Where should hospitalists sit within the academic medical center?

The Future of Hospital Medicine in Japan: Lessons From the United States Hospital Medicine System

Purpose

To compare hospitalist roles and training systems between the United States (US) and Japan, identifying strengths and challenges to guide development of Japan's emerging hospital medicine program.

Methods

A qualitative, descriptive narrative study was conducted during a 10-day observational site visit to the Veterans Affairs Ann Arbor Healthcare System and University of Michigan Hospital in October 2022. Two experienced Japanese hospitalist authors independently observed clinical rounds, interprofessional meetings, and educational sessions. Data were collected through direct observation and structured discussions focusing on care-team structures, workflows, multidisciplinary collaboration, educational approaches, and quality improvement activities. The authors subsequently developed a comparative analysis report of Japan-US differences. Guided discussions based on this report were conducted with experienced US hospitalists and a pioneer physician of General Medicine in Japan to obtain expert commentary on the analyses. No quantitative data analysis or specific analytical software was utilized for this narrative comparison.

Results

The US hospitalist model demonstrated group practice approaches with shift-based schedules supporting work-life balance. Multidisciplinary teams actively incorporated residents and students in patient care, quality improvement, and teaching. Japan's traditional attending physician model emphasized continuity of care but showed high workloads and limited multidisciplinary integration. Japanese hospitalists faced challenges including extensive work hours, fewer specialized training opportunities in quality improvement and patient safety, and less robust team-based learning environments.

Conclusion

Incorporating elements from the US model-such as group practice with shift-based systems, enhanced multidisciplinary collaboration, and structured educational and quality improvement initiatives-could address workload issues and foster professional development in Japan's hospital medicine system while preserving valued aspects of continuity of care. These findings provide specific actionable guidance for healthcare administrators, medical education directors, and policymakers involved in developing Japan's hospitalist system, as well as to practicing Japanese hospitalists seeking to enhance their professional practice environments and educational frameworks.

Mentorship for Non-academic, Mid-Career Hospitalist Physicians: The Journey Taken Less Often

Mentorship plays a crucial role in the professional development of hospitalists by offering guidance, support, and opportunities for career advancement. Multiple studies have reported that mentorship significantly contributes to improving job performance and cultivating happiness in medicine. Further, mentorship also leads to increased confidence in decision-making, and enhanced work-life balance. Additionally, mentees have reported greater engagement, reduced burnout, and commitment to their organizations. Most of these studies were performed on academic hospitalists and very little has been written about the foundation of non-academic organizations: mid-career hospitalists. Academic organizations have invested in mentorship programs, but little focus is given to mentorship of hospitalists, specifically mid-career hospitalists, outside of these settings. The lack of mentorship contributes to lack of professional development, burnout, low job satisfaction, worse patient outcomes, and increased turnover. By fostering a culture of mentorship, healthcare institutions can better retain talent, improve patient care, and ensure sustained career satisfaction among hospitalists. This article delves into the importance of mentorship, its empowering benefits, and strategies tailored to the specific needs of mid-career hospitalists working in non-academic institutions. Further, we advocate for integrating robust mentorship as a strategic initiative to bolster the professional trajectory of this vital group within the healthcare system.

Perspectives on and barriers to research among advanced practice provider and physician hospitalists

Advanced practice providers and physicians at an academic healthcare system comprising more than 15 hospitals across four US states were surveyed to identify barriers to participation in research. Overall, barriers reported by advanced practice providers and physicians were more similar than different, highlighting system-level opportunities to build research skills and accelerate academic productivity.

Perception of barriers to research among internal medicine physician hospitalists by career stage

BACKGROUND

Physician hospitalists may participate in research and generate knowledge for evidence-based hospital practice. Despite this, physician hospitalists are primarily involved in patient care, and there is sparse information on barriers for their participation in research and if these barriers differ by career stage.

METHODS

We conducted a survey of physician hospitalists at Mayo Clinic sites based in four states (Arizona, Florida, Minnesota, and Wisconsin). We surveyed physician hospitalists on demographics, academic rank, current research skills, barriers for participation in research, and research skills they aspire to acquire. Responses were summarized using descriptive statistics and categorized by early-career (<10 years), mid-career (10-20 years), and later-career (≥20 years) stages at Mayo Clinic. The survey was conducted from March to April 2019.

RESULTS

Of 188 physician hospitalists, there was a 52% response rate with 71% in early career, 21% mid-career, and 7% late career, with 39% female. Physician hospitalists at early-career (90%), mid-career (76%), and later-career (71%) stages were interested in participating in research. Among physician hospitalists with ≤3 peer-reviewed publications, barriers for participation in research included lack of mentorship, time, research skills, and funding. Among physician hospitalists with ≥4 peer-reviewed publications, factors for research success included mentorship (89% early-career, 38% mid-career, 75% later-career; p = 0.002) and membership in a research team. Compared to mid- and later-career physician hospitalists, a higher proportion of early-career hospitalists was interested in acquiring skills to both critically review the literature (70% early-career, 43% mid-career, 0% later-career; p = 0.006) and write manuscripts (86% early-career, 57% mid-career, 50% later-career; p = 0.02); there was generally similar interest across career stages to acquire skills to conduct literature searches and write grants.

CONCLUSION

The generally similar responses from physician hospitalists across career stages highlight system-level opportunities to increase research mentorship, promote the acquisition of research skills, and reduce barriers for participation in research.

