Clinical Hospital Medicine Fellowships

Survey I: Employers.

We created an electronic database by extracting employer contact information from all classified advertisements placed between January and June 2005 in the New England Journal of Medicine, JAMA, Today's Hospitalist, Annals of Internal Medicine, and SHM's The Hospitalist. Almost all employers included in their ad or otherwise provided on phone inquiry an E‐mail address to which we sent a request with a link to the Web‐based survey (Supplemental Fig. S1). The remaining employers were faxed a copy of the survey to complete and return by fax or mail. We made up to 3 attempts (including a final phone call attempt) to request a response before considering an employer a nonrespondent. The survey asked employers to indicate how much sign‐on bonus and greater initial salary they would offer a clinical fellowshiptrained graduate and whether such a person would be more likely to be offered a leadership position. Open‐ended comments were sought. Demographic questions related to geographic region, group ownership, number of hospitalists employed, and number of hospitals covered.

Survey II: Hospitalists.

The SHM sent an E‐mail message on our behalf to its roster of practicing hospitalist members. The E‐mail included a link to our Web‐based survey (Supplemental Fig. S2). We asked the hospitalists to suggest a minimum fellowship salary (assuming a 50% clinical workload), to rate the value of a clinical fellowship as a career move, to indicate their perception of causes of dissatisfaction among current hospitalists, and to prioritize each of 12 broad curricular topics as low, medium, or high (open‐ended suggestions were also sought). Demographic questions related to residency and fellowship training, current practice, and perceived likelihood to still be practicing hospital medicine in 5 years.

Survey III: Residents.

We compiled an E‐mail database of internal medicine programs from the Association of Program Directors in Internal Medicine (APDIM) Web site and the ACGME Medical Education Directory (informally known as the green book). Each program director was E‐mailed the rationale for our survey and summary findings from Surveys I and II, with an appended link to our online survey (Supplemental Fig.S3). We made up to 3 E‐mail attempts before considering a program director to be a nonrespondent (confirmation was either by the director or indirectly determined by the E‐mail server domains of responding residents). The survey asked about the resident's likelihood of pursuing a hospitalist career, followed by a hypothetical question: assuming the resident were to become a hospitalist, and knowing the results of Surveys I and II, how likely would the resident be to pursue a clinical hospital medicine fellowship following residency? We also allowed open‐ended responses about the main reasons a resident would or would not consider hospital medicine as a career. Demographic questions concerned current PGY level, geographic region of residency, anticipated future practice, and preferred type of future employer.

Demographics.

Among 241 unique journal classified advertisement sources, we identified 195 representing direct employers of hospitalists, rather than recruitment firms. Of these, 103 (52.8%) completed the survey. Representatives of only 5 employers actively declined to complete the survey, indicating that they were not in positions of authority to provide the information needed.

Table 1 shows that the employers were distributed across the United States, and balanced among hospital‐owned and private group (including academic) ownership (38% vs. 51%, respectively). Although 70% of groups employed at most 15 hospitalists, 20% employed 16‐50, and 10% employed the equivalent of more than 50 full‐time hospitalists. Most groups covered a single hospital, but the remainder distributed their workload over a wide range of facilities.

Primary Measures.

Two‐thirds of employers would offer either a signing bonus or a starting salary increase of at least $10,000 to those coming out of clinical fellowship training; a quarter would offer a bonus and a higher salary (Table 2). More than 20% of employers would offer an initial salary that was at least $20,000 higher. Leadership positions would be considered by 69% of employers.

Demographics.

One hundred and one practicing hospitalists responded to the SHM E‐mail request. The SHM membership office estimates that the survey was sent to deliverable E‐mail addresses of approximately 2300 physicians, of whom approximately 68% (1560) were internists; based on this, our response rate was approximately 6.5%.

Table 3 shows that practicing hospitalists were predominantly internists (88%). They were evenly distributed across the nation and between hospital‐owned groups (46%) and privately owned groups (46%); the latter included medical school practice plans (18% of respondents). Of the respondents, 75% were full‐time hospitalists, and only 1 worked less than 0.25 the equivalent of full‐time. They had graduated a median of 8 years earlier (interquartile range, 6 years; range, 1970‐2005).

Primary Measures.

