FAQs About Working as a Hospitalist

Medscape

06-05-2025

Hospitalists serve a unique role in patient care. Rather than focus on a specific organ system or disease, hospitalists specialize in the comprehensive care of hospitalized patients.
They see patients of all ages and backgrounds dealing with chronic and acute illnesses, emergencies, surgeries, and a range of other causes that have put them in the hospital.
A 2022 report from the Society of Hospital Medicine determined that there were around 44,000 hospitalists in the United States, and those numbers were only climbing.
For medical students seeking a better understanding of what it means to pursue a career in hospital medicine, we turned to Heather Nye, MD, professor of medicine at the University of California San Francisco and associate chief of medicine at San Francisco VA Health Care System, San Francisco. She also serves on the Board of Directors of the Society of Hospital Medicine.
Medscape Medical News asked Nye to share five key aspects about working as a hospitalist. Her responses are given below:
At what point did you decide to become a hospitalist and why?
'I decided to become a hospitalist near the beginning of the movement in the late 1990s. I worked with brilliant hospitalists as a resident and learned about their jobs, their ability to teach residents and make quick, high-impact decisions for sick inpatients.
It seemed fun and not at all mundane. It's been a thrill to watch the field grow into many different niches in need of experts, such as skilled nursing facilities, palliative medicine, perioperative medicine, addiction medicine, etc.
We are problem solvers with a broad lens and our impact continues to grow. Hospitalists are now the healthcare system experts — often serving in C-suite roles, quality and patient safety leadership roles, and many other critical operational areas. [Hospitalists are] well-poised to address the rapidly changing landscape of medicine today.'
What are work-related challenges that may be unique to hospitalists compared with other specialists?
'Hospitals never close. As a result, hours and schedules for hospitalists can be intrusive — and regularly include nights, weekends, and holidays. While the spry and youthful hospitalist just out of residency is accustomed to this work schedule, as family responsibilities grow — and as we enter mid-to-late career — the 7 days on, 7 days off or other common schedules can be grueling.
Another challenge is the breadth of our practice. Like outpatient primary care physicians, our ground covers every organ system, psychosocial issues, and everything in between. In a patient with heart failure, acute coronary syndrome, kidney failure, and out of control diabetes, the fourth left toe pain is still under your purview and may be a meaningful sign of underlying process that must be addressed.'
What are keys to effective communication with patients?
'I've always believed that hospitalists are the consummate interpreters. We synthesize loads of complex information coming from specialists, diagnostic studies, and knowledge of procedures and treatments and must simply describe options, connect the dots between systems, and help patients make decisions around treatment options.
This is a heavy lift, and my favorite part of being a hospitalist. Creating an 'aha' moment for a patient by drawing a simple figure on a piece of paper — for example, the kidneys and bladder and how urinary obstruction causes problems — is a very effective strategy.
Writing out on a whiteboard pain regimen options available to patients or discussing medications and indications for each is often eye-opening and not done nearly enough for patients. Sitting at the bedside has been shown to be effective time and again for making patients feel heard and promoting good communication.'
What's a typical schedule for a hospitalist?
'Many hospitals employ 7 days on, 7 days off strategy with 8- to 12-hour shifts for days and 8- to 12-hour shifts for nights.
Academic centers, like my own, have a number of different services — such as resident ward teams, hospitalist ward teams, surgical comanagement, and consults — each of which may have a different stretch of time covered.
In systems with resident inpatient teams, a hospitalist attending physician will often be on for 1-2 weeks at a time. At my facility, we do sporadic weekend and evening shifts to ensure a hospitalist is available 24/7 for admitting, resident supervision, and hospital emergencies.'
What's a common misconception about hospitalists?
'One misconception might be that hospitalists are glorified residents and do not have a specific skillset or knowledge base required for practice. This couldn't be further from the truth.
First of all, acute care medicine is very different than primary care and requires procedural skills, quick synthesis of information, and knowledge of appropriate diagnostic studies. The syntheses of multi-organ illnesses is also a unique area in which hospitalists excel.
Secondly, understanding and mastering hospital systems is sometimes as important as clinical knowledge in caring for patients admitted to the hospital. Navigating these systems swiftly and effectively can be critical for optimal outcomes, and most especially, transitions back to the community. I like to say hospital medicine is 'full service' medicine — bedside to home.'