Hospitalists have a great deal to contribute to the field of medicine and the improvement of patient care. A major challenge, however, can be finding the time to dedicate specifically to research and scholarly pursuits to advance that knowledge base.

How realistic is it for hospitalists to expect to have time specifically designated for scholarly pursuits?

It may depend on their role, specifically one that demonstrates scholarly success in academic hospital medicine. As a 2023 qualitative study in the Journal of General Internal Medicine noted, “having (protected time) is strongly associated with hospitalists’ ability to publish and advance in academic rank.”

Officially protected time typically comes when one has a leadership or administrative role — and an expectation to do research and publish, noted Joseph Sweigart, MD, an associate professor in the Division of Hospital Medicine, UK College of Medicine in Lexington, Kentucky. If a hospitalist works in a purely clinical role, protected time may not be included.

Working It in

Along with the lack of mentorship, research skills, and funding, the lack of time was one of several major barriers to participation in research physician hospitalists cited in a 2020 study in the journal Hospital Practice.

The reality is that many hospitalists may have to work their research pursuits into their personal time, especially early in their careers when obtaining protected time can be difficult, according to the authors of the 2023 Journal of General Internal Medicine study.

“Academic hospital medicine leaders generally expect that hospitalists will utilize personal time to pursue scholarship, and this is often prerequisite to receiving time from the division,” they wrote.

Some experts acknowledge that it may be challenging at times, but it can work if they change their approach to their nonclinical days. Consider the 7-days-on-7-days-off schedule that’s common for many hospitalists.

Sweigart works a Tuesday-Monday, 7-on-7-off schedule. His job is devoted entirely to clinical care, so he has to think strategically about finding time for scholarly pursuits.

“What works best for me is carving out an hour or 2 from clinical time on most days,” he said, clarifying, “Not all days.”

But that solution may not work for everyone. Others might prefer to dedicate a day or 2 during the 7 days off to engage in research, write case studies, or pursue other goals.

For example, Daniel Brotman, MD, suggested that hospitalists who work a 7-on-7-off schedule consider coming into the hospital on their day off.

“Unless you’re really good at working from home, I would strongly encourage that people take that approach,” said Brotman, director of the Division of Hospital Medicine with Johns Hopkins Hospital in Baltimore.

“Specify it as: This is not a day off. It’s an academic day,” he added. “And be regimented about it.”

If the idea of spending time on scholarship during your days off sounds daunting, Brotman suggested comparing how many clinical hours you work in a typical year against the work load of a physician in private practice in their community, who may work 2000 hours a year.

“In my mind, for an academic hospitalist to say, ‘I’m working 1800 clinical hours a year and that’s a full-time job, and I don’t have time to do anything else,’ is problematic,” Brotman said. “At Hopkins, we consider an academic job to be 2250 hours per year, with most of that time clinical but some academic.”

And they may need to take another look at their work responsibilities.

“If people are finding themselves so burned out by their clinical work that, on their nonclinical days, they can’t do anything other than decompress…then the issue isn’t that they’re not getting that protected time,” Brotman said. “They’re being overworked in their clinical time. Or are in the wrong position. No clinical job should leave you so exhausted that you need more than 2-3 days to decompress after each stint of work.”

Make It Count Twice

One way to find time to incorporate research into a busy schedule is an approach that Neera Ahuja, MD, calls “Make it count twice.”

If a physician can get data from clinical work that they’re already doing, they could turn it into a research project.

“It just has to be innovative,” said Ahuja, senior vice president and chief medicine officer for inpatient care with Stanford Healthcare in Palo Alto, California.

For example, a 2024 Centers for Medicare & Medicaid Services rule that inpatients must be screened for certain social determinants of health, such as food insecurity, housing insecurity, abuse and neglect, generated a unique project at Stanford: the Food Insecurity Reduction & Strategy Team.

Ahuja and her team decided to design a comprehensive community health intervention to explore the relationship between food insecurity and the hospitalized diabetic population. Via a partnership with a local organization to provide free meals to patients, the team was able to assess how the intervention helped the patients with managing their diabetes, as well as their overall health and welling.

“It was based on something that we had to do anyway,” said Ahuja, referring to the requirement to screen patients for food insecurity. “So that’s how I tell my faculty how to approach things, and that’s how I do it myself.”

Find a Strategy That Works for You 

Early-career hospitalists may also need to think small before they think big. According to Brotman, it’s unusual for hospitalists without specific research training to be able to pursue large-scale research projects, unless they have very strong mentorship. But they could start with smaller-scale projects, such as a review article or a case study, before deciding to take on a larger project.

“You’ve got to learn how to crawl before you walk,” he said.

However, acquiring the structured skills training necessary to pursue research is “generally inaccessible to hospitalists not on a predetermined research track,” the Journal of General Internal Medicine study authors wrote.

So is it time for hospital leaders to re-evaluate their approach to supporting scholarship? Perhaps.

“As a field, hospital medicine would benefit from research on effective models for divisional support of scholarship,” the Journal of General Internal Medicine study authors wrote. “Likewise, we encourage leaders in hospital medicine to reconsider the status quo of personal time as a necessary portal of entry to scholarship.”

However, in the meantime, hospitalists may need to step back and consider how to work with what they’ve got.

Andrew Dunn, MD, agreed that a 7-day span of 12-hour days with a very high patient census may indeed make some hospitalists less eager to engage in any kind of extra work during their off days, especially if they have family obligations or other responsibilities competing for their time.

“When you spread the work out over more weeks, you have a little more energy to get involved in other activities,” said Dunn, chief of the Division of Hospital Medicine and professor of medicine with the Icahn School of Medicine at Mount Sinai in New York City.

What works for one hospitalist may not work for another, said Sweigart. “There’s not a one-size-fits-all (solution),” he continued. “Different people are going to have different goals and different bandwidth.”

Dunn has additional advice for hospitalists eager to pursue more scholarship: find what you love to do in the hospital setting besides seeing patients, whether it’s teaching medical students or engaging in quality improvement projects. “If you love it, you’re going to be great at it,” he said. “Find ways to innovate. It is very feasible to translate that into scholarship.”