Gender Issues in Academic Hospital Medicine: a National Survey of Hospitalist Leaders

BACKGROUND

Gender inequities are documented in academic medicine. Within General Internal Medicine (GIM), there are fewer female division directors and first and last authors on publications. With gender parity in US medical school graduates and with Academic Hospital (AH) medicine being a relatively newer discipline, one might postulate that AH would have less gender inequity.

DESIGN

A national survey of AH programs was developed via literature review and expert recommendations. Domains included program and faculty information. Gender of the leader was determined via website or telephone call.

PARTICIPANTS

Leaders of AH programs associated with the American Association of Medical Colleges (AAMC). Programs without a primary teaching hospital or hospitalist program and those not staffed by university-affiliated physicians were excluded.

MAIN MEASURES

Description and characteristics of leaders and programs including a multivariable analysis of gender of hospitalist leaders and the portion of female faculty.

KEY RESULTS

59% response rate (80 of 135); there were no differences between responders/non-responders in NIH funding (p = 0.12), type of institution (p = 0.09), geographic region (p = 0.15), or year established (p = 0.86). Reported number of female and male faculty were approximately equal. 80% of hospitalist leaders were male; 37% of male hospitalist leaders were professors, no female leaders were professors. In univariate and multivariate analysis only the number of hospitals staffed was a significant predictor of having a female hospitalist leader. There were no significant predictors of having fewer female faculty.

CONCLUSION

This study demonstrated gender inequality in academic hospital medicine regarding leadership and rank. Though there was equal gender distribution of faculty, among leaders most were men and all "full professors" were men. As diversity benefits the tripartite mission research on methods, initiatives and programs that achieve gender equity in leadership are needed.

Hospitalist career decisions among internal medicine residents

BACKGROUND

Hospital medicine is a rapidly growing field of internal medicine. However, little is known about internal medicine residents' decisions to pursue careers in hospital medicine (HM).

OBJECTIVE

To identify which internal medicine residents choose a career in HM, and describe changes in this career choice over the course of their residency education.

DESIGN

Observational cohort using data collected from the annual Internal Medicine In-Training Examination (IM-ITE) survey.

PARTICIPANTS

16,781 postgraduate year 3 (PGY-3) North American internal medicine residents who completed the annual IM-ITE survey in 2009-2011, 9,501 of whom completed the survey in all 3 years of residency.

MAIN MEASURES

Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2) and PGY-3.

KEY RESULTS

Of the 16,781 graduating PGY-3 residents, 1,552 (9.3 %) reported HM as their ultimate career choice. Of the 951 PGY-3 residents planning a HM career among the 9,501 residents responding in all 3 years, 128 (13.5 %) originally made this decision in PGY-1, 192 (20.2 %) in PGY-2, and 631 (66.4 %) in PGY-3. Only 87 (9.1 %) of these 951 residents maintained a career decision of HM during all three years of residency education.

CONCLUSIONS

Hospital medicine is a reported career choice for an important proportion of graduating internal medicine residents. However, the majority of residents do not finalize this decision until their final year.

Research needs of pediatric hospitalists

OBJECTIVE

To assess the current state of research productivity, goals, obstacles, and needs of pediatric hospitalists.

METHODS

The American Academy of Pediatrics Section on Hospital Medicine performed a cross-sectional online survey of pediatric hospitalists. Questions assessed demographics, research productivity, system-level factors, research interests, goals and obstacles, and the perceived need for research training and support.

RESULTS

Two hundred twenty pediatric hospitalists in the United States completed the survey. Of these, 56% had presented at a national meeting, 24% were first authors of an article in a peer-reviewed journal, 8% had more than publications, and 12% had secured external grant support. While 90% of respondents had spent 10% or less time in research, 64% had an academic appointment at the assistant professor level or above. Nearly 40% felt that their institution expected them to do research, and 56% were interested and another 27% were very interested in conducting research. The main research interest was quality improvement (QI) evaluation. Common obstacles to research were lack of time, mentorship, and resources.

CONCLUSIONS

Pediatric hospitalists want to conduct research to improve the quality of inpatient care but face significant obstacles including lack of dedicated time for research and mentorship. Coordinated efforts to improve access to academic resources are important for career development and academic growth of the field. National organizations and hospital programs interested in improving the quality of care for hospitalized children can provide support to meet the field's professional needs for research.

Hospitalist time usage and cyclicality: opportunities to improve efficiency

BACKGROUND

Academic medical centers (AMCs) have a constrained resident work force. Many AMCs have increased the use of nonresident service hospitalists to manage continued growth in clinical volume. To optimize their time in the hospital, it is important to understand hospitalists' work flow.

DESIGN

We performed a time-motion study of hospitalists carrying the admission pager throughout the 3 types of shifts we have at our hospital (day shift, swing shift, and night shift).

SETTING

Tertiary academic medical center in the Midwest.

RESULTS

Hospitalists spend about 15% of their time on direct patient care, and two-thirds of their time on indirect patient care. Of the indirect activities, communication and documentation dominate. Travel demands make up over 7% of a hospitalists' time. There are spikes in indirect patient care, followed closely by spikes in direct patient care, at shift changes.

CONCLUSIONS

At our AMC, indirect patient care activities accounted for the majority of the admitting hospitalists' time spent in the hospital, with documentation and communication dominating this time. Travel takes a significant fraction of hospitalists' time. There is also a cyclical nature to activities performed throughout the day, which can cause patient delays and impose variability on support services. There is a need for both service-specific and systemic improvements for AMCs to efficiently manage further growth in their inpatient volume.