Deliberating between 7on/7off neurohospitalist vs 20pts/day outpatient private practice

[sommerwing]

Hello everyone,

I'm at a stage in my life where i am deliberating between a 7 on/7 off neurohospitalist position (12 hr day shifts, 2 hospitals, volume around 15 a day with half as new consults) and a private practice general neurology position (mon-fri 9-5, quoted volume about 20 patients a day) and was wondering if anyone here has had experience with both and what they thought of each. The later pays a lot more (1.5x).

-Does 20 outpatients a day seem comfortably feasible?
-Which seemed the most lifestyle friendly?

---

Members don't see this ad.

 

[Thama]

20 patients per day might be feasible once you are seeing a lot of simple returns for migraine, epilepsy, etc. If you're getting started and they expect you to see 20 patients per day that are new to you anytime soon then run.

 

[Postictal Raiden]

From a financial prospective, the outpatient job is much better.

Say your inpatient job pays 300k for 7 on/off 12 hour shifts. That’s $137/hr.

On the other hand, the outpatient job pays $195/hr assuming 46 work weeks, 50hrs/week.

 

[deathmerchant]

Hello everyone,

I'm at a stage in my life where i am deliberating between a 7 on/7 off neurohospitalist position (12 hr day shifts, 2 hospitals, volume around 15 a day with half as new consults) and a private practice general neurology position (mon-fri 9-5, quoted volume about 20 patients a day) and was wondering if anyone here has had experience with both and what they thought of each. The later pays a lot more (1.5x).

-Does 20 outpatients a day seem comfortably feasible?
-Which seemed the most lifestyle friendly?

It also depends on your aptitude. Inpatient is more unpredictable and obviously more acute. You have less control of the schedule. Its really hard to take a day off if needed urgently. But the day can also be more flexible, as you can see patients much faster. In many places 12hr shifts is just for the record- Many neurohospitalists don't have to be in house for the whole 12 hrs. You can leave once done (sometimes in few hours)- but that depends on the hospital.

20 patients a day seems feasible- but doing that 5 days a week would get exhausting. There will be a lot of patient calls/tasks to do as well. But as mentioned, you have more control over schedule. Its usually a predictable day. You can also take a day or few days off if needed urgently.

To me, an outpatient day of 20 patients would feel much longer than an inpatient day of 15. But that's just me.

 

[sharkbaitwhohaha]

Also consider the consults you'll be seeing in patient vs in clinic.

95% AMS, AMS, AMS, Seizure, stroke, functional.

VS

95% headache, seizure, movement, cognitive, weakness, sensory changes, functional.

 

[Postictal Raiden]

Also consider the consults you'll be seeing in patient vs in clinic.

95% AMS, AMS, AMS, Seizure, stroke, functional.

VS

95% headache, seizure, movement, cognitive, weakness, sensory changes, functional.

Very true. At least from a resident's prospective.

Outpatient work is annoying because of the paper work and pre-auth crap. However, I feel it's more rewarding. You have more "ownership" of you patient's condition. You get to see the evolution of neurological disease over time. Also, you are a more of a brand whereas in inpatient, it feels you're a commodity.

 

[sharkbaitwhohaha]

Agree. After the 1,000th AMS consult that is clearing uremia but "just don't want to miss anything, wanted to get Neuro on board"..... I'll take the clinic, thank you.

Even if, in the future I would be getting paid per consult... a little bit of me would die for every bull**** CYA consult.

Also, getting the right clinic staff can drastically limit prior auth stuff.

 

[Telamir]

Also consider the consults you'll be seeing in patient vs in clinic.

95% AMS, AMS, AMS, Seizure, stroke, functional.

VS

95% headache, seizure, movement, cognitive, weakness, sensory changes, functional.

Thankfully I don't get that many AMS consults. For me it's typically stroke/TIA with a smattering of "idunnolol probably stroke call neuro", and seizure vs seizure like activity. I do see a decent amount of functional, but during residency my clinic was overwhelmingly functional which turned me off of outpatient. I do see a good amount of general neuro, particularly in the ICU with either brain bleeds or critical illness neuropathy/myopathy. The general neuro seems more interesting to me in hospital cause it doesn't come around often.

 

[deathmerchant]

Also consider the consults you'll be seeing in patient vs in clinic.

95% AMS, AMS, AMS, Seizure, stroke, functional.

VS

95% headache, seizure, movement, cognitive, weakness, sensory changes, functional.

Both inpatient and outpatient get equal amount of Nonsults honestly. I do both but I'm definitely biased towards inpatient.

I haven't had that much of a problem with AMS. The medicine/icu guys in my hospital are pretty good about not calling me for most TMEs. I personally don't like em; but my partner loves them - super easy and can be seen in 10 minutes.

May be I am in a small town, but 75% of my outpatient has been chronic headache, peripheral neuropathy and advanced dementia. My partner loves them too - super easy/straightforward!!

So pick your poison!