I know this topic might be discussed in the past but I would appreciate it if someone would discuss the pros/cons of being hospitalist Vs gastroenterologist Vs Cardiologist
GI Vs Hospitalist
- Thread starter Wayner
- Start date
- Joined
- Feb 27, 2007
- Messages
- 5,710
- Reaction score
- 5,460
Or an ENT or a Radiologist? They are different specialties. Pick the specialty you want to practice.
Thank you for your response. I'm a first year medicine resident and liked inpatient medicine, Hepatology and heart failure patients. I asked to get input what's the real practice of each specialty since residency may be different from real life.
- Joined
- Mar 6, 2005
- Messages
- 21,377
- Reaction score
- 17,907
Here's the thing. Most people have only been one of those things. Sometimes 2 of them (hospitalist --> GI or Cards) but in those cases they typically only did hospitalist to buy time (and cash) while applying for fellowship. So you're not going to be able to get a good answer to your question simply because almost nobody has the experience.
I will say that, hepatology and heart failure are both going to be in-demand subspecialties (more Hep C, more alive, but crippled myocardium).
I will say that, hepatology and heart failure are both going to be in-demand subspecialties (more Hep C, more alive, but crippled myocardium).
- Joined
- Jun 12, 2014
- Messages
- 188
- Reaction score
- 97
Had this exact discussion with my gf, who is in medicine as well. Before you get into the minutia of each field, just consider broad strokes:
1. What do you ENJOY learning? You will be studying a particular field for the rest of your life...choose something you love, not something that looks attractive in the moment. GI and Cards are self explanatory. As a hospitalist, you can treat everything from gout to cellulitis to pneumonia...which is pretty cool if you like that kind of clinical variety.
2. What do you see yourself doing? Do you mostly want to do procedures? Teaching rounds? A mixture of things? You can do anything in any field, yes, but if you end in, say, outpatient medicine, you can't help but do fewer procedures, and student exposure may be one at a time as opposed to a posse.
3. This bit is less important than the other two, but still matters...what kind of personality are you, or rather, what kind of WORKER are you? I.e. Laid back + Pulm/Crit for example is doable, but LAZY + Pulm/Crit is not. Let's face it, those going into Cards, GI, etc. tend to be more...type A...than others and the work environment can be a "go go go" type of energy. If you prefer to work at a slower pace, your own pace, or would like to answer to yourself from the get-go, then doing an intensive 3 year fellowship may not be a good choice.
It's very important to be HONEST with yourself in these decisions. Don't say "well, I COULD work hard" or "I COULD like this field." They are questions only you can answer, but answer them with brutal truth. Once you do, feel free to post and we can help a bit more
1. What do you ENJOY learning? You will be studying a particular field for the rest of your life...choose something you love, not something that looks attractive in the moment. GI and Cards are self explanatory. As a hospitalist, you can treat everything from gout to cellulitis to pneumonia...which is pretty cool if you like that kind of clinical variety.
2. What do you see yourself doing? Do you mostly want to do procedures? Teaching rounds? A mixture of things? You can do anything in any field, yes, but if you end in, say, outpatient medicine, you can't help but do fewer procedures, and student exposure may be one at a time as opposed to a posse.
3. This bit is less important than the other two, but still matters...what kind of personality are you, or rather, what kind of WORKER are you? I.e. Laid back + Pulm/Crit for example is doable, but LAZY + Pulm/Crit is not. Let's face it, those going into Cards, GI, etc. tend to be more...type A...than others and the work environment can be a "go go go" type of energy. If you prefer to work at a slower pace, your own pace, or would like to answer to yourself from the get-go, then doing an intensive 3 year fellowship may not be a good choice.
