Hospitalist Career Decisions Among Internal Medicine Residents

Abstract

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.

Measuring Comprehensiveness of Primary Care: Challenges and Opportunities

“…1,20 The U.S. decline may be due to numerous factors, including the dramatic growth in the number of specialists, health plans that enable direct access to specialty care for common conditions, specialist-oriented medical centers, and insufficient support of and payment for practices to comprehensively manage the expanding population of patients with comorbidities. 1,[21][22][23][24][25][26][27][28][29][30][31][32] In addition, patient-centered medical home (PCMH) 33,34 standards include other primary care features, such as accessibility and coordination, 35-38 but underemphasize comprehensiveness. 39,40 Some include a one-time health risk assessment and reminders about individual services for Bindividual conditions.^Although some PCMH recognition tools include care management plans that begin to address the notion of comprehensiveness, they seldom highlight the scope of services offered and the extent to which conditions and comorbidities are managed by the primary care practice.…”

“…Practicing clinicians with primary care training do not necessarily provide comprehensive care. Despite receiving training in obstetrics, many family physicians do not provide obstetrical care, 42 and some internists trained in primary care competencies practice inpatient care exclusively 31,32 or in other narrow venues of care. 43,44 Lack of Professional Agreement on Respective Roles and Indications for Referral.…”

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

“…[4][5][6]23 As part of this effort, U.S. policymakers assumed that primary care and its workforce could be defined by the numbers of practicing physicians with generalist training (e.g., family medicine physicians, general internists, pediatricians and, in past decades, "general practitioners"), but changing roles now challenge this assumption. 24,25 Not all physicians trained as generalists practice primary care; many work as hospitalists and in urgent care or free-standing emergency departments, [26][27][28] on specialized care teams, and in consultative medicine. 29,30 Nurse practitioners and physicians assistants also contribute to primary care delivery, but many work instead in specialty care settings.…”

Medical Students’ Perspectives on Careers in Hospital Medicine: A National Study

“…7 Previous studies have shown that hospital medicine is an increasingly reported career choice for graduating residents in internal medicine (9.3% of graduating residents), through these studies suggest that many residents do not finalize this decision until their final year. 8 Looking at our results, a higher percentage of women select hospital medicine as a likely career choice. This is most likely related to a shorter length of training, as well as to perceived increased flexibility in scheduling.…”