Understanding the characteristics of students interested in pursuing HM can support not only effective changes and adaptations in medical education programs, but also identification of key issues relevant to recruitment of hospitalist physicians. We found consistent diversity characteristics among students interested in going into HM in terms of socio-economic background, race, gender, and sexual orientation. Comparing internal medicine- versus pediatric-based future hospitalists revealed relatively similar demographics for the two groups, whereas they held divergent views in some of their career opinions and preferences.
Students interested in HM are significantly more diverse than those who are unsure, or not interested in this career path. Future hospitalists tend to have a higher proportion of minority characteristics, be they racial (multiracial or non-White), gender (women), or sexual orientations (LGB). As the group of students interested in hospitality medicine becomes more reflective of the overall patient population, there is the potential for actual and perceived higher quality of care delivered to increasingly diverse patients.
Issues of student debt across higher education have raised considerable debate. Although the surveys do not necessarily shed light on students’ individual socioeconomic background, it is conceivable that those with greater student debt may come from families with less means to support their education financially. This is notable since the majority of medical students come from more affluent backgrounds: over 50% of medical students are from families in the top-20 percentage for household income. [14] Prioritizing shorter fellowship programs might also be a proxy for financial concerns and a need to acquire financial stability, rather than prolong and increase debt.
When choosing their specialty, students’ psycho-demographics already influence their choices, for example their intent to go into Internal Medicine vs. Pediatrics. When looking at students interested in HM, there were significant differences between IM and pediatric specialties. However, the importance of role models was evident in both HM/IM and HM/Pediatrics groups, confirming that current hospitalists are crucial in students’ professional development. Among students interested in HM, there were significant differences between IM and pediatric specialties. Those expressing interest in IM acknowledged stronger influence by factors such as salary and debt, and were less likely to plan to enter loan forgiveness programs. They also attributed stronger influence to the possibility of doing a fellowship and the competitiveness of the specialty, along length of residency training prior to entering practice. Work/life balance was slightly more important for those leaning toward HM/IM, but was recognized as a moderate or strong factor for most future Hospitalists (about 4 out of 5). Among students interested in med-peds, almost half (49%) wanted to pursue a career in HM.
Students trained at diverse schools are more comfortable treating patients with a wide variety of racial and ethnic backgrounds, just as patients tend to report higher levels of trust and satisfaction when they share demographic characteristics with their primary care physicians.[15, 16] It is encouraging to find strong trends in choosing HM among students who identify as racial minorities. For example, Black, American Indian, and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women.[17] However, this is mitigated when patients and physicians have concordant racial backgrounds. [18]When patients enter our hospitals, they want to see staff members and physicians who resemble them and there are better outcomes with greater concordance.
Diversity is in itself a laudable goal for programs. Individuals from diverse backgrounds can contribute a wide depth and breadth of perspectives, which allows for more creativity and innovation, but also fosters a more positive working environment and can improve morale among healthcare professionals and patients. Our ability to communicate and care for people from diverse socio-cultural backgrounds, expectations, values, and beliefs define our interaction with patients. Acknowledging the fact that HM attracts students who identify as racial, gender, or sexual orientation minorities allows for better alignment of institutional and programmatic goals with greater physician satisfaction. This has important implications for recruitment and retention. Programs that offer DEI initiatives, value diverse talent acquisition, and align these goals with their mission and vision may be able to more successfully build their body of future Hospitalists and attain greater engagement.
As pragmatic implications, initiatives that reach out early in medical students’ careers might improve their output of future hospitalists. Understanding trends in medical students’ diversity can also inform the creation of pipeline medical programs, at both undergraduate and graduate levels. Recognizing the needs and interests of medical trainees will help programs adapt and maximize recruitment. In graduate medical education (GME), residency programs are creating differentiated tracks among which HM is becoming increasingly popular. Incorporating DEI efforts and cultural competency is integral to the residency curriculum. While a large number of fourth-year medical students (1 in 5) reported being interested in HM, the size of future cohorts of hospitalists might be diminished through the process of completing residency, fellowships, and other training. Medical students are exposed to academic hospitalists for both teaching and mentorship, with hospitalists serving important roles in improving in-patient care and reducing costs through decreasing duration of patient stays.[19]
Surveys modelled on the GQ should be administered nationally during residency, when medical trainees are one-step closer to finalizing their career choices. Such research would help improve general knowledge about the practical aspects of working as a hospitalist, possibly in combination with other specialties. At a minimum, findings such as these insights from GQ surveys can inform program design, content, and emphasis and can provide discussion points for individual hospitalist divisions.
Limitations of using a large survey database include the inability to discern nuance in the questions or to delve more deeply into what individual respondents meant. Although the instruments are comprehensive, there may certainly be other factors that are not captured in this survey but that impact students’ decisions. Focus groups and interviews may help create a more well-rounded picture of the factors that inform career decisions. Additionally, as students continue their residency, their patterns of interest may change. Using data from fourth year medical students does not provide certainty that these students will continue to pursue HM. There is a strong need to build data repositories for longitudinal studies that will inform a more complete picture of the characteristics of trainees who will ultimately enter each field. Another area where more research is imperative includes extension of similar surveys into GME.
Assessing characteristics of trainees across the educational continuum can build pipelines to strengthen and grow hospitalist programs and align interests of students and residents for optimal recruitment and retention, ultimately with a goal to improve patient and physician satisfaction.