Are we being robbed as hospitalists?

[BicepsTriceps]

By working 7 days on ~ 84 hours 7 days off, 26 weeks on a year, no PTO, no sick days, no vacation, no holidays.

Compared to outpatient working 36-40 hours a week, 3-4 days a week with 4-6 weeks vacation, holidays off.

Outpatient gets way more time off while making more money.

How did we get tricked as hospitalists into this schedule? How did we agree to no vacation time, no sick days, no holiday differential?

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[CCM-MD]

7 on/off without PTO has always been a scam.

 

[bronx43]

By working 7 days on ~ 84 hours 7 days off, 26 weeks on a year, no PTO, no sick days, no vacation, no holidays.

Compared to outpatient working 36-40 hours a week, 3-4 days a week with 4-6 weeks vacation, holidays off.

Outpatient gets way more time off while making more money.

How did we get tricked as hospitalists into this schedule? How did we agree to no vacation time, no sick days, no holiday differential?

It’s all supply and demand. Hospitals can fill a hospitalist position much easier than they can fill a longterm general internist. Majority of grads prefer inpatient work over the daily grind of clinic. In my graduating class, only like 2 people ended up as GIM. At least a 15-20 went the hospitalist route. Furthermore, a full panel pcp has infinitely more negotiating power than a plug and play hospitalist.

Just go do outpatient if you think you’re being ripped off inpatient. At the end of the day, flexiblity is the only good thing about IM.

 

[Appellatelove]

It’s all supply and demand. Hospitals can fill a hospitalist position much easier than they can fill a longterm general internist. Majority of grads prefer inpatient work over the daily grind of clinic. In my graduating class, only like 2 people ended up as GIM. At least a 15-20 went the hospitalist route. Furthermore, a full panel pcp has infinitely more negotiating power than a plug and play hospitalist.

Just go do outpatient if you think you’re being ripped off inpatient. At the end of the day, flexiblity is the only good thing about IM.

It’s all supply and demand. Hospitals can fill a hospitalist position much easier than they can fill a longterm general internist. Majority of grads prefer inpatient work over the daily grind of clinic. In my graduating class, only like 2 people ended up as GIM. At least a 15-20 went the hospitalist route. Furthermore, a full panel pcp has infinitely more negotiating power than a plug and play hospitalist.

Just go do outpatient if you think you’re being ripped off inpatient. At the end of the day, flexiblity is the only good thing about IM.

Agree with all of this. I can’t consider hospitalist because I have a child and can’t imagine the rest of my life working weekends.

 

[Ubba]

As bronx43 wrote above, hospitalists are muc more fungible. If you want to live in NYC for a couple of years but might also want to live in Virginia, Florida, and/or Illinois down the line, being a hospitalist "makes more sense" because your remuneration is as your see it up front, unlike being a PCP, which requires sweat equity and planting roots into the area's soil to really get everything you can with and from the practice. Convenience comes at a cost. The only 2 reasons I know why hospitalist medicine is a "good gig" are 1) the flexibility and 2) the fact that you get to more or less continue your residency workflow without having to pick up an entire career's worth of new skills (e.g., being a small business owner as a PCP)

 

[DrMetal]

How did we get tricked as hospitalists into this schedule?

Because we're dumb! Honestly, doctors are incredibly stupid. Look at how we learn (memorize, take test, dump, repeat). We really don't know how to think, to analyze, to question if something makes sense. That's why we get duped into such things.

Having said that: you should always have some mechanism of paid time off. No PTO is a hard no go.

Look into per diem, or part time, or locums hospital work. You can essentially set up your own schedule. Work as much as you want. You don't get the benefits of being a full time employee, but the flexibility is nice.

 

[CleverAlias]

To each their own. As far as I am concerned, weekends are almost completely useless as anything other than "days I don't have to work." Aside from the benefit of not having to be at work, you can't go anywhere or do anything in the space of 2 measly days. The notion of working a 5 (or even 4) day workweek for decades until you're able to retire as an old man, with only a couple of short vacations to look forward to each calendar year until then, is utterly soul destroying to me.

