The Hospitalist Editorial Board Application
2026-2028 Term
Name
*
First Name
Last Name
Gender
*
Please Select
Female / Cisgender Female
Male / Cisgender Male
Gender Non-binary
Transgender
Genderfluid
Trans Woman
Trans Man
Prefer Not to Disclose
Other (enter below)
Other (Gender Not Listed Above)
Ethnicity
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/x
Middle Eastern or North African
Native Hawaiian or Pacific Islander
South Asian
White
Multi-Racial
Prefer Not to Disclose
Other (enter below)
Other (Ethnicity Not Listed Above)
Primary Job Function
*
Please Select
Hospitalist Physician
Nurse Practitioner
Physician Assistant
C-suite / Hospital Leader
Hospital/Practice Administrator or Manager
Physician Advisor
Resident Physician
Medical Student
Other (enter below)
Other (Primary Job Function Not Listed Above)
Institution/Location
*
Practice Setting
*
Please Select
Academic Medical Center (Some of my patient care is delivered while educating and training residents.)
Community Hospital (All of my patient care is delivered directly without trainees.)
Other (enter below)
Other (Practice Setting Not Listed Above)
Certification
*
Please Select
General Internal Medicine
Adult Hospital Medicine
Med-Peds
Family Medicine
Pediatrics or Pediatric Hospital Medicine
Other (enter below)
Other (Certification Not Listed Above)
If you belong to an SHM Special Interest Group, Advisory Council, or Committee, please list them below.
Other Noteworthy SHM Contributions or Appointments
Why do you want to join the editorial board of The Hospitalist?
Please upload your latest CV here.
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