Leaders: Training the Next Generation of Hospitalists

When Dr. Jeffrey J. Glasheen finished his residency nearly a decade ago, he was embarrassed to discover that he wasn't prepared to face the realities of practicing as a hospitalist.

And when he asked around, it turned out that neither were many of the other newly trained hospitalists. Today, Dr. Glasheen is director of the hospitalist training program at the University of Colorado, Denver, and devotes much of his time to making sure that residents interested in hospital medicine get more than just the traditional categorical internal medicine training.

In the University of Colorado's program, residents receive traditional internal medicine training, plus rotations where they get in-depth experience in consultative and perioperative medicine, comanaging orthopedic and neurosurgery patients, managing stroke patients, and inpatient geriatrics and palliative care. Residents also learn nonclinical skills such as quality improvement, patient safety, hospital leadership, and health care finance.

The goal of the program is to train “future leaders and stewards of resources” who can help build a more efficient, high-quality system within the hospital, said Dr. Glasheen, who also is the director of the hospital medicine program at the university.

“Our program is not necessarily for people who want to go out and be clinicians seeing 15 patients a day and go home,” he said. “Our program is really for people who want to lead change in a hospital setting.”

In 2004, Dr. Glasheen and his colleagues launched the hospitalist training program, which is the longest-running hospitalist training program in the country. There are only a few comprehensive training programs like it, he said, though several other programs have begun to offer rotations devoted to training hospitalists. Dr. Glasheen predicted that over time, more universities will begin offering separate hospitalist training programs to keep up with trends in medicine and demand from residents.

“We can say come to Colorado and we'll train you to be a good researcher, a good subspecialist, a good primary care doctor, or a good hospitalist, and you don't have to decide until you get here,” Dr. Glasheen said. “I think that's a big advantage for our training program and our house staff.”

The program at the University of Colorado has been successful, attracting students from around the country. But it wasn't an easy sell at first—for students or the administration. Many people assume that an internal medicine residency, where residents spend 60%-70% of their time working on the inpatient side, would be ideal training for becoming a hospitalist. But the reality, Dr. Glasheen said, is that a hospitalist's job is often very different from the job of a resident.

In 2003 Dr. Glasheen set out to prove his point. He analyzed billing data to find out what community hospitalists actually do. He found that about 30% of a hospitalist's clinical duties fall into the categories of neurology, orthopedics, general surgery, and consultative medicine—areas only briefly touched on in most categorical internal medicine training programs (Arch. Intern. Med. 2007;167:727–8).

But even after the need for additional training became clear, creating a separate training program for hospitalists was challenging, Dr. Glasheen said. The major obstacles have been finding the time to add new elements to the already packed curriculum, changing attitudes about what is needed to train a qualified hospitalist, and finding faculty who can teach areas such as quality improvement, systems of care, and health care financing when they never received this training themselves, he said.

Despite the challenges, hospitalist training is flourishing at the University of Colorado. In addition to the residency training program, Dr. Glasheen and his team have started a clinical fellowship for physicians who are out of residency but want to spend a year getting training specifically tailored to hospital medicine. Last year they launched a 1-year program to train nurse practitioners to be hospitalists. That program has already drawn significant interest, he said.

By Mary Ellen Schneider

When Dr. Jeffrey J. Glasheen finished his residency nearly a decade ago, he was embarrassed to discover that he wasn't prepared to face the realities of practicing as a hospitalist.

And when he asked around, it turned out that neither were many of the other newly trained hospitalists. Today, Dr. Glasheen is director of the hospitalist training program at the University of Colorado, Denver, and devotes much of his time to making sure that residents interested in hospital medicine get more than just the traditional categorical internal medicine training.

In the University of Colorado's program, residents receive traditional internal medicine training, plus rotations where they get in-depth experience in consultative and perioperative medicine, comanaging orthopedic and neurosurgery patients, managing stroke patients, and inpatient geriatrics and palliative care. Residents also learn nonclinical skills such as quality improvement, patient safety, hospital leadership, and health care finance.

The goal of the program is to train “future leaders and stewards of resources” who can help build a more efficient, high-quality system within the hospital, said Dr. Glasheen, who also is the director of the hospital medicine program at the university.

“Our program is not necessarily for people who want to go out and be clinicians seeing 15 patients a day and go home,” he said. “Our program is really for people who want to lead change in a hospital setting.”

In 2004, Dr. Glasheen and his colleagues launched the hospitalist training program, which is the longest-running hospitalist training program in the country. There are only a few comprehensive training programs like it, he said, though several other programs have begun to offer rotations devoted to training hospitalists. Dr. Glasheen predicted that over time, more universities will begin offering separate hospitalist training programs to keep up with trends in medicine and demand from residents.

