The beginning of a new year is often a time of reflection and introspection as people make plans for the coming year and for their futures. Last month we enjoyed hearing from seasoned hospitalists, and to ring in 2025 we’re looking to the next generation. We chatted with resident members of SHM and asked them the following questions: What’s been your biggest challenge so far in your career? What surprises you most about hospital medicine? What are you looking forward to professionally in 2025? What’s going to be the most important issue in hospital medicine in the coming years? Here’s what they had to say.
Sahana Sinnarajah, MD
Sahana Sinnarajah, MD, earned her medical degree from Ross University School of Medicine in North Brunswick, N.J., and is a PGY-2 family medicine resident at the University of Maryland in College Park
Each day presents new challenges, and it is both rewarding and humbling to witness the immediate impact we can have on our patients’ lives in acute settings. — Sahana Sinnarajah, MD
Biggest challenge: One of the most significant challenges I’ve faced during my residency is the inability to assist patients who lack resources or face barriers to healthcare access, particularly within the Baltimore community. The healthcare system’s limited resources, coupled with insufficient empathy for resident struggles and the pressure from hospital management to address capacity issues, complicates the situation. As a resident, it often feels as though our voices are diminished in advocating for these vulnerable populations.
Surprised you most about hospital medicine: What surprises me most is the diversity of cases and the varying levels of patient acuity. Each day presents new challenges, and it is both rewarding and humbling to witness the immediate impact we can have on our patients’ lives in acute settings.
Looking forward to in 2025: I’m eager to dedicate my skills to serving the immigrant population as I participate in an away elective in Accra, Ghana. This inpatient medicine rotation at the University of Ghana will allow me to apply my knowledge in a different context and contribute meaningfully to the care of this patient demographic.
Most important issue in hospital medicine in the future: Looking ahead, a critical issue will be the detrimental effects of economic and social marginalization on health outcomes. The disproportionate rates of hospitalization and mortality from COVID-19 among non-white Americans underscore the ongoing challenge the healthcare industry faces in providing equitable care. The Centers for Disease Control and Prevention (CDC) emphasizes that achieving health equity necessitates sustained societal efforts to dismantle barriers to care and confront long-standing injustices faced by patients based on race, gender, sexual orientation, disability status, and other factors. It is imperative that the healthcare industry plays a proactive role in this endeavor.
Stephen Wanjala, MD
Stephen Wanjala, MD, earned his medical degree from Moi University School of Medicine in Eldoret, Kenya, a Master of Science in Health Economics and Policy from the University of Nairobi, and an MBA from Edinburgh Business School. He is a PGY-3 internal medicine resident at the KU School of Medicine-Wichita in Wichita, Kan., and serves as a resident champion with SHM’s Kansas Chapter. Upon completing his residency, he’ll begin his role as a rural hospitalist with HaysMed in Hays, Kan.
What surprises me most is the glaring gaps in access to primary care and preventive medicine, particularly for illnesses tied to lifestyle choices. — Stephen Wanjala, MD
Biggest challenge: The journey into residency was particularly challenging for me, especially as I had been working as a physician in Kenya for several years. As an international medical graduate, I faced unique challenges such as juggling the demands of studying for steps while continuing to work to provide for my family and balancing my responsibilities as a good husband and father. Finding the right resources to prepare, raising the necessary finances, and finding people who believed in my potential were significant hurdles. However, I’m grateful all these challenges came to pass. My residency experience at the KU School of Medicine-Wichita has prepared me well for a career in internal medicine, and I am excited to embrace the next steps in my professional journey.
Surprised you most about hospital medicine: What surprises me most is the glaring gaps in access to primary care and preventive medicine, particularly for illnesses tied to lifestyle choices. Many of the conditions patients are admitted with are preventable, yet persist due to various disparities—economic, social, and racial—that hinder effective prevention. Additionally, there’s a significant gap in health literacy, and even among those who are informed, achieving healthy behaviors remains a challenge. This ongoing struggle to bridge these gaps and disparities continues to be a profound revelation in my experience.
Looking forward to in 2025: I’m looking forward to completing my residency and starting my career as a hospitalist at HaysMed, which I felt would be a great fit during my interviews. I’m excited about the transition into life as an attending, establishing new connections, and navigating the new professional and social challenges. Additionally, I’m eager to see how the advancements in AI will shape the future of medicine, particularly hospital medicine, and how these innovations will enhance patient care and improve outcomes.
Most important issue in hospital medicine in the future: It is likely to be the emphasis on evidence that drives quality care, how this quality is measured, and the shift toward outcome-based payments. AI is set to play a significant role in this evolution, enhancing the quality and safety of medical care while also alleviating some of the burdens on physicians. This technological integration promises not only to improve patient outcomes but also to streamline workflows, making hospital environments more efficient and effective.
Avery Pellnat, MD
Avery Pellnat, MD, earned his medical degree from SUNY Upstate in Syracuse, N.Y., and is a PGY-1 resident at Maine Medical Center in Portland, Maine
Differences in ideals and cultures are a beautiful thing and make the world such a rich place, but unfortunately, I’ve seen it become a barrier to high-quality medical care. — Avery Pellnat, MD
Biggest challenge: So far, my biggest challenge has been imposter syndrome. When I say that, I mean when you start your intern year people start calling you “Doctor” and start asking you questions and asking you to make decisions about patient care. This was incredibly intimidating at first, and that helpless feeling made it very easy to doubt myself and worry if I was good enough to be able to take care of people. Fortunately, I’m in a program with excellent, compassionate, and personable mentors who answer my questions and never make me feel bad for not knowing anything. This positive environment has allowed me to grow, stifle the imposter syndrome, and gain the experience of knowing how to answer questions, knowing I’ll never know everything, which is okay because no one knows everything.
