Please explain to me what a 'hospitalist' exactly does? What residency/fellowship must one do to work as a hospitalist?

It requires a 3 year residency in Internal Medicine to become a "Hospitalist"
Basically a hospitalist is a doc who doesn't do any outpatient, just works shifts in the hospital covering for docs who want to focus on their office based practices. The doc with the office based practice transfers care to the hospitalist when the patient is admitted.

The SHM has adopted the following official definition of "Hospitalist": Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching research, and leadership related to Hospital Medicine.

The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients. The term was coined by Drs. Robert Wachter and Lee Goldman in a New England Journal of Medicine article in August of 1996 (Wachter RM, Goldman L. The emerging role of "hospitalists" in the American health care system. N Engl J Med 1996;335:514-7). While some doctors have emphasized inpatient care for many years, there has been an explosive growth of such doctors since 1994.

What benefits can hospitalists offer patients?
By focusing his or her practice on the care of hospitalized patient, a hospitalist can gain a great deal of experience in the unique aspects of a patient's needs during the hospital stay. And hospitalists typically spend most or all of their work day in the hospital, and thus can be more readily available to a patient than a doctor who spends much the day outside the hospital in an office or clinic setting.

A hospitalist is generally an internist whose practice is limited to taking care of inpatients. They usually don't see patients in a clinic. In my area they contract with primaries to cover a group's patients while in house. I know one who was pulm/critical care trained but all the rest are internists.

Sounds like a good deal, especially the part about no outpatients and working in shifts. There's got to be a catch somewhere?!

Sounds like a good deal, especially the part about no outpatients and working in shifts. There's got to be a catch somewhere?!

Well some of your shifts will be over night and weekends so for some people that might be considered a catch

Depending on the group size and patient population the schedule vaires. I have had hospitalists as teaching attendings on rounds, some work 14 days on 14 days off, 12 hour shifts, some work 24 hour shifts, but go home (usual places with residents to handle admissions). So work more like ER doctors 12-16 hour shifts than a few days off, then back to the same. There is a lot of variability so it gives you a lot of freedom.

There tends to be a high rate of turnover, but this maybe because many FMG do it to fulfill requirements of their Visas before they go to do a fellowship.

You can do IM or FP and be a hospitalist by the way, but IM is much more common. Some places even have Peds hospitalists.

Biggest advantages for hospitals (and the reason that 40% of hospitals in America use them) are decreased length of stay, better outcomes, higher patient satisfaction, fewer tests ordered, better adherence to formulary drug selection, fewer errors

Cons: People like to see their doctor, but most patients are happy with hospitalists. It is great for people who do not want to specialize but the idea of clinic makes their skin crawl.

Sounds like a good deal, especially the part about no outpatients and working in shifts. There's got to be a catch somewhere?!

Hospitalists salary in low to mid 100's. Many will never see salaries over 200.

Hospitalists salary in low to mid 100's. Many will never see salaries over 200.

True the average is about $160. But thats not bad for just working shifts and cashing a check at the end of every week. No hassles of running a business or managing a practice.

With a 7 on 7 off schedule, theoretically a hospitalist can work "two" jobs and make 320K a year. Obviously they won't work 52. But any hospitalist with a little energy and some business sense can easly make 250K a year. Oh wait,...thats me!!! :D

True the average is about $160. But thats not bad for just working shifts and cashing a check at the end of every week. No hassles of running a business or managing a practice.

Working in shifts, no outpatients, $160K average--sounds too good to be true!

Working in shifts, no outpatients, $160K average--sounds too good to be true!

I think there may be some downsides. Your patients are always pretty sick since they have been admitted. This could get stressful. You are always in the hospital.

As a hospitalist are the patients 'your' patients or are you taking care of them for their doctors?

I think there may be some downsides. Your patients are always pretty sick since they have been admitted. This could get stressful. You are always in the hospital.

