Are hospitalist jobs becoming very competitive?

[EMDO2018]

Hi,

I will be starting med school in August. I have been researching hospitalist medicine and think I would enjoy it as a career. My question is, are a lot of internist interested in hospitalist medicine or are more people interested in outpatient? Also with the number of med schools opening and expanding, will hospitalist jobs be more difficult to find in the future or will the number of jobs expand as the population ages?

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[jdh71]

It seems to me that more and more people in IM are skipping extra training and just doing hospitalist medicine. There will still a lot of work to go around but like many things desirable markets will get full and the good paying jobs will be in small cities and rural areas.

 

[visari]

A simple answer to your question is YES. I still wouldn't call it competitive though but it's slowly getting harder than it used to be especially if you're looking for jobs in big cities. You can still find a job coming out of residency even in the big cities but they wouldn't pay much and they will overwork you. If you don't mind working in a mid-sized to small city then you can still find a job easily. If you are willing to work anywhere you can make a s***load of money.

 

[LoudBark]

Hi,

I will be starting med school in August. I have been researching hospitalist medicine and think I would enjoy it as a career. My question is, are a lot of internist interested in hospitalist medicine or are more people interested in outpatient? Also with the number of med schools opening and expanding, will hospitalist jobs be more difficult to find in the future or will the number of jobs expand as the population ages?

Jobs in major markets on the coasts (and Chicago) will be harder to find but jobs in smaller, rural areas will be plentiful and pay a lot. However, this is generally true for any employed position in any specialty. Just depends where you want to live as far as how "competitive" the job market is.

 

[EMDO2018]

It seems to me that more and more people in IM are skipping extra training and just doing hospitalist medicine. There will still a lot of work to go around but like many things desirable markets will get full and the good paying jobs will be in small cities and rural areas.

A simple answer to your question is YES. I still wouldn't call it competitive though but it's slowly getting harder than it used to be especially if you're looking for jobs in big cities. You can still find a job coming out of residency even in the big cities but they wouldn't pay much and they will overwork you. If you don't mind working in a mid-sized to small city then you can still find a job easily. If you are willing to work anywhere you can make a s***load of money.

Jobs in major markets on the coasts (and Chicago) will be harder to find but jobs in smaller, rural areas will be plentiful and pay a lot. However, this is generally true for any employed position in any specialty. Just depends where you want to live as far as how "competitive" the job market is.

Thank you guys for responding. I know im a long way from residency but I have decisions I have to make soon. I can take a scholarship that would cut the amount of loans I owe in half but I would have to specialize in primary care and work in outpatient medicine for 4 years post residency. If I wanted to be a hospitalist after the 4 year commitment, would I be able to? I know inpatient medicine is more complex and maybe I would have lost some skills working in the outpatient setting for 4 years. Also, is being a hospitalist rewarding? I keep hearing people say stuff like "dumping ground for all other specialties." With the week on week off model how can there be continuity of care?

 

[EMDO2018]

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[trickster123]

Thank you guys for responding. I know im a long way from residency but I have decisions I have to make soon. I can take a scholarship that would cut the amount of loans I owe in half but I would have to specialize in primary care and work in outpatient medicine for 4 years post residency. If I wanted to be a hospitalist after the 4 year commitment, would I be able to? I know inpatient medicine is more complex and maybe I would have lost some skills working in the outpatient setting for 4 years. Also, is being a hospitalist rewarding? I keep hearing people say stuff like "dumping ground for all other specialties." With the week on week off model how can there be continuity of care?

Hospitalist rewarding? You're taking care of people and healing the sick...anyways, take that 7 day off to either work extra shifts for more money or go on vacation every other week of the year and see if that is rewarding lol

 

[rokshana]

Thank you guys for responding. I know im a long way from residency but I have decisions I have to make soon. I can take a scholarship that would cut the amount of loans I owe in half but I would have to specialize in primary care and work in outpatient medicine for 4 years post residency. If I wanted to be a hospitalist after the 4 year commitment, would I be able to? I know inpatient medicine is more complex and maybe I would have lost some skills working in the outpatient setting for 4 years. Also, is being a hospitalist rewarding? I keep hearing people say stuff like "dumping ground for all other specialties." With the week on week off model how can there be continuity of care?

