Background: Choosing a career in hospital medicine is becoming increasingly common among residents and medical students in the United States (US). Little is known about the factors associated with choosing a hospitalist medicine career among fourth-year medical students.

Methods: We collected demographic and survey responses from the Graduating Questionnaire (GQ) survey administered by the Association of American Medical Colleges (AAMC) for the years 2018-2020 to graduating fourth-year US medical students. The data were obtained from, and used by permission of the AAMC. The sample included only participants who answered the question about planning to work as a hospitalist at some point in their medical career (N=30,609). Univariate tests using Chi-square and Kruskal-Wallis test, and a multivariable regression analysis were performed to assess interdependence of factors regarding the choice to work as a hospitalist.

Results: In total, 8,963 students stated an intent to work as a hospitalist (HM) during 2018-2020 survey sets (19% of question respondents, remaining roughly unchanged 2,997 in 2018 to 2981 in 2020). Among future hospitalists, the most frequent subspecialties included internal medicine (IM) (32%), Pediatrics (15%), and Surgery (9.1%). Within subspecialties, however, the percent of respondents interested in HM predominated in Internal Medicine/Pediatrics (49%), Internal Medicine (IM=32%), and Pediatrics (28%). Students who considered HM career plans were more likely among various minority groups in medicine: female (20% vs. 18%, p<0,001); bisexual (23%) or gay/lesbian (22%) rather than heterosexual (19%) (p<0.001); and Hispanic (26%), African American (22%), or Asian (22%) rather than White (17%) (P<0.001). When asked what influenced their career choice, HM respondents stressed the importance of role models (53%), and the ability to do a fellowship (38 %) (All p<0.001). Future HM also averaged higher educational debt ($170,000) when compared to those who were unsure ($155,000) or responded no ($ 153,000). Conversely, interest in higher salary and work/life balance were associated with lower likelihood of choosing hospitalist. Multivariable analysis determined that race, sexual orientation, length of residency, educational debt, plan to enter loan forgiveness program, ability to do a fellowship, were all independently associated with a higher likelihood of HM career choice (p<0.001).

Conclusions: About one in five US medical students are interested in working as Hospitalists. More than a quarter of students interested in Internal Medicine and Pediatrics will also consider HM. The typical future HM professional is most likely gay/lesbian, bisexual, Asian, Hispanic, or African American race, with a higher amount of educational debt, planning on entering loan forgiveness program, and interested in doing a fellowship.