I truly find it difficult to comprehend how anyone who is single would prefer to finish a 5 day stretch and then say, yeah I prefer to have the weekend off before going in for another 5 days of work instead of just working those 2 extra days and having a whole week off. I suppose you can make various arguments about kids and families or whatnot, but in that case just say the 7 on 7 off model is bad for the particular scenario of a dad-bod family man rather than being a "rip-off" in a vacuum.

 

[bronx43]

To each their own. As far as I am concerned, weekends are almost completely useless as anything other than "days I don't have to work." Aside from the benefit of not having to be at work, you can't go anywhere or do anything in the space of 2 measly days. The notion of working a 5 (or even 4) day workweek for decades until you're able to retire as an old man, with only a couple of short vacations to look forward to each calendar year until then, is utterly soul destroying to me.

I truly find it difficult to comprehend how anyone who is single would prefer to finish a 5 day stretch and then say, yeah I prefer to have the weekend off before going in for another 5 days of work instead of just working those 2 extra days and having a whole week off. I suppose you can make various arguments about kids and families or whatnot, but in that case just say the 7 on 7 off model is bad for the particular scenario of a dad-bod family man rather than being a "rip-off" in a vacuum.

How often do you actually travel as a hospitalist? When i was a hospitalist, I thought the same thing - that I was going to do so much traveling or other fun things on my weeks off. In reality, I traveled the same or only slightly more than I do now in clinic, which is about 4 or 5 trips per year. None of my colleagues traveled that much either. Mostly, we just bummed around the house and hung out in the city.
However, if one is a truly aggressive traveler, then hospitalist is really the only job that would allow that lifestyle.

 

[BicepsTriceps]

To each their own. As far as I am concerned, weekends are almost completely useless as anything other than "days I don't have to work." Aside from the benefit of not having to be at work, you can't go anywhere or do anything in the space of 2 measly days. The notion of working a 5 (or even 4) day workweek for decades until you're able to retire as an old man, with only a couple of short vacations to look forward to each calendar year until then, is utterly soul destroying to me.

I truly find it difficult to comprehend how anyone who is single would prefer to finish a 5 day stretch and then say, yeah I prefer to have the weekend off before going in for another 5 days of work instead of just working those 2 extra days and having a whole week off. I suppose you can make various arguments about kids and families or whatnot, but in that case just say the 7 on 7 off model is bad for the particular scenario of a dad-bod family man rather than being a "rip-off" in a vacuum.

You're overlooking the fact that those clinic days you're working you can still have some sort of life.

If clinic starts at 8 or 9 you can workout or run or do something in the morning before work and when you leave at 4-5 pm you can still do something in the evening.

Compared to an aggressive hospitalist shift working 6-7 am to 6-7 pm achieving nothing that day except fatigue.

You need the first and last day of your week off as a hospitalist to rest after/ before work.

I'm not saying doing clinic is better as I'm a hospitalist myself it's just baffling to me that we don't get anytime off whatsoever and we're literally working 40 hours a week year round.

We need 2-4 paid week off to level the playing field.

 

[NewYorkDoctors]

for some individuals who need to pay off debt and/or accrue some savings before attempting to launch a private practice, doing hospitalist for a few years is pretty much the viable strategy.

 

[dozitgetchahi]

To each their own. As far as I am concerned, weekends are almost completely useless as anything other than "days I don't have to work." Aside from the benefit of not having to be at work, you can't go anywhere or do anything in the space of 2 measly days. The notion of working a 5 (or even 4) day workweek for decades until you're able to retire as an old man, with only a couple of short vacations to look forward to each calendar year until then, is utterly soul destroying to me.

I truly find it difficult to comprehend how anyone who is single would prefer to finish a 5 day stretch and then say, yeah I prefer to have the weekend off before going in for another 5 days of work instead of just working those 2 extra days and having a whole week off. I suppose you can make various arguments about kids and families or whatnot, but in that case just say the 7 on 7 off model is bad for the particular scenario of a dad-bod family man rather than being a "rip-off" in a vacuum.

The big problem is that, by and large, the rest of the world doesn’t abide by this kind of schedule. Remember how weird it was during residency when you had a random day off or a “golden weekend” and all your friends didn’t, so you had to call everyone hoping they would grab a bite to eat or otherwise hang postcall? It’s not so much fun to have tons of days off where everyone else is at work. If you have kids, they’re going to be going to school on weekdays and off weekends. Unless your spouse is also a hospitalist, they won’t have those days off either.

