Background The subspecialty of Hospital Medicine (HM) has grown rapidly since the mid-1990s. Diversity and inclusion are often studied in the context of healthcare equity and leadership. However, little is known about the factors potentially associated with choosing this career path among US medical students. Methods We analyzed the results of the Annual Association of American Medical Colleges Survey administered to Graduating medical students from US medical schools from 2018 to 2020. Results We analyzed 46,614 questionnaires. 19.3% of respondents (N = 8,977) intended to work as a Hospital Medicine [HM] (unchanged from 2018 to 2020), mostly combined with specialties in Internal medicine (31.5%), Pediatrics (14.6%), and Surgery (9.1%). Students interested in HM were significantly more likely to identify as female, sexual orientation minorities (Lesbian/Gay or Bisexual), Asian or Black/African-American, or Hispanic. Role models and the ability to do a fellowship were strong factors in choosing HM, as was higher median total debt ($170,000 vs. $155,000). Interest in higher salary and work/life balance negatively impacted the likelihood of choosing HM. There were significant differences between students who chose IM/HM and Pediatrics/HM. Conclusion About one in five US medical students is interested in HM. The probability of choosing future HM careers is higher for students who identify as sexual or racial minorities, with a higher amount of debt, planning to enter a loan forgiveness program, or are interested in doing a fellowship.

Introduction During the preclinical years, students typically do not have extensive exposure to clinical medicine. When they begin their clinical rotations, usually in the third year, the majority of the time is spent on core rotations with limited experience in other fields of medicine. Students then have to decide on their future careers early in their fourth year. We hypothesized that limited exposure to certain fields may prompt students to switch career preferences. Methods We conducted a retrospective, cohort study using the American Association of Medical Colleges Year 2 Questionnaire (Y2Q) and Graduating Questionnaire (GQ) from 2016–2020. Results 20,408 students answered both surveys, but 2,165 had missing values on the career choice question and were excluded. Of the remaining students, 10,233 (56%) changed their career choice between the Y2 and GQ surveys. Fields into which students preferentially switched by the GQ survey included anesthesia, dermatology, ENT, family medicine, OB/GYN, pathology, PM&R, psychiatry, radiology, urology, and vascular surgery. Many characteristics, including future salary, the competitiveness of the field, and the importance of work-life balance, we significantly associated with a higher likelihood of changing career choice. On the other hand, having a mentor and the specialty content were associated with a lower likelihood of change. Conclusion A majority of students switched their career preference from the Y2Q to the GQ. Curricula focused on early integration of a variety of specialties should be designed with a goal of aligning with student interests and needs.

Background: The subspecialty of Hospital Medicine (HM) has grown rapidly since the mid-1990s. Diversity and inclusion are often studied in the context of healthcare equity and leadership. However, little is known about the factors potentially associated with choosing this career path among US medical students. Methods: We analyzed the results of the Annual Association of American Medical Colleges Survey administered to Graduating medical students from US medical schools from 2018 to 2020.Results: We analyzed 46,614 questionnaires. 19.3% of respondents (N=8,977) intended to work as a HM (unchanged from 2018 to 2020), mostly combined with specialties in IM (31.5%), Pediatrics (14.6%), and Surgery (9.1%). Students interested in HM were significantly more likely to identify as female, LGB, Asian or Black/African-American, or Hispanic. Role models and the ability to do a fellowship were strong factors in choosing HM, as was higher average for educational debt (HM $170,000 vs. $155,000. Interest in higher salary and work/life balance negatively impacted the likelihood of choosing HM. There were significant differences between students who chose IM/HM and Pediatrics/HM. Conclusion: About one in five US medical students is interested in HM. The probability of choosing future HM careers is higher for students who identify as sexual or racial minorities, with a higher amount of educational debt, planning to enter a loan forgiveness program or are interested in doing a fellowship.

INTRODUCTION The Affordable Care Act (ACA) was passed by Congress and signed into law by President Obama in March of 2010. The purpose was to increase access to health insurance, improve and standardize the quality of care in the US, and reduce overall costs of our healthcare system. The law includes several provisions that have direct impact on women and the practices that provide their care. Under the legislation, preventive services for women must be covered by health insurance companies at no cost to the patient. The list of services includes annual well woman visits, HPV testing, annual counseling for STIs and HIV, contraceptive counseling and methods, and screening for domestic and interpersonal violence. Federally sponsored health insurance programs began covering these screenings shortly after the ACA was signed, and beginning August 2012, all new and non-grandfathered private insurance plans were required to cover these services as well. 1 In addition to emphasizing preventive care, the ACA made health insurance mandatory, imposing fines for those who do not obtain insurance. The ACA also facilitated the ability to purchase insurance through exchanges, and provided incentives for individual states to expand eligibility for Medicaid. Prior to ACA, Medicaid eligibility was restricted to low-income children, pregnant women, the elderly, and individuals with disabilities. Thirty-one states and the District of Columbia opted to expand Medicaid, and in those states low-income adults became eligible. In New Jersey, Medicaid was expanded to include all adults with an income below 138% of the federal poverty line. This expansion had the potential to greatly impact women who had previously been uninsured as well as the providers who serve Medicaid enrollees. Currently there is mixed evidence on the impact of ACA on services provided and how it may have changed the populations accessing care. Lau and colleagues found that post-ACA, young adults had 1

Wellness and engagement in busy and complex healthcare systems are challenging. Much has been written about how individual healthcare workers can prevent their own burnout and improve wellness as well as the role of institutional and organizational goals to promote engagement and wellness. However, while there is clearly not one explanation or one solution for this problem, there is also not one standard approach to assessing these important issues, though surveys are most commonly used to assess the characteristics of the workplace. We suggest a framework of strategies for effective use of surveys to improve employee wellness and engagement based on practical experience that involve operational next steps organizations and programs can take after surveys as well as contextualizing the information they provide. These steps include adapting and leveraging quality improvement (QI) tools customarily used for patient safety for the purpose of wellness and engagement.