Rebecca Harrison, MD, FACP

Hospitalists are hospital‐based physicians whose primary professional focus is patient care, education, research, and administrative activities related to hospital medicine.1 Initially, community‐based hospitals were far more likely to employ hospitalists than academic centers. However, today most academic centers employ hospitalist models and it is now a fully recognized entity in academic settings.2

While much has been written about the structure, business operations, and potential benefits of nonteaching (clinical) hospitalist programs,3, 4 there is little known about the current state of academic hospitalist programs or their challenges. For example, who are the leaders of academic hospitalist medicine groups? Given the youth of the field, are academic hospitalists receiving adequate mentorship and are they advancing academically? What are future directions and goals for academic hospitalist groups?

To better understand academic hospitalist programs, we surveyed division chiefs and academic hospitalist leaders to explore existing business models and operations, the status of mentorship, and key issues in growth and retention.

Methods

Results

Discussion

Our survey provides a unique snapshot of academic hospitalist groups, highlighting a perceived lack of support and respect for their programs, a need to increase education and scholarly activities, and a desire to better prepare faculty for academic promotion.

Academic hospitalist groups and leaders reflected what one would expect from a field that is just over a decade old. Program leaders were relatively new to their position, as were their division group members. As a result, it is not surprising that most of the academic hospitalist leaders identified mentorship as a major issue. We were encouraged to see that most programs were offering annual reviews. However, the majority of these annual reviews were performed by the group leaders, many of whom are relatively junior (40% Assistant Professors) and may not be experienced in mentoring and performing annual reviews. Importantly, the absence of a mentor (or a high‐quality, experienced one) among physicians, and specifically hospitalists, may result in fewer peer‐reviewed first author and non‐peer‐reviewed publications, and less experience leading a teaching session at a national meeting.6 Research suggests that effective mentoring may help faculty increase career satisfaction and productivity and reduce their risk for burn‐out.7 Hospitalist groups might benefit nationally from focusing specifically on finding adequate mentorship either within or outside their groups. In addition, national organizations such as the SHM and the SGIM could potentially help these groups and individual hospitalists in creating mentorship networks and a mentoring infrastructure.

Academic hospitalist leaders were concerned about the ability of their faculty to develop sustainable nonclinical activities and scholarship. Notably, more than 40% of surveyed leaders agreed or strongly agreed that their faculty were not developing sustainable nonclinical activities. For individual faculty, the inability to develop scholarly activities and engage in academic pursuits may create challenges in getting promoted by traditional academic pathways. Some have recognized this issue and tried to develop practical solutions.2 In addition, academic hospitalists often engage in nonclinical activities such as quality improvement or patient safety which do not fit in the traditional tripartite mission of academics (clinical care, education, and research). In this survey, more than 90% of groups were engaged in quality improvement projects and over half in peer review exercises (Table 1). As many of these scholarly activities require innovation, sophisticated data analysis, and can have far‐reaching and substantial impacts on healthcare, some have argued these should be considered as part of the promotion process.8 Notably, the SGIM Academic Hospitalist Taskforce has created the Quality Portfolio, a structured adjunct to promotions packets to organize and document work in quality improvement and patient safety.9

While there were few CI in the divisions surveyed, building CI programs was a major priority of programs. In programs reporting the presence of CI's, they report limited access to research support. This highlights the potential role and benefit of post residency training in designing and conducting clinical research whether in a traditional general internal medicine fellowship or in 1 of the many growing hospital medicine fellowships.10 There also appears to be a need for funding to support the research careers of junior hospitalists. While access to effective mentorship is integrally linked to achieving increased academic accomplishments, there is certainly an ample call for research in the areas of quality improvement, patient safety; systems‐based practice, hospital efficiency, transitions of care,11 perioperative medicine,12 and education.2, 13, 14 While providing lower costs per admission and lower lengths of stay, hospitalists seem well‐positioned to spearhead active research in cost‐effectiveness in the hospital.14 Additionally, a quality portfolio, documenting such quality improvement projects, has been suggested as an effective means to provide a record of this work for academic promotion.9

The diverse activities of today's hospitalists are transforming the traditional view of academic work and are critical to the growth of hospitals, patient care, and development of the field of hospital medicine itself. Until these areas are fully embraced as legitimate areas of academic productivity and scholarship, the academic advancement of hospitalists will be slow.