Not to mention that seven consecutive 12s is pretty brutal, especially given what they expect you to admit on hospitalist shifts these days. I didn’t go hospitalist because I figured I’d spend half the week off recovering from the week on, and the other half dreading going back to work.

(That said, I do totally agree that 2 days off is barely enough to do anything, or even to recover after a crappy week in clinic. I do feel better after longer periods off.)

 

[CleverAlias]

I'm not saying the hospitalist model is all unicorn farts without any negatives, obviously any model has pros and cons. I just think this thread has focused entirely on the disadvantages while taking the benefits for granted to the point it's as if they don't exist.

First of all, while 7 12hr shifts multiplies out to be the same amount of hours as 10 8hr shifts, would anyone really make the argument that these two are even remotely similar in terms of workload? Unless you're working purely as an admitter, the vast majority of the work as a hospitalist will have been done in the first few hours of your 12 hours shift anyway. If you are super concerned about the whole day being eaten up when you're "on" there are plenty of round and go jobs out there, granted probably not in LA for 350k.

Secondly, I think people are underestimating just how valuable the scheduling flexibility of the hospitalist model really is. It's exceedingly rare for anyone stuck in the rat-race to be able to take extended breaks essentially at will. Which other top tier careers allow for such a thing? Even if you're not going to be traveling every other week the fact that you could if you wanted to is a massive quality of life/satisfaction boost in my book. It's like having the flexibility of being retired with the energy levels of being in the prime of your life. Am I willing to pay for that by working a little harder on the days I'm actually at work? Yeah.

Finally, I think it's almost ironic to say a pitfall of having a lot of time off is that other people are not so fortunate. While it's true that most people out there will not have the freedom to accompany you on your last second excursion to Colombia in the third week of April, that's a shortcoming in the way their life is structured, not yours. With that said, I am of course in total agreement that we should get vacation and sick days on top of all this lol.

 

[Ubba]

There are certainly advantages. I have a friend who travels just an insane amount on his hospitalist off-weeks. This guy is collecting more memories in a year than most will in a lifetime. Kudos to him. The challenge is that hospitalists don't really make all that much per hour, so if you spend your off-weeks gallivanting about, you won't have much left over for investment and retirement unless you have a spouse who also earns highly or plan to live the DINK lifestyle, which is for a minority of people.

People should also consider that the standard for PCP work is becoming 4-4.5 days/week, not a full 5. Keep that in mind as you make your comparisons.

Bottom line, though: this isn't a contest, and there's no need for this to be a perennial argument. The great thing is that for the first few years, you can cross the gap between outpt and inpt if you find that the grass is greener on the other side. Many general internists may find that they want to be hospitalists for a few years so they can party hard on their off time and then move to PCP gigs as they assume different life roles.

 

[AlbinoHawk DO]

This all depends on how you value your time. I think working a 12 hour shift for 7 days makes more sense than working 8 hours for 10 days. I have more time to do whatever i want in 7 days off. Besides, the clinic usually has a lot of unpaid time writing notes, refills, calls, etc.

If you feel ripped off, simply get a clinic job. You can't have your cake and eat it

 

[VA Hopeful Dr]

This all depends on how you value your time. I think working a 12 hour shift for 7 days makes more sense than working 8 hours for 10 days. I have more time to do whatever i want in 7 days off. Besides, the clinic usually has a lot of unpaid time writing notes, refills, calls, etc.

If you feel ripped off, simply get a clinic job. You can't have your cake and eat it

I think people either overestimate how much time the non-patient facing work of clinic takes or don't have their workflow optimized/patients trained properly.

95+% of the refill requests I receive are resolved with a button in the EMR that sends a note to my nurse that says "Patient needs appointment, can call in 30 day supply if needed to make it to their appointment". Even those are rare since most of my patients know that refills need an office visit.

I have a similar button for phone calls that says "Patient needs appointment to address this". Takes care of a solid 50% of calls/messages.

That said, while I take a lot of time off by PCP standards it is no where near what hospitalists get. So if days not spent at work is a priority, hospitalist is definitely the way to go.

