Physician advisor position / transitioning away from clinical medicine

Started by end stage fibro
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end stage fibro

end stage fibro

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Full-time hospitalist here. A physician advisor position fell into my lap recently - definitely easier and with similar pay (potentially more) than my hospitalist job. Anyone know much about positions like this? Don't see many detailed descriptions online. I do know this particular position has only minimal time devoted to nagging physicians.

My main concern i suppose is leaving clinical medicine - I've been practicing for about 7 years and don't mind my job at all. Sure there's some days that are extremely annoying but usually I'm happy at the end of the day. I feel like i might be leaving clinical medicine a little too early with this job.

Any thoughts appreciated. Thanks in advance
 
end stage fibro said:
Full-time hospitalist here. A physician advisor position fell into my lap recently - definitely easier and with similar pay (potentially more) than my hospitalist job. Anyone know much about positions like this? Don't see many detailed descriptions online. I do know this particular position has only minimal time devoted to nagging physicians.

My main concern i suppose is leaving clinical medicine - I've been practicing for about 7 years and don't mind my job at all. Sure there's some days that are extremely annoying but usually I'm happy at the end of the day. I feel like i might be leaving clinical medicine a little too early with this job.

Any thoughts appreciated. Thanks in advance
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As someone who fell into admin work a few years ago, and is actively planning an escape strategy back into FT clinical medicine, I would just encourage you to do a lot of homework on this before making the leap.

I am fortunate that my current job is still 40% clinical, so going back to 100% clinical (actually 80% since I'll keep my research director position) will be trivial. If you went 100% clinical to 100% non-clinical it would definitely be more difficult to go back to clinical in the future if you wanted to.
 
I ended up taking the job and have been at it for a few months. Some stray thoughts for anyone in the future:

I guess I'm admin now, at least according to my hiring packet. It's true- admin life is way easier. However, I've never had a job that it just emails and meetings. It is kinda weird...I feel like a highly paid chat bot sometimes.

My counterpart is nice and obviously intelligent, but he has been nonclinical for a some time and it really shows. Some suggestions raise eyebrows and he is lacking in terms of street cred (whatever that is worth). His experience in this line of work has proven useful though.

A lot of us bemoan the day to day of being in the hospital and monotony of clinical practice. It was nice though to make decisions day to day that would rapidly make an impact. Right now I feel that I am gently turning the rudder on a very large boat. Some of the feedback is very fuzzy as well

There is a large work from home component. Work from home is f*ing sweet. Better than I ever imagined. Ideally, all hospitalist work should be telehealth from home.

I still pick up PRN shifts as an admitter and if I want to self-flagellate, I will pick up a weekend rounding shift. I noticed I do miss medicine in its pure form, but boy oh boy I surely do not miss CM rounds, talking to pts, CYA stupid workup, etc.

I've already learned a ton about non-clinical stuff pertinent to my role. CMS is not dumb, surprisngly. The sausage of medicine is more disgusting than I realized before - and I'm a pretty jaded, cynical fellow. I've also learned quite a bit outside typical IM, which has made me a better physician.

Nagging MDs was a little undersold in the interview process. Probab;y about 10ish% of the job. Usually it goes smoothly (as I know their pain well) but it's hard to couch this as a quality perspective (1% actual purpose) and not a money grab (99% actual purpose)

I can get board ceritfied in this- LOL!
 
end stage fibro said:
I've already learned a ton about non-clinical stuff pertinent to my role. CMS is not dumb, surprisngly. The sausage of medicine is more disgusting than I realized before - and I'm a pretty jaded, cynical fellow. I've also learned quite a bit outside typical IM, which has made me a better physician.
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Congrats on the job.

Do you mind expanding upon this? I am terribly curious.
 
Glad things are going well. Can you give some insight into what a "physician advisor" is? Never heard of that in the 4 systems I'm familiar/involved with.

I'm still mid-exit for my current admin job, but working on some other admin ideas/opportunities as well. Turns out it's the people management that I hate, but systems stuff is still pretty interesting. I'm working up a proposal for a job that doesn't (but should) exist in my system and I think I'm perfectly positioned for it. We'll see. If it doesn't work out, I do still love my clinical job.
 
bronx43 said:
Oh mainly the part about CMS being not dumb and the business of medicine being more distasteful than you thought.

I was at a large academic center and I hated the admin. So I’m just curious if it’s even worse behind the scenes.
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The CMS part I will preface with saying the big national issues like staying cost neutral I don't really deal with. What I was alluding to is the amount of data collected and analysis performed before any change is enacted. CMS collects nearly 100% of medicare billed data and performs very detailed actuarial analysis to determine how payments, DRGs, etc will change. They publish the methodology and math (though some is proprietary). CMS also invites anyone to discuss with them should one have a problem with their methods. Every year, an 1800 page document is released talking about all this, free to see and scrutinize. They also send on an individual hospital level how you compare to peers and the nation regarding safety metrics, high risk diagnoses, red flag patterns that would lead to OIG audits. The most common example of the above is how CMS sticks with the sepsis 2 definition instead of sepsis 3; it is not due to unwillingness to change. A huge analysis about the metrics, payments, bundles, resources needed at bedside, really everything was performed and published prior to any decision. A lot of thought goes into everything they do as any small adjustment has MANY downstream effects.

I too have been at large academic centers until now and hated admin. Each individual person is fine and not a bad actor, but in aggregate they suck. It really does come down to money, which we all knew, but the way it is presented is sad. I am actively told to phrase things not as money generation but as money that MDs were losing previously. There is an army of people I interact with who are totally non clinical whose chief function seems to be CCing emails to each other. Lots of harebrained ideas come up and the only reason they don't get executed is because they get so bogged down in development that the idea is even less viable than when it started. Lot of navel gazing as well. The bureaucracy is thick - luckily having an MD after my name still helps cut through a lot of it but otherwise it is layer and layer of requests. C-suite makes some HUGE purchases only because other hospital systems are doing it so they don't want to be seen as backward-looking. In practice, it just adds to the day of front line clinicians for very dubious benefit. Innovation is looked at with suspicion. I guess there is no new insight in this paragraph not already described in Office Space. I'm not even sure if this satisfies your curiosity or was just rambling incoherence. A lot of these issues are the same across any big organization, but being in the belly of the beast really makes you feel it. I guess to sum it up- I really thought there would be more discussion about helping patients. I can virtually always assume when talking to another physician, the interest of the patient is paramount. I can't assume that anymore.


gutonc said:
Glad things are going well. Can you give some insight into what a "physician advisor" is? Never heard of that in the 4 systems I'm familiar/involved with.

I'm still mid-exit for my current admin job, but working on some other admin ideas/opportunities as well. Turns out it's the people management that I hate, but systems stuff is still pretty interesting. I'm working up a proposal for a job that doesn't (but should) exist in my system and I think I'm perfectly positioned for it. We'll see. If it doesn't work out, I do still love my clinical job.
Click to expand...