I was just going to say the same thing. The hospitalists in my hospital take care of all the "no docs" that come into the hospital. Most of these people are pretty sick when they are admitted, since they have not seen a doctor in years. They have a whole laundry list of medical problems that are not being controlled, so hospitalists have a lot to deal with while their patients are in the hospital.

As a hospitalist are the patients 'your' patients or are you taking care of them for their doctors?

What are "Hospitalists"? They are the best thing since sliced bread!! I am an FP. I have contracted with Cogent to provide my inpatient care. The Hospitalists work for Cogent. My patients become patients of the Hospitalist while they are in the Hospital and come back to see me afterward. I make the decision to admit them and Cogent does the rest. Then presto, I am relaxing on the beach!!

Allows me to work M-F 8-5 with no hospital call!!!!!!!

I LOVE Hospitalists!!!!!!!! :D

As a hospitalist are the patients 'your' patients or are you taking care of them for their doctors?
They are the hospitalist's patients while they are in the hospital just like they are my patients when they are in the ER. One thing docs need to understand is that when they turf their patients to the ER or have them admitted by the hospitalist they lose some control. The alternative is covering your own inpatients, doing direct admits and ensuring that your patients have access to you.

I was just going to say the same thing. The hospitalists in my hospital take care of all the "no docs" that come into the hospital. Most of these people are pretty sick when they are admitted, since they have not seen a doctor in years. They have a whole laundry list of medical problems that are not being controlled, so hospitalists have a lot to deal with while their patients are in the hospital.
Actually in my area the hospitalists only see insured patients who have primaries. The unassigned patients go to the general med on call who is usually not a hospitalist.

So what would be better, joining a "hospitalist group" that contracts with multiple hospitals, or becoming a hosptial employee hosptialist?

[QUOTE=generalIM]Well some of your shifts will be over night and weekends so for some people that might be considered a catch

Depending on the group size and patient population the schedule vaires. I have had hospitalists as teaching attendings on rounds, some work 14 days on 14 days off, 12 hour shifts, some work 24 hour shifts, but go home (usual places with residents to handle admissions). So work more like ER doctors 12-16 hour shifts than a few days off, then back to the same. There is a lot of variability so it gives you a lot of freedom.

There tends to be a high rate of turnover, but this maybe because many FMG do it to fulfill requirements of their Visas before they go to do a fellowship.

You can do IM or FP and be a hospitalist by the way, but IM is much more common. Some places even have Peds hospitalists.
ons: People like to see their doctor, but most patients are happy with hospitalists. It is great for people who do not want to specialize
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can an EM doc be a hospitalist if they want, and like bounce back and forth from the covering the ER and then other areas ? sound like that could be interesting? and profitable?

can an EM doc be a hospitalist if they want, and like bounce back and forth from the covering the ER and then other areas ? sound like that could be interesting? and profitable?


I don't think an EM doc is trained to manage inpatients like an IM doc is so it wouldn't be a good idea.

You could do an EM/IM residency though if you are into that kind of punishment! :)

I was just going to say the same thing. The hospitalists in my hospital take care of all the "no docs" that come into the hospital. Most of these people are pretty sick when they are admitted, since they have not seen a doctor in years. They have a whole laundry list of medical problems that are not being controlled, so hospitalists have a lot to deal with while their patients are in the hospital.


In the hospitals where I've been, the "no docs" go on the Staff Medicine (Resident) services. They are overseen by one of the Academic doctors (who may or may not be hospitalists). The Hospitalist services cover patients of private physicians who have contracted with that specific hospitalist group.

I plan on going into outpatient Internal Medicine, so contracting with a Hospitalist will allow me to work M-F, 9-5, no nights no weekends, no holidays!!!!!!!

In the hospitals where I've been, the "no docs" go on the Staff Medicine (Resident) services. They are overseen by one of the Academic doctors (who may or may not be hospitalists). The Hospitalist services cover patients of private physicians who have contracted with that specific hospitalist group.