 

[AlbinoHawk DO]

I think people either overestimate how much time the non-patient facing work of clinic takes or don't have their workflow optimized/patients trained properly.

95+% of the refill requests I receive are resolved with a button in the EMR that sends a note to my nurse that says "Patient needs appointment, can call in 30 day supply if needed to make it to their appointment". Even those are rare since most of my patients know that refills need an office visit.

I have a similar button for phone calls that says "Patient needs appointment to address this". Takes care of a solid 50% of calls/messages.

That said, while I take a lot of time off by PCP standards it is no where near what hospitalists get. So if days not spent at work is a priority, hospitalist is definitely the way to go.

I'll take your word for it. The only outpatient clinic i knew personally was residency, and what i saw from my peers doing FM residency. We were at a community safety net, so we had quite a few paperwork and other stuff to do

 

[VA Hopeful Dr]

I'll take your word for it. The only outpatient clinic i knew personally was residency, and what i saw from my peers doing FM residency. We were at a community safety net, so we had quite a few paperwork and other stuff to do

Yeah residency is a whole different beast. Staff isn't there to make your life easier. My MAs entire job is to do what I tell them. Some of my partners actually have them order preventative stuff that's due and collect most of the HPI.

 

[CCM-MD]

Are "round-and-go" hospitalist setups hard to find?

Usually an agreement between the hospitalists. “I’ll cover your patients, you go early today” type deals. It’s all fine until something goes wrong at things are put under a microscope.

 

[HemeOncHopeful19]

I'll take your word for it. The only outpatient clinic i knew personally was residency, and what i saw from my peers doing FM residency. We were at a community safety net, so we had quite a few paperwork and other stuff to do

I’ve pointed this out in other places but when your RN makes more than the resident it makes more sense to force scutwork on the residents as they are “cheaper.”

Once you make it to attending your RN starts to be the more efficient person to spend time on paperwork/calls while you see patients, so the system is more willing to hire a nurse that does that stuff.

 

[dozitgetchahi]

Yeah residency is a whole different beast. Staff isn't there to make your life easier. My MAs entire job is to do what I tell them. Some of my partners actually have them order preventative stuff that's due and collect most of the HPI.

This was one of the biggest surprises coming out of residency and fellowship - you have office staff that actually help you and handle the scut work. Granted, some of these staff are way better than others, but they still actually do things to help you along. Contrast this with fellowship, where I not only was the scut monkey but was also somehow expected to cover for when support staff such as schedulers didn’t do their jobs, and chase them down and cajole them into doing what they were supposed to do…

 

[collegestud2013]

By working 7 days on ~ 84 hours 7 days off, 26 weeks on a year, no PTO, no sick days, no vacation, no holidays.

Compared to outpatient working 36-40 hours a week, 3-4 days a week with 4-6 weeks vacation, holidays off.

Outpatient gets way more time off while making more money.

How did we get tricked as hospitalists into this schedule? How did we agree to no vacation time, no sick days, no holiday differential?

Depends on the specific set up of your practice. Both has it's pros and cons.

If you're looking at which makes more per hour, until recently hospitalists usually make more per hour than employed outpatient PCPs (7 12-hr shift x 26 weeks = 2184 hrs per year, which is less hours than most full-time physicians work), and with hospitalist work there's the flexibility of moving from one job to another more easily without having to build up a patient panel. But more recently outpatient PCP jobs are catching up as less people want to do primary care and some hospitalist jobs in the more desirable locations are getting saturated.

Outpatient taking insurance usually has to see large volumes (usually 20+ patients in a 8-9-hour day) and there are on call responsibilities as well to rotate into so probably working more than 36 hrs per week to make similar to a standard 7-on-7-off hospitalist as most places. To make more as outpatient than hospitalist you often need some time of practice ownership (not just being a strict employee), and bring in more revenue than just E&M (eg ancillary services or cash-based concierge services).

You don't have to do 7-on-7-off as hospitalist. Other options like 5-on-5-off are also possibilities. For those with families who want to minimize working weekends, then yes the outpatient schedule may be better for them. If you want to block more time off in between work, then 7-on-7-off gives you a week off every other week.

