Global health hospitalists: The fastest growing specialty's newest niche

Over the last decade, health systems strengthening, workforce training, and patient safety have come to the forefront of global health (GH) priorities. Although a growing literature describes the advantages and challenges of GH experience during medical school and residency, little is known about patterns of GH activity among hospitalists. As the fastest growing US medical specialty, hospital medicine is well suited to meet these global health challenges through specific emphasis on quality improvement, safety, systems thinking, and medical education. To learn about hospitalist involvement in GH, we conducted a survey study of hospitalist members of the Society of Hospital Medicine (SHM). Our survey was sent to the entire SHM membership ( 8000) and examined demographics, characteristics, and patterns of involvement in GH, and explored perceived synergies as well as barriers to GH work. Among the 232 participants who responded to the questionnaire, 60% were male; the mean age was 43 years. Seventy percent had internal medicine training, 41% indicated a community-based nonacademic hospital as their primary professional setting, and 81% indicated that clinical work was their primary professional activity (Table 1). Overall, 51% of all respondents in our study reported having GH experience prior to becoming hospitalists, and 33% of all respondents said that they participated in GH activities after entering the field of hospital medicine. Sixty-five percent of respondents stated that their GH work since becoming hospitalists primarily addressed infectious diseases, and 42% indicated that their activities were in the outpatient setting. Seventy-eight percent of respondents had no funding to support their GH work. Among the 67 respondents who answered a question on the possible influence of GH work on their decision to enter hospital medicine, 29% indicated that scheduling flexibility inherent in hospitalist work is an important enabling factor for continued engagement in GH. Qualitative analysis of responses to open-ended questions revealed several challenges that hospitalists face in the field: 1) lack of mentorship, career development plan, and recognition of GH activities; 2) lack of GH training and knowledge of local systems of care, and difficulty applying domestic clinical experience in GH settings; 3) lack of materials resources and funding; and 4) lack of hospitalist model for inpatient care in many GH settings (Table 2). Despite these challenges, respondents thought that hospitalists could make several important contributions to GH: 1) service delivery, 2) clinical training of healthcare providers and capacity building, 3) quality improvement and systems change, 4) donation of TABLE 1. Demographics (Total N5232)