I plan on going into outpatient Internal Medicine, so contracting with a Hospitalist will allow me to work M-F, 9-5, no nights no weekends, no holidays!!!!!!!
that's good, because I plan on going into hospitalist work, 7days on 7 days off, 2 weeks a month, lots of vacacation time, and never stepping foot in an office, because god do i hate office work!!! I'll take care of your inpatients so you can focus on your non compliant DM, HTN, obese, 15-25 medication list old folks, not to mention treating all of their psychological problems.
We will both be happy and that is what matters.

that's good, because I plan on going into hospitalist work, 7days on 7 days off, 2 weeks a month, lots of vacacation time, and never stepping foot in an office, because god do i hate office work!!! I'll take care of your inpatients so you can focus on your non compliant DM, HTN, obese, 15-25 medication list old folks, not to mention treating all of their psychological problems.
We will both be happy and that is what matters.

Yeah, that's the great thing about medicine-there's a niche for everyone. These days you can pretty much cater your career to whatever lifestyle you would like the have, although income may have to suffer a little bit. I didn't go into medicine with the expectation of becoming a millionaire though, so it doesn't bother me. I still see some of the old school internists who have a 40-50 hour/week office practice. In addition they go to the hospital a couple of hours before the office opens to round on their patients, and may have to go back again after work. They get called during all hours of the night by the ER and the nurses about their patients, and they have to come in on weekends and holidays to see their patients. I know that I don't want that for myself.

Working in shifts, no outpatients, $160K average--sounds too good to be true!

Never true in medicine. There's always drawbacks.

As mentioned, there IS a pretty high burn-out rate, but I don't think that is only because it's alot of FMG's fulfilling credentials. The hospitalists I know have talked about the looong hours and a pager that is basically always beeping.

Like any of the specialties, you gotta love it. The nice thing about hospitalist work is that you're trained in IM or FP and can go on to other types of practices easily. You aren't stuck there forever. I think many docs like the job for awhile, but move on to less demanding work after a few years.

i'm a little confused. does the hospitalist lifestyle tend more often toward an EM sort of thing (just shifts), or to one w/ call, long hours, etc? I guess that would depend on if you were employed by the hospital or contracted w/ a group of primary care docs? Do both situations exist, one moreso than the other?

as of right now my medical nirvana would be an IM or maybe peds hospitalist working three 12-hr shifts/wk. (yes i have already braced myself for the pay decrease) is that a possibility? :)

i'm a little confused. does the hospitalist lifestyle tend more often toward an EM sort of thing (just shifts), or to one w/ call, long hours, etc? I guess that would depend on if you were employed by the hospital or contracted w/ a group of primary care docs? Do both situations exist, one moreso than the other?

as of right now my medical nirvana would be an IM or maybe peds hospitalist working three 12-hr shifts/wk. (yes i have already braced myself for the pay decrease) is that a possibility? :)


As a hospitalist, you have lots of options, one girl from my program is working 1/2 time (therefor 1/2 salary), working 7 out of 28 days. She usually works 7 days in a row, but has broken it down. This is with a hiopital based practice, you could always do locums, and decide when and where you do your shifts. GL

my medical nirvana would be an IM or maybe peds hospitalist working three 12-hr shifts/wk. (yes i have already braced myself for the pay decrease) is that a possibility? :)

Totally doable. If you're really ok with the pay, and cool with doing some searching, it's fully possible.

And yeah, it's like ER work in that there's no call, shift work only. Most everywhere I've seen is 12 hours, but if you're cool with that, the NUMBER of them in a month is very open to local factors...factors that you can identify and bend toward your inexorable will.

Three different flavours of hospitalists:

- hospital employed in a non-teaching hospital. Often dumped upon to do many of the tasks residents would do in a teaching institution. Often required to take all the uninsured ER admits so the community docs don't get burdened with this task. Key skill is to find either 'placement' or to polish the patients enough they can be kicked out of the hospital with minimal financial damage and legal footprint. Very dependent position through employment with the hospital.