 

[collegestud2013]

Are "round-and-go" hospitalist setups hard to find?

Not uncommon, especially at places that have a dedicated admitting shift. Unless you're on that admitting shift, most of your shifts in this set up should be rounding only on admitted patients. However, round and go tends to be more of an unwritten practice than something most jobs will advertise upfront, as you're technically responsible for your patients the entire shift. So you should only leave early if you live nearby the hospital and can come back in case if emergency.

 

[collegestud2013]

It’s all supply and demand. Hospitals can fill a hospitalist position much easier than they can fill a longterm general internist. Majority of grads prefer inpatient work over the daily grind of clinic. In my graduating class, only like 2 people ended up as GIM. At least a 15-20 went the hospitalist route. Furthermore, a full panel pcp has infinitely more negotiating power than a plug and play hospitalist.

Just go do outpatient if you think you’re being ripped off inpatient. At the end of the day, flexiblity is the only good thing about IM.

There are significant turnover costs to replacing any full-time physician. Though studies have found that for hospitalists, the turnover costs tends to be a bit lower than some other specialties. This is probably also true for any shift-based specialty like EM, radiology, anesthesiology, critical care that don't "own" their patients and thus there's no issue with transffering a patient panel to a new provider or losing a lot of patients alltogether when someone leaves. Any outpatient specialty that owns their patients also owns their patients'' problems (and this can lead to burnout). but this leads to better negotiang power with employers.

 

[CCM-MD]

I appreciate everyone sharing their experience. Would it be wrong to assume that 7on/7off hospitalists don't actually work the full 84 hours during their workweek? Becoming efficient, rounding and leaving, or even just working a lot harder during the beginning of a shift and relaxing in the doctor's lounge towards the end, etc.

If so, I feel that should be taken into account when comparing to outpatient fields where there is a constant stream of appointments.

You could be efficient in the outpatient setting too.

Outpatient - 1536-1920 hours annually (48 weeks x 4 day/week x 10h days). All weekends and public holidays off. Some places give more than 4 week vacation/cme time.

Inpatient - 2184 hours (26 weeks, 12h shifts). No additional PTO. Work many holidays. Work half of all weekends forever.

 

[VA Hopeful Dr]

You could be efficient in the outpatient setting too.

Outpatient - 1536-1920 hours annually (48 weeks x 4 day/week x 10h days). All weekends and public holidays off. Some places give more than 4 week vacation/cme time.

Inpatient - 2184 hours (26 weeks, 12h shifts). No additional PTO. Work many holidays. Work half of all weekends forever.

Yep. Efficiency in outpatient typically means either more money or finishing your day earlier (or both).

I'm in the office for 36 hours/week. But, that includes my 90 minute lunch every day I arrive at 8am, lunch from 12-130, almost always out the door by 420. Generally a touch earlier. Typically take 30 days off per year between vacation and sick days.

 

[Splenda88]

By working 7 days on ~ 84 hours 7 days off, 26 weeks on a year, no PTO, no sick days, no vacation, no holidays.

Compared to outpatient working 36-40 hours a week, 3-4 days a week with 4-6 weeks vacation, holidays off.

Outpatient gets way more time off while making more money.

How did we get tricked as hospitalists into this schedule? How did we agree to no vacation time, no sick days, no holiday differential?

But remember hospitalists can leave early at some places. In my situation, I can leave at 5:30pm.

I don't do that but some people at my place would show up at 7:45-8:00 am and still leave at 5:30pm.

The last 2 weeks, I watched close to 4 hrs of soccer games almost every day and still get my work done.

By the way, will make 405k this year working ~17.7 days/month on average. I guess the grass can always be greener.

 

[Splenda88]

How often do you actually travel as a hospitalist? When i was a hospitalist, I thought the same thing - that I was going to do so much traveling or other fun things on my weeks off. In reality, I traveled the same or only slightly more than I do now in clinic, which is about 4 or 5 trips per year. None of my colleagues traveled that much either. Mostly, we just bummed around the house and hung out in the city.
However, if one is a truly aggressive traveler, then hospitalist is really the only job that would allow that lifestyle.

In my case, 3 (5 days) small trips this year and a big one (almost 2 wks in Europe). Took 1 wk off; hence 3 wks uninterrupted off due to how hospitalist schedule is.

