Background: Hospitalists—even at academic institutions—publish fewer papers than physicians in other specialties. In a 2021 study of the top 25 internal medicine residency programs, 51.4% of hospitalist faculty had zero publications and only 11.7% had been promoted beyond assistant professor (Sumarsano et al); by comparison, a 2014 study of academic cardiologists reported 28.2% were full professors (Blumenthal et al). Because dissemination and national reputation are key requirements for promotion, lack of publications can slow academic advancement. Since the beginning of the COVID-19 pandemic, hospitalists have been the primary providers for patients hospitalized with COVID-19 and have been tasked with developing, implementing, and leading surge response teams. As such, hospitalists developed first-hand knowledge and became experts in treating acute COVID-19. However, it is unclear whether hospitalists were able to share this expertise via publication. Thus, we sought to determine how often hospitalists were authors on COVID-19 related publications during the pandemic.
Methods: We reviewed all COVID-19 related articles (identified by keyword) published between March 1, 2020 through February 28, 2021 in the top four US medical journals (identified by impact factor). Because hospital medicine is primarily a US-based specialty, articles were included only if the first or senior author was US-based. For each included article, we identified the specialties of all US-based authors from byline affiliation, online biography, or listed fellowship. Internists not listed as an inpatient physician or hospitalist were presumed to be non-hospital based general internists. Eligibility review and data entry occurred independently in duplicate with discrepancies resolved by consensus. Summary statistics were used to describe author specialties by journal and article type.
Results: Between March 1, 2020 and February 28, 2021, the top four US-based medical journals published 596 articles related to COVID-19 with a US-based first or last author. Of these, 28.7% (171/596) were research articles, 5.9% (35/596) were clinical review or education, and 65.4% (390/596) were commentary, editorial or viewpoint articles. The 596 included articles had a total 3189 US-based authors (578 first, 2137 middle, 474 last). Of these, there were 1315 non-physician authors (41.2%) and 1874 physician authors (58.8%). Only 4.1% (77/1874) of all US-based physician authors were hospitalists (see figure 1). This includes 3.7% (15/410) of physician first authors, 4.4% (49/1124) of physician middle authors, and 3.8% (13/340) of last authors (see figure 2).
Conclusions: Despite serving as the frontline COVID-19 clinicians for hospitalized patients, very few hospitalists have published COVID-19 related work. Rather, the increased call to clinical care appears to have worsened the publication discrepancy between academic hospitalists and their non-hospitalist colleagues. Not only could this lack of publications worsen the imbalance in promotion for academic hospitalists, it also may result in missing critical insights from frontline COVID-19 clinicians. To enable the best care for hospitalized patients, hospitalists should be supported in their academic endeavors. Furthermore, promotions committees should consider the disproportionate effect of COVID-19 on hospitalists and consider non-research related criteria when assessing eligibility for promotion.
