Hospitalist-educator is usually a non-tenured position and these academicians are promoted primarily based on their clinical expertise and perceived skills as teachers. You don’t need to have a fellowship for this position; usually, the hospitalist director will hire individuals from his or her program—often a former chief resident.
3) Hospitalist-clinician: “These hospitalists primarily focus on patient care,” explains Dr. Saint. “A lot of them have been hired recently because of the limits on work hours for residents. There is minimal teaching and scholarly activity.”
Often, people do this for one or two years between residency and a fellowship, or to pay off school loans.
4) Hospitalist-administrator: “A major portion of their day is spent on administrative tasks,” says Dr. Saint. “They may run the hospital medicine program, or have educational administrative tasks, like residency directors.” However, he warns, “a resident isn’t going to go straight into one of these positions; you have to pay your dues first. But this can be an opportunity to think about for the future.”
What is the job market like for these academic positions? “There are huge opportunities for residents wanting to become hospitalists, regardless of which track they want to follow,” says Dr. Saint. “There are only a handful of clinician-investigators in hospital medicine now, and I see tremendous growth in this field. There’s also a growing need for hospitalist-clinicians because of the restrictions imposed on the workweek [for residents]. And as the number of hospitalists grows, there will obviously be a need for more hospitalist-administrators. Of course, there will always be a need for hospitalist-educators—but many are already in those roles.”
Choices in Community-Based Hospital Medicine
The first thing to realize about community-based hospital medicine is that there are various employers involved.
“Programs will have different mandates; a lot depends on the financial drivers,” says Sanjiv Panwala, MD, hospitalist at Providence Medical Center, Portland, Ore. “If you’re paid by the hospital, your priorities will be theirs: coverage of uncovered patients, shorter length of stay, etc. It trickles down.”
Michael-Anthony Williams, MD, regional CMO of Sound Inpatient Physicians in Denver, agrees. “It’s important to understand who the employer is and what their values are,” he says. “Is it the hospital or a local, regional, or national practice? If you’re employed by a hospital, you may be one of several employed specialists.” That can impact what types of clinical work you handle.
Regardless of whom you work for, says Dr. Williams, “The biggest differences [from an academic institution] are a much greater focus on patient care, and the fact that community-based groups change and evolve more quickly than academic groups.”
But there can be more to community-based hospitalists than direct patient care. “Ask if the job is limited to clinical duties or if there are ways to branch out and expand, maybe by becoming a medical director for a hospital or by designing quality programs,” suggests Dr. Williams.
Working Within Managed Care
Cara Steinkeler, MD, a hospitalist at Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore., worked in private practice before she signed on with managed-care giant Kaiser. “Overall, the schedules—in terms of number of days per month and shifts—are pretty similar” for managed care and private practice, she says. “In terms of quality of life, they’re also about equivalent.”
The difference may be in how hospitalists spend their time. “I’m relatively isolated from the business of medicine,” says Dr. Steinkeler. “We’re able to concentrate on treating patients. When I was in private practice, I’d spend 10 or 15 hours a week doing my own coding and billing; here, we [now] have coding experts that do that.”