On average, practicing hospitalists ranked essentially all 12 curricular topics between moderate and high priority. Figure 1 displays the scores sorted by means with standard deviations; any pairwise difference between 2 means greater than 0.286 corresponds to a Bonferroni‐corrected P value < .05. Communication, leadership, and coding skills averaged above 2.5 (ie, closer to high than moderate priority), and bioethics ranked the lowest. There was no overall obvious clustering of topics, with administrative and clinical topics interspersed across the ratings. Respondents offered no separate topics in their open‐ended responses, but recommended subtopics to be included, such as contract negotiation, training for effective committee involvement, dealing with families, consultative medicine, and ICU comanagement. Several respondents also suggested tailoring the weighting of the curricular emphasis according to the needs and experience of individual fellows in each cohort.

Figure 1

Of the practicing hospitalists, 81% believed that clinical fellowship could be a good career move (Table 4), and 59% believed that graduating residents probably or strongly should consider such fellowship training. The median response to the question of minimum salary we should offer a hospitalist fellow was $70,000, with 80% of responses between $50,000 and $90,000.

When asked about their future plans, 69% were very likely to be practicing hospital medicine in 5 years (Table 4). Major reasons for career dissatisfaction were aggregated into 5 categories, 3 of which pertained to internal group management (accounting for 71% of concerns) and the others to external interactions in the hospital milieu (Table 4).

Demographics.

Two hundred and seventy‐nine categorical medicine residents responded to the survey link forwarded by their program director, 43% of whom requested a follow‐up summary of overall survey findings. Based on a total of 385 medicine program directors sent an E‐mail request and the E‐mail domain servers of the respondents, we estimate that about 70 program directors (18%) forwarded surveys to their residents.

Without respect to subspecialty choice, 75% of the 279 categorical residents planned to stay in their region after graduation; among the 25% planning to relocate, most were moving from the East or South to the West or Southwest (Table 5). Interestingly, no residents in the Southwest and the West planned to leave their region of current training. Overall, 40% were academically oriented. About 35% planned to work for a hospital entity, and about 20% planned to work in a private group.

Primary Measures.

One hundred and twenty‐three of the 279 categorical residents (44%) were strongly considering a hospitalist career. There was no significant difference in the proportion of interest across PGY 1‐3 level (P = .48). Seventy of these 123 (57%) would likely pursue a clinical hospital medicine fellowship if it was available to them. Although there was increasing fellowship interest, with interest by PGY1 residents greater than that of PGY2 residents, which was greater than of PGY3 residents, but this trend did not reach statistical significance (Cochrane linear trend, P = .15).

One hundred and forty‐seven of the 279 categorical residents (53%) offered reasons for interest (or lack of interest) in a hospital medicine career (Fig. 2). The predominant attractions (Fig. 2A) were the intellectual challenge and variety of cases encountered in general acute care (49%) and the flexibility in work scheduling and time off (37%). Reasons offered for not pursuing hospital medicine were mainly the intention to purse subspecialty or primary care medicine; remaining factors (from a relatively small number of responders) included perceptions of a lack of professional respect and unfavorable salary or scheduling (Fig. 2B).

Figure 2

Survey I: Employers.

We created an electronic database by extracting employer contact information from all classified advertisements placed between January and June 2005 in the New England Journal of Medicine, JAMA, Today's Hospitalist, Annals of Internal Medicine, and SHM's The Hospitalist. Almost all employers included in their ad or otherwise provided on phone inquiry an E‐mail address to which we sent a request with a link to the Web‐based survey (Supplemental Fig. S1). The remaining employers were faxed a copy of the survey to complete and return by fax or mail. We made up to 3 attempts (including a final phone call attempt) to request a response before considering an employer a nonrespondent. The survey asked employers to indicate how much sign‐on bonus and greater initial salary they would offer a clinical fellowshiptrained graduate and whether such a person would be more likely to be offered a leadership position. Open‐ended comments were sought. Demographic questions related to geographic region, group ownership, number of hospitalists employed, and number of hospitals covered.

Survey II: Hospitalists.

The SHM sent an E‐mail message on our behalf to its roster of practicing hospitalist members. The E‐mail included a link to our Web‐based survey (Supplemental Fig. S2). We asked the hospitalists to suggest a minimum fellowship salary (assuming a 50% clinical workload), to rate the value of a clinical fellowship as a career move, to indicate their perception of causes of dissatisfaction among current hospitalists, and to prioritize each of 12 broad curricular topics as low, medium, or high (open‐ended suggestions were also sought). Demographic questions related to residency and fellowship training, current practice, and perceived likelihood to still be practicing hospital medicine in 5 years.