It is unclear from our survey if academic hospitalist programs are truly getting the support they need to succeed. On one hand, there was general agreement that the Departments of Medicine and Divisions of General and Hospital Medicine were invested in the development of the academic accomplishments. Yet, the majority of program directors believed that they are viewed by the Department or Division as a clinical rather than an academic program. Moreover, over half of program directors report that their hospital was not supportive and therefore have limited the expansion of their hospitalist groups' educational and research activities. Lastly, for a large majority of programs, unavailable funding also acted to limit growth and expansion of academic functions. In a mere 2 decades, Emergency Medicine has become one of the largest US specialties and yet research and funding in the field have been lagging and are limiting academic expansion. Junior faculty seeking research careers struggled to find support and mentorship within their emergency medicine divisions.15 Challenges faced by academic emergency medicine provide important historical perspective for the even more rapidly growing field of academic hospital medicine. Learning from the Academic Emergency Medicine experience, academic hospitalists should proactively identify scholarship and research opportunities unique to hospitalist and fitting the needs of academic institutions. Involvement in national medical organizations, such as SGIM‐SHM‐ACGIM Academic Hospitalist Academy, or the SGIM Academic Hospitalist Task Force, where skill and career development is the focus, will undoubtedly promote the success of academic hospitalist. Expanding valuable niches of expertise, such as quality control, perioperative medicine and care transitions, create an indispensible component of hospital care. Lastly mentoring programs for academic hospitalist within SHM and SGIM are also essential for networking and career development. There are several limitations to our study. Our response rate of 40% was relatively low, and our results may not be representative of all academic hospitalist division chiefs and their programs, may be overstating the perceived difficulties of the survey sample, or conversely missing a large portion too overwhelmed by current duties who lacked the time to complete the survey. Having said this, our survey methodology targeted sites where we could identify potentialnot confirmedhospitalist groups and hospitalist group leaders. For this reason, our response rate could be higher (if some of our contacts were in error). Our results are a cross‐sectional survey based on self report and are subject to recall bias. In addition, our study was carried out in 2007, and while issues such as mentorship may remain important, our results regarding financial arrangements may not be applicable to the current economic climate. Finally, while improving mentorship was identified as a principle objective for program leaders, we did not explore the existing quality of mentorship, nor perceived shortfalls. This should be the subject of future exploration.

The vast majority of academic hospital medicine programs continue to view inadequate support, expanding research, mentorship, and academic promotion as critical issues for the future. Thus, further understanding of these features, and interventions to allow for success, are of crucial importance in the continued development of academic hospitalists. Our study supports the need for mentoring and career development programs, targeting academic hospitalists and their leaders. In addition, attention should be paid to activities that support career fit, creating sustainable and viable job descriptions for academic hospitalists, and preventing burnout.16 At the same time we must expand the traditional view of scholarship and training and advocate for promotion criteria that value the unique contributions of hospitalists to become in line with the broad areas that hospitalists work.

Hospitalists are hospital‐based physicians whose primary professional focus is patient care, education, research, and administrative activities related to hospital medicine.1 Initially, community‐based hospitals were far more likely to employ hospitalists than academic centers. However, today most academic centers employ hospitalist models and it is now a fully recognized entity in academic settings.2

While much has been written about the structure, business operations, and potential benefits of nonteaching (clinical) hospitalist programs,3, 4 there is little known about the current state of academic hospitalist programs or their challenges. For example, who are the leaders of academic hospitalist medicine groups? Given the youth of the field, are academic hospitalists receiving adequate mentorship and are they advancing academically? What are future directions and goals for academic hospitalist groups?

To better understand academic hospitalist programs, we surveyed division chiefs and academic hospitalist leaders to explore existing business models and operations, the status of mentorship, and key issues in growth and retention.

Methods

Results

Discussion

Our survey provides a unique snapshot of academic hospitalist groups, highlighting a perceived lack of support and respect for their programs, a need to increase education and scholarly activities, and a desire to better prepare faculty for academic promotion.