there is very little continuity of care as a hospitalist…unless you count the frequent flyers who are readmitted for the same issues because they have no PCP or feel that they will just come to the hospital for their primary care.

after 4 years of outpt medicine you will have a different skill set and yes, you could then switch to doing inpt medicine, but why would you want to uproot yourself at that point?

as far as rewarding, its as rewarding as being a PCP…some like it some don't…most who go into hospitalist medicine like the money and the flexible schedule…but generally those in hospital medicine like the hospital setting and would hate to be in the clinic setting (at least that was my preference coming out of residency).

 

[IM2GI]

Thank you guys for responding. I know im a long way from residency but I have decisions I have to make soon. I can take a scholarship that would cut the amount of loans I owe in half but I would have to specialize in primary care and work in outpatient medicine for 4 years post residency. If I wanted to be a hospitalist after the 4 year commitment, would I be able to? I know inpatient medicine is more complex and maybe I would have lost some skills working in the outpatient setting for 4 years. Also, is being a hospitalist rewarding? I keep hearing people say stuff like "dumping ground for all other specialties." With the week on week off model how can there be continuity of care?

We need more figures than "half". Personally, 4 years of primary care would make me sad and toxic, and also erode my inpatient skills. Primary care is very challenging, and IMO is the hardest career to go into after completing IM residency. The volume of patients/paperwork, number of complaints, and the huge variety of information/conditions you are responsible for can be overwhelming if you want to be a good PCP. Why do you think the vast majority of people try to specialize or go into hospital medicine?

"I know inpatient medicine is more complex": False, it is just different. Id argue primary care is more complex.

"If I wanted to be a hospitalist after the 4 year commitment, would I be able to?": Sure, if you can find a job. You are asking us to project 10 years in the future, who knows.

Also, is being a hospitalist rewarding? I keep hearing people say stuff like "dumping ground for all other specialties." : Welcome to Internal Medicine, the only field where other specialities can say "admit to medicine". Just once, I want to write in one of my notes "no acute internal medicine issues, admit to surgery, will follow as consult" and see what happens.

With the week on week off model how can there be continuity of care?: This is inpatient medicine, there is no continuity of care, that is the entire hospitalist model.

 

[visari]

Welcome to Internal Medicine, the only field where other specialities can say "admit to medicine"

God it hurts my eyes just reading this statement. Especially when some lazy a** Urology resident "decides" to admit a patient with an infected kidney stone to medicine at 2 AM because he has a complicated medical history (i.e well-controlled diabetes, HLD, HTN and a stent in 95) writing down: admit to medicine, will take to OR tomorrow. This actually happened to me last week. Welcome to Medicine!

 

[flipmd]

God it hurts my eyes just reading this statement. Especially when some lazy a** Urology resident "decides" to admit a patient with an infected kidney stone to medicine at 2 AM because he has a complicated medical history (i.e well-controlled diabetes, HLD, HTN and a stent in 95) writing down: admit to medicine, will take to OR tomorrow. This actually happened to me last week. Welcome to Medicine!

Once you get out of residency, these are the best admits. Takes up one of your slots, takes 30 minutes to interview, examine, write your note, and put admit orders in. God knows what the next admit is for the next guy - could be a 95yo gomer coming in with pneumonia from recurrent aspiration, with 20 medications you need to reconcile correctly, and family members wanting to be updated everyday asking you why you can't cure his dementia.

 

[Bostonredsox]

Once you get out of residency, these are the best admits. Takes up one of your slots, takes 30 minutes to interview, examine, write your note, and put admit orders in. God knows what the next admit is for the next guy - could be a 95yo gomer coming in with pneumonia from recurrent aspiration, with 20 medications you need to reconcile correctly, and family members wanting to be updated everyday asking you why you can't cure his dementia.

30 minutes?? That's about a 12-15 minute admission including h and p and the orders. I get a bonus after x amount of admissions if I'm the night guy. You've got a 52 year old male with atypical chest pain and no risk factors/timi 0 but your too much of a ***** to send home....perfect. 8 minutes to admit him. 89 year old with controlled DM and htn with broken hip ortho too lazy to admit....awesome, 15 min tops and that's with preop risk stratification. Keep em coming I got loans to pay.

