How to Become a Hospitalist
While many physicians divide their time between the hospital and the office, hospitalists specialize in the care of hospitalized patients with serious medical conditions. Their duties are quite varied, but include:
- Managing the care of people recovering from acute injury or illness, including heart attack, stroke, and trauma.
- Working with the surgical team to coordinate patient care after an operation.
- Providing palliative care to help manage pain and relieve distressing symptoms.
- Educating patients and families on health-related topics.
- Ordering and interpreting medical tests.
- Writing and refilling prescriptions, both chronic and acute.
- Consulting with various specialists.
- Facilitating the patient's transition to the next care setting (e.g. - home, rehabilitation hospital, nursing home).
- Leading and supporting quality initiatives that improve patient care.
While hospitalists can theoretically come from any medical background, most have completed a residency in internal medicine, family medicine, or pediatrics. In addition, a growing number of "specialty" hospitalists practice psychiatry, obstetrics, orthopedics, and general surgery exclusively within the realms of the hospital.
Unlike primary care doctors, hospitalists generally have short-term relationships with their patients. Despite this, they benefit from the satisfaction of caring for people during some of the most difficult times of their lives. Hospitalist care is especially important for patients who don't have a family doctor to admit them or to visit them while in the hospital.
Although hospitalists spend most of their time with patients, they also work behind the scenes to make their hospitals safer and more effective at what they do. They often lead committees and initiatives that improve efficiency, focus on quality improvement (QI), promote infection control, and foster teamwork between hospital departments.
Typically, hospitalists are directly employed by individual hospitals or by larger medical networks. Others work for hospitalist or multi-specialty group practices that subsequently provide staffing to their hospital clients.
It's not unusual for hospitalists to work a portion of their shifts in post-acute facilities such as nursing homes and rehabilitation hospitals. This allows them to follow their patients in the transition from short to longer-term care, thus providing smoother transitions between these settings.
Hospitalists' schedules vary by hospital and practice, and options are numerous. Some may choose to work seven 12-hour shifts in a row followed by a full week off. Others work Monday through Friday every week. Still others will work several 24-hours shifts each week. The hospitalists in a department usually rotate night shifts, but some hospitals employ "nocturnist" hospitalists who only work nights.
While the job involves long hours, scheduling flexibility is a major lifestyle perk for hospitalists. Within a group of hospitalists, the team will be able to cover one another's patients when time off is needed. However, hospitalists should still expect to work their share of weekends and holidays.
Hospital medicine is a patient-focused specialty. Hospitalists spend the majority of their shifts interacting with seriously ill patients and their families. Hospital practice is also highly collaborative. Hospitalists work closely with emergency physicians, specialists, primary care providers, and case managers in order to coordinate their patients' care. For these reasons and more, strong interpersonal skills are required for anyone considered a career in hospital medicine.
Like all health care professionals, hospitalists must take precautions to prevent exposure to contagious diseases and hazardous chemicals. They also spend long periods standing and walking, which requires good health and stamina.
Major steps to becoming a hospitalist are as follows:
- Complete an undergraduate degree
- Complete medical school
- Complete a residency (often internal medicine, family medicine, or pediatrics)
- Become state-licensed
- Become board-certified (optional)
Education - Undergraduate and Medical School
Given that medical specialty selection does not begin until one is in medical school, the pathway towards practicing hospital medicine begins in the same fashion as it does for any medical specialty.
High school students can best prepare for a career in medicine by focusing on courses in mathematics and the sciences. Advanced coursework through AP, IB, or post-secondary option programs is particularly desirable. Students should seek out work or volunteer experience in the medical field by working in a lab, shadowing a doctor, or volunteering as applicable. The Association of American Medical Colleges lists summer science enrichment programs for high school students on its website [insert reference].
Most aspiring physicians complete a bachelor's degree before medical school (though a few schools offer combined BA/BS + MD programs). No specific major is required for medical school, but college students should maintain a high GPA and must complete prerequisite courses in biology, physics, and general and organic chemistry. Undergraduates must also take the Medical College Admissions Test (MCAT), which is required for admission to almost all medical schools. It's important to continue gaining medicine-related work and volunteer experience during college, as with high school.
Medical school typically lasts four years and leads to an MD (Medical Doctor) or DO (Doctor of Osteopathic Medicine) degree. The first two years of medical school are dedicated to classroom-based instruction in anatomy, physiology, pharmacology (medication science), pathology, biochemistry, human behavior, medical ethics, and health law. During the final two years, students rotate through various hospital departments as they practice their new clinical skills under supervision.
After medical school, graduates complete three to eight years of additional training in their specialty of interest. This period is called residency.
