Academic internal medicine hospitalist professional identity development

Academic hospitalists have major roles in medical education, clinical care, and other academic medical center missions. Their professional identity development has implications for vitality, burnout, retention, and patient safety.

To characterize academic internal medicine hospitalist professional identity and its development.

Ten focus group interviews were conducted with 31 hospitalists in early-, mid-, and late-career stages at three academic medical centers. Data were analyzed using thematic analysis.

Academic hospitalist identity development was characterized by (1) constant core clinician identity, (2) navigating interfaces between different spheres of knowledge, influence, and activity (patients, systems, learners, and multiple medical and psychosocial issues), (3) expanding identities in the "extension zone" outside of patient care, (4) variable and ambiguous academic identity, (5) ongoing negotiation between extrinsic factors (resources, relationships, and validation), intrinsic factors (personal identities and professional values), and identity development, (6) diverse career trajectories, and (7) professional identity driving career decision-making.

In contrast to a "deficit" view of generalists lacking focus on a specific disease or organ system, academic internal medicine hospitalist professional identity encompasses distinct roles and skills. While hospitalists individualize their activities outside the context of patient care, the core clinician identity remains a beacon guiding these activities. Hospitalists' varied and ambiguous concepts of what it means to be academic may contribute to lagging academic progress. Organizations should support hospitalists' unique professional identities, seek clarity around what it means to be academic, and foster ongoing professional identity development.