highly ranked academic medical centers. History Hospital medicine is a relatively new phenomenon in American medicine and as such is the fastest growing specialty in the history of medicine. Almost unheard of a generation ago, this type of practice arose from three powerful shifts in medical practice: Nearly all states, as well as the national residency accreditation organizations, the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA), have established limitations on house staff duty hours, the number of hours that interns and residents can work. Many hospitalists are coming to perform the same tasks formerly performed by residents; although this is usually referred to as a House Officer rather than a hospitalist. The fundamental difference between a hospitalist and a house officer is that the hospitalist is the attending physician of a patient while that patient is hospitalized. The house officer admits the patient for another attending physician and cares for that patient until the attending physician can see the patient. Most primary care physicians are experiencing a shrinking role in hospital care. Many primary care physicians find they can generate more revenue in the office during the hour or more they would have spent on inpatient rounds, including traveling to and from the hospital. In addition to patient care duties, hospitalists are often involved in developing and managing aspects of hospital operations such as inpatient flow and quality improvement. The formation of hospitalist training tracks in residency programs has been driven in part by the need to educate future hospitalists about business and operational aspects of medicine, as these topics are not covered in traditional residencies. Certification As a relatively new specialty, only recently has certification for specialty experience and training for hospital medicine been offered. The American Board of Hospital Medicine (ABHM), a Member Board of the American Board of Physician Specialties (ABPS), was founded in 2009. The ABHM was North America’s first board of certification devoted exclusively to hospital medicine. In September 2009, the American Board of Internal Medicine (ABIM) created a program that provides general internists practicing in hospital settings the opportunity to maintain Internal Medicine Certification with a Focused Practice in Hospital Medicine (FPHM). Employment The number of available hospitalists positions grew exponentially from 2006 to 2010 but has since then leveled off. However, the job market still remained very active with some hospitals maintaining permanent openings for capable hospitalists.