Survey III: Residents.

We compiled an E‐mail database of internal medicine programs from the Association of Program Directors in Internal Medicine (APDIM) Web site and the ACGME Medical Education Directory (informally known as the green book). Each program director was E‐mailed the rationale for our survey and summary findings from Surveys I and II, with an appended link to our online survey (Supplemental Fig.S3). We made up to 3 E‐mail attempts before considering a program director to be a nonrespondent (confirmation was either by the director or indirectly determined by the E‐mail server domains of responding residents). The survey asked about the resident's likelihood of pursuing a hospitalist career, followed by a hypothetical question: assuming the resident were to become a hospitalist, and knowing the results of Surveys I and II, how likely would the resident be to pursue a clinical hospital medicine fellowship following residency? We also allowed open‐ended responses about the main reasons a resident would or would not consider hospital medicine as a career. Demographic questions concerned current PGY level, geographic region of residency, anticipated future practice, and preferred type of future employer.

Demographics.

Among 241 unique journal classified advertisement sources, we identified 195 representing direct employers of hospitalists, rather than recruitment firms. Of these, 103 (52.8%) completed the survey. Representatives of only 5 employers actively declined to complete the survey, indicating that they were not in positions of authority to provide the information needed.

Table 1 shows that the employers were distributed across the United States, and balanced among hospital‐owned and private group (including academic) ownership (38% vs. 51%, respectively). Although 70% of groups employed at most 15 hospitalists, 20% employed 16‐50, and 10% employed the equivalent of more than 50 full‐time hospitalists. Most groups covered a single hospital, but the remainder distributed their workload over a wide range of facilities.

Primary Measures.

Two‐thirds of employers would offer either a signing bonus or a starting salary increase of at least $10,000 to those coming out of clinical fellowship training; a quarter would offer a bonus and a higher salary (Table 2). More than 20% of employers would offer an initial salary that was at least $20,000 higher. Leadership positions would be considered by 69% of employers.

Demographics.

One hundred and one practicing hospitalists responded to the SHM E‐mail request. The SHM membership office estimates that the survey was sent to deliverable E‐mail addresses of approximately 2300 physicians, of whom approximately 68% (1560) were internists; based on this, our response rate was approximately 6.5%.

Table 3 shows that practicing hospitalists were predominantly internists (88%). They were evenly distributed across the nation and between hospital‐owned groups (46%) and privately owned groups (46%); the latter included medical school practice plans (18% of respondents). Of the respondents, 75% were full‐time hospitalists, and only 1 worked less than 0.25 the equivalent of full‐time. They had graduated a median of 8 years earlier (interquartile range, 6 years; range, 1970‐2005).

Primary Measures.

On average, practicing hospitalists ranked essentially all 12 curricular topics between moderate and high priority. Figure 1 displays the scores sorted by means with standard deviations; any pairwise difference between 2 means greater than 0.286 corresponds to a Bonferroni‐corrected P value < .05. Communication, leadership, and coding skills averaged above 2.5 (ie, closer to high than moderate priority), and bioethics ranked the lowest. There was no overall obvious clustering of topics, with administrative and clinical topics interspersed across the ratings. Respondents offered no separate topics in their open‐ended responses, but recommended subtopics to be included, such as contract negotiation, training for effective committee involvement, dealing with families, consultative medicine, and ICU comanagement. Several respondents also suggested tailoring the weighting of the curricular emphasis according to the needs and experience of individual fellows in each cohort.

Figure 1

Of the practicing hospitalists, 81% believed that clinical fellowship could be a good career move (Table 4), and 59% believed that graduating residents probably or strongly should consider such fellowship training. The median response to the question of minimum salary we should offer a hospitalist fellow was $70,000, with 80% of responses between $50,000 and $90,000.

When asked about their future plans, 69% were very likely to be practicing hospital medicine in 5 years (Table 4). Major reasons for career dissatisfaction were aggregated into 5 categories, 3 of which pertained to internal group management (accounting for 71% of concerns) and the others to external interactions in the hospital milieu (Table 4).

Demographics.

Two hundred and seventy‐nine categorical medicine residents responded to the survey link forwarded by their program director, 43% of whom requested a follow‐up summary of overall survey findings. Based on a total of 385 medicine program directors sent an E‐mail request and the E‐mail domain servers of the respondents, we estimate that about 70 program directors (18%) forwarded surveys to their residents.

