Background: Building a diverse hospitalist workforce is of paramount importance as a growing number of studies demonstrate the value of diverse teams on patient care (reference 1). A 2019 Association of American Medical Colleges report on race/ethnicity data of full-time academic medicine faculty showed that 3.6% self-identified as Black or African American, and 5.5% self-identified as LatinX or Hispanic, which is not representative of the U.S. population (reference 2). These patterns continue to be reflected in the hospital medicine workforce and leadership across the nation. A holistic review framework can serve as a strategy to hire a diverse healthcare workforce; however, many hospitalist groups do not have experience in applying holistic review principles to the recruitment and hiring process.

Purpose: Develop and implement a standardized and effective workflow for reviewing hospitalist applicants utilizing principles of holistic review at an academic hospital medicine division at a large, tertiary care urban hospital. The aim is to improve the recruitment and hiring experience for applicants and to increase the number of individuals who identify as underrepresented in medicine (URM) in our division.

Description: Holistic review refers to a mission-aligned selection process that considers applicants’ broad range of attributes and experiences in addition to more traditionally assessed metrics such as awards, honors, and positions held (reference 3). The conceptual design of our hospital medicine holistic review process was four-fold: 1) determine our guiding principles; 2) align our division’s mission statement with characteristics we value in hospitalist applicants; 3) standardize recruitment and hiring processes to ensure greater equity in applicant experiences and interview evaluations; and 4) provide training on holistic review to those participating in the recruitment and hiring process. In creating our guiding principles, we determined selection criteria would not be solely based on academic experiences, but would equally value broad identities and lived experiences, personal and professional attitudes, interpersonal style and communication, and journey and contributions to medicine. We aligned our division’s mission statement with characteristics we value in applicants, which were clinical excellence, teaching potential, academic potential, contribution to diversity, communication skills, and caring and compassion. Standardized interview questions with an accompanying quantitative and qualitative assessment tool were created to assess each of these domains. Concurrently, we modified our website, job description, and public branding to reflect our mission. Faculty and staff development sessions regarding recruitment and hiring workflows were deployed such that each applicant could be approached and evaluated in a similar manner.

Conclusions: Creating and applying a holistic review process for hospitalist applicants at an academic division is feasible, and remains an ongoing process that is continuously improved. Early results demonstrate that 20% of our new academic hospitalist faculty identify as URM in the most recent hiring year; however, this needs ongoing study to determine effect on retention, and the impact on applicant and faculty satisfaction of the holistic review process remains unknown. Ongoing concurrent steps include continuing to think about diversity broadly and cultivating a sense of inclusion and belonging amongst all faculty and staff.

IMAGE 1: Figure 1. Sample questions for conducting holistic interviews that assess for characteristics our division values in applicants and is aligned with our division’s mission statement.