The term physician advisor has a lot of synonyms (Medical Director of Care Management, Director of Utilization Management, Medical Director of Denial and Appeals, Chief Medical Compliance and Regulatory Officer). On a systemwide level, I help make sure we're in a good spot for future issues like value based purchasing, CMS metrics, etc. I am not especially savvy about any of this but I am a good middle man I guess- usually can get C-suite and front line grunts on the same page in a positive manner. people still wave to me in the hallway. I agree with you, the people management is definitely the hardest part.
 
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end stage fibro said:
I ended up taking the job and have been at it for a few months. Some stray thoughts for anyone in the future:
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Ehh . . . no thanks. I'd rather be a rounding hospitalist. At least the job is well defined and you have a clear goal: taking care of sick people. You can go in and see your patients, bail, write notes from wherever you'd like and tend to your pager.

The problem with these admin jobs (I've had plenty of them) is that you get plagued down by BS emails (as you pointed out), and meetings on top of meetings (btw there's a good inverse correlation between the # of meetings you have and the meaningfulness of your job). Everyone's in a rat race to justify their job. And then you run into a litany of HR issues, with people not doing what they're supposed to be doing, some of them you can discipline, some of them you can't or wont (perhaps b/c of age, gender, race, or some other circumstance . . . I'm sorry but it's true). People calling in sick, filing EO complaints, getting into stupid cat fights, etc etc. And this isn't just in healthcare obviously. The American workplace is seriously deteriorating on many fronts . . .

No thanks. Is the pay better? Ehh . . . I'll pick up a few more shifts.
 
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end stage fibro said:
I too have been at large academic centers until now and hated admin. Each individual person is fine and not a bad actor, but in aggregate they suck. It really does come down to money, which we all knew, but the way it is presented is sad. I am actively told to phrase things not as money generation but as money that MDs were losing previously. There is an army of people I interact with who are totally non clinical whose chief function seems to be CCing emails to each other. Lots of harebrained ideas come up and the only reason they don't get executed is because they get so bogged down in development that the idea is even less viable than when it started. Lot of navel gazing as well. The bureaucracy is thick - luckily having an MD after my name still helps cut through a lot of it but otherwise it is layer and layer of requests. C-suite makes some HUGE purchases only because other hospital systems are doing it so they don't want to be seen as backward-looking. In practice, it just adds to the day of front line clinicians for very dubious benefit. Innovation is looked at with suspicion. I guess there is no new insight in this paragraph not already described in Office Space. I'm not even sure if this satisfies your curiosity or was just rambling incoherence. A lot of these issues are the same across any big organization, but being in the belly of the beast really makes you feel it. I guess to sum it up- I really thought there would be more discussion about helping patients. I can virtually always assume when talking to another physician, the interest of the patient is paramount. I can't assume that anymore.
Click to expand...
Honestly, that sounds about right. I sat in on a few administrative meetings when I was in fakedemics, and it was almost like a sketch comedy show in terms of the sheer inanity and lack of self awareness. It was more or less a bunch of self aggrandizing people who talked at each other trying to sound smarter than they actually are. However, it was clear that no one actually knew what anyone else was talking about given that the conversation was nothing but one non-sequitur followed by another.
 
DrMetal said:
Ehh . . . no thanks. I'd rather be a rounding hospitalist. At least the job is well defined and you have a clear goal: taking care of sick people. You can go in and see your patients, bail, write notes from wherever you'd like and tend to your pager.

The problem with these admin jobs (I've had plenty of them) is that you get plagued down by BS emails (as you pointed out), and meetings on top of meetings (btw there's a good inverse correlation between the # of meetings you have and the meaningfulness of your job). Everyone's in a rat race to justify their job. And then you run into a litany of HR issues, with people not doing what they're supposed to be doing, some of them you can discipline, some of them you can't or wont (perhaps b/c of age, gender, race, or some other circumstance . . . I'm sorry but it's true). People calling in sick, filing EO complaints, getting into stupid cat fights, etc etc. And this isn't just in healthcare obviously. The American workplace is seriously deteriorating on many fronts . . .

No thanks. Is the pay better? Ehh . . . I'll pick up a few more shifts.
Click to expand...

forgot to reply to this- the pay is comparable to a hard working hospitalist income. The main reason I took it was that I left one gig and the new gig severely backfired. So I pivoted into this current job. This job really lets me structure my day and has opened the door to some PRN medical director stuff, so now I actually work 3-5 jobs and have a diverse income. the goal is not avarice - I want to get out asap before the vultures finish off the bloated albatross of healthcare. Maybe I'l join you at Phil's BBQ and black's beach after
 
update after a little more than a year:

I have uncovered even more people who I think can be replaced by an email bot that automatically CCs word salad

I was promised a lot of data analysis in this job. and there is...except the data oftentimes is totally nonsensical. Too bad so sad, it will still affect your MeTrIcS

Lots of projects just vanish into black holes. after time, the project is either abandoned or the project manager has moved on. high profile projects have a lot of "stakeholders" and are slow going.

"this meeting could have been an email"

Medicine is more F'd than i realized as a floor level grunt. Try to retire ASAP

I am FLOORED at the help some service lines get. the usual money makers: cards, onc, ortho, etc. Makes me kind of upset when I see these guys dumping on hospitalists and crit care.

some CMOs do a lot of work and are instrumental at gently turning the rudder of the hospital in a positive direction. some just gum up the works

i have kept my word of trying to make things as best as I can for the folks in the trenches. for this, i did not get a hero's welcome, not that I expected that. I was actually kinda shocked at some of the responses i got from MDs i know well. they really think there is some secret cabal of people hoarding away money and at times said docs actively try to sink the hospital system's mission. Newsflash bro: money is TIGHT right now. It does not help anyone for you to complain about a lack of RN/RT/CM/PT and low MD stipend then balk at the hospital requesting some stuff. a common theme is that they signed up to practice medicine, not support the garbage healthcare industry. I wish I had access to whatever supply is fueling their phantasmagoria. this is worsened by the fact that my health system is one of the "good guys" especially compared to the other groups in town.

midlevel proliferation is way more than i expected, especially in the specialty clinics.

I thought i had a lot of energy as a hospitalist. walked my dog BID, played with the kids, worked out, etc. Nay. I feel effing superhuman now. when i do rounding shifts on the weekends, i feel like self-flagellating. Admission shifts are whatever. I don't really look forward to talking to 99% of pts when i know the orders are some permutation of vanczosyn cultures CT CAP trops echo cbc/cmp

thanks for reading my blog. Idk if anyone finds this interesting but I am always happy to share more. I feel like the road I'm on is pretty opaque compared to the tradtional clinical tracks we all know so I just wanted to shed some light on the process.
 
end stage fibro said:
update after a little more than a year:

I have uncovered even more people who I think can be replaced by an email bot that automatically CCs word salad

I was promised a lot of data analysis in this job. and there is...except the data oftentimes is totally nonsensical. Too bad so sad, it will still affect your MeTrIcS

Lots of projects just vanish into black holes. after time, the project is either abandoned or the project manager has moved on. high profile projects have a lot of "stakeholders" and are slow going.