Without respect to subspecialty choice, 75% of the 279 categorical residents planned to stay in their region after graduation; among the 25% planning to relocate, most were moving from the East or South to the West or Southwest (Table 5). Interestingly, no residents in the Southwest and the West planned to leave their region of current training. Overall, 40% were academically oriented. About 35% planned to work for a hospital entity, and about 20% planned to work in a private group.

Primary Measures.

One hundred and twenty‐three of the 279 categorical residents (44%) were strongly considering a hospitalist career. There was no significant difference in the proportion of interest across PGY 1‐3 level (P = .48). Seventy of these 123 (57%) would likely pursue a clinical hospital medicine fellowship if it was available to them. Although there was increasing fellowship interest, with interest by PGY1 residents greater than that of PGY2 residents, which was greater than of PGY3 residents, but this trend did not reach statistical significance (Cochrane linear trend, P = .15).

One hundred and forty‐seven of the 279 categorical residents (53%) offered reasons for interest (or lack of interest) in a hospital medicine career (Fig. 2). The predominant attractions (Fig. 2A) were the intellectual challenge and variety of cases encountered in general acute care (49%) and the flexibility in work scheduling and time off (37%). Reasons offered for not pursuing hospital medicine were mainly the intention to purse subspecialty or primary care medicine; remaining factors (from a relatively small number of responders) included perceptions of a lack of professional respect and unfavorable salary or scheduling (Fig. 2B).

Figure 2

Survey I: Employers.

We created an electronic database by extracting employer contact information from all classified advertisements placed between January and June 2005 in the New England Journal of Medicine, JAMA, Today's Hospitalist, Annals of Internal Medicine, and SHM's The Hospitalist. Almost all employers included in their ad or otherwise provided on phone inquiry an E‐mail address to which we sent a request with a link to the Web‐based survey (Supplemental Fig. S1). The remaining employers were faxed a copy of the survey to complete and return by fax or mail. We made up to 3 attempts (including a final phone call attempt) to request a response before considering an employer a nonrespondent. The survey asked employers to indicate how much sign‐on bonus and greater initial salary they would offer a clinical fellowshiptrained graduate and whether such a person would be more likely to be offered a leadership position. Open‐ended comments were sought. Demographic questions related to geographic region, group ownership, number of hospitalists employed, and number of hospitals covered.

Survey II: Hospitalists.

The SHM sent an E‐mail message on our behalf to its roster of practicing hospitalist members. The E‐mail included a link to our Web‐based survey (Supplemental Fig. S2). We asked the hospitalists to suggest a minimum fellowship salary (assuming a 50% clinical workload), to rate the value of a clinical fellowship as a career move, to indicate their perception of causes of dissatisfaction among current hospitalists, and to prioritize each of 12 broad curricular topics as low, medium, or high (open‐ended suggestions were also sought). Demographic questions related to residency and fellowship training, current practice, and perceived likelihood to still be practicing hospital medicine in 5 years.

Survey III: Residents.

We compiled an E‐mail database of internal medicine programs from the Association of Program Directors in Internal Medicine (APDIM) Web site and the ACGME Medical Education Directory (informally known as the green book). Each program director was E‐mailed the rationale for our survey and summary findings from Surveys I and II, with an appended link to our online survey (Supplemental Fig.S3). We made up to 3 E‐mail attempts before considering a program director to be a nonrespondent (confirmation was either by the director or indirectly determined by the E‐mail server domains of responding residents). The survey asked about the resident's likelihood of pursuing a hospitalist career, followed by a hypothetical question: assuming the resident were to become a hospitalist, and knowing the results of Surveys I and II, how likely would the resident be to pursue a clinical hospital medicine fellowship following residency? We also allowed open‐ended responses about the main reasons a resident would or would not consider hospital medicine as a career. Demographic questions concerned current PGY level, geographic region of residency, anticipated future practice, and preferred type of future employer.

Demographics.

Among 241 unique journal classified advertisement sources, we identified 195 representing direct employers of hospitalists, rather than recruitment firms. Of these, 103 (52.8%) completed the survey. Representatives of only 5 employers actively declined to complete the survey, indicating that they were not in positions of authority to provide the information needed.

