7: What is a Hospitalist? An Academic Doc Talks with Us

Session 7 Whether you are a pre-med or medical student, you have answered the calling to becoming a physician. Soon you will have to start deciding what type of medicine you want to practice. This podcast will tell you the specialists from every field, so you can have the information you need to make the most well-informed decision possible when it comes down to choosing your specialty. Today we hear from Shoshana R. Ungerleider, M.D, an internist practicing hospital medicine at California Pacific Medical Center in San Francisco. CPMC is an academic hospital set in a community setting with several residencies, including internal medicine, where she is on the teaching faculty. She has been practicing medicine for three and a half years and finished her residency in 2013.  (2:20)  Discovery Moment Shoshana knew she wanted to be a hospitalist midway through internal medical residency while working “night float” shifts (6pm-8am), admitting patients into the hospital overnight as well as doing cross cover. While there were other specialties that she considered, including cardiology and critical care, she knew she could be happy in a hospital setting and ultimately felt like hospital medicine was a good fit for her. There is a variety of patients that a hospitalist cares for, in terms of age, illness, chief complaint and levels of acuity; they may take care of patients who come into the hospital for a routine hip surgery who are otherwise pretty healthy, while on the other end of the spectrum they co-manage ICU patients who are incredibly ill and spend days or weeks in the intensive care unit. (3:51) The Traits That Lead To A Good Hospitalist There are many personalities that can be happy doing hospital work. One must enjoy interacting with patients, which a hospitalist does often. Additionally, maintaining an intellectual curiosity throughout your years in practice, as things are constantly changing as far as how common medical problems are managed. Hospitalists treat for many types of issues so staying up on the literature is very important; in fact, Shoshana finds herself constantly looking up the most recent guidelines. Flexibility and adaptability are also important traits to have as a hospitalist, because the hours and shifts are unstructured. If you love the structure of an 8am-5pm, she says, you are better suited for working in a clinic or outpatient facility, where the hours are standard. Flexibility and adaptability also come into play for the types of conditions a hospitalist sees--one never knows how busy the ER will be at any given day or time, so it’s good to roll with the punches!  (6:22) A Typical Day For A Hospitalist (or evening, in Shoshana’s case!) After arriving at the hospital, a quick check-in with colleagues on the previous shift, then the pager almost immediately goes off! As a nighttime doctor, the majority of what she does is admit new patients to the hospital and the majority of those patients come through the emergency room. Sometimes they get direct admissions from specialists or primary care doctors where the patients come directly to the floor or may get a transfer from another hospital, but at least 75-85% come directly from the ER. The majority of her shift is therefore in the ER seeing patients and working with the residents. The residents often go in with the physicians together to see patients, or sometimes the resident goes in and chats with the patient first, does a history and physical and then she will come in later to follow up with more questions. They will do a modified round at night  where the residents present the H&P and together  they discuss the assessment and plan. On occasion there will be some cross-cover fires to put out on the floor when patients become ill overnight and she needs to read up on the history of the patient to find out what she needs to do in...