"this meeting could have been an email"

Medicine is more F'd than i realized as a floor level grunt. Try to retire ASAP

I am FLOORED at the help some service lines get. the usual money makers: cards, onc, ortho, etc. Makes me kind of upset when I see these guys dumping on hospitalists and crit care.

some CMOs do a lot of work and are instrumental at gently turning the rudder of the hospital in a positive direction. some just gum up the works

i have kept my word of trying to make things as best as I can for the folks in the trenches. for this, i did not get a hero's welcome, not that I expected that. I was actually kinda shocked at some of the responses i got from MDs i know well. they really think there is some secret cabal of people hoarding away money and at times said docs actively try to sink the hospital system's mission. Newsflash bro: money is TIGHT right now. It does not help anyone for you to complain about a lack of RN/RT/CM/PT and low MD stipend then balk at the hospital requesting some stuff. a common theme is that they signed up to practice medicine, not support the garbage healthcare industry. I wish I had access to whatever supply is fueling their phantasmagoria. this is worsened by the fact that my health system is one of the "good guys" especially compared to the other groups in town.

midlevel proliferation is way more than i expected, especially in the specialty clinics.

I thought i had a lot of energy as a hospitalist. walked my dog BID, played with the kids, worked out, etc. Nay. I feel effing superhuman now. when i do rounding shifts on the weekends, i feel like self-flagellating. Admission shifts are whatever. I don't really look forward to talking to 99% of pts when i know the orders are some permutation of vanczosyn cultures CT CAP trops echo cbc/cmp

thanks for reading my blog. Idk if anyone finds this interesting but I am always happy to share more. I feel like the road I'm on is pretty opaque compared to the tradtional clinical tracks we all know so I just wanted to shed some light on the process.
Click to expand...

Thanks for sharing a very unique insight into the unknown for most clinical docs

I agree with mid level proliferation, in my field which is oncology, hospital prefers to hire mid levels and have us supervise them at the same time not paying us any extra to do so. Created more work and liability.
 
end stage fibro said:
update after a little more than a year:

I have uncovered even more people who I think can be replaced by an email bot that automatically CCs word salad

I was promised a lot of data analysis in this job. and there is...except the data oftentimes is totally nonsensical. Too bad so sad, it will still affect your MeTrIcS

Lots of projects just vanish into black holes. after time, the project is either abandoned or the project manager has moved on. high profile projects have a lot of "stakeholders" and are slow going.

"this meeting could have been an email"

Medicine is more F'd than i realized as a floor level grunt. Try to retire ASAP

I am FLOORED at the help some service lines get. the usual money makers: cards, onc, ortho, etc. Makes me kind of upset when I see these guys dumping on hospitalists and crit care.

some CMOs do a lot of work and are instrumental at gently turning the rudder of the hospital in a positive direction. some just gum up the works

i have kept my word of trying to make things as best as I can for the folks in the trenches. for this, i did not get a hero's welcome, not that I expected that. I was actually kinda shocked at some of the responses i got from MDs i know well. they really think there is some secret cabal of people hoarding away money and at times said docs actively try to sink the hospital system's mission. Newsflash bro: money is TIGHT right now. It does not help anyone for you to complain about a lack of RN/RT/CM/PT and low MD stipend then balk at the hospital requesting some stuff. a common theme is that they signed up to practice medicine, not support the garbage healthcare industry. I wish I had access to whatever supply is fueling their phantasmagoria. this is worsened by the fact that my health system is one of the "good guys" especially compared to the other groups in town.

midlevel proliferation is way more than i expected, especially in the specialty clinics.

I thought i had a lot of energy as a hospitalist. walked my dog BID, played with the kids, worked out, etc. Nay. I feel effing superhuman now. when i do rounding shifts on the weekends, i feel like self-flagellating. Admission shifts are whatever. I don't really look forward to talking to 99% of pts when i know the orders are some permutation of vanczosyn cultures CT CAP trops echo cbc/cmp

thanks for reading my blog. Idk if anyone finds this interesting but I am always happy to share more. I feel like the road I'm on is pretty opaque compared to the tradtional clinical tracks we all know so I just wanted to shed some light on the process.
Click to expand...
Thanks for coming back and sharing all of this. I can't speak for everyone but I'm really enjoying your updates on this.
 
end stage fibro said:
update after a little more than a year:

I have uncovered even more people who I think can be replaced by an email bot that automatically CCs word salad

I was promised a lot of data analysis in this job. and there is...except the data oftentimes is totally nonsensical. Too bad so sad, it will still affect your MeTrIcS

Lots of projects just vanish into black holes. after time, the project is either abandoned or the project manager has moved on. high profile projects have a lot of "stakeholders" and are slow going.

"this meeting could have been an email"

Medicine is more F'd than i realized as a floor level grunt. Try to retire ASAP

I am FLOORED at the help some service lines get. the usual money makers: cards, onc, ortho, etc. Makes me kind of upset when I see these guys dumping on hospitalists and crit care.

some CMOs do a lot of work and are instrumental at gently turning the rudder of the hospital in a positive direction. some just gum up the works

i have kept my word of trying to make things as best as I can for the folks in the trenches. for this, i did not get a hero's welcome, not that I expected that. I was actually kinda shocked at some of the responses i got from MDs i know well. they really think there is some secret cabal of people hoarding away money and at times said docs actively try to sink the hospital system's mission. Newsflash bro: money is TIGHT right now. It does not help anyone for you to complain about a lack of RN/RT/CM/PT and low MD stipend then balk at the hospital requesting some stuff. a common theme is that they signed up to practice medicine, not support the garbage healthcare industry. I wish I had access to whatever supply is fueling their phantasmagoria. this is worsened by the fact that my health system is one of the "good guys" especially compared to the other groups in town.

midlevel proliferation is way more than i expected, especially in the specialty clinics.

I thought i had a lot of energy as a hospitalist. walked my dog BID, played with the kids, worked out, etc. Nay. I feel effing superhuman now. when i do rounding shifts on the weekends, i feel like self-flagellating. Admission shifts are whatever. I don't really look forward to talking to 99% of pts when i know the orders are some permutation of vanczosyn cultures CT CAP trops echo cbc/cmp

thanks for reading my blog. Idk if anyone finds this interesting but I am always happy to share more. I feel like the road I'm on is pretty opaque compared to the tradtional clinical tracks we all know so I just wanted to shed some light on the process.
Click to expand...
Thanks for posting.

How high up the admin chain are you? Are you VP+ level pulling in the near (or greater than) 7 figure exec salary or more middle level?