Table 1 shows that the employers were distributed across the United States, and balanced among hospital‐owned and private group (including academic) ownership (38% vs. 51%, respectively). Although 70% of groups employed at most 15 hospitalists, 20% employed 16‐50, and 10% employed the equivalent of more than 50 full‐time hospitalists. Most groups covered a single hospital, but the remainder distributed their workload over a wide range of facilities.

Primary Measures.

Two‐thirds of employers would offer either a signing bonus or a starting salary increase of at least $10,000 to those coming out of clinical fellowship training; a quarter would offer a bonus and a higher salary (Table 2). More than 20% of employers would offer an initial salary that was at least $20,000 higher. Leadership positions would be considered by 69% of employers.

Demographics.

One hundred and one practicing hospitalists responded to the SHM E‐mail request. The SHM membership office estimates that the survey was sent to deliverable E‐mail addresses of approximately 2300 physicians, of whom approximately 68% (1560) were internists; based on this, our response rate was approximately 6.5%.

Table 3 shows that practicing hospitalists were predominantly internists (88%). They were evenly distributed across the nation and between hospital‐owned groups (46%) and privately owned groups (46%); the latter included medical school practice plans (18% of respondents). Of the respondents, 75% were full‐time hospitalists, and only 1 worked less than 0.25 the equivalent of full‐time. They had graduated a median of 8 years earlier (interquartile range, 6 years; range, 1970‐2005).

Primary Measures.

On average, practicing hospitalists ranked essentially all 12 curricular topics between moderate and high priority. Figure 1 displays the scores sorted by means with standard deviations; any pairwise difference between 2 means greater than 0.286 corresponds to a Bonferroni‐corrected P value < .05. Communication, leadership, and coding skills averaged above 2.5 (ie, closer to high than moderate priority), and bioethics ranked the lowest. There was no overall obvious clustering of topics, with administrative and clinical topics interspersed across the ratings. Respondents offered no separate topics in their open‐ended responses, but recommended subtopics to be included, such as contract negotiation, training for effective committee involvement, dealing with families, consultative medicine, and ICU comanagement. Several respondents also suggested tailoring the weighting of the curricular emphasis according to the needs and experience of individual fellows in each cohort.

Figure 1

Of the practicing hospitalists, 81% believed that clinical fellowship could be a good career move (Table 4), and 59% believed that graduating residents probably or strongly should consider such fellowship training. The median response to the question of minimum salary we should offer a hospitalist fellow was $70,000, with 80% of responses between $50,000 and $90,000.

When asked about their future plans, 69% were very likely to be practicing hospital medicine in 5 years (Table 4). Major reasons for career dissatisfaction were aggregated into 5 categories, 3 of which pertained to internal group management (accounting for 71% of concerns) and the others to external interactions in the hospital milieu (Table 4).

Demographics.

Two hundred and seventy‐nine categorical medicine residents responded to the survey link forwarded by their program director, 43% of whom requested a follow‐up summary of overall survey findings. Based on a total of 385 medicine program directors sent an E‐mail request and the E‐mail domain servers of the respondents, we estimate that about 70 program directors (18%) forwarded surveys to their residents.

Without respect to subspecialty choice, 75% of the 279 categorical residents planned to stay in their region after graduation; among the 25% planning to relocate, most were moving from the East or South to the West or Southwest (Table 5). Interestingly, no residents in the Southwest and the West planned to leave their region of current training. Overall, 40% were academically oriented. About 35% planned to work for a hospital entity, and about 20% planned to work in a private group.

Primary Measures.

One hundred and twenty‐three of the 279 categorical residents (44%) were strongly considering a hospitalist career. There was no significant difference in the proportion of interest across PGY 1‐3 level (P = .48). Seventy of these 123 (57%) would likely pursue a clinical hospital medicine fellowship if it was available to them. Although there was increasing fellowship interest, with interest by PGY1 residents greater than that of PGY2 residents, which was greater than of PGY3 residents, but this trend did not reach statistical significance (Cochrane linear trend, P = .15).

One hundred and forty‐seven of the 279 categorical residents (53%) offered reasons for interest (or lack of interest) in a hospital medicine career (Fig. 2). The predominant attractions (Fig. 2A) were the intellectual challenge and variety of cases encountered in general acute care (49%) and the flexibility in work scheduling and time off (37%). Reasons offered for not pursuing hospital medicine were mainly the intention to purse subspecialty or primary care medicine; remaining factors (from a relatively small number of responders) included perceptions of a lack of professional respect and unfavorable salary or scheduling (Fig. 2B).

Figure 2