 

[flipmd]

You're a baller. Takes me your 8 mins admitting someone just chatting with the nurse. LOL.

In any case, I try to stay with the patient and make them like me, even if all we do is talk about their kids or the football game. I enjoy talking to patients to reassure them - hey call me sentimental. Also, there's that thing where they won't sue you if they like you.

 

[jdh71]

I don't rush admits either.

 

[Bostonredsox]

I made no mention of rushing admits. That's just honestly how long it takes to do a soft admit. A 42 y/o chest pain that is totally ok to be discharged home with office follow up for outpatient stress takes <10 min to admit. I'm very nice and joke with my pts too. I just don't waste time. And at my shop we get chastised for sending any ER admit home so if they call for admit, they get admitted even if I know they can go home. So a lot of simple COPD, chf, asthma, chest pain, PNA pts who are young and healthy enough for outpt therapy get admitted as observation. Those admissions are very easy and take little time to accomplish. Also, we don't have a 30min block time. We have a three hour block time. You might get 8 admits during those three hours so no time to dilly dally. And at night, where I will be working mostly, your covering the 100 floor pts, 14 MICU pts, and you on average get 14-16 admits, sometimes up to 22, during the night. There's just isn't time to really bs a lot, as much as I'd like to. Apart from prepping for boards I've spent most of my third year focusing solely on efficiency to handle this workload come July. Big difference as a community hospitalist compared with academia.

Also, I've found pts like getting the hell out of the loud and chaotic Ed to their own room upstairs so I often admit them quick and then see them again on the floor and spend a few min with them/family.

 

[flipmd]

I made no mention of rushing admits. That's just honestly how long it takes to do a soft admit. A 42 y/o chest pain that is totally ok to be discharged home with office follow up for outpatient stress takes <10 min to admit. I'm very nice and joke with my pts too. I just don't waste time. And at my shop we get chastised for sending any ER admit home so if they call for admit, they get admitted even if I know they can go home. So a lot of simple COPD, chf, asthma, chest pain, PNA pts who are young and healthy enough for outpt therapy get admitted as observation. Those admissions are very easy and take little time to accomplish. Also, we don't have a 30min block time. We have a three hour block time. You might get 8 admits during those three hours so no time to dilly dally. And at night, where I will be working mostly, your covering the 100 floor pts, 14 MICU pts, and you on average get 14-16 admits, sometimes up to 22, during the night. There's just isn't time to really bs a lot, as much as I'd like to. Apart from prepping for boards I've spent most of my third year focusing solely on efficiency to handle this workload come July. Big difference as a community hospitalist compared with academia.

Also, I've found pts like getting the hell out of the loud and chaotic Ed to their own room upstairs so I often admit them quick and then see them again on the floor and spend a few min with them/family.

Ouch. That's a lot of work. I guess I have it good then. Average of about 13-17 patients (ranged from 10-20 so far, with 10 and 20 happening only for about 3 days each over the past year), 0-2 admits (there's an admitter and we get admits if they get overwhelmed) on a 7-7 shift (usually done by 4-5p). We do nights every now and then and average about 8 admits (usually 6 if you're carrying the cross cover pager).

 

[jdh71]

I made no mention of rushing admits. That's just honestly how long it takes to do a soft admit. A 42 y/o chest pain that is totally ok to be discharged home with office follow up for outpatient stress takes <10 min to admit. I'm very nice and joke with my pts too. I just don't waste time. And at my shop we get chastised for sending any ER admit home so if they call for admit, they get admitted even if I know they can go home. So a lot of simple COPD, chf, asthma, chest pain, PNA pts who are young and healthy enough for outpt therapy get admitted as observation. Those admissions are very easy and take little time to accomplish. Also, we don't have a 30min block time. We have a three hour block time. You might get 8 admits during those three hours so no time to dilly dally. And at night, where I will be working mostly, your covering the 100 floor pts, 14 MICU pts, and you on average get 14-16 admits, sometimes up to 22, during the night. There's just isn't time to really bs a lot, as much as I'd like to. Apart from prepping for boards I've spent most of my third year focusing solely on efficiency to handle this workload come July. Big difference as a community hospitalist compared with academia.

