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Why Hospital Medicine?

Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Caputo chose the field of Internal Medicine and specifically Hospital Medicine. Want to know more about Hospital Medicine? Keep reading...

Working at an academic medical center I have the privilege of working with medical students. One of the questions I am asked most often is “how did you know which specialty you wanted to pursue?” This question often comes in the spring when it is time to set third year schedules for clinical rotations, students fearful that if they have rotations in the “wrong order” they will miss out on finding their right fit specialty. The question resurfaces from fourth year students approaching their residency applications and one final time shortly before rank lists are due and the last minute existential dread of leaving one’s future up to The Match is overwhelming.

I must say I feel ill equipped to answer these students. For me, the decision never felt like a conscious decision at all. It was obvious all along I would do internal medicine. Internal medicine was my first rotation of third year. After two years of sitting in a lecture hall, it was three months of feeling like I was finally doing what I went to medical school to do. I loved it! There was such a broad range of pathology and acuity. I was connecting patients and their histories and physical exams to the diseases I’d been reading about in books and PowerPoint slides up to that point. Each day was different than the one before it because the patients were so diverse. I disliked every rotation after that. So my decision was made. I applied to internal medicine with no doubts.  

The thing about internal medicine residency is that it is not a final destination so much as a layover on the way to figuring out what you want the rest of your career to look like. For many it is a path to fellowship. And while I considered my options, I couldn’t think of any one subspecialty I was excited enough about to continue on as a trainee for additional years. Sure, it was exciting to rotate with the EP attendings and for those 2 weeks feel like I finally had a handle on EKGs, but the patients had so many other things going on beyond whether they needed a beta blocker or a pacemaker and I had a hard time putting those to the side. Again, for me it was obvious, I was a generalist.

Even as a generalist there is still the decision to make between primary care versus hospitalist versus some combination of the two. I thrive in the hospital. I enjoy treating acute problems. Maybe it’s the millennial in me, but I live for the instant(ish) gratification of watching people get well in a matter of hours to days. It is so satisfying to admit a patient, who is often quite ill at the time, and a few days later to send that patient home. I need efficiency and a steady flow of action to not feel restless and frustrated in my work, so the pace of hospital medicine is a perfect fit for my personality.

I also like the control hospital medicine gives me over my schedule and the way it allows me to compartmentalize my professional and personal lives. I work a 7 day on/7 day off schedule with 12 hour shifts and no home call. My day is mine to structure in whatever way works for me as long as all my patients are seen by the end of the shift. When I leave the hospital at the end of the day, I leave work at work. There is no charting from home. There are no pages or calls to return. I highly value the way I can protect my personal life and family time as a hospitalist. There is a broad array of scheduling structures employed by hospitalist groups so there is a hospitalist job out there to fit everyone’s lifestyle and career goals. In addition to the common 7 on/7 off schedule I have, there are full time nocturnist positions, part time positions, locums positions that allow you to work in various locales for variable periods of time, and many other arrangements I’m not even aware of.

They say variety is the spice of life and hospital medicine is nothing if not variety. In addition to the breadth of job opportunities, the patients and their conditions are incredibly diverse. On any given day I may treat heart failure, cirrhosis, pneumonia, complications of AIDS, and co-manage a hip fracture with my orthopedic surgery colleagues. I take care of post op patients for routine overnight observation and take care of ICU patients with multiorgan system failure. The diversity and complexity of hospitalized patients is incredibly intellectually stimulating and presents continuous opportunities for learning.

Finally, hospital medicine provides me the immense privilege of helping people during some of the worst times of their lives. I meet people and their families at moments of critical or sometimes terminal illness. I deliver devastating news. I bear witness to patients’ suffering and I help them navigate decisions about how they can live their lives in accordance with their values even in the face of incurable disease.

During my time as a medical student and resident I felt there was if not pressure, at least encouragement, to pursue specialization and subspecialization. In some ways general internal medicine was looked at as a plan B for if your step scores weren’t high enough for your first choice specialty. Internal medicine and hospital medicine were never plan Bs for me, my career as a hospitalist has been the result of finding the field that allows me to showcase my strengths, achieve my professional and personal goals, and constantly challenge myself. I’m encouraged by a new wave of pride in general internal medicine building in the #medtwitter community. I am #ProudtoBeGIM.

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