It’s ironic but perhaps fitting that an internist–my blogging colleague, Erik DeLue–was the first to use this space in defense of family medicine and FM-hospitalists. As an FM-trained, career hospitalist, I can attest that my peers in the specialty are generally self-effacing, a trait that doesn’t always serve us well as we try to carve out our niche in hospital medicine.
To Erik, let me say thanks for your objective and fair viewpoint. You clearly articulated our strengths and our challenges, to which I’ll add just a few of my own thoughts.
I’m admittedly biased on this topic. In addition to my own FM training, I chair the FM task force for the Society of Hospital Medicine. I’m also in the business of recruiting and hiring physicians for my locum tenens company. I echo Erik’s sentiments that “a good doctor is a good doctor” and that we should base all of our hiring decisions on the individual’s merit. Just as there are IM trained physicians that I would not hire, the same falls true with some FM trained physicians.
The traditional objection to FM trained physicians working as hospitalists is their relative lack of inpatient and, particularly, critical care rotations as residents. The core curriculum of a FM residency program can vary widely but invariably allows for a fair amount of elective time during the second and third year. It is my belief that, if used wisely, this elective time can prepare residents for a hospital medicine position directly out of residency. It requires careful planning, but it can be done.
It would obviously require using that time to schedule critical care and medical subspecialty electives in the inpatient setting with a focus on getting exposure to procedures — particularly central lines and intubations. Demonstrating competency in these will make the physician much more marketable out of residency. Also, recommendations from Pulmonary/Critical Care physicians who serve as attendings will go a long way toward bridging the gap in the job market. Nothing speaks to their ability to function well in the ICU better than a letter from an intensivist.
Hospital medicine fellowships, such as those listed on the SHM Web site, are beneficial and necessary for those who feel inadequately prepared for a hospital medicine job based on their training (both FM and IM). We must, however, guard against these fellowships becoming the rule rather than the exception as our workforce struggles will only get worse. For FM trained physicians, there are almost as many fellowships available as for our IM trained colleagues (12 FM vs. 17 IM).
I would also mention that the focus of these fellowships can vary widely as well. You are correct that some are oriented to an academic career. The majority, though, focus on quality and process improvement in the hospital setting and are geared to those interested in leadership positions on the medical staff of the future.
To the credit of SHM, the organization has not only accepted but embraced FM trained physicians, who have become one of the fastest growing groups within SHM. The FM Committee is an active part of the SHM structure and FM trained physicians hold very visible posts within SHM. Many thanks to the leadership of SHM for supporting this cause.
Thanks again to Erik for taking up our cause so eloquently. IMs, FMs and all others with a stake in hospital medicine’s future need to work together to meet our goals for a thriving workforce and optimal patient care.