Although no specific type of residency is required to practice hospital medicine, many hospitalists will typically have completed a residency in internal medicine, family medicine, or pediatrics. A growing number of internal medicine residencies have even begun to offer dedicated hospital medicine tracks.
In addition to residency, many hospitalists also complete a one- or two-year fellowship in a related sub-specialty (for example, general internal medicine, geriatrics, etc). The Society of Hospital Medicine retains a list of hospital-medicine-focused fellowships. Most fellowships have both clinical and research components.
Many physicians become hospitalists after first working in another practice area. However, this trend is shifting as more newly minted physicians are entering hospital medicine directly out of residency.
Licensing and Certification for Physicians
Like all physicians, hospitalists must be licensed in the state where they practice. The first step is to pass the national licensing exam:
- United States Medical Licensing Examination – USMLE (for MDs)
- Comprehensive Osteopathic Medical Licensing Exam (for DOs).
Many states have additional licensing requirements, but these vary from state to state. To learn more, contact your state medical board.
Board certification of physicians is voluntary and signifies a high level of proficiency in a certain specialty. Board certified doctors are regularly evaluated to ensure they're keeping up with the latest advances in their field. At present, neither the American Board of Medical Specialties nor the American Osteopathic Association offers board certification in hospital medicine. However, physicians who want to increase their job prospects often pursue certification in a related specialty such as internal or family medicine.
Skills and Qualities of a Hospitalist
- Leadership and organizational skills – Hospitalists must be able to take responsibility for managing all aspects of a patient's care, in addition to leading quality improvement (QI/QA) initiatives within the organization.
- Communication - Hospitalists must be able to convey complex information to patients, families, and other healthcare professionals in a timely and appropriate manner.
- Problem-solving skills - Hospitalized patients have very complex medical needs. Therefore, hospitalists must be able to analyze all information available to make the most appropriate treatment decisions.
- Empathy - Hospitalists must be able to work well with people who are upset and in physical pain.
- Attention to detail – Given the complexity of caring for critically ill patients, even small mistakes can have big consequences. Hospitalists must be alert for small changes in the patient’s condition that could signal impending trouble. They must also be meticulous when managing patients' medications.
Opportunities for Advancement
As hospitalists gain experience, they often take on administrative roles such as safety officer, directors of quality, or chief medical officers. Some will ultimately choose to leave clinical practice to become hospital executives and administrators.
Teaching is another option for hospitalists. Some supervise residents and fellows in the clinical setting. Others seek professorships and research positions at medical schools.
If you would like to gain the necessary education to become a hospitalist, we highly recommend that you check out our free School Finder Tool located HERE.
Salary and Job Outlook
Interactive Map of Income and Job Growth Projections
Hover over any state to explore local income and job growth data.
Many factors can impact a hospitalist's earnings, including employer type, experience level, education, and patient population. A 2014 biannual survey by the Society of Hospital Medicine found that the median annual salary of a hospitalist is:
- $252,996 for adult hospitalists in non-academic (non-teaching) settings (up 8.2 percent since 2012)
- $195,832 for pediatric hospitalists in non-academic settings (up 9.5 percent since 2012)
- $187,600 for hospitalists in academic (teaching) settings (up 6.1 percent since 2012).
Salaries also varied by geographic area, with hospitalists in the Midwest earning the most and hospitalists in the larger metropolitan areas earning less. Hospitalists who are partners in physician-owned groups earned significantly more than those employed by hospitals or corporations.
The Bureau of Labor Statistics states that the median annual salary for physicians, including hospitalists, is $187,200 or higher. In efforts to increase their compensation, hospitalists can take on additional administrative and leadership duties.
Employment opportunities for physicians in general, and hospitalists in particular, should be excellent for the foreseeable future. According to the Bureau of Labor Statistics (BLS), employment of physicians and surgeons is expected to grow by 18 percent between 2012 and 2022, which is faster than the average for all occupations. There are several reasons for this trend. The health care industry is expanding in order to care for America's aging population. In addition, federal health care reform laws have expanded insurance coverage to millions of people, increasing the demand for physician services.
Beyond this, changes in physician practice have also increased the need for hospitalists. In the past, family doctors traveled to hospitals to care for their patients. However, this practice has been curtailed by the growing shortage of primary care providers. At the same time, today's hospital patients are more likely to suffer from multiple chronic conditions that require complex management. In response, more and more hospitals are hiring dedicated hospitalists to care for their complex inpatients.
Hospitalists can improve their job prospects by obtaining board certification and demonstrating leadership ability within their hospitals. Job openings are usually most plentiful in rural and lower-income areas.
The Society of Hospital Medicine maintains an online career center especially for hospitalists, including job listings and career advice articles.