Academic hospitalist groups and leaders reflected what one would expect from a field that is just over a decade old. Program leaders were relatively new to their position, as were their division group members. As a result, it is not surprising that most of the academic hospitalist leaders identified mentorship as a major issue. We were encouraged to see that most programs were offering annual reviews. However, the majority of these annual reviews were performed by the group leaders, many of whom are relatively junior (40% Assistant Professors) and may not be experienced in mentoring and performing annual reviews. Importantly, the absence of a mentor (or a high‐quality, experienced one) among physicians, and specifically hospitalists, may result in fewer peer‐reviewed first author and non‐peer‐reviewed publications, and less experience leading a teaching session at a national meeting.6 Research suggests that effective mentoring may help faculty increase career satisfaction and productivity and reduce their risk for burn‐out.7 Hospitalist groups might benefit nationally from focusing specifically on finding adequate mentorship either within or outside their groups. In addition, national organizations such as the SHM and the SGIM could potentially help these groups and individual hospitalists in creating mentorship networks and a mentoring infrastructure.

Academic hospitalist leaders were concerned about the ability of their faculty to develop sustainable nonclinical activities and scholarship. Notably, more than 40% of surveyed leaders agreed or strongly agreed that their faculty were not developing sustainable nonclinical activities. For individual faculty, the inability to develop scholarly activities and engage in academic pursuits may create challenges in getting promoted by traditional academic pathways. Some have recognized this issue and tried to develop practical solutions.2 In addition, academic hospitalists often engage in nonclinical activities such as quality improvement or patient safety which do not fit in the traditional tripartite mission of academics (clinical care, education, and research). In this survey, more than 90% of groups were engaged in quality improvement projects and over half in peer review exercises (Table 1). As many of these scholarly activities require innovation, sophisticated data analysis, and can have far‐reaching and substantial impacts on healthcare, some have argued these should be considered as part of the promotion process.8 Notably, the SGIM Academic Hospitalist Taskforce has created the Quality Portfolio, a structured adjunct to promotions packets to organize and document work in quality improvement and patient safety.9

While there were few CI in the divisions surveyed, building CI programs was a major priority of programs. In programs reporting the presence of CI's, they report limited access to research support. This highlights the potential role and benefit of post residency training in designing and conducting clinical research whether in a traditional general internal medicine fellowship or in 1 of the many growing hospital medicine fellowships.10 There also appears to be a need for funding to support the research careers of junior hospitalists. While access to effective mentorship is integrally linked to achieving increased academic accomplishments, there is certainly an ample call for research in the areas of quality improvement, patient safety; systems‐based practice, hospital efficiency, transitions of care,11 perioperative medicine,12 and education.2, 13, 14 While providing lower costs per admission and lower lengths of stay, hospitalists seem well‐positioned to spearhead active research in cost‐effectiveness in the hospital.14 Additionally, a quality portfolio, documenting such quality improvement projects, has been suggested as an effective means to provide a record of this work for academic promotion.9

The diverse activities of today's hospitalists are transforming the traditional view of academic work and are critical to the growth of hospitals, patient care, and development of the field of hospital medicine itself. Until these areas are fully embraced as legitimate areas of academic productivity and scholarship, the academic advancement of hospitalists will be slow.

It is unclear from our survey if academic hospitalist programs are truly getting the support they need to succeed. On one hand, there was general agreement that the Departments of Medicine and Divisions of General and Hospital Medicine were invested in the development of the academic accomplishments. Yet, the majority of program directors believed that they are viewed by the Department or Division as a clinical rather than an academic program. Moreover, over half of program directors report that their hospital was not supportive and therefore have limited the expansion of their hospitalist groups' educational and research activities. Lastly, for a large majority of programs, unavailable funding also acted to limit growth and expansion of academic functions. In a mere 2 decades, Emergency Medicine has become one of the largest US specialties and yet research and funding in the field have been lagging and are limiting academic expansion. Junior faculty seeking research careers struggled to find support and mentorship within their emergency medicine divisions.15 Challenges faced by academic emergency medicine provide important historical perspective for the even more rapidly growing field of academic hospital medicine. Learning from the Academic Emergency Medicine experience, academic hospitalists should proactively identify scholarship and research opportunities unique to hospitalist and fitting the needs of academic institutions. Involvement in national medical organizations, such as SGIM‐SHM‐ACGIM Academic Hospitalist Academy, or the SGIM Academic Hospitalist Task Force, where skill and career development is the focus, will undoubtedly promote the success of academic hospitalist. Expanding valuable niches of expertise, such as quality control, perioperative medicine and care transitions, create an indispensible component of hospital care. Lastly mentoring programs for academic hospitalist within SHM and SGIM are also essential for networking and career development. There are several limitations to our study. Our response rate of 40% was relatively low, and our results may not be representative of all academic hospitalist division chiefs and their programs, may be overstating the perceived difficulties of the survey sample, or conversely missing a large portion too overwhelmed by current duties who lacked the time to complete the survey. Having said this, our survey methodology targeted sites where we could identify potentialnot confirmedhospitalist groups and hospitalist group leaders. For this reason, our response rate could be higher (if some of our contacts were in error). Our results are a cross‐sectional survey based on self report and are subject to recall bias. In addition, our study was carried out in 2007, and while issues such as mentorship may remain important, our results regarding financial arrangements may not be applicable to the current economic climate. Finally, while improving mentorship was identified as a principle objective for program leaders, we did not explore the existing quality of mentorship, nor perceived shortfalls. This should be the subject of future exploration.