Surprised you most about hospital medicine: What surprises me most is the number of social issues we do directly address with hospitalized patients. I feel like oftentimes people equate that “social” work with primary care physicians, but I genuinely find these social issues we tackle in hospital medicine to be just as rewarding as managing their medical problems. The sheer breadth of hospital medicine, which encompasses what our bodies are doing and what they’re doing wrong, along with the social structures and factors that impact us are utterly fascinating, and both are rewarding to address.
Looking forward to in 2025: Professionally, I’m most looking forward to leading teams as a senior resident. I have loved being able to step back and see the bigger picture and steer the medical plans toward the best outcome. This has and will continue to allow me to have time to learn more about individual patients and their conditions. I also really like to create a positive, supportive environment on a medicine team and to reassure people who may also be struggling to find their confidence as a medical practitioner, just like I was.
Most important issue in hospital medicine in the future: I think the biggest issue will be healthcare inequity—this includes uninsured patients, unhoused patients, and even patients with cultural differences that become obstacles in the U.S. healthcare system. I truly worry about the uninsured. They will likely refrain from seeking care until their disease process is advanced, and even when they do come in, getting them the appropriate follow-up for their comorbidities has proved and will continue to prove very challenging. The same goes for those who are unhoused: discharging them to unstable or unsafe housing is far less than ideal and will likely only lead to poor health outcomes. I have already seen in residency how people from different cultural backgrounds are at a disadvantage. One obvious barrier is language. We’re so fortunate to have in-person interpreters occasionally but are often forced to use iPad interpreters, where things can be lost in interpretation. When things like this are lost, it’s easier for other aspects of one’s culture to be misunderstood or not considered. I have seen this a lot in my residency, especially with the large refugee population we have here. Differences in ideals and cultures are a beautiful thing and make the world such a rich place, but unfortunately, I’ve seen it become a barrier to high-quality medical care.
Dorothy Kenny, MD
Dorothy Kenny, MD, earned her medical degree from Creighton University School of Medicine in Omaha, Neb., and she’s a PGY-2 internal medicine resident at the University of California Davis Medical Center in Sacramento
The diversity of conditions that medicine sees is what drew me to the specialty, but it’s still impressive to see—even more so considering hospitalists at smaller hospitals may have to step up to the challenge of managing rare diagnoses with less subspecialist support. — Dorothy Kenny, MD
Biggest challenge: I think my biggest challenge so far has been adjusting to my new role as a senior resident and being in charge of managing or teaching our interns as well as the medical students. It’s been a big change, but I’ve also been very excited to have more leadership and teaching opportunities!
Surprised you most about hospital medicine: As someone fairly new to the field, I’ve found the most surprising thing to be how broad the scope of hospital medicine is. Admitted patients can be very complex and can have anything from routine heart failure or chronic obstructive pulmonary disease to conditions we’ve never even heard of. The diversity of conditions that medicine sees is what drew me to the specialty, but it’s still impressive to see—even more so considering hospitalists at smaller hospitals may have to step up to the challenge of managing rare diagnoses with less subspecialist support.
Looking forward to in 2025: I’m currently at a crossroads in my career where I’m trying to determine what path I want to pursue, i.e., if I want to pursue infectious disease as a career versus hospitalist versus perhaps a mix of both. I’m also deliberating if I would want to do a year as a chief resident. I’m in an information-gathering stage, but making those decisions will be coming up next year so I’m very excited to see where life takes me!
Most important issue in hospital medicine in the future: Equitable access to care. No matter how much care we’re able to provide in the hospital, it won’t help if patients are unable to access timely follow-ups with their primary care physicians or the necessary specialists.
Dhruv Srinivasachar, MD
Dhruv Srinivasachar, MD, earned his medical degree from Virginia Commonwealth University in Richmond, Va., and is a PGY-4 internal medicine/pediatrics resident at Western Michigan University Homer Stryker MD School of Medicine in Kalamazoo, Mich.
The biggest challenge in my career so far has been navigating the changing training landscape in pediatric hospital medicine as a med-peds trained physician, particularly the designation of pediatric hospital medicine as a subspecialty board requiring fellowship training for all residents graduating post-July 2019. — Dhruv Srinivasachar, MD
Biggest challenge: The biggest challenge in my career so far has been navigating the changing training landscape in pediatric hospital medicine as a med-peds trained physician, particularly the designation of pediatric hospital medicine as a subspecialty board requiring fellowship training for all residents graduating post-July 2019. This also includes challenges with finding opportunities to get involved in research and quality improvement due to training at a smaller institution that is more community-focused.
Surprised you most about hospital medicine: The biggest surprise is the wide array of people I get to interact with and the varying ways they have carved out niches in hospital medicine beyond direct patient care. Social media has been a big help in this regard.
Looking forward to in 2025: Looking forward to hopefully figuring out if and where I’ll match for my PHM fellowship!
Most important issue in hospital medicine in the future: I think the most important issue is the continued need to define what we do and to get folks to see the specialty as more than just a stepping stone to fellowship, for instance. In addition, there should be a more defined role that we play when working with other services in co-management (surgical services, subspecialty, etc.).