deanSANE

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Hey, guys. MS3 here. I'm currently trying to decide on IM vs neuro for residency. If I choose internal medicine, I'd definitely prefer hospital medicine over outpatient. I'd probably not sub-specialize and work as a hospitalist at a private community hospital (I don't want to do research).

Having said that, I've read (and I emphasize "read," I don't know any private practice hospitalists to directly speak with) that many hospitalists are unhappy (ie. only 25% of IM docs would choose IM if they had to do it again, according to the new Medscape survery).

My question is: why? If they're working 8-5 with call q7, and you're seeing interesting cases in the hospital, why are hospitalists unhappy? Is it too much paperwork? Overwhelming pt load? Having to coordinate care between too many specialists and subspecialists? If they went into IM to work as a hospitalist because they love inpatient Medicine, I'm really curious to know what their sources of their frustration are.

Thanks so much for any feedback on this guys!! It would really help me as I try to figure out the rest of my life :)
 

jdh71

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Hey, guys. MS3 here. I'm currently trying to decide on IM vs neuro for residency. If I choose internal medicine, I'd definitely prefer hospital medicine over outpatient. I'd probably not sub-specialize and work as a hospitalist at a private community hospital (I don't want to do research).

Having said that, I've read (and I emphasize "read," I don't know any private practice hospitalists to directly speak with) that many hospitalists are unhappy (ie. only 25% of IM docs would choose IM if they had to do it again, according to the new Medscape survery).

My question is: why? If they're working 8-5 with call q7, and you're seeing interesting cases in the hospital, why are hospitalists unhappy? Is it too much paperwork? Overwhelming pt load? Having to coordinate care between too many specialists and subspecialists? If they went into IM to work as a hospitalist because they love inpatient Medicine, I'm really curious to know what their sources of their frustration are.

Thanks so much for any feedback on this guys!! It would really help me as I try to figure out the rest of my life :)

Look. I think it can be a great way to make a living if you're into it.

I'll be honest and shoot straight with you, most of the hospitalists I know tolerate it because they get paid to. You're an H&P and D/C Summary writing monkey who gets dumped on by the ED, the ICU, the surgeons, and the surgical sub-specialists. You're the bitch.

Now the trade off is you get paid relatively well and you work about half the year.

The more rural you go the more you'll get to be a "real" doctor again.
 
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surge55

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Look. I think it can be a great way to make a living if you're into it.

I'll be honest and shoot straight with you, most of the hospitalists I know tolerate it because they get paid to. You're an H&P and D/C Summary writing monkey who gets dumped on by the ED, the ICU, the surgeons, and the surgical sub-specialists. You're the bitch.

Now the trade off is you get paid relatively well and you work about half the year.

The more rural you go the more you'll get to be a "real" doctor again.

I know from personal experience this isn't always the case but what can you do. I worked with a machine of an ER doc during my rotation and while it SEEMED like he would hold patients then dump four or five on the hospitalist, he really didn't intend to; when you go 100 miles an hour the whole time it really isn't efficient to sit there and call up an hospitalist for each individual admission - when you've got to do follow up tests and paperwork on 20 patients, it doesn't make sense to stop what you're doing to wait for the hospitalist to show up and give the h+p for one patient; makes more sense to do it for four or five of the twenty.

now granted, the poor hospitalists do get dumped on for bs cp admins, but what can you do? you want to be that doc that sends home a bounce back MI?
 

jdh71

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now granted, the poor hospitalists do get dumped on for bs cp admins, but what can you do? you want to be that doc that sends home a bounce back MI?

No one has a good answer for CP rule-outs. Hell some hospitals have their own chest-pain rule-out service!! :laugh:

I wasn't exactly dogging on the ED, but they do admit a lot of crap that they don't want to send home simlpy because they are able - they kick the can, punt the responsibility to the hospitalist. Failure to thrive and ambulate in a 92 y/o demented female without anything else really going on outside of poor nutrition and social situation?? Yeah. That's coming in and it's a dump.

BUT

What else are they supposed to do? I get it. I've worked in the ED too, though I don't pretend to be an ED doc.

I have one buddy who does the hospitalist thing and loves it. Most of my friends who've gone that way do not and are looking either to get into fellowship or a more general IM type of practice where you get to do some out-patient work as well.
 

NOsquid

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My question is: why? If they're working 8-5 with call q7, and you're seeing interesting cases in the hospital, why are hospitalists unhappy? Is it too much paperwork? Overwhelming pt load? Having to coordinate care between too many specialists and subspecialists? If they went into IM to work as a hospitalist because they love inpatient Medicine, I'm really curious to know what their sources of their frustration are.

