A Hospitalist in Academics

I fell into hospital medicine rather unexpectedly. I knew I wanted to stay in general internal medicine, but I thought I would be a primary care internist. Then, in residency, I discovered how much I loved the inpatient setting - not for the actual medicine part - but for the educational part: I loved teaching and the ability to do so with scale with the large learner-heavy teams on the wards.

A lot of people equate hospitalists with shift work, and in many cases, this is true. Working within well-defined and pre-scheduled shifts may be very alluring to mothers in medicine: predictable hours, a defined schedule, potentially no call, and the flexibility to easily work part-time.

However, for my particular job as a hospitalist in an academic setting, I don't do shift work. Most of my clinical time is supervising resident-run teams (the other clinical time is spent doing consults or supervising a PA-led "non-teaching" service without residents), which means longer or shorter days depending on team census, the acuity of our patients, whether the resident or interns are in clinic for the afternoon, call-days, and how independent my resident is (new R2 very different supervision time than a seasoned R3). I'm available by phone to my teams when they are on call at night. I work many weekends and holidays. And although I can take compensatory days off in lieu of working the holiday, which is great and something I put into action as chief of the hospitalist section, my kids will be home without me.

Parts of my clinical job are absolutely draining, mentally and emotionally. There's the family meetings to discuss goals of care in dying patients who may or may not have decision-making capacity. There's the bearing witness to tremendous suffering -like those with difficulty coping that they have a chronic disease that brings them in and out of the hospital so frequently. But, these parts are also what give me pause - I have a job where I can make a difference. I can make someone's suffering heard, metabolized, and given meaning. I can lead a difficult family discussion and make sure everyone's needs are identified. Hard but good.

I'm in my 9th year as a full-time hospitalist and in that time, have had three children. I've taken on more administrative duties and my weeks on the wards have accordingly decreased. I have the flexibility to do research, to do committee work, to teach. I'm meeting my personal goals of academic success. I feel like I am compensated fairly for my work and the requirement to work some weekends and holidays. This scaling back of clinical duties has been critical to achieving the balance I need as my family has grown. Granted, I worked my butt off in the beginning doing a much heavier clinical schedule, starting a family, and establishing my ability to take on these non-clinical duties and establishing a research agenda to be able to scale back these last few years.  On admin time, I have major flexibility. Flexibility to linger after school drop-off and chat with the other moms. Flexibility to help out with my daughter's art class. I know I have a really good thing going. And it works. Like others, key to this working for me is: 1) an amazing husband who shares the responsibilities of our home and family equally (minus this last year when he's been deployed to a war zone but that's the topic of another post...); 2) supportive and nearby family; 3) great childcare (which currently is synonymous with number 2); 4) having a flexible enough work environment and an awesome boss; 5) I try hard not to drink the Working Mother in Medicine Guilt Kool-Aid, no matter how tempting it looks some days. (Note operative word is "try.")

Hard but good. I think that about sums it up.