One comment--The hospital mission doesn't mean **** to anyone except the C suite people. The mission for the people who work at that hospital is to make sick people either get better or die to make room for more sick people. Until there are high profile admin firings or cutbacks on admin staff (ie the CEO of the hospital has to manage his own schedule and make his own coffee) nobody is going to sympathize with how little money the hospital has to pay for adequate staffing, it just looks like more of the usual 'cutbacks for thee and none for me' crap we have all grown to accept and hate.
 
chessknt said:
Thanks for posting.

How high up the admin chain are you? Are you VP+ level pulling in the near (or greater than) 7 figure exec salary or more middle level?

One comment--The hospital mission doesn't mean **** to anyone except the C suite people. The mission for the people who work at that hospital is to make sick people either get better or die to make room for more sick people. Until there are high profile admin firings or cutbacks on admin staff (ie the CEO of the hospital has to manage his own schedule and make his own coffee) nobody is going to sympathize with how little money the hospital has to pay for adequate staffing, it just looks like more of the usual 'cutbacks for thee and none for me' crap we have all grown to accept and hate.
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i would say middle level. My title says senior director and I report to the same "executive VP" the CMOs report to. I think the CMO comp package higher than mine though. I do hope to climb this ladder as high as possible...not because I am a slurper but I want to see first hand how deep this rabbit hole goes. They say more physicians should get into positions of power so I am putting my money where my mouth is.

also, I guess I illustrated what a bad suit I am. i did not mean the Hospital's Mission™, I literally meant the hospital's mission as you and I see it- cycling gomers and occasionaly fixing people. Any other mission is meaningless to me. I agree the healthcare system is bloated. In an ideal world, I don't think my position should exist but the healthcare system is bedlam, so he we are.

one more thing i forgot to mention earlier- I am in charge of arguing with payors about reimbursement for DRGs. My God... talk about selling your soul! The stuff they deny is maddening
 
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Final thoughts:

Talking in percentages and analyzing "quarterly results" makes me feel like a corporate sleazeball.

i know everyone here knows this, but those clipboards warriors DGAF about what is going on on the floor- the only focus is polishing the metrics. it is infuriating. Moreover, so many meetings I go to are just people waiting to talk about their project. the rest of the hour is free time (myself included). bronx43 said it best in post #11

Earlier in this thread, there was mention that it looks as if the cuts in healthcare are only affecting the bottom feeders. Well, no longer. several bigwigs at my system have been asked to resign (including my direct supervisor and their boss, both of whom are on a first name basis with the CEO of the whole system). the roles of department directors/managers who are retiring have dissolved and are are being redistributed among existing people. Prior to this job, i had no idea 99% of these people existed. I assure you similar cuts are happening at your shop. There is emphasis on keeping whatever phleb techs, RNs, etc they can as morale is in the toilet and people have a hair trigger to quit. I still believe my specific health system is a good actor overall and we have top quartile rates of retention and bottom quartile rates of travelers.

the preceding paragraph makes me think about my job security but not in any serious capacity. There are 4 of us in my exact role in a medium/large system and we each pay for our salary within the first 6 months of the year- either through peer to peers, operationalizing a buncho of CMS mumbo jumbo (inpt v. obs, patient safety indicators, cardiology metrics, massaging readmission, etc). It is a testament to our healthcare system that me becoming a paper pusher and excel jockey generates more money than seeing patients.

the data continues to be garbage. if it exists in powerbi/tableaux, no one questions it. It is very difficult to dig deeper and you are met with suspicious eyes if you try.Just recently, person X at my job was trying to dump some blame on the hospitalists. took a lot of digging and elbow grease but I was able to show their assertion was stupid af. they just moved the goalposts a bit and made their complaint more nebulous. I took this as a personal affront because generating and wrangling that 9000 row and 20 column spreadsheet took a lot of work for a one-off issue. Furthermore, everyone only reads the top line or executive summary. Forget about communicating nuance. No worries...by next quarter no one cares about previous results anyways.

as the wise dr. metal commented above in post #10, the people management is annoying. I work with a lot of people who insist on being notified on the result of every interaction and meeting I have. superiors, people below me, people next to me. just do your damn job and stfu.

work is gonna get tougher through the years. your payment is gonna have more shared risk with the hospital. audits are going to be more merlicess and more common. you will have more and more of a "value" component in your pay instead of straight FFS. Pt complaints regarding the chart are rising and rising and it will get worse come October. (see USCDI version 3/4 section in the cures act). Even the chads in ortho, cards, and NSGY are getting hit. They no longer have license to just pound out procedures and not care about anything else.

surprisingly, my fellow physicians have warmed up to me. Even if i show up in a suit (rare), they can tell by general disgruntled attitude and straight talk that I am on their side. I don't have a point here...only to say that I really am on their side. People that knew me from "before" are surprised I can string together several sentences in a row without an F bomb.

Some people expect me to be clinically brain dead. dude...I listen to like 4 medical podcasts and read at least NEJM JAMA every week. I read more now and in greater depth in this job than I ever did as a hospitalist.

I am still doing this job and grinding away at a few others. the rotation of work helps keep things interesting and gives me an overall greater appreciation of how the different part of the healthcare system fit togehter. Fit is a bad word....how they are cudgeled together into a poorly differentiated abomination

this will probably be my last update as I feel i have hit a steady-state in this job. thanks for reading and a more general thank you to everyone on SDN. I hope I was able to imbue you with equal parts enlightenment and despair. Back to my meeting
 
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end stage fibro said:
Final thoughts:

Talking in percentages and analyzing "quarterly results" makes me feel like a corporate sleazeball.

i know everyone here knows this, but those clipboards warriors DGAF about what is going on on the floor- the only focus is polishing the metrics. it is infuriating. Moreover, so many meetings I go to are just people waiting to talk about their project. the rest of the hour is free time (myself included). bronx43 said it best in post #11

Earlier in this thread, there was mention that it looks as if the cuts in healthcare are only affecting the bottom feeders. Well, no longer. several bigwigs at my system have been asked to resign (including my direct supervisor and their boss, both of whom are on a first name basis with the CEO of the whole system). the roles of department directors/managers who are retiring have dissolved and are are being redistributed among existing people. Prior to this job, i had no idea 99% of these people existed. I assure you similar cuts are happening at your shop. There is emphasis on keeping whatever phleb techs, RNs, etc they can as morale is in the toilet and people have a hair trigger to quit. I still believe my specific health system is a good actor overall and we have top quartile rates of retention and bottom quartile rates of travelers.

the preceding paragraph makes me think about my job security but not in any serious capacity. There are 4 of us in my exact role in a medium/large system and we each pay for our salary within the first 6 months of the year- either through peer to peers, operationalizing a buncho of CMS mumbo jumbo (inpt v. obs, patient safety indicators, cardiology metrics, massaging readmission, etc). It is a testament to our healthcare system that me becoming a paper pusher and excel jockey generates more money than seeing patients.

