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Calling all jugglers, multitaskers, directors, and problem-solvers, aka hospitalists.

Hospital medicine is one of the fastest growing and evolving pathways in medicine. Unlike some other specialties where lateral movement is almost impossible, the field offers multiple opportunities to divide your time between the clinic and other areas of interest, hone new skills, build subspecialties, and even teach.

But what does a hospitalist position entail? Is it the right career pathway for you? Medscape Medical News spoke with several seasoned hospitalists to help guide your decision.

Whole Body, Whole Playing Field

What’s the first thing that comes to mind when you hear the term ‘quarterback?’ Remove the gridiron and you have hospital medicine, where hospitalists take the lead on whole-body patient care strategies. Hospitalists thrive on taking a 30,000-foot view from the hospital bedside.

“What I really love is taking care of all of the parts of the patients in their most vulnerable periods, when they are acutely ill and admitted as medical inpatients,” said Joseph R. Sweigart MD, a direct care hospitalist and associate professor of hospital medicine at the University of Kentucky College of Medicine, Lexington, Kentucky.

Darlene Tad-y, MD, associate chief medical officer of patient flow at University of Colorado Hospital, Aurora, Colorado, noted that it was this whole-body, organic approach that first drew her to the field.

“I liked the generalness of it and didn’t have a particular organ system or a set condition that really stood out for me,” said Tad-y, who is also a professor of medicine at the University of Colorado School of Medicine, Aurora, Colorado. “I think being a hospitalist allows me to be more of the quarterback on the patient’s care and see the whole playing field.”

Teamwork Is Key

A hospitalist must be a team player. Though often in charge of spearheading decisions, they are also required to check their egos at the door. “The field is not for people who feel the need to be an expert in one particular area or whose nature makes them want to definitively fix everything,” said Shannon Martin, MD, academic hospitalist and associate professor of medicine at University of Chicago Medicine, Chicago.

Martin, who specializes in hospital medicine education, noted that “as a generalist, hospitalists need to rely on consultants and bring help seeking and humility to every patient encounter.” The teams range from clinicians and nurses, to therapists, social workers, and care managers, who collectively address patients’ needs.

To do this job successfully, you must be organized and quick on your feet, added Allison Ashford, MD, meds-peds hospitalist and program director at the University of Nebraska Medical Center, Omaha, Nebraska. “You’re juggling a lot, and there’s a lot of balls in the air at the same time you’re coordinating with other consultants and the patient,” Ashford said.

Juggling also requires the ability to negotiate and simultaneously ensure that what’s best for the patient remains in the foreground. At the same time, hospitalists need to be well-versed in patience and mindful of frustrations patients often face about their illnesses and other challenging life experiences.

“We’re meeting people under very, very trying circumstances,” said Martin. “We often have to deal with the baggage that comes from their prior interactions with a complicated healthcare system. You’re taking care of patients whose outcomes are often also influenced by social determinants of health, like care access and social and structural inequities.”

The Patient Relationship

A frequent criticism of hospital medicine is that there is no real opportunity to form longitudinal physician-patient relationships. But it’s a bit more complicated than that, according to Sweigart.

“There’s a myth that continuity is only available in the outpatient clinic, but I’ve come to recognize that over the course of a hospitalization, I may actually spend more physical time in the room getting to know patients than they might spend with their outpatient doctors over the course of several years,” said Sweigart.

Sweigart said that the flexibility that comes with the job means that he can spend as much time as he needs to help patients and their families understand their medical issues, learn their values and circumstances, and then work together to formulate an action plan, even amid difficult diagnoses.

“This is very different than in a clinic environment where time is very much externally mandated,” he said. “It’s a different kind of continuity, but in terms of depth, I really get to know people and have meaningful relationships with them.”

Ashford concurs. “I find that the challenge of needing to quickly form a therapeutic relationship with somebody that might be one of the worst moments of their lives is very rewarding and almost a relationship in and of itself,” she said. “It’s a high-stake moment in their lives, their family’s lives, and their health as well.”

Tad-y added another perspective: Seeing critically ill patients who land in the hospital go home.

“The longitudinal relationship is less important to me than doing a really good job in the short-term, one that allows patients to be well enough to go home and not come back,” she said.

A Shifting Perspective on Shift Work

Work-life balance is a hot topic across several industries, and medicine is no exception. It’s become increasingly important in hospital medicine, where hospitalists work nights, weekends, and holidays to deliver 24-hour patient care.

The default approach — shift work — has long been 7-, 12-hour days on duty, followed by 7 days off, said Sweigart, acknowledging that it can be a difficult existence when families, children, and various schedules need to be coordinated. But many hospitals are moving toward a clinical shift model that is more “life-friendly.”

“This is where some leaders in hospital medicine have gotten creative, and it’s not just the rote 7 days on, 7 days off,” said Tad-y. “Instead, the shift is from 7 AM to 4 PM, and then there’s a swing shift, and then, the night team comes in at 6 PM. New innovative staffing models have also come into play, where maybe the number of consecutive days is shaved to 3, and then you have 3 days off, followed by 4 days on, etc.” 

Wide-Ranging Opportunities for Hospitalists

Hospitalists often come into the field with a 100% focus on clinical work. But hospital medicine provides a breadth of opportunities that permit doctors to expand their expertise and interests. That helps sustain interest in the field, while also building lateral roles. 

“Hospitalists are central to so many different parts of the care system, and because of that, take many different avenues and get involved in a lot of different things,” explained Tad-y. Examples include subspecialties, such as oncology hospital medicine or surgical hospital medicine.

“There’s an opportunity to develop areas of expertise and clinical niches, pursue research interests, or get involved in things like quality improvement or group leadership or education,” said Sweigart. “Lots of hospitalists make the transition to full-time hospital administration, into the C-suite, or hospital executive positions, while others become program directors and take dean positions at universities and colleges.”

Martin also acknowledged the growing field of health systems science. For example, how the system can be improved to optimize care delivery — an area that is especially relevant to addressing gaps in pediatric care delivery. (Martin is a dual internal medicine and pediatric specialist.)

“I’m really passionate about finding those little spaces where hospitalists can lead outside of their traditional clinical roles,” said Martin. “It’s really exciting and cool to see how the work has evolved.”

Sweigart and Tad-y are members of the Board of the Society of Hospital Medicine. Ashford is the member of several Society of Hospital Medicine Committees. Martin had no financial disclosures of interest.

Liz Scherer is an independent health and medical journalist.