The vast majority of academic hospital medicine programs continue to view inadequate support, expanding research, mentorship, and academic promotion as critical issues for the future. Thus, further understanding of these features, and interventions to allow for success, are of crucial importance in the continued development of academic hospitalists. Our study supports the need for mentoring and career development programs, targeting academic hospitalists and their leaders. In addition, attention should be paid to activities that support career fit, creating sustainable and viable job descriptions for academic hospitalists, and preventing burnout.16 At the same time we must expand the traditional view of scholarship and training and advocate for promotion criteria that value the unique contributions of hospitalists to become in line with the broad areas that hospitalists work.

Hospitalists are hospital‐based physicians whose primary professional focus is patient care, education, research, and administrative activities related to hospital medicine.1 Initially, community‐based hospitals were far more likely to employ hospitalists than academic centers. However, today most academic centers employ hospitalist models and it is now a fully recognized entity in academic settings.2

While much has been written about the structure, business operations, and potential benefits of nonteaching (clinical) hospitalist programs,3, 4 there is little known about the current state of academic hospitalist programs or their challenges. For example, who are the leaders of academic hospitalist medicine groups? Given the youth of the field, are academic hospitalists receiving adequate mentorship and are they advancing academically? What are future directions and goals for academic hospitalist groups?

To better understand academic hospitalist programs, we surveyed division chiefs and academic hospitalist leaders to explore existing business models and operations, the status of mentorship, and key issues in growth and retention.

Methods

Results

Discussion

Our survey provides a unique snapshot of academic hospitalist groups, highlighting a perceived lack of support and respect for their programs, a need to increase education and scholarly activities, and a desire to better prepare faculty for academic promotion.

Academic hospitalist groups and leaders reflected what one would expect from a field that is just over a decade old. Program leaders were relatively new to their position, as were their division group members. As a result, it is not surprising that most of the academic hospitalist leaders identified mentorship as a major issue. We were encouraged to see that most programs were offering annual reviews. However, the majority of these annual reviews were performed by the group leaders, many of whom are relatively junior (40% Assistant Professors) and may not be experienced in mentoring and performing annual reviews. Importantly, the absence of a mentor (or a high‐quality, experienced one) among physicians, and specifically hospitalists, may result in fewer peer‐reviewed first author and non‐peer‐reviewed publications, and less experience leading a teaching session at a national meeting.6 Research suggests that effective mentoring may help faculty increase career satisfaction and productivity and reduce their risk for burn‐out.7 Hospitalist groups might benefit nationally from focusing specifically on finding adequate mentorship either within or outside their groups. In addition, national organizations such as the SHM and the SGIM could potentially help these groups and individual hospitalists in creating mentorship networks and a mentoring infrastructure.

Academic hospitalist leaders were concerned about the ability of their faculty to develop sustainable nonclinical activities and scholarship. Notably, more than 40% of surveyed leaders agreed or strongly agreed that their faculty were not developing sustainable nonclinical activities. For individual faculty, the inability to develop scholarly activities and engage in academic pursuits may create challenges in getting promoted by traditional academic pathways. Some have recognized this issue and tried to develop practical solutions.2 In addition, academic hospitalists often engage in nonclinical activities such as quality improvement or patient safety which do not fit in the traditional tripartite mission of academics (clinical care, education, and research). In this survey, more than 90% of groups were engaged in quality improvement projects and over half in peer review exercises (Table 1). As many of these scholarly activities require innovation, sophisticated data analysis, and can have far‐reaching and substantial impacts on healthcare, some have argued these should be considered as part of the promotion process.8 Notably, the SGIM Academic Hospitalist Taskforce has created the Quality Portfolio, a structured adjunct to promotions packets to organize and document work in quality improvement and patient safety.9

