What is a hospitalist? A reader asked for my analysis on what it takes to become a hospitalist and what it is like to be a hospitalist? I'm currently a year 2 medical student and seeing our year 4s just match a couple of weeks ago has piqued my interest in residencies and career opportunities. I've heard of hospitalists before but never really knew what they are until I recently did some research and now have a fair grasp of what they do generally (hospital-based inpatient care, ER-like shift work, week on/week off). And I'm liking mostly what I've read so far. (Although some claim it's dog-work like conditions and you are basically glorified IM residents?)
But in any event I was wondering what residencies after med school are geared towards a hospitalist career? Is it just internal medicine? I've read in other places (on studentdoctor.net threads, and on the mdsalaries blog) that Peds, Family Medicine, and even Psychiatry are qualifying residencies for a hospitalist job. I'm not sure if you already covered this in your blog already (and if that's the case a link to that page would be greatly appreciated) otherwise can you list some residencies that qualifies for hospital medicine?
A hospitalist is exactly what the word means. Hospitalists practice medicine exclusively in the hospital. The word hospitalist was first reserved mostly for internists who cared for patients only in the hospital. Use of the term hospitalist has expanded through the years to pretty much include any physician who works exclusively in the hospital. We have neuro hospitalists, pediatric hospitalists, obstetrical hospitalists and even surgical hospitalists.
For adult medicine, most hospitalists are internist trained. There is a process now in place to recertify in hospitalist medicine instead of internal medicine. Not all of your preconceptions are accurate. Not all hospitalist employment models involve shift work. Some take their own call in 24 hour blocks either in house or at home. You can plan on hospitalists at small hospitals doing home call and hospitalists at large hospitals doing in-house 24 hour coverage. It costs a lot of money to staff a hospital with a physician in-house 24 hours a day. Most small hospitals can't afford that.
Many people think hospitalists are employees of the hospital. That's not at all true. Some are employees, but many hospitalists work in a local private or corporate practice hospitalist setting with a contractual agreement to provide hospitalist services with a hospital or hospital system. Some hospitalists are paid strict salary. Some are paid strictly on production and relative value units (RVUs). I suspect, based on hospitalist salary surveys, that most are paid a combination of both. How you structure your employment contract is entirely up for negotiation. You are a physician. You are not a high school drop out. You don't have to accept what they offer you. You will always have many options. Your services are always in demand.
Those hospitalists that do shift work don't necessarily do seven days on and seven days off. I don't have that schedule. I know many that don't. It's just one of many possible schedules that can be developed. As physicians, you can make your own schedule and figure out how to cover the shifts that need to be covered. That's the beauty of having an education. You have earned the right to manage your own schedule to your own liking. You aren't clocking in or out. You take care of patients just like everyone else.
As for the dog like conditions and the glorified IM resident attitude, I have never felt like that because I won't allow myself to be treated like that. I don't do skut work, the essence of being defined as a resident. I manage patient care issues just like physicians who round on patients and head back to their clinics. If you can stay ahead of the recruitment curve, you have half your battles won before the war begins. How you allow yourself to be treated as a hospitalist is how you will be treated as a hospitalist. Establish appropriate ground rules based on best practices and skut work won't be an issue. Just because you are in the hospital doesn't mean you are there to field every physician's call for them.
There are good programs and there are bad programs. The good programs have administrators that understand the exceptional value hospitalists bring to the table. Great programs do not run their board certified internal medicine physicians into the ground. If they do, and the physician chooses to stay and work in that environment, that's up to them. I would never put up with such a program. Remember, you went to medical school and residency and you passed the test. If you choose to work in an environment where you are abused, you make your own bed. Live with the consequences.
So what is a hospitalist? It is a doctor who practices exclusively in the hospital. If you want to do adult medicine in the hospital the most intense residency that will train you for a full scope of hospitalist practice is internal medicine. That's not to say family medicine residency training can't provide hospitalist services. It's just their training is shared with obstetrics and pediatrics. For an adult only hospitalist, internal medicine residency should be your field of choice if you wish to pursue specialty training for adult hospitalist medicine and the vast array of patient pathology you'll see at all hours of the night, except when you pitch a no-hitter, as these medical ecards explain. Now that all the boring stuff is out of the way, please indulge in some good hospitalist humor below.
Facebook hospitalist humor:
I try not to tell patients I'm a hospitalist. Most patients have no idea what that is and may even confuse the word hospice with hospitalist. So...
Happy: Hello Mrs Smith. I'm Dr Happy. I am a specialist in caring for hospitalized patients and do almost everything except surgery or take care of pregnant women during delivery.
Demented 92 yo: You're a wise doctor.
I went ahead and had dementia stricken from her record.
The worst thing I've ever done to a partner hospitalist of mine is to have six fake but really sick and complex patients with scant details written out waiting for them at shift change as I scurry out the door in a hurry. I'll never forget the look on their face.
At least I thought it was funny...
Partner #1: Happy, your patient loves you. I walked in there and she said, "Where did Dr. Happy go?"
Happy: Oh. That's nice of her.
Partner #1: She started crying when I told her I was going to be her doctor for now on.
Happy: Oh. That's really sad.
Partner #2: Are you sure the patient wasn't confused and demented?
As a hospitalist I pride myself on being detail oriented. So please forgive me for showing up to work with my scrubs inside out.
"Why I blog"...
Hi Dr. Happy,
Today I was reminded of your explanations of what it means to be a hospitalist...when one was discussing the treatment plan for my mother with the two of us. My mom is one of your "complicated" old ladies - 86 years old, with a 7-year-old porcine mitral valve and quite a few meds. She's in the hospital now because I took her from sea level to 7000 feet in one afternoon, to go visit the Grand Canyon, and various things went wrong after that. (She went with me to the North Rim when she was 82; she still wanted to see the South Rim, and I was going anyway.)
The point, though, is that I knew she was in good hands with a hospitalist, thanks to you. (She got transferred to ICU and now has an intensivist, which also seems to be a good thing.) I appreciate having someone who can look at the big picture in detail (so to speak). Just what she needed...
Thanks again for your blog - I enjoy it. And today, it brought me some peace of mind in a challenging situation.
Rule #1` of hospitalist medicine: Never tell a cardiac patient who's team is playing tonight that "we don't get that channel" without first having the crash cart ready at the bedside. For some strange reason, he wasn't amused.
As I leave today, there is no greater feeling in the world as a hospitalist than knowing I have such excellent partners that can handle the seven direct admits coming in the next hour. They are in excellent hands. Good luck guys! I'll be thinking about you.
Some of this post contains humor that may only be understood by those in a healthcare profession. Read at your own risk.