Since the role of a hospitalist was defined more than 25 years ago, hospital medicine has become an established and increasingly popular career choice for residency graduates. A recent report estimated that 71% of newly certified general internal medicine physicians choose hospital medicine over outpatient or hybrid positions.1 Although the demand for hospitalists remains strong, with more than 2,500 new positions created each year, positions in well-established programs and desirable locations are becoming more competitive.2 While everyone’s path toward a dream job will be as unique as what makes up one’s dream job, these are general steps and factors to consider in your journey.
Timing and preparation
In general, for most applicants, preparing a year before your expected start date will provide plenty of time. You may consider exploring positions earlier if you have special circumstances like coordinating a move with a spouse or securing a work visa. Gathering materials at this time mirrors the fellowship application cycle, which is beneficial given faculty are in a career mentorship mindset assisting your peers in applications as well. Applying early can be beneficial as many larger established hospitalist groups have a set number of new faculty that they are seeking to hire each year.
In preparing your application, a curriculum vitae should list major educational experiences and awards accrued during residency. Notable clinical experiences such as hospitalist electives, rural rotations, addiction medicine, perioperative consults, and critical care and procedural competence may demonstrate your ability to transition smoothly to independent practice.
Additional achievements such as research, teaching, leadership, and public service may also help demonstrate your potential to serve in non-clinical roles. As for clinical references, it’s generally best to ask mentors early and to provide details about your career goals. Your mentors can then decide what qualifications to highlight to give the strongest overall impression to those reviewing your application.
The next step is to make contact. Recent residency graduates and early career faculty may be able to share their personal experiences and connections to hospitalist groups. Local career fairs and national conferences such as SHM Converge also provide a unique networking opportunity. If you have significant time constraints or find the process too complex, you could consider working with a recruiter. However, recruiters may only work with a few programs and their services do come at a cost. Moreover, your residency programs should be committed to your success and will be able to provide dedicated time for interviewing. Aiming to receive at least three to four job offers will then allow accurate comparison between positions and provide leverage in negotiation.
Practice setting
As you consider different opportunities, the practice setting is important to consider. Larger urban academic hospitals often have higher acuity but should offer more specialist support. Due to their size, these systems sometimes divide their services to focus on organ systems, such as cardiology, pulmonary, and cancer service lines. These centers may also offer more variety in practice settings, including intensive care units, long-term acute care hospitals, inpatient rehabilitation centers, and skilled nursing facilities. Some groups are exploring integrating more telemedicine and hospital at home services. In rural settings, some hospitalists find significant autonomy and a broad scope of practice including open intensive care units.
Another key decision is whether to practice in an academic setting. Academic centers often provide more flexibility to pursue interests outside of clinical medicine and usually have a decreased focus on volume. You should also consider opportunities for professional development in teaching, leadership, quality improvement, research, and procedures. When exploring positions, it is worth specifying the support and opportunities you will be given as well. Some academic systems have transitioned to having dedicated teaching faculty and may only offer very few opportunities to teach on the wards, especially to junior faculty.
Schedule
Regarding scheduling, most practices offer the traditional seven-days-on-seven-off model. Larger groups may have flexibility with admission, swing, and night shifts. Rural critical access hospitals may offer 24-hour shifts which can be manageable due to a low census and low acuity. Locum tenens work also offers flexibility in scheduling, although they generally also request seven-on-seven-off.
When considering a position that requires working evening and night shifts, be sure to clarify how many of these shifts are expected. It’s common for junior physicians to cover more of these undesirable shifts, even while they are sometimes reimbursed at a higher rate. Understanding if internal or external moonlighting is permissible is important to discuss early.
Finally, understand the rules regarding time off for sick and vacation days, as junior faculty may be required to be on backup and work more vacations unless this is specifically stated.
Most shifts will be between eight and 12 hours, although requirements to be in-house may differ. Many programs now allow for remote coverage of routine issues from home after rounds are complete, with a rotating physician in-house who is then “on call” to respond to urgent issues requiring in-person assessments. Many of these details can be determined by asking what an average day on service may look like and by asking junior faculty about their experience.
Salary and benefits
After the above factors are considered, candidates should think about the importance of salary and benefits to them. The cost of living should be examined when reviewing salary. Comparing different positions allows you to have a good sense of the fair market rate for your services. Understanding bonus structures and group priorities is important, as groups may rate your performance based on RVU (relative value unit) production versus other quality metrics. Bonuses will typically be easier to negotiate than salary and might include some combination of payments for signing, relocation, production, and student loan repayment. Be aware, however, that some of the larger bonuses you encounter may have specific requirements or multiyear commitments.
Larger groups may also have opportunities to moonlight or add additional shifts, translating to a significant earning opportunity. If you have an entrepreneurial spirit, understanding the details of your contract’s limitations on outside employment and ventures is important. Some university systems may also have strict regulations regarding your ability to create patents or other intellectual property as faculty.
The decision to work in private practice or be hospital-employed may also have significant implications. Private practice may offer financial benefits and autonomy, but there is associated risk and commitment as an owner. In addition, private groups must continue working hard to secure contracts at a time when many hospitals have been creating their own hospitalist groups. As a business partner, you will also be involved in business decisions such as hiring, contracts, and scheduling. If these additional responsibilities are attractive to you or at least tolerable, the financial benefit may be worth it.
Conclusion
Hospital medicine continues to be a growing field with significant variety in practice settings and responsibilities. This translates into many factors to consider as you search for that first dream job. Hopefully, this article gives you an idea of how to give yourself the best opportunity to find your dream job by preparing early, asking mentors for advice, determining your priorities, and comparing multiple offers.
Dr. Huang
Dr. Huang serves as a clinical assistant professor in the division of hospital medicine at The Ohio State University in Columbus, Ohio. This content is sponsored by the SHM Physicians in Training (PIT) committee, which submits quarterly content to The Hospitalist on topics relevant to trainees and early-career hospitalists.
References
- Gray BM, Vandergrift JL, et al. Evolving practice choices by newly certified and more senior general internists: a cross-sectional and panel comparison. Ann Intern Med. 2022;175(7):1022-27.
- Lapps J, Flansbaum B, et al. Growth trends of the adult hospitalist workforce between 2012 and 2019. J Hosp Med. 2022;17(11):888-92.