The Hospitalist medicine profession was almost unheard of 20 years ago (A kind reader did point out to me that he was a Hospitalist 35 years ago!). Today it is one of the most popular jobs for physicians, simply due to the demand for hospital medicine and the evolution of healthcare. Those of us in Hospital medicine can certainly vouch for the perks of the job and also the headaches that are associated with it. Whether you love it or hate it, it is a “specialty” in medicine that will likely continue to increase in demand–this means that there’ll likely be a job waiting for you no matter which city you’re looking to live in. Today we’re going to discuss the salient aspects of the profession and how to become a Hospitalist.
What happened before Hospitalists became a thing?
Years ago when people became sick enough to be hospitalized they would be cared for by their own Internist/primary care physician who had hospital privileges. If the patient didn’t have a primary care physician, they would be assigned the one who was on call for the hospital at the time. When that patient was discharged from the hospital, they would likely continue outpatient care with that same doctor.
Internists at the time frequently rounded at the hospitals in the early mornings before their clinics opened or in the evenings afterward. They would also round in the hospital on the weekends if they had any patients who were admitted. Physicians with multiple hospital privileges would often have to stop by every one that had one of their patients admitted. During their clinics, Internists would also have to triage pages from the hospital for management orders, and check labs throughout the day. In essence, the hours were long and stressful. (Gotta pay for the Mercedes right? j/k, but only partially).
Someone saw that there was money to be had in Hospital medicine
Rounding before dawn, a full day of clinic, and more rounding in the evening isn’t completely sustainable when health insurance regulations, EHR mandates, and other charting requirements started creeping in the system. Furthermore, hospitals knew this and they also knew that successful businesses controlled production from the top down. What this means is that if the hospital employed its own doctors, it could likely care for its inpatients more efficiently and make some good money in the process. Insurances tend to reimburse work performed in the hospital at a higher rate than outpatient.
Remember that kids.
Insurances reimburse at a higher rate for hospital-based work.
When there is someone in the hospital taking care of the inpatients, the outpatient primary care physicians would no longer need to handle the hospital work in addition to their clinic duties.
And this is where we are today; we have Internists who strictly care for those patients in the hospital, and they are called Hospitalists. Those who work strictly overnight are called, “Nocturnists”. These physicians are most commonly employed by hospitals, although Hospitalist groups also exist and contract with hospitals to provide a service.
How do I become a Hospitalist?
Since Hospitalists care of the general aspects of medicine, the field consists mostly of doctors who completed an internal medicine residency (3 years). Emergency medicine physicians can certainly be Hospitalists, as can family medicine physicians. Obviously each of these medicine specialties has a different level and focus on training, but overall the skills are interchangeable.
Those of you who might feel that you aren’t equipped to handle hospital medicine because of your residency path, realize this: there are plenty of hospitals that employ allied health fields as “Hospitalists” to handle lower acuity disease. Whether that is an appropriate healthcare decision is another controversial topic, but as a physician who completed medical school and residency you are equipped to critically apply your knowledge to inpatient medicine.
Fast facts of Hospitalist medicine
Hospitalist medicine is inpatient medicine only that operates on shifts. These shifts can be during the day, late-afternoons (swing shift), and overnight (nocturnal shift). This means that you are not going to be paged (hopefully) when you are off. Many of these schedules have physicians working for 7 days in a row, followed by 7 days of break. Generally, this amounts to 14 working (long) days in a given month.
Since this profession is usually employed by hospitals, Hospitalists enjoy both the perks of hospital employment (read: earlier access to COVID19 vaccines) and the quality improvement measures that you might not be as excited about.
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The income rates are relatively set. You will likely earn more as a Hospitalist than as an outpatient primary care physician, but your income ceiling will be fixed. The only way to earn more as a Hospitalist is to pick up additional shifts or find additional work during your off-days. You can decide if this flexibility is a perk to you.
What do Hospitalists do?
Think about your inpatient rotations as a medical student. When people are sick enough to be admitted for a hospital stay, the Hospitalists are the ones who get them better to be discharged. This means checking labwork, ordering tests, handling specialty consults as needed, and adjusting treatment modalities to make people better. The volume of patients on your list may be relatively high, as hospitals have certain business and quality measures to meet. For you as the physician, this means trying to minimize the number of days a patient needs to stay before discharge. Hospitals make money by admitting more people, discharging them quickly, and making sure they don’t bounce back for another admission soon afterward.
To sum it up…
Hospitalists are internists who work strictly with inpatients. There is a relatively high availability of positions across the country, and the work hours are relatively predictable as a shift work field. There are various paths of training to become a Hospitalist, and there are even Hospitalist tracks in many training programs!
For those of you in Hospital medicine, what other comments do you have about your field?