Embarking on a Hospitalist Career: Residents’ Views and Perspectives

Background:

The number of hospitalists in the US grew from 1000 in 1996 to 30,000 in 2010. In 2013, 70% of hospitals with over 200 beds are served by hospitalists. Driving forces behind hospital medicine’s increasing popularity remain uncertain, opening unique prospects for collaborative research at the intersection of geriatrics and hospital medicine. This study examines decision pathways of residents leading to hospitalist careers in our aging society.

Methods:

An anonymous survey was distributed to Internal Medicine Residents (PGY 1‐4) at Grand Rounds from September to November 2013. Descriptive statistics were calculated for each variable/survey question. Association between potential factors and hospitalist career consideration were assessed using chi square or Fisher’s exact test, as appropriate.

Results:

There were 149 respondents: 49% were male, 71% US citizens, 56% US trained. Half (57%) were less than 30 years old. Residency level was equally divided between PGY‐1 (31%), PGY‐2 (36%), and PGY‐3 (32%). Almost all (92%) reported working over 50 hours/week. Half (48%) would consider a hospitalist career, while 8% would pursue a geriatric hospitalist future.

When asked about the most influential factors for career choice, 29% selected workload schedule, 16% professional environment, 16% reward incentives, and 15% personal autonomy.

Significant factors associated with decision to pursue a hospitalist career included: PGY level (p=0.008), age (p=0.02), enjoyment of interaction with older patients’ family members (p=0.03) and timing of career decision during either medical school or residency (p<0.001). Older respondents, those at higher residency training level, those who enjoy interacting with family members, and those who finalized career decisions during residency, were more likely to embark on a hospitalist career.

Conclusions:

Although a hospitalist career has become a popular choice among internal medicine residents, few are open to becoming geriatric hospitalists. In view of aging demographics challenges in the US, this study underlines pressing needs for educational initiatives, particularly during early residency, to better prepare young physicians to the realities of caring for the older population in hospital settings and to explore opportunities for geriatric innovations within hospital medicine.