Long-term Plans for Those Selecting Hospital Medicine as an Initial Career Choice

Abstract

BACKGROUND: The proportion of the newly graduated pediatric workforce that becomes hospitalists has been increasing slightly over the past decade. However, it is unknown what proportion of those who accept hospitalist positions as their fi rst job intend to remain in the fi eld longer term. This is important to workforce projections regarding the magnitude of those who will function in this role. METHODS:The American Board of Pediatrics incorporated a structured questionnaire within the online application process to the General Pediatrics certifi cation application. Respondents identifi ed as residents or chief residents who selected "hospitalist position" as their immediate postresidency plan were the focus this study. We compared survey responses by gender and location of the medical school attended. RESULTS:Since the initiation of the general pediatrics certifi cation examination application survey, 6335 completed the questionnaire. 79% (n = 5001) were either in residency training or were a chief resident. Of those, 8% (n = 376) reported they planned to work as a pediatric hospitalist immediately after completing residency. Fewer than half (43%; n = 161) reported this to be their long-term career plan. This fi nding varied by both medical school type and by gender. CONCLUSIONS:The majority of pediatric residents and chief residents who take hospitalist positions immediately after training do not intend for hospital practice to be the long-term focus of their careers. As the fi eld of hospital medicine continues to develop, understanding career trajectories can help inform current and future efforts regarding the potential for different mechanisms for training and certifi cation. Long-term Plans for Those Selecting Hospital Medicine as an Initial Career ChoiceMuch recent attention has been focused on those who practice hospital medicine (aka, hospitalists) and the potential for recognition of these clinicians into a defi ned fi eld of practice.1 Over the past several years, there have been efforts to establish specifi c training programs to prepare hospitalists for a unique role in the health care system.2 Although currently variable in content and duration, such programs are growing in number. However, there are currently no fi xed expectations or requirements for those who practice hospital medicine. Thus, the "price of entry" into the fi eld is lower than formally trained subspecialists and similar to general pediatricians. As such, there are fewer barriers to changing direction, and some who begin their clinical careers as hospitalists may not remain in those roles over time.

Graduating Pediatric Residents Entering the Hospital Medicine Workforce, 2006–2015

“…Results of a previously published ABP survey reported that 8% of residents planned to work as hospitalists following residency, with 43% of these envisioning long-term hospitalist careers. 12 These differences may reflect different sampling strategies and survey timing; our survey was administered during or following residents' last month of training, while the ABP survey was conducted earlier during the academic year.…”

Development of a Curricular Framework for Pediatric Hospital Medicine Fellowships

“…2,3 More recently, 8% of pediatric residents reported PHM as their chosen area of practice upon completion of residency, with half of these intending PHM to be their long-term career path. 4,5 Thus, PHM represents one of the largest areas of practice for graduating pediatric residents.…”

Counting Hospitalists—Does it Matter?

“…Ultimately, the study's fi nding that less than one-half of those taking a PHM job are planning a career in PHM is diffi cult to interpret, given the mixed group of respondents and the lack of clarity regarding the nature of the PHM position they are assuming. Other studies, including a recent American Academy of Pediatrics survey, indicate a higher percentage of retention and more maturity of the PHM workforce than implied by the study of Freed et al 1 Perhaps the most interesting results were those of the respondents who identifi ed themselves as advancing to fellowship training on the way to a career in PHM. This group is analogous to those entering other ABP-certifi ed fellowship programs.…”