National Hospitalist Day was established by the Society of Hospital Medicine (SHM) in 2019. According to SHM’s official statement, “Occurring the first Thursday in March annually, National Hospitalist Day celebrates the fastest growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving healthcare landscape.” In honor of Hospitalist Day, ABIM spoke with Luci Leykum, MD, and Peter Shin, MD, both members of the ABIM Hospital Medicine Traditional, 10-Year MOC Exam Approval Committee, about the unique challenges and rewards of working in hospital medicine, and the future of the discipline.
Why did you become a hospitalist and what do you like about it?
Dr. Leykum: I became a hospitalist in 2002, early in the quality and safety movement—it was an exciting time. I worked on projects as a resident, and being able to stay on as a hospitalist and continue that work was really exciting.
Dr. Shin: My primary reason for being a hospitalist is that I get to see patients with a variety of different diagnoses. Patients come in pretty sick and by the time they leave, they’re well or on their way to recovery. I like that there’s an immediate impact on the work we do and you can see that. You get to know your colleagues in the hospital and have personal interactions. I think those are fun and I can learn from them and teach more effectively.
What is uniquely challenging about being a hospitalist?
Dr. Leykum: You have to be adaptable. You’re not sure what’s going to happen every day. Being able to have that flexibility is something a lot of us like but it’s also a challenge to manage.
Dr. Shin: It’s unpredictable. When it’s busy, our peaks can be crushing. There’s no average day for a hospitalist; every day is different. We do have a lot of flexibility that some other specialists may not have but at the same time, there’s more weekend and holiday work, so being able to maintain a work-life balance can be challenging.
How was your role as a hospitalist affected by the pandemic?
Dr. Shin: The worst part was spring of 2020. Working in the hospital felt like being in a disaster zone. There’s a lot of personal pressure about my own safety, and a lot of uncertainty—that was unique, something I never experienced even in the most difficult times of training.
I think hospitals at baseline deal with a lot of systems of care and inefficiencies frequently. We have a large impact on patient quality and process improvement. When the hospital’s workflow had to change quickly to meet the needs of the pandemic, we were in a good position to create new pathways to meet that need. Along with the emergency department and critical care medicine specialists, hospitalists contributed heavily.
Dr. Leykum: A number of my colleagues said that when the pandemic hit, other specialists understood what it was like to be a hospitalist. Some of them even had to step into hospitalist work because extra hands were needed. It wasn’t easy. So much of our work on safety and improvement happens behind the scenes from the perspective of our colleagues, so they got a good appreciation for that as a result of the pandemic.
What are the challenges and opportunities facing hospital medicine today and in the future?
Dr. Leykum: Evolution. Care is moving out of the hospital. The role we play in that care outside the hospital is a question, so there’s a lot of opportunity.
Dr. Shin: Because of that shift to outpatient care, the patients admitted to the hospital are often much sicker, so acuity of illness has gone up. There’s more and more emphasis on improving quality of care, which is measured and reported to different entities, and there are challenges tied to that.
Dr. Leykum: With a greater concentration of sicker people in the hospital, hospitalist expertise is more critical. Similarly, systems need increasing capability to take care of sicker people outside of the hospital; hospitalists can do that as well.
Dr. Shin: There are movements to bring an inpatient type of care to the outpatient setting. I’m not sure how that evolution is going to look. Part of the challenge of hospital medicine is that its evolution is faster compared to some other specialties. So, adapting to those new environments is going to be a challenge.
Dr. Leykum: The “extensivist” model is an example of care that is in an outpatient arena physically, but is essentially very intensive, rapidly moving care for frail, sick people. Hospitalists are used to doing that level of work. This is the excitement of hospital medicine, that it can really go in so many interesting and important directions.
What disparities have you observed in the profession of hospital medicine?
Dr. Leykum: The same gender inequities that exist in other areas of medicine also exist in hospital medicine. In academic hospital medicine, there are a lot of women and many of them are going to have children. Figuring out how to accommodate that and keep women on an upward track for career progression is really important. In academic settings, there are expectations around promotion, and a number of institutions have made changes to address making promotion criteria more flexible and relevant. But a lot of senior leadership groups are not diverse, so making sure you have the right mentorship and sponsorship for a diverse workforce when you don’t have diverse leadership is still a relevant issue.
Dr. Shin: Optimistically, I think the outlook is improving in that regard. In my own institution I see a lot of racially and gender diverse leaders emerging. As time goes on, I think those inequities will still be there to some extent, but forward momentum is improving.
Why do you serve on the Hospital Medicine Exam Approval Committee?
Dr. Shin: Personally, for me it’s just fun. We’re all working to make questions more relevant and interesting. It’s like solving a puzzle together. I also think we serve the interests of the diplomates, to pick clinically relevant questions that have an impact on their practice. It’s fun for me to do and I want to give back to inpatient providers doing the same thing I’m doing.
Dr. Leykum: The person who first contacted me about joining the Approval Committee described it as the best education you will ever have with the most fun group of people. To a person, I think everybody takes the responsibility of writing questions that are relevant to practice very seriously. It’s a great opportunity to me.
What do you want diplomates to know about the work of the Approval Committee?
Dr. Leykum: It’s hard work to write good questions. The vetting process is significant. I hope diplomates know how much effort and thought goes into the questions. They really are thoroughly done.
Dr. Shin: Agreed. I also want to point out that the people who write these questions are just like the people who take the exam. We’re all practicing hospitalists. It’s very important to us that the questions are appropriate for those test-takers.