Internal Medicine vs Family Medicine...Lifestyle specialties?

[Howard7]

Hello everyone need some wise individuals to chime in on this. I keep hearing that with the emergence of the hospitalists that outpatient family medicine is now a lifestyle specialty since hospitalists take all of the admissions via the ED?

If this is true, isn't it possible to be an outpatient internist and just do outpatient M-F just like Dermatology? Sure dermatologists make bank but money is not as important to some with a big family.

Is it possible to be an outpatient internist with no admission responsibilities?

If this is possible, how common is this?

Thank you very much for your insight everyone.

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[jdh71]

Hello everyone need some wise individuals to chime in on this. I keep hearing that with the emergence of the hospitalists that outpatient family medicine is now a lifestyle specialty since hospitalists take all of the admissions via the ED?

If this is true, isn't it possible to be an outpatient internist and just do outpatient M-F just like Dermatology? Sure dermatologists make bank but money is not as important to some with a big family.

Is it possible to be an outpatient internist with no admission responsibilities?

If this is possible, how common is this?

Thank you very much for your insight everyone.

Possible and common.

 

[Frugal Traveler]

This seems to be common.

If you want a lifestyle specialty, then I would find a job that is 40 hours a week, preferably a desk job with no responsibility for patients' well-being (which requires a lifetime commitment to learning and an inquisitive mind that exceeds working 40 hours a week). For instance, working at an insurance company as an MD and denying claims. Working for the federal government. By far my personal favorite is working as one of the representatives in the operating room showing surgeons how to use your company's "straight-forward" equipment that an attending surgeon scrubs out just so they can break it in front of your face (that's your clue to leave for lunch).

I guess what I am saying is that if you want to be a real doctor... then don't expect a 40 hour work week as work encompasses patient care, continuing education, and other aspects intrinsic to being in medicine.

 

[Howard7]

I understand what you are saying but family is first for many. nThere is nothing wrong with just wanting outpatient medicine only with no call responsibilities. Lests put value judgements aside.

 

[Howard7]

I understand what you are saying but family is first for many. nThere is nothing wrong with just wanting outpatient medicine only with no call responsibilities. Lests put value judgements aside.

As mentioned earlier money isnt everything. We should know our limitations. Power money is secondary to family time. While at work outpatient docs work hard there is no way around that but call responsibilities hurt lifestyle for a family. if people are willing to sacrifice money for lifestyle for family there is nothing wrong with that.

 

[Abacab]

This seems to be common.

If you want a lifestyle specialty, then I would find a job that is 40 hours a week, preferably a desk job with no responsibility for patients' well-being (which requires a lifetime commitment to learning and an inquisitive mind that exceeds working 40 hours a week). For instance, working at an insurance company as an MD and denying claims. Working for the federal government. By far my personal favorite is working as one of the representatives in the operating room showing surgeons how to use your company's "straight-forward" equipment that an attending surgeon scrubs out just so they can break it in front of your face (that's your clue to leave for lunch).

I guess what I am saying is that if you want to be a real doctor... then don't expect a 40 hour work week as work encompasses patient care, continuing education, and other aspects intrinsic to being in medicine.

You're not even a physician yet. Why make such hasty judgments about others? The OP merely wants a position that affords him the satisfaction of a healthy and balanced life with no admission responsibilities. You seem bitter and angry...and you're not even in residency yet...wow, what a shame.

To the OP: Yes, it's easy to do so. There are many others who have the same goals you mention. Internal medicine is versatile...you can be a hospitalist...you can do outpatient only...you can do fellowships and specialize...etc Don't let anyone dissuade you if you're interested in the field. Maintaining a balanced perspective and having time away from work will make you a well-adjusted physician that doesn't end up overworked and disgruntled.

 

[Howard7]

Thank you for understanding.

To the other poster, one's values change when one has kids that love you to death.

To me once you have a 2 year old and a 4 year old run toward you once you walk to the door with a big smile on their face, it doesn't matter if I make one million dollars or 90 thousand dollars. I rather spend as much time as I can with them and not miss them while they are growing up.

 

[greenthing]

.....and how fortunate we are that the lowest value in our radar of potential salaries is $90k!

 

[Howard7]

$90,000 isnt bad if ones loan situation is not that high. its all relative.

 

[efex101]

There are tons of jobs for IM outpatient ONLY with NO call, there are now also hospitalist positions M-F nine hour days with NO call, the possibility in IM is literally limitless.