the data continues to be garbage. if it exists in powerbi/tableaux, no one questions it. It is very difficult to dig deeper and you are met with suspicious eyes if you try.Just recently, person X at my job was trying to dump some blame on the hospitalists. took a lot of digging and elbow grease but I was able to show their assertion was stupid af. they just moved the goalposts a bit and made their complaint more nebulous. I took this as a personal affront because generating and wrangling that 9000 row and 20 column spreadsheet took a lot of work for a one-off issue. Furthermore, everyone only reads the top line or executive summary. Forget about communicating nuance. No worries...by next quarter no one cares about previous results anyways.

as the wise dr. metal commented above in post #10, the people management is annoying. I work with a lot of people who insist on being notified on the result of every interaction and meeting I have. superiors, people below me, people next to me. just do your damn job and stfu.

work is gonna get tougher through the years. your payment is gonna have more shared risk with the hospital. audits are going to be more merlicess and more common. you will have more and more of a "value" component in your pay instead of straight FFS. Pt complaints regarding the chart are rising and rising and it will get worse come October. (see USCDI version 3/4 section in the cures act). Even the chads in ortho, cards, and NSGY are getting hit. They no longer have license to just pound out procedures and not care about anything else.

surprisingly, my fellow physicians have warmed up to me. Even if i show up in a suit (rare), they can tell by general disgruntled attitude and straight talk that I am on their side. I don't have a point here...only to say that I really am on their side. People that knew me from "before" are surprised I can string together several sentences in a row without an F bomb.

Some people expect me to be clinically brain dead. dude...I listen to like 4 medical podcasts and read at least NEJM JAMA every week. I read more now and in greater depth in this job than I ever did as a hospitalist.

I am still doing this job and grinding away at a few others. the rotation of work helps keep things interesting and gives me an overall greater appreciation of how the different part of the healthcare system fit togehter. Fit is a bad word....how they are cudgeled together into a poorly differentiated abomination

this will probably be my last update as I feel i have hit a steady-state in this job. thanks for reading and a more general thank you to everyone on SDN. I hope I was able to imbue you with equal parts enlightenment and despair. Back to my meeting
Click to expand...
I am morbidly curious--relative to your hospitalist pay previously where would you put your comp from the admin only job at? 100%? 150%? Clearly your hours are far better so your pay per hour must be way up.
 
chessknt said:
I am morbidly curious--relative to your hospitalist pay previously where would you put your comp from the admin only job at? 100%? 150%? Clearly your hours are far better so your pay per hour must be way up.
Click to expand...
At my peak earnings as a hospitalist, current pay is actually only 90ish percent . These days, extra shifts are hard to come by so it’s more like 140ish%. Keep in mind, i live in a large desirable city. Hospitalists here are not making $800/hr paid to them in gold doubloons every shift, as is common on SDN. There are small bonuses like COLA and merit raises. The benefits are otherwise similar to an employed physician- health insurance, 401k, 457b, etc
 
This has been extremely informative as a PGY-2 in IM who is currently reading this. Thank you fibro. Look forward to hearing more about the journey
 
DrMetal said:
Ok I'll bite. What do you do, how do you 'advise'?
Click to expand...
I was debating If i should bump this but I guess a short review would be useful for people searching in the future.

one liner: help the hospital achieve it's quality/financial goals through regulatory compliance and navigating payor issues.

CMS compliance- very broad. make sure national and local coverage determinations are being met for procedures. make sure we are not doing anything too goofy that will get us fined (e.g. good documentation, not being an outlier in a specific diagnosis [see CMS PEPPER publication], following CMS procedure manual

pt status- inpt vs. outpt/obs. some hospital systems have the hospitalist argue status with the payor. the average hospitalist is ill equipped to do this and probably uninvested in the outcome. criteria such as MCG and interqual help determine status. most systems use software called XSOLIS to help with status these days. also help the denial teams with their templates and provide high level review of tough cases. edit: for those who don't know, status is CRITICAL. it has a HUGE impact on the amount you get paid for a hospitalization, even though the same care is (or at least should be) delivered. The difference can be as much as 6 figures of cold hard cash. It is not monopoly money at risk.

physician education- things change every year. I relay the important stuff to docs. If something isn't up to par, i talk with the med director to help fix stuff.

nagging- takes nagging to get some of the above things done. i hate this part of the job but it is only a small part

committee participation for UM, patient safety indicators, lab stewardship, etc.

argue with payors- go to court (over teams, but yes literally court) with the payors over payment issues. it's me vs the insurance med director team

help with new systemwide projects- my system is working on a big cardiology project, i am involved in the nuts and bolts regulatory aspect of a lot of things regarding it. I also function as a general plugin to find medical pitfalls in implentation if say, there is only a cardiologist and no hospitalist.

SDN shítposting- this is key. try to sneak stuff past mods

the work is not for everyone but i find 85% of it interesting. the downsides have been discussed in detail above. also i dont have to talk to patients, so i got that going for me
 
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ussdfiant said:
How do you think the commercial payors will handle MA plans needing to follow the 2MN rule?
Click to expand...

this is sheer buffoonery. Even UnitedHealth Group acknowledges that the 2MN rule applies to MA plans already! I feel like the CMS CY2024 changes make the 2MN rule even more explicit. I think we will get a boost in inpatient rates but I don't think it will be 100% smooth sailing. Getting post-acute discharges approved more easily is also welcome.

btw, is there anywhere else that PAs go to hang out? i know the ACPA website and rac relief. otherwise it is slim pickins
 
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This is a corollary to this post that is on the front page. I agree with the thrust of all the posters in that thread: work sucks, need money. I am here to tell you I feel like that about admin work too,now.


My job was pretty chill for a while. My department became successful and now everyone wants us involved. I can’t help most of these people, but I go their meeting anyways, say some buzzwords, and go back to playing my video games, daydreaming about being a quant, or working on side hustles. What is annoying is that I am expected to speak up in large committees now. I say the truth and in unadorned fashion. Naturally, this gives rise to push back that eventually leads to “taking this discussion offline.” I then send detailed emails with a tl;dr up top proving my point…only to be met with crickets. I made an especially detailed analysis about a certain risk score that the whole enterprise is focusing on. The risk score is garbage. I went on about Pearson correlation coefficients, generated a ROC curve, financial scenarios, I mean totally overboard to show that this is a bad idea. Silence in the meetings. Follow up emails have yielded no reply. This has led me to a state of existential dread (I mean, as much as I can have at work…real life still pretty cool). I really just dgaf about what the corporation does anymore. Sometimes I wonder if I should quit this and grind out hospitalist shifts instead. Dare I say…less bullsh*t to deal with?