“We can say come to Colorado and we'll train you to be a good researcher, a good subspecialist, a good primary care doctor, or a good hospitalist, and you don't have to decide until you get here,” Dr. Glasheen said. “I think that's a big advantage for our training program and our house staff.”

The program at the University of Colorado has been successful, attracting students from around the country. But it wasn't an easy sell at first—for students or the administration. Many people assume that an internal medicine residency, where residents spend 60%-70% of their time working on the inpatient side, would be ideal training for becoming a hospitalist. But the reality, Dr. Glasheen said, is that a hospitalist's job is often very different from the job of a resident.

In 2003 Dr. Glasheen set out to prove his point. He analyzed billing data to find out what community hospitalists actually do. He found that about 30% of a hospitalist's clinical duties fall into the categories of neurology, orthopedics, general surgery, and consultative medicine—areas only briefly touched on in most categorical internal medicine training programs (Arch. Intern. Med. 2007;167:727–8).

But even after the need for additional training became clear, creating a separate training program for hospitalists was challenging, Dr. Glasheen said. The major obstacles have been finding the time to add new elements to the already packed curriculum, changing attitudes about what is needed to train a qualified hospitalist, and finding faculty who can teach areas such as quality improvement, systems of care, and health care financing when they never received this training themselves, he said.

Despite the challenges, hospitalist training is flourishing at the University of Colorado. In addition to the residency training program, Dr. Glasheen and his team have started a clinical fellowship for physicians who are out of residency but want to spend a year getting training specifically tailored to hospital medicine. Last year they launched a 1-year program to train nurse practitioners to be hospitalists. That program has already drawn significant interest, he said.

By Mary Ellen Schneider

When Dr. Jeffrey J. Glasheen finished his residency nearly a decade ago, he was embarrassed to discover that he wasn't prepared to face the realities of practicing as a hospitalist.

And when he asked around, it turned out that neither were many of the other newly trained hospitalists. Today, Dr. Glasheen is director of the hospitalist training program at the University of Colorado, Denver, and devotes much of his time to making sure that residents interested in hospital medicine get more than just the traditional categorical internal medicine training.

In the University of Colorado's program, residents receive traditional internal medicine training, plus rotations where they get in-depth experience in consultative and perioperative medicine, comanaging orthopedic and neurosurgery patients, managing stroke patients, and inpatient geriatrics and palliative care. Residents also learn nonclinical skills such as quality improvement, patient safety, hospital leadership, and health care finance.

The goal of the program is to train “future leaders and stewards of resources” who can help build a more efficient, high-quality system within the hospital, said Dr. Glasheen, who also is the director of the hospital medicine program at the university.

“Our program is not necessarily for people who want to go out and be clinicians seeing 15 patients a day and go home,” he said. “Our program is really for people who want to lead change in a hospital setting.”

In 2004, Dr. Glasheen and his colleagues launched the hospitalist training program, which is the longest-running hospitalist training program in the country. There are only a few comprehensive training programs like it, he said, though several other programs have begun to offer rotations devoted to training hospitalists. Dr. Glasheen predicted that over time, more universities will begin offering separate hospitalist training programs to keep up with trends in medicine and demand from residents.

“We can say come to Colorado and we'll train you to be a good researcher, a good subspecialist, a good primary care doctor, or a good hospitalist, and you don't have to decide until you get here,” Dr. Glasheen said. “I think that's a big advantage for our training program and our house staff.”

The program at the University of Colorado has been successful, attracting students from around the country. But it wasn't an easy sell at first—for students or the administration. Many people assume that an internal medicine residency, where residents spend 60%-70% of their time working on the inpatient side, would be ideal training for becoming a hospitalist. But the reality, Dr. Glasheen said, is that a hospitalist's job is often very different from the job of a resident.

In 2003 Dr. Glasheen set out to prove his point. He analyzed billing data to find out what community hospitalists actually do. He found that about 30% of a hospitalist's clinical duties fall into the categories of neurology, orthopedics, general surgery, and consultative medicine—areas only briefly touched on in most categorical internal medicine training programs (Arch. Intern. Med. 2007;167:727–8).

But even after the need for additional training became clear, creating a separate training program for hospitalists was challenging, Dr. Glasheen said. The major obstacles have been finding the time to add new elements to the already packed curriculum, changing attitudes about what is needed to train a qualified hospitalist, and finding faculty who can teach areas such as quality improvement, systems of care, and health care financing when they never received this training themselves, he said.

Despite the challenges, hospitalist training is flourishing at the University of Colorado. In addition to the residency training program, Dr. Glasheen and his team have started a clinical fellowship for physicians who are out of residency but want to spend a year getting training specifically tailored to hospital medicine. Last year they launched a 1-year program to train nurse practitioners to be hospitalists. That program has already drawn significant interest, he said.

By Mary Ellen Schneider