- 'hospitalist' within a IM group that has multiple far flung outpatient practices. The senior partners don't want to move their butts out of the office and use the 'hosptialist' (a new hire), to carry out THEIR plans on the inpatients. The patients never become 'your' patients, you are just the lakey that writes the daily notes and shuffles the paper so the seniors can read ECHOs without interruption. Downside is that you don't create a lot of collections for your work compared with the guys sitting in the office. I have seen people who busted their behind in this kind of job but kept being harassed by the senior partners on how 'they have to drag you along'.

- hospitalist groups, either independent or within a large staffing company. They are typically the ones that work the ER like shift schedules. The patients become patients of the hospitalist group for the duration of the stay and get sent back to their primary for follow-up. Often, the hospitalists do plenty of procedures like central lines, LPs and the like. Part of your income are the billings you generate from your E/Ms and procedures, the other part is an annual fee the people you cover for might pay you or an annual stipend the hospital provides to make hospitalist practice attrative (the hospital is the one really to gain from a well-oiled hospitalist service. Short LOS in the setting of DRG based billing means more $$ for the hospital and a bigger benz for the hospital CEO) Similar to the ED, this has to be something you like. Patients come to you, you 'process' them and send them on their way. If long-term relationships are your thing, independent hospitalist practice is not for you.

There are clearly degrees of attractiveness to the three models described here. Some of the 'burnout' is probably limited to first and second scenario noted above. This is the kind of job many people will do if they have to bridge a year between IM residency and a competitive fellowship such as cards.

There is an effort to establish the 'hospitalist' as a subspecialty within internal medicine. Sort of a 'critical care light' fellowship.

I don't think it will ever be a fellowship per se... AFAIK the new curriculum described by the Society of Hospital Medicine will be based on the U of Colorado hospitalist track.

seriously what an ideal specialty for me personally, at least i think so, at this very early point. hopefully the concept will still be booming in 7 years when i finish an IM res.

Mumpu, can we see the Hospitalist Track at Colorado? I interviewed several places that had so called Hosp. Tracks, but it really only differs from the IM curiculum by a few electives and one less ambulatory rotation. Unless the track includes more ICU time, I dont think its such a big deal...Just MHO! :D

It's a couple of hospitalist rotations in 2nd and 3rd years, a lot of specialty didactic stuff (coding, billing, patient safety, QA, abx resistance and nosocomial infections, etc.), and more procedures. The track is still developing and AFAIK they are planning to integrate the results of hospitalist studies to expand experience in such specialties as neurology (30% of real-world hospitalist patients in some studies).

It is a real track with a real curriculum run by real hospitalists, not a con to get you to do more inpatient months in your 3rd year. :p

(and for the record, inpatient months are a good thing. I will take Q3 call over clinic any day)

(and for the record, inpatient months are a good thing. I will take Q3 call over clinic any day)

I second that motion!!!! :D

How would you describe your typical weekly schedule....

With a 7 on 7 off schedule, theoretically a hospitalist can work "two" jobs and make 320K a year. Obviously they won't work 52. But any hospitalist with a little energy and some business sense can easly make 250K a year. Oh wait,...thats me!!! :D

- hospitalist groups, either independent or within a large staffing company. They are typically the ones that work the ER like shift schedules. The patients become patients of the hospitalist group for the duration of the stay and get sent back to their primary for follow-up. Often, the hospitalists do plenty of procedures like central lines, LPs and the like. Part of your income are the billings you generate from your E/Ms and procedures, the other part is an annual fee the people you cover for might pay you or an annual stipend the hospital provides to make hospitalist practice attrative (the hospital is the one really to gain from a well-oiled hospitalist service. Short LOS in the setting of DRG based billing means more $$ for the hospital and a bigger benz for the hospital CEO) Similar to the ED, this has to be something you like. Patients come to you, you 'process' them and send them on their way. If long-term relationships are your thing, independent hospitalist practice is not for you.


I saw some "PICU fellows" listed at the teaching hospital where I've been shadowing... the docs I was shadowing said they were no-kidding doing a PICU fellowship, not just rotating a month through the PICU. Is a hospitalist job like this one the sort of job that an ICU fellowship would lead to (neglecting the pediatric/adult discrepancy)?