 

[jdh71]

This seems to be common.

If you want a lifestyle specialty, then I would find a job that is 40 hours a week, preferably a desk job with no responsibility for patients' well-being (which requires a lifetime commitment to learning and an inquisitive mind that exceeds working 40 hours a week). For instance, working at an insurance company as an MD and denying claims. Working for the federal government. By far my personal favorite is working as one of the representatives in the operating room showing surgeons how to use your company's "straight-forward" equipment that an attending surgeon scrubs out just so they can break it in front of your face (that's your clue to leave for lunch).

I guess what I am saying is that if you want to be a real doctor... then don't expect a 40 hour work week as work encompasses patient care, continuing education, and other aspects intrinsic to being in medicine.

I think this is largely uncalled for and a completely douchbag statement. We need physicians in the clinic. And as busy as out patient and in patient medicine is there is plenty of room for purely in patient and purely out patient docs. In fact I would go so far as to say separating the out patient from the in patient is better medical practice. Who do you want taking care of your pneumonia the guy that admits 10 a month or the guy who admits 10 a day? I think the answer is obvious.

 

[asmallchild]

^ Agree with above.

I imagine this scenario is becoming more common. At my internship program, hospitalists are rapidly snatching up almost all inpatient-work. And it's probably for the best as one could make the argument inpatient-work is maybe best left for those who are a bit younger and can focus solely on that kind of work.

We just had a PGY-3 graduate last year who landed her dream outpatient-only job.

3-4 days/week. Outpatient only. 9-5. No call, no weekends, no holidays.

The money isn't great (I think 80K, maybe less) but since her loans were minimal and her husband happened to be a surgeon, it was a sacrifice she was willing to make to spend more time with her children.

 

[chitown82]

Outpatient-only medicine is definitely becoming more common. I know a group of eight physicians who do outpatient only (they have two hospitalists in their group). They each make over >150K.

 

[Pathologenius]

Does anyone who has recently interviewed for IM jobs have any ballpark data about salaries for these types of clinic-based jobs? Particularly in the South, if anyone knows.

 

[CanIMakeIt]

Does anyone who has recently interviewed for IM jobs have any ballpark data about salaries for these types of clinic-based jobs? Particularly in the South, if anyone knows.

All depends on how big, where, and how bad they need you. I have seen numbers all the way from 140s to 200s. And once you become partner, it is a different ballgame

 

[Khaos05]

I know this probably doesn't help answer your outpatient-only question, but just giving another angle on IM flexibility.

The hospitalist group at the hospital i work at (4 MDs) all work on a 7 on, 7 off schedule. The work am or pm sun-sat then have the next week off and rotate days/nights. Sounds nice to work 2 weeks per month. It does come out to be like 80hr/wk though

 

[indiamacbean]

do NOT go into medicine/FP for the lifestyle. there are lots of good reasons to do medicine, this isn't one of them. even if you are only seeing patients from 9-5 you will likely have paperwork, authorizations, after hour call coverage, etc. I am all for lifestyle specialties if you can find one you like but just go into this with your eyes open. if lifestyle is the key factor (and congrats on placing value in spending time with your family) you should probably pick something else.

 

[efex101]

I think that IM/FP *can* be a lifestyle specialty IF you do not place $$$$ high on your list. You can easily do hospitalist M-F 8-5 with lesser patient contacts per day in CERTAIN geographical areas. I see offers all the time in the South for over 200K and some with as little as 7-10 daily patient contacts, sure, these are in smaller towns but that is a sacrifice that some are willing to pay. Also, there are excellent outpatient only opportunities with NO call, with excellent hours and M-Thurs with Fridays OFF. You can also opt to do UC M-Thurs from 8-4. I mean the possibilities are endless and yes, I consider these lifestyle jobs minus the cash. If you subspecialize in certain IM subspecialties life *can* be good (endo/rheum/allergy) but the $$$ is actually less than hospitalist. The more demaning subspecialties like GI/cards will pay a lot more but the hours are worse. Heme-onc can also be a very good lifestyle but doubtful if you can work this a la hospitalist mode.