That's most of it. They work relatively few hours and are paid well which is what attracts most people. But the hours they do work are miserable in many cases. They don't have time to provide care they can be proud of, even if they happen to find something interesting. It's reaaally busy in the places I've seen. That doesn't mean you couldn't find a better situation - probably wouldn't be in the most desirable location though. Academics is a bit better too (residents do the worst of the work), but you have to teach/publish and the money isn't nearly as good.
 

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Being a hospitalist is one of those "it is what it is" professions in my opinion.

If you can accept you're a glorified resident that can get dumped on by the ER and other specialties (sometimes they really do have to), that you have to see the same 10 things 95% of the time and that you aren't that respected than you can do it.

The plus side is you can make good-great money (250-350k) working half the month usually anywhere in the country you want to go (obviously less in certain places). There's usually always extra shifts that you can take.

IMO, you can make good money with a fair amount of time off doing something that really isn't that stressful or hard (if social problems in themselves don't stress you out) taking care of patients that if they get sick-sick can get transferred to an ICU.

You always have the option to move on to fellowship too.

Most hospitalists I know like what they do, though seems like >50% end up doing a fellowship after 5 years. Will be interesting how many become lifers in the hospitalist world as the profession matures.
 

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I would point out that most physicians, regardless of field, see the same 10 things 95% of the time. The key is to enjoy those things.
 
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LoudBark

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I would point out that most physicians, regardless of field, see the same 10 things 95% of the time. The key is to enjoy those things.

Hospitalists actually see a lot, lot more variety than any other subspecialty of medicine. A cardiologist will see NSTEMI a million times, a nephrologist a million ESRD patients, GI will see a million GI bleeds, pulm CC will see a million ARDS patients. A hospitalist will see all of those patients in one day of rounding.

The key about being a hospitalist is get being used to being the jack of all trades, master of none (kind of like ER docs). The issue with hospitalists is not so much "seeing the same 10 things 95% of the time." It is seeing so many different things and feeling that you know so little and are in so little control over all of them that you are constantly on the phone calling consults.

You come to feel that you are doing little more than just being a secretary who places calls and organizes consults whenever your patient is really sick or has a difficult issue.
 

Blitz2006

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Being a hospitalist is one of those "it is what it is" professions in my opinion.

If you can accept you're a glorified resident that can get dumped on by the ER and other specialties (sometimes they really do have to), that you have to see the same 10 things 95% of the time and that you aren't that respected than you can do it.

The plus side is you can make good-great money (250-350k) working half the month usually anywhere in the country you want to go (obviously less in certain places). There's usually always extra shifts that you can take.

IMO, you can make good money with a fair amount of time off doing something that really isn't that stressful or hard (if social problems in themselves don't stress you out) taking care of patients that if they get sick-sick can get transferred to an ICU.

You always have the option to move on to fellowship too.

Most hospitalists I know like what they do, though seems like >50% end up doing a fellowship after 5 years. Will be interesting how many become lifers in the hospitalist world as the profession matures.


Really, 250-300K?

I did a Sub-I in Medicine in the Boston Area, and the Hospitalists were making around 180K...7 days on, 7 days off...
 

jdh71

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Really, 250-300K?

I did a Sub-I in Medicine in the Boston Area, and the Hospitalists were making around 180K...7 days on, 7 days off...

Yes. 300k is pushing it a bit, but yeah - 220-250k easy almost anywhere in the country outside of certain markets. Boston is a saturated market, and you take a cut in pay to live and work there.
 
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How likely is it to apply for fellowship after several years' working as a hospitalist? What's the maximum number of years' gap between completion of residency and fellowship that is feasible?
 

surge55

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How likely is it to apply for fellowship after several years' working as a hospitalist? What's the maximum number of years' gap between completion of residency and fellowship that is feasible?

I'm guessing it is darn near impossible to get Cardio and GI if you don't have an otherwise strong app and you took off more than a year or two to work as a hospitalist.

for others I'm sure it's not as hard, especially Endo, ID and Nephro.
 

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This is what I gather from talking to hospitalists, non-hospitalists, reisdents/fellows.

For most, one of the most gratifying things about internal medicine is the relationships and continuity of care formed by the outpatient aspect. Hospitalists forego this completely, and deal mostly with managing exacerbations of existing diseases for patients they don't know and won't see again. Their pay relative to their hours is ok, but with a low income ceiling. If you aren't at an academic center teaching (with a lower income as a trade-off), then it can be quite monotonous and unrewarding, really almost like existing as a permanent resident.

It is pretty popular choice among residents these days because
1) resident education is so heavily inpatient based with poor outpatient clinic experiences that residents feel most comfortable continuing this type of work after. Outpatient general medicine is probably more intellectually and socially challenging, so continuing in the hospital is the path of least resistance.
2) Easier, less complicated lifestyle.
 

surge55

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This is what I gather from talking to hospitalists, non-hospitalists, reisdents/fellows.

