looked at as traditional outpatient practice,” said the SIG’s immediate past president Shyam Odeti, MD, MS, FAAFP, MBA, SFHM, section chief of Carilion Clinic in Roanoke, Va.
In the early days of hospital medicine, “there were not many organizations that were too familiar with family medicine physicians taking care of hospitalists’ roles,” he said. This perception has improved but isn’t completely gone. “So, one of the biggest advocacy initiatives is, ‘How do we make sure all the organizations across the nation know that family-medicine-trained physicians’ training during their residency programs adequately prepares them for the inpatient medicine practice?’”
Advocacy began with statements of support from SHM and the American Academy of Family Physicians. But to keep the progress rolling, the SIG acts as a real-time advocacy platform for its 1,129 members.
For SIG chair Usman Chaudhry, MD, FHM, advocacy often starts with recruiters and medical directors hiring physicians in the first place. “They should be comfortable hiring them in their programs,” said Dr. Chaudhry, a family-medicine hospitalist medical director with Texas Health Physicians Group in Flower Mound, Texas.
SIG vice-chair Krishna Syamala, MD, FAAFP, says a basic step for health care is for many institutions to change hospital bylaws, some created 25 or 50 years ago, long before hospital medicine became a specialty. Protocols that don’t account for family-medicine-trained hospitalists may not seem important, but some of the SIG leaders’ experiences suggest otherwise. They’ve secured positions in hospital leadership roles that were advertised for internal-medicine-trained hospitalists exclusively.
“They ended up in their roles because of their exemplary track records, experience, and their ability to make a case for their roles,” said Dr. Syamala, who practices with SSM Health in suburban St. Louis. “So, likewise, I think educating more hospital medicine department chiefs, and engaging with them and advocating for taking family-medicine-trained hospitalists into their programs, I think that’s where SHM is really important for us.”
Another area of education is, well, education.
“When people are training in family medicine, they may not be aware of all the opportunities they would have in hospital medicine,” Dr. Odeti said. “So, we want to educate the group on what opportunities we have after the training.”
The SIG “reaches out to the residency programs and is also looking into reaching out to the medical students and having them be a part of the special interest group,” Dr. Chaudhry said. “That will help future residents, and it will help their careers improve.”
As is often the case in health care, continuing education is just as important. So family-medicine-minded hospital medicine leaders worked with the American Board of Family Medicine (ABFM) and the American Board of Internal Medicine (ABIM) to create a pathway for practitioners with different training backgrounds to work better together.
“We had to work with ABFM and ABIM to come up with the specialized certification called designated focus in hospital medicine,” Dr. Odeti said. “Once the hospitalists trained in family medicine were able to get certified after taking a test, per the Accreditation Council for Graduate Medical Education, they could be faculty in the internal-medicine training programs.
“What would that do? That would help family-medicine-trained hospitalists progress farther in their careers and be able to seek opportunities where there are internal-medicine residents in a program, and that would not become an exclusion factor for them for being hired.”
The SIG’s leadership board is focusing on advocacy not just with SHM and hospitalist leaders nationwide, but with stakeholders from the American Academy of Family Physicians, ABFM, ABIM, and other physician associations that have a role in spreading the word. Steps as seemingly simple as creating training modules within each specialty that recognize the roles played by family-medicine-trained hospitalists would be a step in the right direction.
“This is a cross-organization collaboration,” Dr. Odeti said, “so that we are not doing the work in silos.”
One initiative gaining steam is a critical-care fellowship that the SIG is pursuing via the ABIM.
“If family-medicine-trained hospitalists are accepted by ABIM, and they are allowed to participate in academic programs as full faculty members, it will be a big change in practice,” Dr. Syamala said. “The critical care pathway is one option that will be open. Also, other fellowship options will be open for us, like endocrinology, rheumatology, and so on and so forth.”
Richard Quinn is a freelance writer in New Jersey.