Q&A: What future hospitalists are thinking now

Young docs talk about training experiences, expectations for their careers.

About 9% of third-year internal medicine residents want to become hospitalists, a recent study found.

The statistic was gathered from Internal Medicine In-Training Examination surveys taken in 2009 to 2011 as an effort to understand what leads physicians to choose hospital medicine. The results, which also found that only 9% of medicine residents had a consistent specialty choice throughout their residency, were published in the July Journal of General Internal Medicine.

Following up on these findings, ACP Hospitalist recently undertook a less scientific investigation of residents' interest in hospital medicine. Two representatives from the College's Council of Resident/Fellow Members shared their thoughts on becoming hospitalists.

Sandeep Palakodeti, MD, MPH, is a third-year resident at Kaiser Permanente San Francisco and Fatima Syed, MD, MSc, is a second-year resident at Jefferson University Hospital in Philadelphia.

Q: Did you enter medical school planning to become an internist?

A: Dr. Syed: Before I started medical school, I did a master's in public policy and social policy. It was an internationally focused degree, and I saw that in a lot of other countries they seem to emphasize general medicine. I thought, I want to do that. As I went through medical school...everything that I did clinically confirmed the goal that I had from the beginning.

Q: What particularly interested you in hospital medicine?

A: Dr. Palakodeti: When I imagined as a kid being a doctor, what I really [pictured is] hospital medicine—walking around the wards, taking care of patients who are coming to you with all different kind of disease states.

Q: What have you observed of hospitalists in practice?

A: Dr. Palakodeti: The hospitalists that I work with all seem pretty happy. I'm at Kaiser Permanente, so we have a salary-based model where physicians have a lot of backup and a lot of shift work.

Q: What factors are you considering in that decision?

A: Dr. Syed: The first thing I think about is what kind of [medical problems] do I want to see. [Then] a lot of it has to do with lifestyle. What I see is that the hospitalists seem really happy with their schedules. The primary care physicians also seem pretty happy with their schedules.

Q: How are you leaning between academic and community practice?

A: Dr. Palakodeti: I like the academic style. I enjoy having residents and teaching more than I thought I would. I also like the inquiry. You have questions, you think about them, then you create studies, you observe and you write things up and find things out. Not that that doesn't exist in private practice or community-based [hospital medicine]. For me, I want something a little bit more than just doing the shift work and being a physician and going home.

Q: Do you think the current internal medicine training system encourages residents to become hospitalists?

A: Dr. Palakodeti: I think that's absolutely true. We do our best to provide good outpatient experiences but invariably throughout the year, it almost ends up being a distraction from your inpatient work. We get 1 month of outpatient training per year. From a comfort standpoint, it's much easier to go from residency training to [being a] hospitalist, because you're pretty used to being a hospitalist already. You don't get a great sense of managing chronic conditions over time, I don't think, at least in our program.