Also, I've found pts like getting the hell out of the loud and chaotic Ed to their own room upstairs so I often admit them quick and then see them again on the floor and spend a few min with them/family.

Sounds a lot like rushing to me. Hope you don't miss anything. Good luck with the new and busy job. You couldn't pay me enough to work like that.

 

[DrBowtie]

Sounds a lot like rushing to me. Hope you don't miss anything. Good luck with the new and busy job. You couldn't pay me enough to work like that.

You forget he's the greatest resident ever.

 

[IM2GI]

I made no mention of rushing admits. That's just honestly how long it takes to do a soft admit. A 42 y/o chest pain that is totally ok to be discharged home with office follow up for outpatient stress takes <10 min to admit. I'm very nice and joke with my pts too. I just don't waste time. And at my shop we get chastised for sending any ER admit home so if they call for admit, they get admitted even if I know they can go home. So a lot of simple COPD, chf, asthma, chest pain, PNA pts who are young and healthy enough for outpt therapy get admitted as observation. Those admissions are very easy and take little time to accomplish. Also, we don't have a 30min block time. We have a three hour block time. You might get 8 admits during those three hours so no time to dilly dally. And at night, where I will be working mostly, your covering the 100 floor pts, 14 MICU pts, and you on average get 14-16 admits, sometimes up to 22, during the night. There's just isn't time to really bs a lot, as much as I'd like to. Apart from prepping for boards I've spent most of my third year focusing solely on efficiency to handle this workload come July. Big difference as a community hospitalist compared with academia.

Also, I've found pts like getting the hell out of the loud and chaotic Ed to their own room upstairs so I often admit them quick and then see them again on the floor and spend a few min with them/family.

God damn that sounds like an awful gig. What do you get paid to do that? One sick MICU patient and your night is screwed.

 

[KnuxNole]

30 minutes?? That's about a 12-15 minute admission including h and p and the orders. I get a bonus after x amount of admissions if I'm the night guy. You've got a 52 year old male with atypical chest pain and no risk factors/timi 0 but your too much of a ***** to send home....perfect. 8 minutes to admit him. 89 year old with controlled DM and htn with broken hip ortho too lazy to admit....awesome, 15 min tops and that's with preop risk stratification. Keep em coming I got loans to pay.

I wish I can be as fast as you one day :O

 

[Bostonredsox]

You forget he's the greatest resident ever.

? Don't think we've ever met and not sure what prompted that comment

 

[Bostonredsox]

God damn that sounds like an awful gig. What do you get paid to do that? One sick MICU patient and your night is screwed.

Well I will have a senior resident in MICU and an admitting team with a pgy2 and a few interns so the amount of documenting I have to do is reduced to addendums to h and ps. That helps a lot

But yes one trainwreck in MICU and it's a big wrench especially if the senior resident upstairs isn't the strongest

 

[IM2GI]

Well I will have a senior resident in MICU and an admitting team with a pgy2 and a few interns so the amount of documenting I have to do is reduced to addendums to h and ps. That helps a lot

But yes one trainwreck in MICU and it's a big wrench especially if the senior resident upstairs isn't the strongest

Oh ok, you have residents as primary. Still challenging but not as insufferable as that job would have been alone.

 

[EMDO2018]

Question about hospitalist medicine. I can imagine when working a 12 hr shift all you have time to do is work, sleep, eat, and shower. Is it easy to get burned out working that type of schedule? Of course you have 7 consecutive days off, but do you dread the upcoming week?

 

[flipmd]

Seeing my siblings in non-medical fields working 8-5 or 8-6 M-F, I don't think it's that much more work. 7-7 is just 2 more hours a day, and for that you get an entire week off, not just 2 days. I also didn't go for the highest paying hospitalist job I could find, it also pays to look for one where they're concerned about more than $$$

 

[mrpankration]

So true about the surgical dumps you hate as a resident being the admissions you love as a hospitalist.