It's very important to be HONEST with yourself in these decisions. Don't say "well, I COULD work hard" or "I COULD like this field." They are questions only you can answer, but answer them with brutal truth. Once you do, feel free to post and we can help a bit more
I like seeing chest pain/heart failure patients on the wards. The thing is I hate the ICU environment and be the primary person dealing with cardiogenic shocks and unstable cardiac cases. This is not my personality as I like dealing with more stable patients. Obviously, I don't want to do pulm/cc. The thing is I enjoy dealing with abnormal LFTs and inflammatory bowel disease but I'm just afraid my practice will be mostly doing colonoscopies all day and dealing with functional abdominal pain cases more than anything. If that's the case then probably I should think about something else. I do enjoy inpatient medicine but the amount of social issues, pain seekers and placement drives me crazy.
- Joined
- Jun 12, 2014
- Messages
- 188
- Reaction score
- 97
Right. Well, you've touched on all the (potentially) annoying parts of each field
Another way to think about this is which annoying this do you dislike the LEAST? If you are ok, for example, dealing with fibromyalgia, then maybe Rheum is ok for you...if not, then look elsewhere. More specifically, for the things you are interested in:- Cards #1 complaint: chest pain - potentially drugs, pain med seeking, place to stay for the night, general bullsh*t
- GI #1 complaint: belly pain - again, place to stay, pain med seeking, generally crazy people with underlyinh psych issues (see IBS)
- Hospitalist #1 complaint - fatigue/dizziness/chest pain/etc. etc. etc... all the annoying bits of the above but with the added hassle/privilege of being team organizer and potentially having a great impact by dealing with social issues...if you like dealing with that.
For the ICU part not being your bag, that's fine. I don't like MICU, but I enjoy IM and am damn thankful for my MICU time going into GI. You deal with the bits you dislike but take all you can from them to apply that knowledge when you need it. No medical field is without its emergencies and acute setting situations. Is the CCU a happy time? No. Can your patient have an MI in the office? Yep. Will you be happy you did CCU if that happens? Yep.
From your answer, as much as anyone can surmise from these things, it seems like you like outpatient/general cards best. You seem most excited about those patients on gen med service and less so about routine GI procedures (there's always hepatology too, but that's becoming more and more of a post-GI fellowship than a 1 year clinical fellowship). No matter what you do, social issues will follow...they are too tightly meshed in with medicine for any other scenario.
From what I'm hearing though: inquisitive, laid back, less procedural, take your time with patients, enjoyment of specifically cards patients, less (but not no) social issues, I'd say: Gen Cards > Hepatology > Hospitalist > GI for you. What the heck do I know though? Keep at it, you've still a few months left to decide before needing to start research...which you might want to think about starting anyway just in case.
Thanks! That's helpful. How is the lifestyle/hours of NON-invasive cardiologist is different from gastroenterologist. Since both have emergencies, both will bring you at the middle of the night. Would a general cardiologist get frequent calls at the middle of the night?
- Joined
- Jun 12, 2014
- Messages
- 188
- Reaction score
- 97
Academic - yes, as often as you are on call residents will call you to present. Fellows will likely call interventionalists overnight.
Private - yes, as often as your group has you take call, and yes, as often as your patients are the anxious type or really have chest pain.
In this instance, you may not have housestaff so you will be going in to assess.
If this is a really big deal to you, maybe shiftwork is best then?
- Joined
- Feb 28, 2015
- Messages
- 64
- Reaction score
- 0
avg pay for hospitalist vs GI ( academic and private)? Can some one shed light on it?
- Joined
- Mar 6, 2005
- Messages
- 21,377
- Reaction score
- 17,907
The Medscape Salary Survey (yes, you need to have a Medscape account to view that, no I'm not going to post the figure here, it's free, take 14 seconds and sign up) has roughly 2 million things to criticize but it's not a horrible place to get a general idea of salaries. IM includes both outpatient and hospitalist and average hospitalist salary is a little (not massively) higher than outpatient. Bottom line is that GI pays 1.5-2x better than "IM". You can make more or less in either of those specialties though so if you're using this to make a decision about whether to be a hospitalist or a scope jockey, you're doing it wrong.
