applying for hospitalist position (tertiary care center/community hospital)

[pgy0246]

I am a graduating resident looking at hospitalist attending position.

I am deciding between working for a large academic center versus working for smaller (200 bed hospitals) that offer higher in salary (50-80k higher)

I have been fortunate to have multiple interviews invite within 2 hours drive from my family. But both of them are in a community hospital (~200 beds).

I also have a phone interview with a number of university programs.
Wanting to eventually become a hospitalist director. I want to see if it's worth it to take a 60-80k pay cut to work for a brand name hospital right out from residency.

Or whether I can work for a smaller hospital for 2-3 years, pay off my massive student loan, and then transition into a larger academic center.

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[Psai]

60-80k? How is this not a no brainer

 

[Doc_Mcstuffins]

60-80k is a big difference and a lot of money to leave on the table. If you are comfortable with the community job in terms of other aspects other than salary (subspecialist support, open/closed icu, procedures, night shifts, Administration support, etc.), then I’d take the community program position. Having worked as an academic hospitalist in a tertiary center, sometimes it’s a lot of politics and leadership tends to stay around for a long time so you might get less opportunities to lead at the tertiary center. Lastly, you said you wanted to be a hospitalist Director - you can easily be one at community hospital even coming from a community program but if you said you had to be a hospitalist Director/Division chief at an academic tertiary program/top 50 program, then that’s a little different scenario

Good luck

 

[IMreshopeful]

Are you kidding

Screw the brand name academic position. If the job at the community place pays more and has better benefits/options then definitely go for it

If you’re someone who feels some undescribable pleasure at being affiliated with the brand name place, then idk

 

[pgy0246]

I actually just come across a county hospital (with full sub-specialty support); that pay 2-3k more than the community hospital.

The county hospital is a referral center just 20 minutes from where I live in.

I am trained in a community hospital that only sees bread and butter, with a prelim year done at a major tertiary care center.
Who much of a learning curve with that be if I choose
to county hospital (referral center)?

 

[Trogghunter]

Find yourself a community hospital with a FM residency and you'll get the best of both worlds... community pay with an academic-ish feel. You'll likely have plenty of opportunities for leadership and you won't have as much of the academic oversight. I work at one of these places, and I love it. I feel like I am appreciated as a hospitalist, as opposed to what I saw at my residency hospital where fellows and subspecialists/subsubspecialists looked down on IM.

 

[Scope guy]

be careful with community hospitals with name sake "Univ of XXX state" name where the univ health system flexes muscle and buys out smaller hospitals into their system, tags their UNIV name but has nothing to do with university or education. They have known to pay lesser than an out and out community system.

Take the higher pay option, do part time MBA on the side with extra income, in 5 years you can inch your way to administration.

 

[aafisahar]

You'll probably be a better doctor working at a community shop that's busy with sick patients. If that university is anything like ours, there are so many specialty services that what comes to internal medicine is fairly narrow.

 

[VA Hopeful Dr]

60-80k? How is this not a no brainer

My wife's first hospitalist job was at a community place.

Open ICU with once/day pulm rounding. Constant fights with the ER about what wasn't appropriate for that hospital (and needed to be sent to the tertiary shop down the round). No neuro. No ENT. Once/week ID. Anesthesia in-house was CRNA only. Night float week every other month.

There's a lot to be said about less money but an easier and much less stressful job.

 

[pgy0246]

Trying to decide working directly for the hospital versus joining a national group (TeamHealth, ApolloMD, etc).
I always hear horror story that just give you 20 patient to see on day #1, and then pay you 15% high salary but make you see 25-26 patients, ad the burn out the new graduate How can I tease out a malignant hospital/hospitalist group?

 

[medstudent2IM]

Trying to decide working directly for the hospital versus joining a national group (TeamHealth, ApolloMD, etc).
I always hear horror story that just give you 20 patient to see on day #1, and then pay you 15% high salary but make you see 25-26 patients, ad the burn out the new graduate How can I tease out a malignant hospital/hospitalist group?

I can only speak of my recent experience on the interview trail for hospitalist gigs. I interviewed at 5 different hospitals around 2 major cities. I only looked at direct hospital-employed jobs. One of the hospitals I interviewed at transitioned from contracting with one of those national groups to a direct, hospital-employed practice. Talking to the hospitalists who saw both sides of that situation, it sounded quite awful with that national group. It seems that it was just a different mindset; you are there to make that organization money and that means keeping their own costs low (ie maintaining low hospitalist/patient ratio). There was supposedly a lot of turnover.

You should have your own checklist of what is important (census numbers, open/closed ICU, procedures, nights, codes, etc). On the days that you visit, you can see what individual censuses look like (just ask to look). The best piece of advice I got before I started the process was to ask about turnover. Ask the recruiter from HR, ask hospitalist lead, ask hospitalists themselves. Its the best marker of job satisfaction because it takes everything into account (money, schedule, day-to-day, etc). All I can say is that even in a half day, I did feel that I was able to get a general sense of each of the hospitalist groups I met with (it was surprising how different some of those groups were in terms of personality). The couple that I was most interested in, I reached out to a few of the hospitalists I had met on those days. Good luck!

 

[Doc_Mcstuffins]

I can only speak of my recent experience on the interview trail for hospitalist gigs. I interviewed at 5 different hospitals around 2 major cities. I only looked at direct hospital-employed jobs. One of the hospitals I interviewed at transitioned from contracting with one of those national groups to a direct, hospital-employed practice. Talking to the hospitalists who saw both sides of that situation, it sounded quite awful with that national group. It seems that it was just a different mindset; you are there to make that organization money and that means keeping their own costs low (ie maintaining low hospitalist/patient ratio). There was supposedly a lot of turnover.

You should have your own checklist of what is important (census numbers, open/closed ICU, procedures, nights, codes, etc). On the days that you visit, you can see what individual censuses look like (just ask to look). The best piece of advice I got before I started the process was to ask about turnover. Ask the recruiter from HR, ask hospitalist lead, ask hospitalists themselves. Its the best marker of job satisfaction because it takes everything into account (money, schedule, day-to-day, etc). All I can say is that even in a half day, I did feel that I was able to get a general sense of each of the hospitalist groups I met with (it was surprising how different some of those groups were in terms of personality). The couple that I was most interested in, I reached out to a few of the hospitalists I had met on those days. Good luck!

In my area, the same can be said. Generally speaking (always outliers), the national companies have a less favorable impression and experience of them by most Hospitalists I’ve spoken to.