 

[FutureInternist]

I will be starting as a hospitalist soon & my schedule is pretty chill
Unofficial cap of 18 , with max of 2 admits per day (more money if you do more admits)
When working nights, max of 5 pts per shift
NP takes all the cross cover call overnight

Having been through residency & fellowship without a cap it's nice to get an easy admit that takes a small amount of time but still counts towards your 2 or 5 for the day

Like I tell interns, being in Medicine, you're going to getting kicked in the nuts (first in Residency & then in practice) but at least in practice they hand you a $100 bill while kicking you.

 

[mercaptovizadeh]

I don't rush admits either.

How long does an admit take you?

My main concern from MS3/4 is my efficiency. It takes me like 1-1.5+ hrs to get through the prior history, outpatient records, interview the patient, and then put together a note. I'm terrified that residency is going to kill me when it comes to this....

 

[flipmd]

How long does an admit take you?

My main concern from MS3/4 is my efficiency. It takes me like 1-1.5+ hrs to get through the prior history, outpatient records, interview the patient, and then put together a note. I'm terrified that residency is going to kill me when it comes to this....

1-1.5 hours is pretty standard/good for an MS3/4. Don't worry about it. Just focus on learning. It'll get better with more reps.

 

[jdh71]

How long does an admit take you?

My main concern from MS3/4 is my efficiency. It takes me like 1-1.5+ hrs to get through the prior history, outpatient records, interview the patient, and then put together a note. I'm terrified that residency is going to kill me when it comes to this....

Well. I don't know. It kind of depends. I like to see, speak with, and examine the patient first, and then spend a bit of time confirming what the ED said (images and labs), then a look at PMHx and Meds, finally I'll reviewed an old data if I think it's important and we have it, pfts, echos, old ct's, ols labs. Orders. Consult calls then documentation. I can have most of that done in 30-40 minutes, BUT tucking everything in so I'm happy with a hand off can take a good amount of additional time, especially if I'm tracking down a pesky consult, trying to get an important imaging/lab result, or obtaining any old records can add a good amount of time.

You tend to multitask as much as you can.

 

[Bostonredsox]

How long does an admit take you?

My main concern from MS3/4 is my efficiency. It takes me like 1-1.5+ hrs to get through the prior history, outpatient records, interview the patient, and then put together a note. I'm terrified that residency is going to kill me when it comes to this....

That's fine as a med student. Your goal now, and even as an intern, is learning. Obtaining medical knowledge needed to make decisions. Efficiency will come as a senior resident and an attending.

 

[EMDO2018]

How common is it to Moonlight in years 2 and 3 of an internal medicine residency? Maybe 1 12-15 hour shift a week?

 

[path or no path]

How common is it to Moonlight in years 2 and 3 of an internal medicine residency? Maybe 1 12-15 hour shift a week?

I would like to know that too

 

[jdh71]

How common is it to Moonlight in years 2 and 3 of an internal medicine residency? Maybe 1 12-15 hour shift a week?

I would say NOT common.

Maybe one, maybe two 12's a month and it won't be in IM. You can't get credentialed to do that kind of work as a resident. Urgent care is the best you'll be able to find.

 

[EMDO2018]

I would say NOT common.

Maybe one, maybe two 12's a month and it won't be in IM. You can't get credentialed to do that kind of work as a resident. Urgent care is the best you'll be able to find.

Okay. Seems like psych has more numerous moonlighting opportunities.

 

[jdh71]

Okay. Seems like psych has more numerous moonlighting opportunities.

Maybe there will be in house gigs?

 

[Bostonredsox]

I would say NOT common.

Maybe one, maybe two 12's a month and it won't be in IM. You can't get credentialed to do that kind of work as a resident. Urgent care is the best you'll be able to find.

/nod
I signed with the hospitalist group at my hospital and they still would not let me moonlight for overnight admissions in any of there other hospitals during residency.

 

[gutonc]

I would say NOT common.

Maybe one, maybe two 12's a month and it won't be in IM. You can't get credentialed to do that kind of work as a resident. Urgent care is the best you'll be able to find.

