“With the rise of hospitalists, people think that we need to emphasize hospital training more. But our residents already do a tremendous amount of hospital training,” he explains. “They do wards, ICU, and CCU; and even many of their electives—infectious disease and cardiology, for example—involve inpatient care. In addition, all of our residents have night float responsibilities, so they cover overflow patients and are in the hospital all night. We are training people pretty solidly for hospital practice.”
Dr. Ford believes it would a mistake for a resident to replace an ambulatory care rotation with a hospitalist track because he or she wants to be a hospitalist. “There is no question that hospitalists save money, lower lengths of stay, and improve patient outcomes and satisfaction,” he says. “But anyone can be a hospitalist. We aren’t an elite group of people.”
It is best to give hospitalists broad training, insists Dr. Ford, because “they still will need the actual job experience of working as a hospitalist to be effective in that role.” He adds that lack of a hospitalist program at UCLA in no way hurts his residents: “We are conventional here, but we do a superb job of education and training. Our residents are not at a disadvantage.”
His advice to residents who want to be hospitalists? “Pay attention—learn to do ambulatory medicine really well. This will help you tremendously when you perform as a hospitalist,” he explains. “You will have better sense of when someone can be discharged and who doesn’t need to come into hospital in the first place.”
Does Hospitalist Training Make a Difference?
“The feedback we’ve received so far makes it clear that this type of training helps people understand hospital medicine and better determine where they want to practice,” says Dr. Dressler. “Residents also have said that they like the variety of exposure to community settings. They said that they learned about activities and issues that they didn’t realize were part of physicians’ responsibilities, such as quality improvement and committee work.”
Dr. Dressler says that his health system has benefited from the program as well. “We have had some good residents stay to practice at one of our hospitals because their hospitalist training was such a positive experience,” he states.
Emory’s program has been in existence for only a few years. And while the number of participants remains small, Dr. Dressler says interest is growing: “We get about 5%-10% of residents in any given year. We are pleased with the turnout, and it has become more popular.”
Way of the Future
“We feel that all of this additional preparation is in our residents’ best interest,” states Dr. Rudmann. “We think it will be popular. Our residents are excited about it already.” He predicts that before long there will be many such programs around the nation. “Residency training programs will use these to gain a competitive edge to attract the best students.” TH
Writer Joanne Kaldy is based in Maryland.