Introduction

Prior research in the field of academic hospital medicine has described challenges to achieving promotion for academic hospitalists.1, 2 A consensus conference identified barriers for academic hospitalist success including alignment of hospitalists with clinical priorities that may not be recognized for academic advancement, inadequate infrastructure to promote success, and lack of national funding for research in general inpatient medicine.3 Research is needed to better understand perspectives of academic hospitalists regarding the pathway to career success.1 This qualitative study explores the barriers and facilitators of career success as perceived by early career academic hospitalists.

Methods

This was a qualitative descriptive study in which we conducted in-depth interviews facilitated by a semi-structured interview guide. Cognitive interviewing with three representative academic hospitalists was done for face validation of the question probe structure. Interviews with early career academic hospitalists self-identifying as clinician-educators from three academic medical centers were conducted by the primary investigator as part of a study to explore their experiences and perceptions of career success.4 All interviews were recorded, de-identified, and transcribed, with auditing for accuracy and completeness. This study was approved by the Colorado Multiple Institution Review Board.

Transcripts of interviews relating to barriers, resources, and hospital medicine group support for success were analyzed for themes using an iterative general inductive approach. Two members of the research team independently reviewed the transcripts and assigned codes to meaningful text segments. A consensus code framework was developed by research team members with codes added, removed, or combined at this stage of the analysis. Each segment of text was then re-coded. Text segments assigned to each code were combined and analyzed to determine themes.

Results

Seventeen academic clinician-educator hospitalists were interviewed. Subjects had been academic hospitalists an average of 3.1 years, 94% were assistant professors, 47% (8/17) were female, and 12% were underrepresented minorities. Interviews lasted an average of 32 min.

Resources to Find Career Success

The most common resources identified by early-career hospitalists to facilitate success included protected non-clinical time (Table 1), individual mentorship, and a wide professional network.

“Whatever direction you do as an academic hospitalist… without having someone to show you by example how to do these things… it’s almost impossible.”

Table 1 A Brief Exploration of Time
Full size table

Barriers to Career Success

The most commonly identified barriers included a lack of protected non-clinical time to devote to academic pursuits, burnout due to excessive work stress, and competing professional responsibilities creating tension between clinical and non-clinical academic priorities.

“That constant battle between the clinical work and the academic work is a real struggle.”

Hospital Medicine Groups’ Supporting Success

Hospitalists most frequently thought the hospital medicine group could support success through facilitating mentorship and providing protected non-clinical time.

“I think building in protected time from day one… makes a world of difference. Because it’s not necessarily the time, it’s the gesture saying that we know you need the breathing room to figure out who you are, what your interests are, and how to develop these skills.”

Discussion

The presence, or absence, of protected non-clinical time was a cross-cutting theme and could mitigate burnout and the conflict referenced by early career hospitalists between clinical and non-clinical obligations. Faculty perspectives on importance of time are supported by research demonstrating a positive association between protected time and scholarly productivity.1 The concept of “time” as an essential facilitator of career success was complex as highlighted in Table 1. It also encompassed time to focus fully on the delivery of clinical care and time for life outside of work. Mechanisms for the group to maximize time included creating a clinical environment that functioned efficiently as well as administrative support to allow time to be used more effectively.

Our findings also suggest that structures to facilitate individual mentoring and collegial professional networks are key to academic hospitalists’ career success. This suggests leadership and should closely attend to the efficacy of both mentorship relationships as well as infrastructure to facilitate connections and collaborations between early career hospitalists and their colleagues. Our findings raise questions about the impact of academic positions without protected time for early career faculty to establish their career trajectory and offer insights into levers for academic medicine groups to utilize that may increase the ability of early career hospitalist faculty to find success.