That's the funny thing about moonlighting in residency. Many places won't let you moonlight in your own specialty but have no problem with you moonlighting somewhere else. So we get FM residents moonlighting on the cards service and OB-Gyns moonlighting on the BMT service...both things I've witnessed, both really bad ideas. But an IM R3 moonlighting as a hospitalist? Nope...can't do that.

 

[jdh71]

That's the funny thing about moonlighting in residency. Many places won't let you moonlight in your own specialty but have no problem with you moonlighting somewhere else. So we get FM residents moonlighting on the cards service and OB-Gyns moonlighting on the BMT service...both things I've witnessed, both really bad ideas. But an IM R3 moonlighting as a hospitalist? Nope...can't do that.

Yup. It's not my world, I just have to live there. 4 more months.

Ironically, we'd put out better docs if we actually let them work a little. I know the lawyers ruin everything, but it really makes you softer than you should be coming out of training. I can even feel it right now looking at real work in 6 months. Glad my future partners are cool guys and know I'll be green as heck.

 

[VA Hopeful Dr]

Yup. It's not my world, I just have to live there. 4 more months.

Ironically, we'd put out better docs if we actually let them work a little. I know the lawyers ruin everything, but it really makes you softer than you should be coming out of training. I can even feel it right now looking at real work in 6 months. Glad my future partners are cool guys and know I'll be green as heck.

My wife's program has a deal with the local LTACH, residents can cover the night shifts as soon as they have a permanent license.

 

[jdh71]

My wife's program has a deal with the local LTACH, residents can cover the night shifts as soon as they have a permanent license.

That's really nice work if you can get it.

 

[JTWheaton]

How common is it to Moonlight in years 2 and 3 of an internal medicine residency? Maybe 1 12-15 hour shift a week?

It depends on the program. Almost every program will let you moonlight at least PGY-3 after passing step 3 and getting your license. Only one program I interviewed at did not allow moonlighting at all during residency. Many programs allow you to start moonlighting once you pass step 3 and get your license, meaning you could start early PGY-2 if you are intentional about taking step 3 soon. Some programs even allow you to moonlight starting PGY-2 regardless of whether or not you have taken step 3.

It also varies whether a program lets you moonlight internally (at your home institution) vs externally (outside local hospital). Some let you do either; others only let you do one of the two. A decent chunk of the programs I looked at allow internal hospitalist moonlighting, often on a specialty service such as oncology. For the programs that only allow external moonlighting, I've heard of residents doing either/both of inpatient or urgent care.

Overall, it is very feasible to moonlight PGY-2-3, especially PGY-3, and especially during outpatient/elective blocks (an x+y schedule is nice for this). Pay will vary from $65-150/hr standard, although at one institution I've heard of pay rising to $250/hr for hard-to-fill shifts (yes this is for a resident). Also, internal moonlighting malpractice insurance is I believe always provided by the program. Externally, sometimes that local hospital will provide it, or else you have to figure it out on your own. Anecdotally, and from a few different programs, I've heard of residents "landing in the attending tax bracket" or "doubling their salary." So, at the right program, moonlighting $ (and the extra training) is plentiful and a great deal for IM PGY2-3.

 

[Medstud1988]

It depends on the program. Almost every program will let you moonlight at least PGY-3 after passing step 3 and getting your license. Only one program I interviewed at did not allow moonlighting at all during residency. Many programs allow you to start moonlighting once you pass step 3 and get your license, meaning you could start early PGY-2 if you are intentional about taking step 3 soon. Some programs even allow you to moonlight starting PGY-2 regardless of whether or not you have taken step 3.

It also varies whether a program lets you moonlight internally (at your home institution) vs externally (outside local hospital). Some let you do either; others only let you do one of the two. A decent chunk of the programs I looked at allow internal hospitalist moonlighting, often on a specialty service such as oncology. For the programs that only allow external moonlighting, I've heard of residents doing either/both of inpatient or urgent care.

