FM Hospitalist Track

[Mitch Connor]

I have read in many places that it can be hard to find a job as a FM hospitalist depending on where you are. There are now several FM residencies that offer a hospitalist track or even some fellowships for hospitalist medicine.

Can anyone speak to the utility of the kinds of programs? Are they even necessary if you go to a residency with sufficient inpatient training?

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[InternistDO]

I doubt they add much to your resume other than some reassurance that you've had an above average amount of inpatient experience. Big academic hospitals that only want internists for whatever reason are unlikely to be make an exception just because someone did a hospitalist track.

For people who really want to do hospital medicine from the get-go, I always wonder why they don't just pursue IM. Yes, most of the stigma against FM hospitalists is silly and to my knowledge has nothing to do with patient outcomes, but there's no denying that internists have an easier time getting hospitalist jobs, and smaller IM programs aren't exactly super competitive. Obviously if you want to do broad spectrum practice FM makes sense, but for pure adult hospital medicine (99% of hospitalist jobs) FM training seems like you're spending a lot of time learning about kids and OB/GYN if all you want to do is treat old farts in the hospital.

All that being said, I see jobs that will hire FM or IM hospitalists all the time, even in big cities.

 

[Make Or Break]

I doubt they add much to your resume other than some reassurance that you've had an above average amount of inpatient experience. Big academic hospitals that only want internists for whatever reason are unlikely to be make an exception just because someone did a hospitalist track.

For people who really want to do hospital medicine from the get-go, I always wonder why they don't just pursue IM. Yes, most of the stigma against FM hospitalists is silly and to my knowledge has nothing to do with patient outcomes, but there's no denying that internists have an easier time getting hospitalist jobs, and smaller IM programs aren't exactly super competitive. Obviously if you want to do broad spectrum practice FM makes sense, but for pure adult hospital medicine (99% of hospitalist jobs) FM training seems like you're spending a lot of time learning about kids and OB/GYN if all you want to do is treat old farts in the hospital.

All that being said, I see jobs that will hire FM or IM hospitalists all the time, even in big cities.

With FM you have the best of all the worlds. Hospitalist 7 on 7 off and work a few urgent care or emergency med shifts every other week, or not! I don’t know any IM physicians who feel comfortable working in those settings besides some of the older docs.

 

[InternistDO]

With FM you have the best of all the worlds. Hospitalist 7 on 7 off and work a few urgent care or emergency med shifts every other week, or not! I don’t know any IM physicians who feel comfortable working in those settings besides some of the older docs.

My guess is any area rural or underserved enough to allow you to work in an ER as FM will allow you to work as a hospitalist. The areas where FM has trouble getting hospitalist jobs are also areas where ERs are going to be completely staffed by EM.

IM does urgent care where I am, but it requires a big enough UC to have a second provider who can see kids.

 

[Make Or Break]

My guess is any area rural or underserved enough to allow you to work in an ER as FM will allow you to work as a hospitalist. The areas where FM has trouble getting hospitalist jobs are also areas where ERs are going to be completely staffed by EM.

IM does urgent care where I am, but it requires a big enough UC to have a second provider who can see kids.

I wouldn’t call a lot of the locations that accept FM “rural”. I’ve gotten plenty of offers to do Hospitalist in some of the smaller to mid-sized cities throughout the US. Of course hospitals that have IM residencies were already not hiring FM but there are plenty of opportunities out there.

I do agree though that doing EM, unless you’re lucky or grandfathered in, is likely going to be in a rural or underserved location.

 

[InternistDO]

I wouldn’t call a lot of the locations that accept FM “rural”. I’ve gotten plenty of offers to do Hospitalist in some of the smaller to mid-sized cities throughout the US. Of course hospitals that have IM residencies were already not hiring FM but there are plenty of opportunities out there.

I do agree though that doing EM, unless you’re lucky or grandfathered in, is likely going to be in a rural or underserved location.

Thats my point. There are FM hospitalists in NYC and in the boonies, but you are dramatically limiting yourself geographically if you want to do EM as well, almost to the point of it not being an option anymore as the EM surplus grows.

Again, FM is a great speciality. But if you really want to do primarily inpatient medicine, doing IM will make it easier for you. If you want to do full general medicine, especially with an outpatient component, then FM will serve you better.

 

[Mitch Connor]

Thank you everyone for the responses. I have plenty of time to decide at this point but lean towards FM because it seems more flexible to a point. I like smaller towns anyways and don't have an interest living in a big city or working at a top tier academic center.

 

[Atlas Shrugged]

Family medicine also allows you to admit pediatric patients. Covering both services for smaller hospitals can be a selling point.

 

[AlbinoHawk DO]

With FM you have the best of all the worlds. Hospitalist 7 on 7 off and work a few urgent care or emergency med shifts every other week, or not! I don’t know any IM physicians who feel comfortable working in those settings besides some of the older docs.

You don't know IM docs that can work urgent care? What? ED only for ob/gyn cases is the problem

 

[jm192]

You probably won't find a job in the biggest cities being FM. That's just reality of it. If you want to do Hospitalist in NYC, LA, Chicago, etc. you're going to have a harder time as FM. Doing a Hospital Medicine track or a fellow ship isn't going to change that. None of the fellow ships are formally accredited/certified/whatever you want to call it. It's a year or 2 of Hospitalist experience where you're still under guidance and you get paid less. Employers care more about experience as an attending.

Finding A job is pretty easy. And you can probably find a job on the outskirts of the city you want to be in. I get multiple e-mails per day from recruiters looking for FM hospitalist. You'll be in demand.

If you know you want to be a hospitalist--and your residency has a hospital medicine track--do it. Put yourself in a position to succeed. But I would encourage just about everyone to skip the fellowship.

I went DEEP down the fellowship rabbit hole. Researched them. Contacted people. Basically got told that it was mine if I wanted it after a brief phone interview. I was SO anxious about going out on my own. Am I really ready to do this?

Ultimately, I'm glad I didn't do it.
1. I talked to employers about it. It didn't move the needle. I was told point blank years of experience did.
2. You're going to make way less money as a Hospitalist fellow. And you're probably going to do just as much if not more work. They're bringing you in to get production out of you in exchange for teaching. Which is fine if it's something that's certified by an accrediting board. But if you're doing it for a paper certificate that no one cares about--meh.
3. Your 1st year as an attending is going to feel like a fellowship. I learned so much more when the buck stopped with me. Nothing teaches you to swim like being in the water on your own.

 

[Trousseau]

Trust me, these days you won’t even find a job in a major city as an IM-Board Hospitalist (like me). I searched hard to no avail, currently work in a small exurban county.

I wouldn’t do hospitalist fellowships unless you’re really passionate about it, IM Residency is bad enough doing 6 months of core inpatient services a year, 80+ hr weeks…from what I hear hospitalist fellowships do like 9 months of core services, I’d rather cut off my manhood than do 9 months of that in a year…

And yeah first year out of residency is tough.