 

[Arijos0222]

I think that IM/FP *can* be a lifestyle specialty IF you do not place $$$$ high on your list. You can easily do hospitalist M-F 8-5 with lesser patient contacts per day in CERTAIN geographical areas. I see offers all the time in the South for over 200K and some with as little as 7-10 daily patient contacts, sure, these are in smaller towns but that is a sacrifice that some are willing to pay. Also, there are excellent outpatient only opportunities with NO call, with excellent hours and M-Thurs with Fridays OFF. You can also opt to do UC M-Thurs from 8-4. I mean the possibilities are endless and yes, I consider these lifestyle jobs minus the cash. If you subspecialize in certain IM subspecialties life *can* be good (endo/rheum/allergy) but the $$$ is actually less than hospitalist. The more demaning subspecialties like GI/cards will pay a lot more but the hours are worse. Heme-onc can also be a very good lifestyle but doubtful if you can work this a la hospitalist mode.

Everyone brace for the neurobump......

Does this still hold true?

 

[goprisko]

From my personal experience.

My kids were 18 mths and 3 the last year I farmed. The older one spent most of each and
every day with me. The younger one spent his days with his mother.

The farm bankruptcy destroyed our family. Obligations meant I could not be there anymore.

To this day, I have a great relationship with the older son, while the younger one hates me.

FYI, It is critical that you spend as much time with your kids between the ages of 18 mths and 6 yrs, as possible.

INDY

 

[Rheumination]

Everyone brace for the neurobump......

Does this still hold true?

Outpt IM/FM is NOT a lifestyle specialty - these folks work really hard for some of the lowest paying jobs in medicine...they deserve a lot more respect than they are given. Depending on the situation, they might have to see a lot of patients per day and unless you are charting while seeing patients, you have a lot of charting to do at the end of the day in addition to responding to patient calls, filling out paperwork for patients, etc. There are tons of opportunities, outpt docs are in very high demand, there are not enough of them. The farther you are from a big city, the more money you will likely make. Plenty of my colleagues have found all outpatient work.

 

[P Diddy]

From my personal experience.

My kids were 18 mths and 3 the last year I farmed. The older one spent most of each and
every day with me. The younger one spent his days with his mother.

The farm bankruptcy destroyed our family. Obligations meant I could not be there anymore.

To this day, I have a great relationship with the older son, while the younger one hates me.

FYI, It is critical that you spend as much time with your kids between the ages of 18 mths and 6 yrs, as possible.

INDY

so your point is...don't go bankrupt?

p diddy

 

[bronx43]

Outpt IM/FM is NOT a lifestyle specialty - these folks work really hard for some of the lowest paying jobs in medicine...they deserve a lot more respect than they are given. Depending on the situation, they might have to see a lot of patients per day and unless you are charting while seeing patients, you have a lot of charting to do at the end of the day in addition to responding to patient calls, filling out paperwork for patients, etc. There are tons of opportunities, outpt docs are in very high demand, there are not enough of them. The farther you are from a big city, the more money you will likely make. Plenty of my colleagues have found all outpatient work.

Well, it's still more "lifestyle" than the majority of specialties - the caveat being that your hourly wage will be crappy compared to the orthopod or the derm. If I were going to pursue an outpatient medicine career, I would not hesitate to go the route of concierge medicine. The demand out there is sky high for concierge care, and you can easily cut 50% of your overhead without the headache of hiring staff for clerk work and billing. All the concierge guys I know of love their job and are easily pulling 250k+ while seeing on average 8-10 patients 4 days a week. No joke.

 

[xenotype]

I think concierge is literally going to be 10-20% of the entire primary care market in less than a decade. The access most patients get with insurance is terrible because insurance has always under-reimbursed primary care and overtaxed it with paperwork. Concierge drives right by those two problems. There's a post in the fam med forum of a doc that has managed to get his monthly fee down to an average of 50$ a month, makes over $200k, and sees about 5-7 patients a day. I think a lot of patients don't want to see nurses for primary care and are willing to pay extra to avoid it. With a monthly fee of 50$, that is cheap enough that over half the people in this country can afford it. You can charge more in high cost of living areas obviously and it is not one size fits all unlike the current crappy reimbursement system. I am certainly planning on IM for flexibility and then concierge or hospitalist because most of the subspecialties seem too vulnerable to CMS cuts.

 

[goprisko]

My point is.. . .

As Said in the last sentence.. . .

Which you, knucklehead, can't seem to get.. . .

Because your up to your eyeballs in medical journals.. . .

FYI, It is critical that you spend as much time with your kids between the ages of 18 mths and 6 yrs, as possible.

FYI, It is critical that you spend as much time with your kids between the ages of 18 mths and 6 yrs, as possible.

FYI, It is critical that you spend as much time with your kids between the ages of 18 mths and 6 yrs, as possible.