My boss is cool, but his boss is high ranking and a total clown with zero business sense.
the people i usually have meetings with are braindead...I am the smartest person in the room a lot of the time, and i am not even smart.

as an example of a tldr, my whole post can be summed up by:
1750992506831.gif
 

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end stage fibro said:
This is a corollary to this post that is on the front page. I agree with the thrust of all the posters in that thread: work sucks, need money. I am here to tell you I feel like that about admin work too,now.


My job was pretty chill for a while. My department became successful and now everyone wants us involved. I can’t help most of these people, but I go their meeting anyways, say some buzzwords, and go back to playing my video games, daydreaming about being a quant, or working on side hustles. What is annoying is that I am expected to speak up in large committees now. I say the truth and in unadorned fashion. Naturally, this gives rise to push back that eventually leads to “taking this discussion offline.” I then send detailed emails with a tl;dr up top proving my point…only to be met with crickets. I made an especially detailed analysis about a certain risk score that the whole enterprise is focusing on. The risk score is garbage. I went on about Pearson correlation coefficients, generated a ROC curve, financial scenarios, I mean totally overboard to show that this is a bad idea. Silence in the meetings. Follow up emails have yielded no reply. This has led me to a state of existential dread (I mean, as much as I can have at work…real life still pretty cool). I really just dgaf about what the corporation does anymore. Sometimes I wonder if I should quit this and grind out hospitalist shifts instead. Dare I say…less bullsh*t to deal with?

My boss is cool, but his boss is high ranking and a total clown with zero business sense.
the people i usually have meetings with are braindead...I am the smartest person in the room a lot of the time, and i am not even smart.

as an example of a tldr, my whole post can be summed up by:
Click to expand...

Who in the organization is championing this risk score? Any reason why they are so invested?

It's always amusing when administration starts to focus on various measures year to year. Most make little to no sense. It is always some clown who is pushing for it who happens to have disproportionate influence.
 
end stage fibro said:
This is a corollary to this post that is on the front page. I agree with the thrust of all the posters in that thread: work sucks, need money. I am here to tell you I feel like that about admin work too,now.


My job was pretty chill for a while. My department became successful and now everyone wants us involved. I can’t help most of these people, but I go their meeting anyways, say some buzzwords, and go back to playing my video games, daydreaming about being a quant, or working on side hustles. What is annoying is that I am expected to speak up in large committees now. I say the truth and in unadorned fashion. Naturally, this gives rise to push back that eventually leads to “taking this discussion offline.” I then send detailed emails with a tl;dr up top proving my point…only to be met with crickets. I made an especially detailed analysis about a certain risk score that the whole enterprise is focusing on. The risk score is garbage. I went on about Pearson correlation coefficients, generated a ROC curve, financial scenarios, I mean totally overboard to show that this is a bad idea. Silence in the meetings. Follow up emails have yielded no reply. This has led me to a state of existential dread (I mean, as much as I can have at work…real life still pretty cool). I really just dgaf about what the corporation does anymore. Sometimes I wonder if I should quit this and grind out hospitalist shifts instead. Dare I say…less bullsh*t to deal with?

My boss is cool, but his boss is high ranking and a total clown with zero business sense.
the people i usually have meetings with are braindead...I am the smartest person in the room a lot of the time, and i am not even smart.

as an example of a tldr, my whole post can be summed up by:
View attachment 405716
Click to expand...
Well the hospital admins are the business school graduates who couldnt hack it in a real business, not that those guys are much better. You can't disagree with the groupthink over dumb metrics because if you don't have those what is the point of all of their super ridiculous salaries?
 
anonperson said:
Who in the organization is championing this risk score? Any reason why they are so invested?

It's always amusing when administration starts to focus on various measures year to year. Most make little to no sense. It is always some clown who is pushing for it who happens to have disproportionate influence.
Click to expand...

bolded part bang on. in this case, came from the board wanting a specific goal --> system CEO + CMO --> various --> CMIO (who is a good/smart guy) and head of case mgmt (who means well and i think is overall effective, but perhaps set in their ways) settled on the score. This specific score is part of Epic, which is why I think it gained so much purchase rapidly. epic's predictive analytics leave a bit to be desired.

chessknt said:
Well the hospital admins are the business school graduates who couldnt hack it in a real business, not that those guys are much better. You can't disagree with the groupthink over dumb metrics because if you don't have those what is the point of all of their super ridiculous salaries?
Click to expand...

i keep telling myself maybe this isnt the case...it really just seems like medicine is a backwater in terms of business. it makes sense though...slow moving, lots of regulation, no one individual action will likely cause harm or can even be traced back to who did it. can just rest and vest.

sloh said:
You overestimate their intelligence haha.

Does this work on an hour to hour basis pay better than just grinding clinical shifts?
Click to expand...

hopefully i didn't come across as too sanctimonious. of course, i don't just start dropping random math terms and graphs in an attempt at the weakest flex ever. I couch all this in their language. still, i dont think it makes sense to most of them lol

on my W2....pays maybe 20k more than the average hospitalist salary in the area. per actual man-hour...way more. the average grunt is working harder for the money, but their ceiling is higher. there are hospitalists in my area that round, then hitup 2 SNFs, they make significantly more than i do. i am not allowed to see patients on the weekdays, so theres a cap there.
 
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end stage fibro said:
update after a little more than a year:

I have uncovered even more people who I think can be replaced by an email bot that automatically CCs word salad

I was promised a lot of data analysis in this job. and there is...except the data oftentimes is totally nonsensical. Too bad so sad, it will still affect your MeTrIcS

Lots of projects just vanish into black holes. after time, the project is either abandoned or the project manager has moved on. high profile projects have a lot of "stakeholders" and are slow going.

"this meeting could have been an email"

Medicine is more F'd than i realized as a floor level grunt. Try to retire ASAP

I am FLOORED at the help some service lines get. the usual money makers: cards, onc, ortho, etc. Makes me kind of upset when I see these guys dumping on hospitalists and crit care.

some CMOs do a lot of work and are instrumental at gently turning the rudder of the hospital in a positive direction. some just gum up the works

i have kept my word of trying to make things as best as I can for the folks in the trenches. for this, i did not get a hero's welcome, not that I expected that. I was actually kinda shocked at some of the responses i got from MDs i know well. they really think there is some secret cabal of people hoarding away money and at times said docs actively try to sink the hospital system's mission. Newsflash bro: money is TIGHT right now. It does not help anyone for you to complain about a lack of RN/RT/CM/PT and low MD stipend then balk at the hospital requesting some stuff. a common theme is that they signed up to practice medicine, not support the garbage healthcare industry. I wish I had access to whatever supply is fueling their phantasmagoria. this is worsened by the fact that my health system is one of the "good guys" especially compared to the other groups in town.

midlevel proliferation is way more than i expected, especially in the specialty clinics.

