Features of Successful Academic Hospitalist Programs: Insights from the Scholar (Successful Hospitalists in Academics & Research) Project

Background:

Balancing academic work with expanding clinical demands is a challenge for many academic hospital medicine programs (AHMs). Understanding the infrastructure that best positions successful programs to thrive academically is important to facilitate broader maturation of the field. The SCHOLAR project research group, a joint venture between the Academic Hospitalist Committee of SHM and the Academic Hospitalist Task Force at SGIM, was formed to undertake this work.

Methods:

“Success” for AHMs was prospectively defined as: 1) a high percentage of faculty above the rank of Assistant Professor, 2) significant grant funding, and 3) a track record of scholarly output. An SHM Task Force survey of AHM leaders provided comparative self‐reported data on the first 2 metrics. Scholarly output was defined as the number of research abstracts per AHM accepted at the SHM and SGIM national meetings in 2010 and 2011. AHMs were rank ordered in each of the 3 categories. Programs that appeared in the top 10 lists for at least 2 of the 3 metrics were included; 17 AHMs met these criteria. Leaders of these programs completed a survey detailing the structural components of their respective groups.

Results:

Data are reported as mean (range). Top ranking AHMs met the following measures of success: percent of faculty above assistant professor was 45% (31‐60). Total grant dollars were $5.5 million (1‐15.5 million); grant dollars/FTE was $469,307 (0.38 ‐1.4 million). Abstracts per group were 12.8 (4‐21).For the 17 AHMs identified, mean program age was 13.2 years (6‐18), and faculty size was 36 (18‐95, median 28). The percent of faculty by academic rank was as follows: clinical instructor 19.5% (0‐58%), assistant professor 53% (20‐92%), associate professor 11% (1‐33%), professor 4.6% (0‐26%). Ten percent of hospitalists were in non‐faculty positions (0‐40.6%). Faculty with any fellowship training comprised 14.7% (0‐37%) of the hospitalists in the identified groups. Among the 17 AHMs, 53% were a separate division or section in the Department of Medicine, 29% were a section within General Internal Medicine, and 18% were a clinical group without formal designation.

Conclusions:

Despite the maturity and large size of successful AHMs, they are comprised of relatively few senior faculty members; overall less than 15% rank above Assistant Professor. The predominance of early‐career hospitalists may reflect rapid expansion or pervasive barriers to promotion. There was significant variation in structure among successful AHMs, including some with a heavy reliance on non‐faculty hospitalists. In addition, fellowship training was rare. As there is no comparison set of AHMs, it is difficult to determine if these basic characteristics contributed to their current success or are a consequence of it. Semi‐structured interviews with leaders of the 17 AHMs will provide further perspective on factors driving success.