While there were few CI in the divisions surveyed, building CI programs was a major priority of programs. In programs reporting the presence of CI's, they report limited access to research support. This highlights the potential role and benefit of post residency training in designing and conducting clinical research whether in a traditional general internal medicine fellowship or in 1 of the many growing hospital medicine fellowships.10 There also appears to be a need for funding to support the research careers of junior hospitalists. While access to effective mentorship is integrally linked to achieving increased academic accomplishments, there is certainly an ample call for research in the areas of quality improvement, patient safety; systems‐based practice, hospital efficiency, transitions of care,11 perioperative medicine,12 and education.2, 13, 14 While providing lower costs per admission and lower lengths of stay, hospitalists seem well‐positioned to spearhead active research in cost‐effectiveness in the hospital.14 Additionally, a quality portfolio, documenting such quality improvement projects, has been suggested as an effective means to provide a record of this work for academic promotion.9

The diverse activities of today's hospitalists are transforming the traditional view of academic work and are critical to the growth of hospitals, patient care, and development of the field of hospital medicine itself. Until these areas are fully embraced as legitimate areas of academic productivity and scholarship, the academic advancement of hospitalists will be slow.

It is unclear from our survey if academic hospitalist programs are truly getting the support they need to succeed. On one hand, there was general agreement that the Departments of Medicine and Divisions of General and Hospital Medicine were invested in the development of the academic accomplishments. Yet, the majority of program directors believed that they are viewed by the Department or Division as a clinical rather than an academic program. Moreover, over half of program directors report that their hospital was not supportive and therefore have limited the expansion of their hospitalist groups' educational and research activities. Lastly, for a large majority of programs, unavailable funding also acted to limit growth and expansion of academic functions. In a mere 2 decades, Emergency Medicine has become one of the largest US specialties and yet research and funding in the field have been lagging and are limiting academic expansion. Junior faculty seeking research careers struggled to find support and mentorship within their emergency medicine divisions.15 Challenges faced by academic emergency medicine provide important historical perspective for the even more rapidly growing field of academic hospital medicine. Learning from the Academic Emergency Medicine experience, academic hospitalists should proactively identify scholarship and research opportunities unique to hospitalist and fitting the needs of academic institutions. Involvement in national medical organizations, such as SGIM‐SHM‐ACGIM Academic Hospitalist Academy, or the SGIM Academic Hospitalist Task Force, where skill and career development is the focus, will undoubtedly promote the success of academic hospitalist. Expanding valuable niches of expertise, such as quality control, perioperative medicine and care transitions, create an indispensible component of hospital care. Lastly mentoring programs for academic hospitalist within SHM and SGIM are also essential for networking and career development. There are several limitations to our study. Our response rate of 40% was relatively low, and our results may not be representative of all academic hospitalist division chiefs and their programs, may be overstating the perceived difficulties of the survey sample, or conversely missing a large portion too overwhelmed by current duties who lacked the time to complete the survey. Having said this, our survey methodology targeted sites where we could identify potentialnot confirmedhospitalist groups and hospitalist group leaders. For this reason, our response rate could be higher (if some of our contacts were in error). Our results are a cross‐sectional survey based on self report and are subject to recall bias. In addition, our study was carried out in 2007, and while issues such as mentorship may remain important, our results regarding financial arrangements may not be applicable to the current economic climate. Finally, while improving mentorship was identified as a principle objective for program leaders, we did not explore the existing quality of mentorship, nor perceived shortfalls. This should be the subject of future exploration.

The vast majority of academic hospital medicine programs continue to view inadequate support, expanding research, mentorship, and academic promotion as critical issues for the future. Thus, further understanding of these features, and interventions to allow for success, are of crucial importance in the continued development of academic hospitalists. Our study supports the need for mentoring and career development programs, targeting academic hospitalists and their leaders. In addition, attention should be paid to activities that support career fit, creating sustainable and viable job descriptions for academic hospitalists, and preventing burnout.16 At the same time we must expand the traditional view of scholarship and training and advocate for promotion criteria that value the unique contributions of hospitalists to become in line with the broad areas that hospitalists work.