I thought i had a lot of energy as a hospitalist. walked my dog BID, played with the kids, worked out, etc. Nay. I feel effing superhuman now. when i do rounding shifts on the weekends, i feel like self-flagellating. Admission shifts are whatever. I don't really look forward to talking to 99% of pts when i know the orders are some permutation of vanczosyn cultures CT CAP trops echo cbc/cmp

thanks for reading my blog. Idk if anyone finds this interesting but I am always happy to share more. I feel like the road I'm on is pretty opaque compared to the tradtional clinical tracks we all know so I just wanted to shed some light on the process.
Click to expand...

Hope im not reviving a dead thread completely

Kind of confirms everything we already knew about the absymal state of medicine

What exactly are you floored by?

What kind of dumping do you see that is preventable and what do you think is inevitable ?
 
Floored...in terms of help the service lines get?
cards- literally the whole organization changed course to help service line metrics. it is a not insignificant part of my day buffing these metrics. there is a ton of wraparound support to help patients as well. high dollar procedures that are frequently denied get swept under the rug, other service lines have to explain why they do a procedure that keeps getting denied. you may argue cardiology is involved in a lot of metrics, and metrics equals money. trauma has metrics, pulm has metrics (especially PNA/COPD). they arent getting help like this.
onc- there are literally dedicated employees that get all medical records for a patient, organize, and summarize it before an onc sees the patient. the onc has a right to refuse seeing the patient if this packet is not prepared. also get a dedicated midlevel per MD/DO
ortho- literally only operate and do maybe 1 preop visit. they are essentially unreachable for anything else

being a money maker for the hospital doesn't guarantee anything. neurosurg surprisingly doesn't get many benefits that i know of. i dont begrudge the above specialties for having some perks. its just annoying when PCPs are burning out in clinic and are asked to do more, or a surgeon never did a transfer med rec and then the hospitalist gets a page at 6:59pm to fix it.

dumping...surely youve been dumped on? maybe its just my neck of the woods but having an infected joint that im begging the surgeon to come by and instead the NP comess and says "wrap limb tighter, OK to discharge" or private onc group coming by for patient with chemo side effects and only rec is litterally "blah blah blah dont effing stop the chemo"(thankfully our employed group is good). patient wants to talk about a PPM while in shock and EP asking the intensivist to explain it and cards deferring shock management...i mean the list goes on and on. i know part of being a hospitalist is being the dumping ground, but confronting that vis-a-vis seeing other service lines getting support both in patient facing aspects and also on the non-clinical side of things causes umbrage.
 
sloh said:
You overestimate their intelligence haha.

Does this work on an hour to hour basis pay better than just grinding clinical shifts?
Click to expand...
At my hospital i was offered a full time phys advisor role. I turned it down.

Pay was $185/hr. Comes out to $1480 paid per “typical” day.
On typical days, would be “scheduled” to work (remotely, from home) from 9am to 5pm M-F. In this time period you get a maximum of 6 peer to peer conversations with some insurance company to do each day.

You get additional paid hours for taking on 2 hour chunks of time where you review inpt vs obs status at 7pm and 2 hours on weekend days/holidays (no peer to peer convos on these short blocks)

I turned it out down. I didn’t go to med school and residency just to talk to insurance companies. This is the kind of BS work that exists only because of the BS payor system we have in place
 
biglurker said:
At my hospital i was offered a full time phys advisor role. I turned it down.

Pay was $185/hr. Comes out to $1480 paid per “typical” day.
On typical days, would be “scheduled” to work (remotely, from home) from 9am to 5pm M-F. In this time period you get a maximum of 6 peer to peer conversations with some insurance company to do each day.

You get additional paid hours for taking on 2 hour chunks of time where you review inpt vs obs status at 7pm and 2 hours on weekend days/holidays (no peer to peer convos on these short blocks)

I turned it out down. I didn’t go to med school and residency just to talk to insurance companies. This is the kind of BS work that exists only because of the BS payor system we have in place
Click to expand...
When you say “scheduled” hours/days that means you’re actually working like a fraction of that time, correct?
 
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biglurker said:
At my hospital i was offered a full time phys advisor role. I turned it down.

Pay was $185/hr. Comes out to $1480 paid per “typical” day.
On typical days, would be “scheduled” to work (remotely, from home) from 9am to 5pm M-F. In this time period you get a maximum of 6 peer to peer conversations with some insurance company to do each day.

You get additional paid hours for taking on 2 hour chunks of time where you review inpt vs obs status at 7pm and 2 hours on weekend days/holidays (no peer to peer convos on these short blocks)

I turned it out down. I didn’t go to med school and residency just to talk to insurance companies. This is the kind of BS work that exists only because of the BS payor system we have in place
Click to expand...


I agree with you in general. In fact, I said above that ideally this position shouldn’t exist. I also get that the work is not for everyone; I likewise did not go to med school to jump into the dirty machinery of healthcare. Having said that, your take is myopic. I work in a medium-large healthcare system that has multiple risk based contracts with CMS. The nature of contracts these contracts essentially force the hospitalist to consult a specialist for the affected organ, with cards, pulm, and heme/onc being the main medical ones. You think the hospitalist is actively managing anything in these cases? They’re riding the pine, brother. I didn’t go to med school to do that either. With ever increasing revenue challenges, I can see hospital systems that refuse to adapt are instead electing to die, so I think such contracts will be more common.. A bad hospitalist job plus conditions at the time are what led me into this job…not perfect work, but still useful in the real world.

This paragraph is half middle age person rant and half to illustrate that yes, I too would like to just rock medical cases all day long, but that is simply not reality in 2025. The above is a microcosm of what I think is a bigger issue for us- the physician is being displaced more and more, now to an extreme, with IM/FM on the frontline. Just 5 or so years ago, I was bullish on a hospitalist career and still think it is safe for the current-ish generation. However, more and more work for the hospitalist is being outsourced- TPN and med mgmt by pharmacy, CM arranging all f/u, rapid response nurses empowered with standing orders to get workup going (and it’s the good nurses running these, an effective enough meat shield so that the floor RN doesn’t notify the hospitalist except as an FYI). Stroke codes run by tele-neuro, hospital at home programs, medical management of bread and butter cases like HF being run by specialists, protocols protocols protocols, Epic having AI tools that write a better DC summary than 80% of hospitalists currently and expanding to progress notes. I mean I could keep going. Hell, the New Yorker just ran a piece on AI diagnosis…written by a doctor! I admit I am only halfway through on the article. There is a lot of downward pressure. The hospitalists I know that are eat what you kill are out of the hospital by 1pm en route to SNF (another care setting overrun by midlevels). The ones that are employed are subsidized by the hospital. That is an economic formula ripe for reduction.

Also, the rate at your system is pretty good. 6 P2P is pretty low, unless you mean 6 calls but several cases are discussed each call.
 
