Multiverse of Medicine
A captivating feature of hospital medicine is its variety and flexibility. This manifests daily in our clinical duties caring for a wide spectrum of patients and diseases. While our hours are long, we also generally have some control over our average day’s workflow. This variety and flexibility extend to our longer-term career aspirations. Given our broad medical knowledge and experience with the intricacies of the hospital system, we hospitalists often find ourselves involved in additional leadership roles. Here, we outline several hospital medicine career pathways including early tips for involvement in hospital leadership, quality improvement and research, education, and primary clinical care.
Leadership
Hospital medicine is often the largest division, section, or practice group within the hospital and is integral to clinical service, interacting with all care teams and medical specialties. Thus, it’s not surprising that numerous leadership roles may be available within the internal medicine department and across the hospital system. Hospitalists are well suited for a variety of hospital leadership roles such as division chief, department chair, information technology director, utilization management director, vice president of medical affairs, and chief of staff or chief medical officer. Hospital leadership roles can be extremely rewarding and have the ability to positively impact global change affecting thousands of patients and practitioners. In these roles, hospitalists can reason through day-to-day hospital functions and develop strategies and ideas to position the hospital for the future.
Early-career hospitalists can get a sense of what hospital leadership looks like by joining hospital committees such as patient care committees, credentialing committees, or a variety of interdepartmental work groups. These are great ways to grow professionally and understand and troubleshoot systems issues. For those passionate about hospital leadership, it’s often worth pursuing additional local leadership training, national leadership training (e.g., the SHM Leadership Academy), and/or post-secondary education such as a Master’s in Business Administration.
Quality improvement and research
Being on the front line for inpatient care can lead directly to research and quality improvement to improve best practices. The pandemic exemplified our critical role in clinical research as hospitalists joined in recruiting and organizing randomized controlled trials for COVID-19 treatments. As experts in the hospital system, we are also exposed to challenges in the direct implementation of care. Quality improvement is critical in making systems work and providing evidence-based care. Hospitalists are exposed to system-based errors that impact clinical care and can help navigate barriers in order-set creation, protocol development, and care-change implementation, assuring direct-care practitioners have input into the process. Experience in quality improvement and research can lead to funded positions and potential opportunities as task force and committee leaders, quality directors, chief quality officers, and funded researchers. Satisfaction in a quality-improvement and research career can be considerable; knowledge to improve patient care can be disseminated and impactful on numerous health systems and millions of patients.
Building this as part of your career can be accelerated by connection with appropriate mentors who can connect you to studies and committees. Additional training in quality improvement such as Plan-Do-Study-Act or courses on hospital quality improvement (e.g., SHM Quality Improvement Academy) or research can help you better understand how an effective intervention can impact the hospital and, most importantly, patients.
Education
Whether at an academic center, a residency-affiliated hospital, or a community hospital, there are many opportunities to become a skilled physician-educator. Opportunities exist at academic centers within the medical school to serve on educational committees, as small group leaders, as pre-clinical or clinical course directors, or in the dean’s office. Within residency programs, there are opportunities to become rotation directors, core faculty, and associate program directors. In these roles, there is time set aside to develop specialized rotations and curriculum or to manage educational sites, rotations, and workload aimed at improving the skillset of our future colleagues. In a community hospital setting, you can seek out opportunities to teach colleagues integral to hospital medicine, such as junior physicians, advanced practice clinicians, or pharmacy students. There may be opportunities for medical-student teaching as well. The benefits of an educational career are the development of long-lasting relationships with your learners and the positive impact on the development of numerous future providers.
Get involved early in your career by taking on a learner in the clinical setting. If you enjoy teaching, join an educational committee, volunteer for residency interviews, or develop an educational session for the learners at your site. Opportunities typically evolve from there, so follow the path you find most fulfilling. Seeking faculty development conferences (e.g., Academic Hospitalist Academy) and mentorship can open up further opportunities and stimulate growth.
Clinical
Lastly, it should be emphasized how important a primary clinical career caring for patients can be. Hospitalists are the backbone of direct inpatient care throughout the U.S. We continue to grow in our clinical roles at every type of institution, whether at a rural community hospital or an academic hospital in the city. We went into medicine to care for patients. Our enjoyment of the acute care of hospitalized patients, seeing them through admission to discharge, is what drove us to hospital medicine. Our roles vary vastly from working in intensive care units, through telemedicine, on direct care subspecialty services, and as consultants and co-managers of surgical patients. Some work with outpatients in consultative medicine or post-discharge clinics. In the community, we may be the primary service for all inpatients, with other services serving in a consultative role. At academic institutions, expectations may extend beyond just clinical care. In the current environment, residency programs are limited in positions available, and residents are limited by work hours with hospitalists shouldering more of the clinical workload. This has led to an increase in purely clinical jobs at academic hospitals.
Building a clinical career takes knowing what environment you want to work in and knowing what patient population you want to serve. However, flexibility remains throughout your career for transforming your role. Payment structures vary when you are primarily clinical. There may be a higher relative value units burden when focused solely on clinical care, which can lead to a higher, but possibly less regular, salary. In the community, you may work for a larger organization rather than the hospital itself. Expectations beyond clinical care are minimal, aside from standard annual training and certification maintenance. You may be asked to work as a contractor rather than a full employee with benefits, especially if seeking part-time work.
Gratification from a primary clinical career comes with the fulfillment of helping care for patients in a time of need, factors that drove many of us to a career in medicine in the first place. You can also develop a niche in clinical care, including targeted work with subspecialized populations such as hospital management of oncologic or transplant patients, or in specific treatments such as anticoagulation.
Summary
Hospital medicine provides a plethora of diverse opportunities for career fulfillment. Early-career hospitalists should consider initial opportunities and faculty development in different domains to see what sparks their passion and brings them the most joy.
Dr. Gray
Dr. Skarda
Dr. Molitch-Hou
Dr. Gray is a hospitalist and clerkship director at the University of Kentucky, Lexington. Dr. Skarda is a hospitalist and primary internist at HealthPartners and Regions Hospital in Saint Paul, Minn. She is also an associate program director for the University of Minnesota Internal Residency Program and chair of credentialing at Regions Hospital. Dr. Molitch-Hou is a hospitalist and assistant professor of medicine at the University of Chicago, Ill. This content is provided by the SHM Physicians in Training committee, which submits quarterly content to The Hospitalist on topics relevant to trainees and early-career hospitalists.