- Joined
- Feb 28, 2015
- Messages
- 64
- Reaction score
- 0
Thank you for the link. Can anyone shed light on how much advanced endoscopy makes vs a transplant hepatologist ( academic vs private)?
- Joined
- Mar 6, 2005
- Messages
- 21,377
- Reaction score
- 17,907
You asked 4 different questions there.
PP endoscopist (advanced or not) = fat bank, like rad onc or derm cash
Academic transplant hepatologist = slightly more than a PGY6 fellow
The other 2 are somewhere in between.
- Joined
- Mar 18, 2015
- Messages
- 17
- Reaction score
- 1
Is there really not a salary difference between bread and butter endoscopy and advanced (biliary or EUS)?
- Joined
- Jun 12, 2014
- Messages
- 188
- Reaction score
- 97
If anything b+b docs make more. as gutonc mentioned, these are just numbers...they really can mean nothing. Anyone can make any amount in any specialty if they go the private route...as a salaried employee, yes, things are a bit more defined. The highest earning GI docs I know are private docs that do pretty much b+b (and have 1 or 2 partners who CAN do the advanced stuff).
I wouldn't do advanced endo based on money. I would do it if I found it exhilarating and felt like a badass being able to perform endoscopic interventions not many can do. Of course, this would be at the expense of added call and complication rate.
I haven't started my fellowship yet and this isn't a question I can answer adequately for myself. I've never done an ERCP or an EUS. I have no idea if I will like doing them any more than a first year med student knows whether or not they like doing thoras or centrals. If you love GI, wonderful, do GI. THEN you can figure out if you want to super-subspecialize based on your experience with your own two hands.
- Joined
- Feb 28, 2015
- Messages
- 64
- Reaction score
- 0
Do transplant hepatologist actually just make at level of PGY 6 fellow? is it that low?
- Joined
- Feb 27, 2007
- Messages
- 5,710
- Reaction score
- 5,460
No.
- Joined
- Jun 12, 2014
- Messages
- 188
- Reaction score
- 97
EDIT: What Gastrapathy said
- Joined
- Feb 28, 2015
- Messages
- 64
- Reaction score
- 0
what is the average for tx hepatologist?
I dont want to be woken up at night. I dont want to do daily rectal exams for every patient. I dont want to suffer 3 more years of training. I want to have half of the year free. I want to do something else other than medicine. So I chose Hospital Medicine. I love it so far.
- Joined
- Feb 27, 2007
- Messages
- 5,710
- Reaction score
- 5,460
I don't want to be an indefinite intern. I don't want to burn out. I don't want to be bored. So...see how easy that is?
- Joined
- Jun 17, 2015
- Messages
- 110
- Reaction score
- 69
- Joined
- Oct 21, 2008
- Messages
- 2,353
- Reaction score
- 2,321
I don't want to be an indefinite intern. I don't want to burn out. I don't want to be bored. So...see how easy that is?
As a resident, I agreed with all these points and thus sent out apps to rheumatology. Maybe not quite as much time off vs being a hospitalist, but I don't think I'll be regretting it.
- Joined
- Apr 22, 2006
- Messages
- 2,794
- Reaction score
- 2,625
What people don't realize is that the whole "indefinite intern" business only pertains to academia, which the vast majority of us will not work in. Besides specialization, what difference does it make in private practice? You're either a resident for life, or you're a fellow for life. There is no one to help you with your b**** work, write your notes, or talk to nurses. It's all on the specialist just like it's all on the hospitalist.
With that said, rheum is a great choice. An up and coming field. I'm applying this year too. Best of luck.
- Joined
- Feb 27, 2007
- Messages
- 5,710
- Reaction score
- 5,460
Totally disagree with the last post. Academia or not, hospitalists are paperwork machines.
- Joined
- Dec 28, 2014
- Messages
- 325
- Reaction score
- 166
Could I "double like" this?