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end stage fibro said:
I agree with you in general. In fact, I said above that ideally this position shouldn’t exist. I also get that the work is not for everyone; I likewise did not go to med school to jump into the dirty machinery of healthcare.
Click to expand...
it looks like its been a few years since u took the admin job, are u still doing it? not sure if u mentioned already but is it 100% nonclinical?

after working 12 years as a nocturnist, i'm about to make a very big decision of moving overseas and taking at least a year off, then either getting a part time hospitalist job overseas vs coming back to the US for locums once in a while.

im primarily concerned about keeping a reasonable degree of clinical ability so that i can return to working if i ever decide to in the future.
do u find this to be an issue after a few years of doing admin work? while money is not an issue as the place im going to be living in is cheap (cost of living in the US has skyrocketed so much since covid that it almost offsets living and working here) i really do not want to lose my clinical skill at age 40 that i spent to many years working to get

i do plan on studying for + keeping up with the LKA even while im away which i found to be quite helpful recently
 
yes still doing it. 100% nonclinical.

i could see it being an issue. i do a lot of clinical side work, so i am not as concerned. when i do hospital shifts, I am definitely slower going through order sets and whatnot but i dont miss much and definitely nothing major (after discharge, i go back and review every pt i saw).

if i did the bare minimum at my day job, i could see clinical reasoning getting worse. frequently, for complex patients, i start from the beginning of the chart and run through it like a medical simulator to see where i end up. however, i still believe by the perhaps antiquated notion that the best way to keep your skills sharp is seeing the patient at the bedside.

i know what you mean about losing skills...that was initially a big concern for me but less so now. i also remain up to date with journals, podcasts, etc. going back to see patients kinda feels like riding a bike
 
end stage fibro said:
Floored...in terms of help the service lines get?
cards- literally the whole organization changed course to help service line metrics. it is a not insignificant part of my day buffing these metrics. there is a ton of wraparound support to help patients as well. high dollar procedures that are frequently denied get swept under the rug, other service lines have to explain why they do a procedure that keeps getting denied. you may argue cardiology is involved in a lot of metrics, and metrics equals money. trauma has metrics, pulm has metrics (especially PNA/COPD). they arent getting help like this.
onc- there are literally dedicated employees that get all medical records for a patient, organize, and summarize it before an onc sees the patient. the onc has a right to refuse seeing the patient if this packet is not prepared. also get a dedicated midlevel per MD/DO
ortho- literally only operate and do maybe 1 preop visit. they are essentially unreachable for anything else

being a money maker for the hospital doesn't guarantee anything. neurosurg surprisingly doesn't get many benefits that i know of. i dont begrudge the above specialties for having some perks. its just annoying when PCPs are burning out in clinic and are asked to do more, or a surgeon never did a transfer med rec and then the hospitalist gets a page at 6:59pm to fix it.

dumping...surely youve been dumped on? maybe its just my neck of the woods but having an infected joint that im begging the surgeon to come by and instead the NP comess and says "wrap limb tighter, OK to discharge" or private onc group coming by for patient with chemo side effects and only rec is litterally "blah blah blah dont effing stop the chemo"(thankfully our employed group is good). patient wants to talk about a PPM while in shock and EP asking the intensivist to explain it and cards deferring shock management...i mean the list goes on and on. i know part of being a hospitalist is being the dumping ground, but confronting that vis-a-vis seeing other service lines getting support both in patient facing aspects and also on the non-clinical side of things causes umbrage.
Click to expand...
So knowing what you know now, what medical specialty would you say has it best in a hospital employed model? what would you recommend med students look into more?
 
chessknt said:
It is right there in the post--ortho, onc, cards. GI won't ever depend on a hospital for employment but is a good pick. Avoid everything else in IM.
Click to expand...
Yeah but I was wondering if there are any others for people not into those specialties
 
chessknt said:
Nope
Click to expand...
Yeah, so this is certainly a grass is greener syndrome, at least when it comes to ortho which i did residency in for 1 year operating is back breaking work, and no cardio I ever spoke to was NOT burnt to a crisp from on calls, even in medschool. I guess outside of derm maybe there are always compromises in medicine
 
Doc mu said:
Yeah, so this is certainly a grass is greener syndrome, at least when it comes to ortho which i did residency in for 1 year operating is back breaking work, and no cardio I ever spoke to was NOT burnt to a crisp from on calls, even in medschool. I guess outside of derm maybe there are always compromises in medicine
Click to expand...
So you didnt finish and actually do it then?

This isn't grass is greener, this is the realities of how our medical payment system works. An ortho bro can do a single TKA and will make more than an ICU doctor does in an entire 12 hour day. Have you ever worked in an ICU answering nurse calls and talking to crazy families for 12 hours? Was it harder than a 45 minute TKA? Because CMS sure doesn't think so. Not sure if you made it in to attending level to actually see how the world works but there are glaringly obvious reasons why everyone is trying to become cards/GI/onc and nobody gives a **** about pulm/icu/endo/rheum. If your time is valued at 2-7x that of a colleague why wouldn't you opt for that?
 
chessknt said:
So you didnt finish and actually do it then?

This isn't grass is greener, this is the realities of how our medical payment system works. An ortho bro can do a single TKA and will make more than an ICU doctor does in an entire 12 hour day. Have you ever worked in an ICU answering nurse calls and talking to crazy families for 12 hours? Was it harder than a 45 minute TKA? Because CMS sure doesn't think so. Not sure if you made it in to attending level to actually see how the world works but there are glaringly obvious reasons why everyone is trying to become cards/GI/onc and nobody gives a **** about pulm/icu/endo/rheum. If your time is valued at 2-7x that of a colleague why wouldn't you opt for that?
Click to expand...

I think this notion of OR work >>>> All else is slightly outdated and getting more outdated by the year here is an interesting article (dated but the trend still holds):
www.healio.com

Orthopedic surgical reimbursement may equal in-office reimbursement within 5 years

If current reimbursement trends continue, reimbursement for time in the OR performing arthroplasty surgery may be equal to the time spent in the office seeing Medicare patients within the next 5 years, according to published results. Louis F. McIntyre, MD, and colleagues accessed the...
www.healio.com www.healio.com


Also I think a big mistake is looking at total compensation in isolation instead of pay per hour (esp. if you factor in calls), this changes things drastically.

Some napkin calculations comparing orthopedic surgery vs ICU:
Pay: the 2024 MGMA data I have for both
On call hours that resulted in active work were approximated with this canadian based survey: https://www.cma.ca/sites/default/files/2019-01/orthopedic-surgery-e.pdf

Orthopedic surgery
Hours: 52.2 hrs/week = 226.2 hrs/month, plus 58 hrs/month on-call direct patient care = 284.2 hrs/month total
Pay: $706,912/yr = $58,909/mo = $207.28/hr (based on 284.2 hrs/mo)

Critical Care — 14×12-hr shifts/month = 168 hrs/mo
Pay: $441,273/yr = $36,773/mo = $218.89/hr

I'd say that taxes make the difference even smaller
 
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