When I finished my residency I went into private practice. Like most residents of the time I was totally unprepared for ambulatory care. I could run a code, knew all the latest diagnostic tests, and could even quote a few articles.
But the first time I saw a young man with chronic back pain who wanted to go on disability, or an elderly lady with osteoporosis and breast cancer who wondered if she could take quinine for leg cramps, I was lost. It only took a decade or two for me to feel vaguely competent. Meantime I did some hard time in the hospital, but my focus shifted tectonically toward the outpatient. When my running partner Mitchell Wilson decided to start one of the early hospitalist programs (at the University of Texas) my hospital time ever more rapidly receded.
At the same time, the forces of capitalism were at work: IPAs and IPOs, practice management groups, university expansions and contractions, hospital closings. This was the new shifting sand (or shifting dullness) of medical practice. I was ready for a change, but could I give up my comfortably cluttered office, my established, fairly well-tuned patients, my six-year-old National Geographic magazines in the waiting room? Would going back to the hospital feel like being a resident again? There was only one way to find out.
I said goodbye to the beach and the fire ants, loaded my truck like Jed Clampett, and moved to Rochester—Minn., that is—frozen tundra, lots of geese. Under the auspices of Jeanne Huddleston and the Mayo Clinic Inpatient Internal Medicine Team, I joined the world of hospitalists.
New Beginnings
My first impression of life as a hospitalist was that I was cold. Frigid really. Of course it was winter in Minnesota, so I guess I should have expected that. I rapidly discovered that it was a lot nicer being a member of the consulting staff than a member of the house staff. In some ways I felt like an intern again. It was difficult to believe, but hospital medicine had changed over the last decade or two; however, the patients hadn’t.
I was armed with acceptable history taking and exam skills. I had a superb support system in the nurse practitioners and physician assistants who carried my load the first few weeks. My colleagues were supportive. I muddled through and, after several years, felt like I was back to my baseline level of moderate competence.
Though my story is immensely fascinating (to me) from an autobiographical standpoint, does it answer the question of why I enjoy being a hospitalist? Usually people ask me, “What is a hospitalist?” I usually explain that I’m an internist—not an intern—though some days I feel like the latter. The taxonomy of hospitalists is fairly diverse. Some of us come straight from residency, for others it’s the resolution of a mid-career crisis.
One of my favorite things about being a hospitalist is the control I have over my schedule. As an outpatient doctor I had a timetable to keep based on the waiting patient. If I got behind, waxed conversational, or got involved with a family, my day was ruined. Patients got mad at me; my nurses were aggravated.
In the hospital, I have a body of work I must do each day. It’s predictably unpredictable at the beginning of the shift. I have a certain number of patients to see, discharge, and admit. I risk acute medical emergencies, unexpected families who want an update on their mother’s condition, and similar hospitalist activities of daily life (aka HADLs). The volume of work is variable: Some days are difficult, some aren’t. The complexity of cases is stimulating and makes continued learning a necessity. Instead of being isolated in an office I interact with other physicians and staff. The most stimulating aspect I experience is the sensation that hospital medicine is an evolving field and there are hundreds of dedicated colleagues out there trying to make it better.