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You’re a what?
Hospitalist

Sara Royster | July 2015

“Being hospitalized can be a scary time for people, and they may not always understand what’s going on,” says William Atchley, a hospitalist in Norfolk, Virginia. “I try to simplify it for them, explain their treatment, and answer any questions they have.”

Hospitalists aim to reduce the confusion of a hospital stay and guide patients through their treatment. Although they are physicians, hospitalists don’t have an office practice. Instead, they serve as the single point of contact for a patient moving through the hospital, from admittance to discharge—and beyond.

What they do

Hospitalists specialize in caring for patients throughout a hospital stay. This specialty is relatively new, departing from the past practice of having hospital physicians admit patients only for referring them to surgeons or other specialists for treatment. Hospitalists perform medical procedures, design treatment plans, and communicate and coordinate with patients and hospital staff, among other duties.

Care. William’s work starts when patients are admitted to the hospital. He diagnoses each patient’s condition, provides treatment, and creates a plan of care. “I am the patients’ advocate,” he says. “I make sure they are receiving whatever they need.”

In addition to providing patient care, some hospitalists help manage or improve hospital functions. For example, hospitalists might compare patient admission numbers between day and night to anticipate staffing needs. They might also try to find ways to use hospital resources more efficiently to reduce both the length of patient stays and treatment costs.

Communication. William collaborates with many different workers, including other hospitalists, specialists (such as cardiologists), nurses, and surgeons. He also addresses questions or concerns that the patient or the patient’s family may have.

To help decide on treatment, a hospitalist discusses options with patients and their families. The hospitalist then relays the chosen course of treatment to each patient’s physician, coordinates with the physician to ensure that that treatment fits with the patient’s medical history and health needs, and keeps the physician updated on the patient’s condition.

Coordination. When patients are discharged, the hospitalist connects them with resources in their communities that help with recovery or ongoing treatment. For example, William refers patients to his hospital’s discharge specialists, who link patients with rehab centers; he also may recommend a treatment plan, such as for temporary home care, or prescribe medications to ensure a safe transition home.

How they prepare

Hospitalists need to have certain qualities to work effectively with and for their patients. They also must have a medical degree and be licensed. And some may choose to be certified in a specialty related to hospital medicine.

Qualities. Hospitalists need communication skills to be able to describe complex medical procedures or treatment options in a way that patients and their families can understand.

Compassion and interpersonal skills are also important, because hospitalists often provide comfort to patients who are sick or in pain. “You need to be professional and have a good bedside manner, because you’re around people all the time,” says William.

In addition, hospitalists need physical stamina. They often work long shifts and are usually on their feet as they move throughout the hospital.

And problem-solving skills are a must. Hospitalists need to be able to evaluate a patient’s condition and prescribe medications or treatments—sometimes quickly, such as when the patient’s life is at stake.

Education. Hospitalists are physicians, so they must attend 4 years of medical school after getting their bachelor’s degree. After earning a medical degree, they complete a hospital residency program, which may last 3 to 8 years. Some residency programs have started developing instructional tracks to address issues that are specific to hospital medicine, such as quality improvement or hospice care.

According to a survey by the Society of Hospital Medicine, nearly 90 percent of hospitalists specialize in general internal medicine, with smaller percentages focusing on pediatrics, family practice, and pediatric internal medicine.

Licensure and certification. Hospitalists need a license to practice medicine. Requirements for licensure vary by state but can include background checks, training, and fees.

Most hospitalists—including William—are certified by a medical specialty board, such as internal medicine. This voluntary certification requires passing an exam and paying a fee, and it means that the physician is in good standing with the medical community. Hospitals may require it for hospitalist jobs.

Physicians who are board certified must renew their credentials every 10 years. Hospitalists can undertake a fellowship or focused practice specific to hospital medicine in order to maintain their credentials.

What to expect

As their name implies, hospitalists work in hospitals. Working conditions may be hectic, but wages are often high. And workers typically enjoy helping patients in need.

Employment and wages. The U.S. Bureau of Labor Statistics (BLS) does not collect data specifically on hospitalists. Instead, it includes this occupation among other physicians, such as general internists, family and general practitioners, and general pediatricians.

According to BLS, there were 48,390 general internists, 124,810 family and general practitioners; 31,010 general pediatricians, including pediatric internists; and 311,320 physicians and surgeons, all other, in the United States in 2014. The Society of Hospital Medicine estimates that there were about 44,000 practicing hospitalists in the United States that year. The society expects that number to increase, however, as programs continue to develop.

BLS data also show that, in 2014, general internists had a mean annual wage of $190,530. Family and general practitioners had a mean annual wage of $186,320; general pediatricians made $175,400; and physicians and surgeons, all other, earned $189,760.

William predicts that, as the occupation becomes more established, hospitalist training also may provide more career options. “Many hospitalists are going on to be in positions of authority, such as chief medical officers,” he says, “because we understand the ins and outs of how hospitals work.”

Work environment. Hospitalists, like many physicians, work long shifts and have erratic schedules. For example, hospitalists commonly work 12-hour day or night shifts 7 days in a row, then have 7 days off, although schedules vary by hospital. “Twelve-hour shifts aren’t for everyone,” says William. “Those hours can be challenging.”

Hospitals have, on average, three or four hospitalists working during the day and one at night. Bigger or busier hospitals may have more. On a given shift, hospitalists like William are on the go often as they care for 15 to 20 patients.

In addition to its difficult or busy schedules, hospital work can be stressful because it often involves emotional situations, such as life-and-death decisionmaking, and exposure to patients who may have contagious illnesses. Aspiring hospitalists should be able to work under pressure and handle multiple problems at once.

Despite the demanding work, it’s rewarding for hospitalists like William to know that their efforts can ease a patient’s hospital experience. Every day, hospitalists have the opportunity to affect a patient’s life in a positive way. “Hospitalists are agents of change in how hospital care is provided,” he says. “It’s exciting to know we can really make a difference.”