For most, one of the most gratifying things about internal medicine is the relationships and continuity of care formed by the outpatient aspect. Hospitalists forego this completely, and deal mostly with managing exacerbations of existing diseases for patients they don't know and won't see again. Their pay relative to their hours is ok, but with a low income ceiling. If you aren't at an academic center teaching (with a lower income as a trade-off), then it can be quite monotonous and unrewarding, really almost like existing as a permanent resident.

It is pretty popular choice among residents these days because
1) resident education is so heavily inpatient based with poor outpatient clinic experiences that residents feel most comfortable continuing this type of work after. Outpatient general medicine is probably more intellectually and socially challenging, so continuing in the hospital is the path of least resistance.
2) Easier, less complicated lifestyle.

this is a fine point for sure. If I was giving any advice to upcoming IM residents it is to look at the program's commitment to their outpatient education; some programs neglect it whereas others embrace it.
 

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Yes. 300k is pushing it a bit, but yeah - 220-250k easy almost anywhere in the country outside of certain markets. Boston is a saturated market, and you take a cut in pay to live and work there.
If you are including bonuses I think $300K is possible (speaking from personal experience). As a base salary? Maybe in Montana and have to be "comfortable" with intubations, etc.
 

jdh71

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If you are including bonuses I think $300K is possible (speaking from personal experience). As a base salary? Maybe in Montana and have to be "comfortable" with intubations, etc.

I'm not seeing base that high. But yeah, you add in the package and bonuses, and the money you can make picking up extra shifts . . . know a guy who cleared over 500k doing hospitalist work, but he worked for every dime of that.
 

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I'm not seeing base that high. But yeah, you add in the package and bonuses, and the money you can make picking up extra shifts . . . know a guy who cleared over 500k doing hospitalist work, but he worked for every dime of that.

But he's the 1%, time to pay moar taxes on it since he has ezmode life.
 

dragonfly99

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The survey the medical student above is quoting (low job satisfaction for IM docs) likely included many outpatient docs. Outpatient medicine can be a b*tch, particularly if you are employed, because they often get forced to see patients Q15 minutes...and you are never free of the patient emails, prior authorizations, FMLA forms, etc. At least as a hospitalist you are done at the end of your shift.
 

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Hospitalists actually see a lot, lot more variety than any other subspecialty of medicine. A cardiologist will see NSTEMI a million times, a nephrologist a million ESRD patients, GI will see a million GI bleeds, pulm CC will see a million ARDS patients. A hospitalist will see all of those patients in one day of rounding.

The key about being a hospitalist is get being used to being the jack of all trades, master of none (kind of like ER docs). The issue with hospitalists is not so much "seeing the same 10 things 95% of the time." It is seeing so many different things and feeling that you know so little and are in so little control over all of them that you are constantly on the phone calling consults.

You come to feel that you are doing little more than just being a secretary who places calls and organizes consults whenever your patient is really sick or has a difficult issue.

This has largely been my experience from my vantage point as a moonlighter for a hospitalist service over the past 2 years. It's not necessarily a bad thing, in terms of always having someone to call for advice and not being the one with whom the buck stops. But it's sort of a dead end in a way. I'm not sure i could do that sort of thing for my ENTIRE career.

And like you said, i've seen my fair share of bread and butter but also a lot of interesting diagnostic cases, even though it's a small community hospital.
 

WorkaholicsAnon

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The survey the medical student above is quoting (low job satisfaction for IM docs) likely included many outpatient docs. Outpatient medicine can be a b*tch, particularly if you are employed, because they often get forced to see patients Q15 minutes...and you are never free of the patient emails, prior authorizations, FMLA forms, etc. At least as a hospitalist you are done at the end of your shift.

Exactly. I couldn't possibly stand that sort of a set-up. If I had to do outpatient medicine I'd rather set up my own solo practice and see patients q30m to q1h. F- the system!!

q15min appointments is not how i envisioned practicing the kind of medicine i want to practice and that is why I am staying away from that sphere even though I otherwise love outpatient medicine. I hate being time pressured when a patient has problems to figure out.
 

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Workaholics anon,
the problem is that trying to see patients Q30min-1hr and set up your own practice is probably not financially viable, even for a specialist (unless maybe you are a derm or allergist?). Remember, you would need some way to do the medical billing (because most patients won't pay cash and will expect you to bill their insurance company), office staff, rent for an office, etc. Many docs haven't found this to be financially viable at all in recent years.
 

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If you are interested in medical education, working as an academic hospitalist could not be a better fit. Who else spends as much time with residents and medical students that the General Medicine ward attending (in most places, a hospitalist)?
 
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