Careers in Family Medicine: Hospital Medicine

We are continuing our blog series, Careers in Family Medicine. Each week, I will highlight a family physician and their career path. Each one will share their pearls. So far, we have highlighted examples of Rural Practice, Value Based Care, Academic Medicine, US Department of State, Multi-specialty group and Leadership, Direct Primary Care, and FQHC practices. This week, we take a look at working in Hospital Medicine highlighted by Dr. Beth Wagner. 

Beth, give the readers an overview of your career in family medicine.

I always envisioned myself as a rural family medicine doctor and really enjoyed the continuity of care with patients. I attended the Alaska Family Medicine Residency from 2009-2012. Following graduation, I worked at Providence Alaska Medical Center as a hospitalist and moved to Vermont (my husband and I are from the northeast) to work as a hospitalist in a community hospital where I still work 10 years later. 

How did you know that you wanted to focus on hospital medicine?

While I loved rural medicine and the relationships I was forging with my patients, I fell in love with inpatient hospital medicine during residency. I realized that I loved dealing with complex, acute problems and also realized that I’m an inpatient control freak who can’t stand waiting for an outpatient CT scan or specialist referral. I loved being in the hospital- the hustle and bustle of the place, the collegiality of working side by side with many specialties. I was lucky to be able to spend time working with the Providence hospitalists in residency to see what that would feel like as a career plus my landlord in residency was a hospitalist, so I also observed the nice work life balance that comes with shift work. 

What are the benefits of your current role, both personally and professionally?

There is a lot of flexibility to be had with being a hospitalist- even more so at a community hospital where our group is smaller and we work in both the ICU and medical/surgical units. As the years have passed I’ve been able to tailor my schedule to one that works the best for me and my family- I have found that I really enjoy working nights, so now do the majority of my shifts as night shifts. I’m currently working only 13 shifts a month, which leaves me with a lot of time to be a mom, wife, friend, etc and still be considered ‘full time’.  Professionally, being a hospitalist is hard work- we have to keep up with a wide breadth of medical knowledge - which I like, because I always feel like I’m learning. I love the collegiality of this job, we are constantly interacting with nurses, respiratory therapists, dieticians, case managers, other subspecialties, etc. I have found that my desire for continuity is also fulfilled by working at a community hospital as we have many chronically ill patients that we care for repeatedly- we get to know them and their families quite well. In fact, I just saw a patient I had discharged a week ago in the hallway visiting his mom, who is now hospitalized. 

What have been the challenges?

Where do I start?! Ha. I do love this job but as I said above, it’s not easy! Working in healthcare is hard no matter what specialty. I work mostly nights where I am alone managing sick people with little physician support (just phone consultation and an ER doc to help with codes). The stress of that has gotten easier as I’ve gained experience, but some nights I still have high sphincter tone and creeping self-doubt.  Working at a smaller hospital has challenges - such as limited subspecialty support which means we manage a lot of challenging and complex medical conditions without much help. Shift work is great because I get a lot of days off to be a normal person, but it also means I have to work weekends and holidays, which is a bummer, but part of the gig. 

What specific approaches do you take to enhance your personal and professional fulfillment and joy?

I’m a social person, so for me interacting with colleagues and patients work really helps me feel happy at work. I value connection and the friendships that you can develop with your co-workers. Taking extra time to get to know patients beyond their acute medical problems is something that really fills my cup and helps make this job more satisfying. Sometimes my socializing can be a detriment…bc I talk too much and don’t get my work done!  Working nights has also helped me with professional fulfillment because at night I’m only doing medicine- I’m not dealing as much with discharge hurdles or social problems which can really suck your energy on day shift. Being a hospitalist really helps with professional boundaries- because it’s shiftwork it feels easy to keep work and home separate which is important for me. 

Any tips for those looking at their first job (or those who are looking to pivot) on how to decide?

I think it’s important to just figure out what makes you tick as a doctor- this is obviously going to help decide outpatient vs inpatient medicine. Once you decide on being a hospitalist really look at the group you are joining- do they seem to like each other, do they appear happy or super burned out, how many patients do they round on daily, is their schedule flexible, do they feel supported by specialists and admins? I think the general feeling of the group is really what to look for when picking a job, really quiz them if they like their jobs and each other- we spend a lot of time at work together, you want to be able to like and trust your co-workers. 

Any tips or perspectives you'd like to share with readers wondering about a career as a hospitalist?

Coming out of residency you may feel like you don’t know enough…and you don’t! You never will! But FM residency will equip you with all the skills you need to do this job. I think there is some worry that a FM doc may not have as much experience or education as an IM trained doc and I don’t agree with this- sure IM residents spend more hours on the medical wards while we are birthing babies, assisting in surgery, and seeing outpatients but all of these experiences have helped me as a hospitalist and I feel as capable as my IM colleagues to do my job. If you are in residency and thinking that this is the path you wish to take- I would try to get some extra ICU rotations because I think you will get the most bang for your buck with these rotations as far as procedures and medical complexity. 

Any other things you’d like to share?

The beauty of a career is medicine is that there is no one size fits all…we are allowed to pivot and be creative with our careers. You may do hospital medicine for a few years- maybe at an academic center or maybe at a community hospital- there is a lot of job variation even between hospitals and definitely between community and academic medicine. Perhaps you find a clinic where you can do both inpatient and outpatient! Don’t settle on any one thing- we are lucky to be able to do so many different jobs as family physicians and I wish you all the best of the luck finding your happy place!

Great! Thank you for taking the time to share your wisdom with the readers. How can people find you if they want to learn more? 

[email protected]

So many great lessons. I told you family physicians are inspiring. What are your take-aways from today's blog?  

Next week, we'll dive into Tribal Health with Dr Shanda Lohse. Don't miss any in this series; sign-up to have them delivered to your inbox. 

Until then, have a joy-filled week! Tonya