FYI, It is critical that you spend as much time with your kids between the ages of 18 mths and 6 yrs, as possible.

IT IS CRITICAL THAT Y O U SPEND AS MUCH TIME WITH Y O U R KIDS,

BETWEEN THE AGES OF 18 MONTHS AND 6 YEARS, AS POSSIBLE !!!!!!!

Got it now????

INDY

 

[goprisko]

Well, it's still more "lifestyle" than the majority of specialties - the caveat being that your hourly wage will be crappy compared to the orthopod or the derm. If I were going to pursue an outpatient medicine career, I would not hesitate to go the route of concierge medicine. The demand out there is sky high for concierge care, and you can easily cut 50% of your overhead without the headache of hiring staff for clerk work and billing. All the concierge guys I know of love their job and are easily pulling 250k+ while seeing on average 8-10 patients 4 days a week. No joke.

I am very interested in a practice model that eliminates insurance companies entirely. I want my wife's practice to be first in the food chain, not sitting last behind a bunch of greedy insurance rats.

Frankly, I don't understand why MDs put up with this crap.

So, I'm not interested in the model where patients pay an annual subscription for availability, in addition to fees for services rendered, which may be paid by insurers.

I am interested in a model called "Direct Primary Care" where patients become members of a non-profit association which offers it's members services based upon the type of membership held. The services are envisioned by me to be primarily focused on prevention and on wellness, but also include full diagnostics, routine prescriptions, vaccinations, quarterly checkups, in depth interviews as part of the assessment process, outpatient surgery to the greatest possible extent, home delivery of babies to the greatest possible extent, a farmers market on weekends offering non- adulterated food, psych counseling, fitness, and other services necessary to prevention.

INDY

 

[goprisko]

There's a post in the fam med forum of a doc that has managed to get his monthly fee down to an average of 50$ a month, makes over $200k, and sees about 5-7 patients a day. I think a lot of patients don't want to see nurses for primary care and are willing to pay extra to avoid it. With a monthly fee of 50$, that is cheap enough that over half the people in this country can afford it.

Dunno about you, but my wife pays $80/month for her gym membership, and the internet service provider I currently use charges $50 / month.

I think a properly organized medical assn could charge, and get more than this.

INDY

 

[Gpan]

So I just spoke with a recent grad from my IM program. He just graduated last year. He said that he's making about $40K a month
He admitted that he's taking more calls than usual, and I usually see him there every other day. He said that the group he's in is incentive based with minimum over head pay. His gross income for the 1st year is roughly $420,000. Holy St
Is that possible? I know this guy and he's not the show off type either

 

[gutonc]

So I just spoke with a recent grad from my IM program. He just graduated last year. He said that he's making about $40K a month
He admitted that he's taking more calls than usual, and I usually see him there every other day. He said that the group he's in is incentive based with minimum over head pay. His gross income for the 1st year is roughly $420,000. Holy St
Is that possible? I know this guy and he's not the show off type either

Let me get this straight. You have 2nd hand information from somebody you claim to know and trust, and you're asking random internet douchewads if he's a liar?

Are jobs like this out there? Of course.

Will you want to put a bullet in your head after a couple of years of doing this? Of course.

 

[Gpan]

Let me get this straight. You have 2nd hand information from somebody you claim to know and trust, and you're asking random internet douchewads if he's a liar?

Are jobs like this out there? Of course.

Will you want to put a bullet in your head after a couple of years of doing this? Of course.

yea exactly. He's a good guy but does not mean he woundn't lie. I just want to see if any of u guys ever seen this potential on the job market. What's wrong with that?
He seems to be on call very often, but he said it's all worth it when the checks come

 

[Bostonredsox]

yea exactly. He's a good guy but does not mean he woundn't lie. I just want to see if any of u guys ever seen this potential on the job market. What's wrong with that?
He seems to be on call very often, but he said it's all worth it when the checks come

Well I signed for a pretty good rate and I have friends who signed for more in some less desirable areas, in the neighborhood of 300k for week on week off hospitalist medicine. If they picked up only 2 shifts I. The off week they'd be over 415k. It's doable. But as gutonc stated.....there is always a catch.

 

[DrWBD]

Primary care physicians I know that have lifestyle-oriented practices tend to work for hospital-owned practices or large corporation-type practices. Also, the VA tends to afford primary care doctors a fairly easy practice schedule except for the few weeks you have to cover the inpatient wards.