Essential Yet Invisible: Professional Identity Formation Among Academic Internal Medicine Hospitalists

Academic Hospitalists (AHs) in internal medicine who are practicing in the United States (U.S.), are physicians whose inpatient clinical work is integrated with teaching, quality improvement, and research. Over 90% of US and Canada internal medicine programs rely on AHs as primary inpatient teaching attendings for medical students and residents. However, AH experience disproportionate burnout despite younger career stage, suggesting that structural and identity-related factors beyond typical career progression may drive dissatisfaction. This study explores how AHs construct their professional identity and how they view their role in the academic enterprise.

Using identity theory as a conceptual framework this constructivist qualitative study used semi-structured interviews with 20 academic hospitalists across nine U.S. academic institutions during 2024-2025, selected using information power sampling to ensure sufficient data depth. Interviews explored professional roles, identity within those roles, and identity formation across distinct domains. Transcripts were coded and analyzed iteratively using Braun and Clarke's thematic analysis.

Four interconnected themes were identified reflecting identity ambiguity, role strain, developmental needs, and recognition gaps among academic hospitalists: (1) the absence of consensus: defining what it means to be an Academic Hospitalist; (2) identity non-verification: the mismatch between self-perception and external recognition; (3) competing responsibilities, tensions, and burnout; and (4) mentorship and professional growth.

AHs construct identity amid structural ambiguity and institutional non-recognition of salient professional roles. Institutions should clarify role expectations, provide non-negotiable protected time for academic engagement, establish robust mentorship infrastructure, and formally recognize educational contributions through performance metrics and compensation structures. These systemic changes are essential for supporting professional identity formation, enhancing career satisfaction, improving retention, and strengthening academic medicine's educational mission.