Hospital medicine remains a crucial part of the healthcare system, with hospitalists not only managing inpatient care but also collaborating with colleagues from critical care, emergency medicine, cardiology, neurology, orthopedics, and additional specialties.

The traditional model of clinicians making rounds at the hospital isn’t the new standard of hospitalists. In fact, the acuity and complexity of hospital-based care continue to rise, and it requires clinicians who are experts not only in disease management but also capable of navigating the complex hospital system to make sure that care is efficient and safe, said Amber Inofuentes, MD, division chief of hospital medicine at UVA Health in Charlottesville, Virginia.

Key Factors to Evaluate When Selecting a Hospital

Selecting a practice location is a decision that warrants careful evaluation of relevant factors. Consider the following guidelines to support your decision.

Practice dynamics. Consider what your daily role will be and decide what your priorities include. These factors can help drive your decision-making process. 

“Day-to-day patient load, and the structure of the rounding team on which you will work, is one of the most important factors to consider for a hospitalist position,” Inofuentes said. She also recommended considering exploring not only what the average or typical census is, but also whether there are caps, and what is done if the census exceeds those caps? For example: Is there a mechanism for bringing in additional support, or do the rounders just have to divide up the additional patients?

The landscape of the clinical environment is also significant. Delve deeper into these possible queries, Inofuentes said:

Ask about your team. Learn whether you will be working with advanced practice clinicians, and if so, what is expected of them. Will they round on a subset of your patients independently, handle new admissions to your team while you focus on rounding, or manage certain tasks for the entire list, such as placing orders, calling consults, and communicating with primary care physicians? 

Inquire about workload and census. What’s the ancillary support provided to manage that patient load? Will you have a designated case manager and/or care coordinator to help with nonphysician tasks? “The level of support for things like prior authorization and coordinating post-acute care needs can significantly impact your day-to-day workload,” said Inofuentes. Ask whether the job involves only day shifts or also includes nights, and if so, how many night shifts per year are expected. It’s also smart to inquire about the role at night. “Is it admitting, cross-covering, or both, and what is the workload?” Inofuentes said.

Research employment trends. Consider why this institution is hiring: growth, temporary needs, or turnover. “Be mindful of whether a hospitalist program has a higher-than-average degree of turnover and ask why [the] turnover is occurring,” Inofuentes recommended. It is not uncommon for programs to take newer graduates who work as hospitalists for a couple of years before fellowship, but the annual high turnover of more experienced hospitalists would be a red flag. 

Understand clinical workflow protocol. It’s helpful to know the norms around consultation. She suggests finding out about these two issues: Is it more of a model of co-management where consultants take over the ownership of a specific problem and write orders for diagnostic tests and treatments, or do they make recommendations that you, as the hospitalist, must enact? Is there a lot of direct communication with consultants, or is it typical to only interact through notes?

Take note of pay. Consider compensation holistically and review the benefits plan offered, including retirement plans and discretionary dollars for conference fees, recertification, and other materials, noted Inofuentes. “Sometimes a lower base salary at one institution that comes with considerable benefits may actually equate to a higher compensation than an institution with a higher base salary,” she said.

Explore whether teaching opportunities exist. Find out about learner exposure, and have an open mind about students who are not just medical students, including physician assistant and nurse practitioner students who might rotate through the services, Inofuentes said.

The Influence of Location on Decision-Making

Location is a significant variable. 

“The location of the hospital you are interested in practicing will influence what type of hospital it is, and what patient population you will be caring for,” said Samantha Murray-Bainer, MD, an academic hospital medicine physician and assistant professor at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. Also, teaching opportunities should be considered when weighing location choices. 

“Academic medical centers associated with a medical school are typically in suburban and urban locations, so if you desire to work with learners, medical students, and residents, you will need to take that into account,” she said. 

If you work in a rural area, your scope of practice may be different. “Rural hospitals are typically smaller, with less access to subspecialty support and ICU care, and therefore the hospitalist may need to expand their scope of conditions cared for,” Murray-Bainer outlined. 

The Importance of Conducting a Site Visit

There are several benefits to going to the hospital and conducting face-to-face interviews. “You should absolutely do an in-person interview when able,” said Murray-Bainer. 

This gives you an opportunity to get a sense of the culture of the hospital and colleagues. 

“Getting to socialize with the hospitalists in the group will help you determine how likely you will be to make friends — which is vital for well-being in the workforce — as well as make sure the geographic area makes sense for you and anyone else who is relocating with you,” she said. Further, be mindful of whether the hospital medicine group works at more than one site and consider where you would live to have a reasonable commute to all the sites, Murray-Bainer advised. 

Technology, Evolving Patient Care, and Hospital Medicine

Regarding patient care, Murray-Bainer said to opt for a hospital with an adequate electronic medical record (EMR) that integrates well with other systems through tools such as Care Everywhere. 

“It is very hard to work at hospitals that don’t talk to other EMRs because of the fact that patients transfer in and out of hospitals regularly,” explained Murray-Bainer. “With the breakthroughs in AI [artificial intelligence], you will also want to know what the hospital is doing with AI in the inpatient space.”

Inofuentes and Murray-Bainer reported no disclosures.