Overall, it is very feasible to moonlight PGY-2-3, especially PGY-3, and especially during outpatient/elective blocks (an x+y schedule is nice for this). Pay will vary from $65-150/hr standard, although at one institution I've heard of pay rising to $250/hr for hard-to-fill shifts (yes this is for a resident). Also, internal moonlighting malpractice insurance is I believe always provided by the program. Externally, sometimes that local hospital will provide it, or else you have to figure it out on your own. Anecdotally, and from a few different programs, I've heard of residents "landing in the attending tax bracket" or "doubling their salary." So, at the right program, moonlighting $ (and the extra training) is plentiful and a great deal for IM PGY2-3.

What about moonlighting as an attending? Say you are a rheumatologist or something and have weekends off. How feasible is it to pick up some shifts here and there doing general IM stuff and maybe adding another 50K to your yearly income.

 

[mercaptovizadeh]

What about moonlighting as an attending? Say you are a rheumatologist or something and have weekends off. How feasible is it to pick up some shifts here and there doing general IM stuff and maybe adding another 50K to your yearly income.

Wouldn't you make more money just volunteering to be the rheum on call attending for the weekend consults?

 

[EMDO2018]

Didn't want to start a new thread but I just want to know, is the 7 on 7 off schedule sustainable for older docs? I can see how working all day could wear on you in your 50s and 60s, also are 7-4 8-5 shift types becoming more popular?

 

[DoctwoB]

Didn't want to start a new thread but I just want to know, is the 7 on 7 off schedule sustainable for older docs? I can see how working all day could wear on you in your 50s and 60s, also are 7-4 8-5 shift types becoming more popular?

While every arrangement under the sun can and does exist, when it comes to inpatient coverage where you need someone 24/7, you can see where that gets difficult. 12h shifts is easy to schedule, you need a day person and a night person. Often the night person gets higher compensation for obvious reasons. If you want to work 8-5 they are going to need a 5 to midnight and a midnight to 8 person every day. Good luck trying to fill those other two shifts without paying a whole lot of extra money.

 

[Otto of the Silver-Hand]

Hi,

I will be starting med school in August. I have been researching hospitalist medicine and think I would enjoy it as a career. My question is, are a lot of internist interested in hospitalist medicine or are more people interested in outpatient? Also with the number of med schools opening and expanding, will hospitalist jobs be more difficult to find in the future or will the number of jobs expand as the population ages?

It's not competitive yet, but will be soon. Because of poor re-imbursements, stricter admissions criteria from CMS, more denials of payments, hospitals are in the red and are moving away from the in-patient side of medicine and moving towards outpatient services, urgicares, surgicenters and free-standing EDs. This is a national trend.
Fewer inpatients= fewer need of hospitalists = fewer job openings for hospitalists.

 

[jdh71]

It's not competitive yet, but will be soon. Because of poor re-imbursements, stricter admissions criteria from CMS, more denials of payments, hospitals are in the red and are moving away from the in-patient side of medicine and moving towards outpatient services, urgicares, surgicenters and free-standing EDs. This is a national trend.
Fewer inpatients= fewer need of hospitalists = fewer job openings for hospitalists.

I just have a hard time seeing how this is possible when patients are getting sicker and sicker.

 

[VA Hopeful Dr]

I just have a hard time seeing how this is possible when patients are getting sicker and sicker.

Agreed. All these sick people have to go somewhere, and that somewhere is the hospital.

 

[Bostonredsox]

agree as well. Free standing urgent cares and EDs and whatever else cannot accomodate heart failure pts in flash pulmonary edema from poorly controlled HTN, which is the #1 reason for admission in this country. Nor the COPD pts who arent better after two neb treatments in the ED. Or old gomer X with 37 problems and home meds who is to weak to walk. The % of of patients needing admission to a hosital for 2-3-4+ days is growing, expectedly as the population gets older and thus gets sicker. I think the demand for hospitalists is going to continue to rise. Especially when you factor in that these older sicker pts take so much time to round on the PCPs do not want to leave there clinic to care for them, they just cant afford too. The time it takes to see one 85 year old in the hospital with pneumonia and heart failure equals 3 or 4 clinic visits. Several of my friends who are in PP primary care have told me though they like coming to the hospital there group is moving away from it because it just costs too much money in the long run. The hospitalist field is here to stay and is only going upward.