This spring, 20 or so hospital medicine faculty and staff will gather at the University of California, San Francisco (UCSF), for a week of sessions devoted to filling an educational gap in their career trajectory.
On the agenda: education about personality types and leadership styles, discussions of negotiation and communication strategies, and guidance on how to manage teams and handle difficult situations. The boot camp was developed a few years ago to assist early-career hospitalists as they move into mid-career and assume more leadership roles, said Trevor Jensen, MD, MS, one of the co-leaders of the boot camp and an associate clinical professor of medicine in the division of hospital medicine at UCSF.
“They get those roles, oftentimes, and they want those roles, but they haven't had even basic leadership or management training,” Dr. Jensen said. “As residents, you mostly learn how to get things done and how to treat disease. But you don't learn how to manage anything bigger than a three-person team most of the time.”
The boot camp is one of various approaches medical institutions are taking to help hospitalists build management skills and hone others mid-career. While there's no precise definition of that stage, Dr. Jensen and others describe it as a point at least five years into practice at which physicians have identified their specific interests and passions but hunger for more support and guidance to pursue them.
Even before the pandemic strained the resilience of all physicians, mid-career could be a precarious stretch, with physicians pulled between competing professional demands, along with sometimes raising a family as well, said Gaby Frank, MD, FACP, a professor of medicine and director of faculty development and advancement at the division of hospital medicine at the University of Colorado in Aurora.
She cited a 2013 study, published in Mayo Clinic Proceedings, finding that mid-career physicians—defined as 11 to 20 years into practice—were more likely to report emotional exhaustion and burnout than those earlier or later in their careers.
“I feel that when you are a mid-assistant or early associate professor, you already know what you want,” Dr. Frank said. “But then you need to find the time to do it. We know that it's very, very hard to find ways to get protected time to do what you enjoy doing the best.”
Meeting individual needs
The specialization and variation of mid-career hospitalists' interests make it difficult to identify broader programming or training that's useful to the population as a whole, said ACP Member James Park, MD, MPH, MSHP, an associate professor of clinical medicine and an associate director of faculty development in the section of hospital medicine at the University of Pennsylvania in Philadelphia.
For instance, a hospitalist who is interested in medical education might seek guidance on creating curricula and moving into academic leadership, while another physician who has specialized in quality improvement may want scholarship-related mentorship, said Dr. Park, who leads his hospital medicine program's faculty development.
“You can see right there that those are two completely different needs requiring different senior faculty and requiring different information,” Dr. Park said. “And that's where we hit our biggest roadblocks. While we have great senior faculty who want to help our midcareer and junior faculty, they're also stretched thin as it is.”
Instead of trying to build midcareer programming that meets the needs of all, Dr. Park strives for longitudinal faculty development. Several years ago, Penn launched a formal mentorship structure for junior hospitalist faculty—small mentorship teams that Dr. Park hopes will follow physicians as they advance in their careers. Under the approach, an incoming physician is paired with several other individuals, one a fellow hospitalist and additional physicians who have knowledge related to the faculty member's interest.
As one example, an early-career hospitalist in the department has completed an ultrasound fellowship, so her mentorship team includes physicians from emergency medicine and pulmonary medicine, both of whom possess expertise in point-of-care ultrasound.
The University of Colorado is in the initial stages of forming niche groups along interest lines to assist early and mid-career physicians with building broader networks of expertise. “How can we facilitate and be creative to create the right venue for these mid-career people to showcase their expertise and at the same time create those networks so they can learn from them, and also to be proactive together and grow together?” said Dr. Frank.
For example, physicians with a passion for correctional medicine could meet and develop projects with affiliated hospitals, such as Denver Health, a process that will likely foster connections with experts outside of the state as well, Dr. Frank said.
The stress of caring for so many patients during the pandemic, as well as the migration of meetings and other gatherings to the internet, has impaired the more subtle interactions that help support all faculty, including those in mid-career, said Ankur Segon, MD, MPH, MEd, FACP, a professor and chief of the division of hospital medicine at UT Health San Antonio Lozano Long School of Medicine.
It's also more difficult to provide optimal training in a virtual setting, Dr. Segon said. “If they are all on Zoom, you can't really have them do group activities.”
For example, a program of eight in-person one-hour monthly sessions that Dr. Segon organized in his previous faculty development role at the Medical College of Wisconsin was cut short once the pandemic struck. In a typical session, someone would provide a brief lecture on a subject and then the group would break up into pairs to practice the skills taught, he said. “It gets people moving, it gets people engaged,” said Dr. Segon, who shared the model as an abstract at SHM Converge 2022.
The leadership boot camp at UCSF, which is geared toward hospitalists three to five years out of residency, was launched during the pandemic, and the sessions to date have been conducted virtually. But the participants are encouraged to apply the concepts to their daily work, bringing in examples of changes they want to implement, so the group can troubleshoot and brainstorm solutions, Dr. Jensen said.
Prior to the pandemic, UCSF regularly hosted faculty development small groups on topics such as how to deliver a compelling presentation or polish a curriculum vitae, said Margaret Fang, MD, MPH, division chief and professor of medicine. The gatherings often included food and were just as much about getting to know colleagues as building skills, she said. Once the groups moved online, attendance really dropped off, she noted.
More recently, there's been an effort to vary the format depending on the substance of the faculty development session, Dr. Fang said. If the session involves primarily delivering information, it's online, but sessions focused on improving skills or involving interactive case discussions have started to be held in person again, she said.
As one example, a sports medicine physician taught a session this fall on how to give a musculoskeletal exam, Dr. Fang said. “You could do that on Zoom, but it's much more effective to do it in person and to have the hands-on part.” Plus, as a bonus, meeting in person provides a networking opportunity.
Mid-career hospitalists need to not only learn new things but also feel seen, Dr. Frank said. At the University of Colorado, a recognition committee looks for talented physicians to nominate for an array of awards, from local to national, which typically involves writing a letter of support, she said.
“Even if they don't get the award, being able to read a letter of nomination of what their peers are saying about them is very powerful,” Dr. Frank said.
Praise from peers, mentorship arrangements, and faculty education initiatives can all help mid-career hospitalists strive for what should be the goal, according to Dr. Fang—finding meaning in their work. “We support your clinical work, and then we support you finding your passion. Where is your passion in medicine? Where can you derive that internal sense of purpose?” she said.
Charlotte Huff is an independent medical journalist in Fort Worth, Texas.