Hospital medicine is still a relatively young field. Coined as a formal term in 1996, it has since become a cornerstone of inpatient care in the U.S. The 2010s marked a significant turning point, as a large portion of internal medicine graduates gravitated toward this dynamic and evolving specialty. The appeal was clear—hospitalists can work shifts, focus on acute care, and engage in hands-on, high-intensity patient management. It is a field that offers a fast-paced environment, but is this sustainable over the long run, particularly as those early pioneers of hospital medicine begin to reach their 60s and 70s?
For many hospitalists, this question has grown increasingly relevant. Hospitalists typically manage up to 25 patients per day, work 12-hour shifts, and cover a significant number of weekends and nights. The intensity of this schedule—rotating between days, nights, and weekends— has long been a selling point for early-career hospitalists. However, as hospitalists age, the physical and emotional demands of this rigorous schedule can become more challenging. For those now entering the later stages of their careers, it is important to consider whether the practice of hospital medicine can and should evolve to accommodate hospitalists at every stage of life.
The Challenge of Maintaining the Status Quo
Senior hospitalists today face a unique set of challenges. Unlike many other fields of medicine, where physicians gradually taper off demanding duties such as night shifts, hospital medicine requires sustained physical and cognitive stamina to manage the acute needs of patients. Many hospitalists in their 50s, 60s, and beyond have found it increasingly difficult to work overnight, stating that it takes longer to recover from night shifts and that the physical toll becomes harder to ignore. Even so, many institutions continue to rely on a one-size-fits-all approach to hospitalist scheduling, with little flexibility offered to accommodate aging physicians.
The field needs to ask an important question: Can hospital medicine adapt to better support senior hospitalists? Is there a path forward where hospitalists in their later careers can continue to contribute without being subjected to the same demands as their younger colleagues? These questions are not just about personal preference—they are about sustainability and the overall retention of senior talent in the workforce.
Finding Flexibility in Scheduling
One potential solution is to modify shift structures to better support hospitalists as they age. For example, rather than requiring all hospitalists to maintain 12-hour shifts, senior physicians could be offered the opportunity to work 8-hour shifts or to reduce the number of patients they see per day. While this might result in lower remuneration, many senior hospitalists would gladly accept this trade-off if it meant they could continue practicing medicine in a way that fits their evolving lifestyle. In fact, this flexibility could enhance their performance, allowing them to focus on quality patient care and efficient documentation without being weighed down by physical exhaustion.
Another approach could involve reducing or eliminating night shifts for hospitalists who have been in the field for a longer period. Many senior physicians express a desire to reduce their involvement in night work, as they find it harder to recover from these shifts. Transitioning to daytime-only work would enable these hospitalists to remain in the field and continue to contribute their skills and experience while avoiding the more taxing aspects of the job.
The Value of Senior Hospitalists
It is crucial to recognize the immense value that senior hospitalists bring to the table. The idea that hospitalists lose value as they age is a misconception. On the contrary, hospitalists with decades of experience often have superior skills in communication, documentation, and interdisciplinary collaboration. They excel at navigating hospital systems, coordinating care with various teams, and avoiding unnecessary errors in the complex landscape of inpatient care. Their understanding of hospital dynamics, patient management, and system-based practice is invaluable.
These hospitalists have mastered the intricacies of coding and billing, enabling their departments to maximize reimbursement while ensuring accurate patient records. Their ability to foster strong relationships with patients, nurses, and fellow physicians is unmatched. They are often the calm, steady presence in crises, helping to guide younger colleagues through the storm.
This experience and knowledge shouldn’t be discarded simply because the current model of hospitalist practice is inflexible. Rather than pushing senior hospitalists out of the field, we should seek ways to harness their strengths while making the work more adaptable for them. This might involve more administrative roles, mentorship of junior hospitalists, or even involvement in quality improvement projects and strategic planning, areas where their insights could lead to meaningful changes.
Making Hospital Medicine Sustainable for All Ages
It is essential that we do not lose sight of the long-term sustainability of the hospitalist workforce. Currently, many hospitalists view transitioning into a new field as the only option once they reach a certain age. The demands of the job simply don’t seem compatible with their long-term career goals. However, by reevaluating how we structure hospitalist practice, we can create a system that allows hospitalists to thrive in their 60s and beyond.
This includes being proactive in creating flexible scheduling models, offering tailored patient loads, and giving senior hospitalists a chance to continue practicing in ways that suit their needs and skills. Most importantly, we need to build a culture that values the contributions of hospitalists at every stage of their careers, ensuring that their expertise and wisdom are passed down to the next generation.
Looking Ahead
The evolution of hospital medicine is far from complete. As a relatively young specialty, we can shape it into a field that supports physicians throughout their entire career, from their first day on the job to their last. As senior hospitalists continue to demonstrate their value, we must advocate for flexible practice models that allow them to continue contributing their expertise in ways that are sustainable and fulfilling.
By creating a system that recognizes the unique challenges and strengths of hospitalists as they age, we can ensure that the field remains vibrant, inclusive, and supportive for generations to come. Hospitalists of all ages should have a place in the future of hospital medicine—one that adapts to their needs and allows them to thrive at every stage of their careers.
Dr. Mehta
Dr. Mehta is a hospitalist, medical director, and assistant professor of medicine at the University of Cincinnati Medical Center in Cincinnati, Ohio, and associate editor of The Hospitalist.
Great commentary. The same things that make hospitalism more palatable for senior staff are what will make it sustainable for younger staff. Lowering team censuses and reducing shift length will help reduce moral injury and turnover at all ages. Everyone will benefit.
I worked as a hospitalist / nocturnist for the last 11 years of my career as an internist until I retired at 70 years old. After 5 years on 12 hour night shifts I transferred to another hospital that allowed 8 hour night shifts. I found it enjoyable and satisfying, although management piled on more and more work until it became quite unmanageable. When I retired, they had to replace me with two hospitalists.
I think the term Hospitalist was coined in 1996 not 1998 by Dr Wachter. Great article. I’m still working at 73. I need a more accommodating schedule!!
Very timely article. All too relevant, especially as us senior hospitalist are invariably also training our own replacements as we do residents training.
I totally agree with this article. Many jobs demand night work from everybody,and it’s just unsustainable. I was willing to do it right out of residency with the pressures of buying a home, paying for a nanny, and starting to pay down student debt, but now that I’m more focused on actually enjoying what I am doing, I find the hospitalist work intolerable. The patients have actually gotten more complicated, and the number of people transferring into hospitals all through the night has just made working evenings and nights that much harder than 20 years ago.
Brilliant article, hitting the nail on the head! Recognition of the increasingly complex patient population often places sick patients on the floor who, even 10 years ago would have been in the ICU! There’s barely any MedSurg beds in tertiary hospitals and turned to mostly acute care. Our institution actually offers senior staff to take on schedules without nights. Identifying the problem is the first step towards solving it!!