It's hard to beat hospital medicine flexibility. For instance, there are 2 part timers where I work that put in ~ 9 days/month and both make ~200k/yr.

 

[BicepsTriceps]

But remember hospitalists can leave early at some places. In my situation, I can leave at 5:30pm.

I don't do that but some people at my place would show up at 7:45-8:00 am and still leave at 5:30pm.

The last 2 weeks, I watched close to 4 hrs of soccer games almost every day and still get my work done.

By the way, will make 405k this year working 17.7 days/month on average. I guess the grass can always be greener.

Hospitalist in chill places when well compensated is very good.

Problem is many places are trying to squeeze every drop out of you & will work you 12 hours a day 7 days straight leaving you burned out in few months tops.

I just can't see it staying a sustainable career for too long.

 

[Splenda88]

Hospitalist in chill places when well compensated is very good.

Problem is many places are trying to squeeze every drop out of you & will work you 12 hours a day 7 days straight leaving you burned out in few months tops.

I just can't see it staying a sustainable career for too long.

I guess if you want to live in a big city, some places might try to take advantage of the supply.

I used to work M-F (8am-5pm) as a RN at a county health department. My responsibility was probably <5% of that of an outpatient PCP. Half of the time I was talking on the phone with friends or surfing the web, and there is no way in hell I will go back working a Mon-Fri or even Mon-Thur 8am to 5pm unless hospital medicine become extremely unbearable.

 

[HemeOncHopeful19]

I used to work M-F (8am-5pm) as a RN at a county health department… Half of the time I was talking on the phone with friends or surfing the web

Are you sure you weren’t a VA nurse manager?

 

[Splenda88]

Are you sure you weren’t a VA nurse manager?

No.. It was a county health department.

 

[gutonc]

No.. It was a county health department.

Po-tay-to/Po-tah-to

 

[aafisahar]

Are you sure you weren’t a VA nurse manager?

Legit my favorite memory of the VA is basically admitting a guy for a gout flare then waiting on placement for 9 ****ing days

 

[FutureInternist]

Who’s actually staying the full 12 hours.

Weekdays I’m home at 2-3, and weekends latest is noon.
Get paid till 7 pm 😏

 

[Splenda88]

Who’s actually staying the full 12 hours.

Weekdays I’m home at 2-3, and weekends latest is noon.
Get paid till 7 pm 😏

Can outpatient PCP beat that? I guess to each its own...

I can't imaging myself going from 'cubicle' to 'cubicle' to see patients for 5-10 mins and then write notes.

Today, I got to work ~7 am, spend 45 mins eating breakfast in the physician lounge while talking with my co-workers and doing chart review; then see patients until 10 am. Watched the world cup final for 3 hrs and then write notes until 4pm. After that, I watched American football and left work at 5:30pm.

Hospital medicine is 8 hours of ACTUAL work at worst and 5-6 hrs at best.

I think people underestimate the flexibility of hospital medicine. However, no job is perfect.

 

[VA Hopeful Dr]

Can outpatient PCP beat that? I guess to each its own...

I can't imaging myself going from 'cubicle' to 'cubicle' to see patients for 5-10 mins and then write notes.

Today, I got to work ~7 am, spend 45 mins eating breakfast in the physician lounge while talking with my co-workers and doing chart review; then see patients until 10 am. Watched the world cup final for 3 hrs and then write notes until 4pm. After that, I watched American football and left work at 5:30pm.

Hospital medicine is 8 hours of ACTUAL work at worst and 5-6 hrs at best.

I think people underestimate the flexibility of hospital medicine. However, no job is perfect.

Yes, we never work weekends.

 

[jm192]

By working 7 days on ~ 84 hours 7 days off, 26 weeks on a year, no PTO, no sick days, no vacation, no holidays.

Compared to outpatient working 36-40 hours a week, 3-4 days a week with 4-6 weeks vacation, holidays off.

Outpatient gets way more time off while making more money.

How did we get tricked as hospitalists into this schedule? How did we agree to no vacation time, no sick days, no holiday differential?

Does outpatient make more money?

I interviewed for Primary care where I did residency. The lady put on a show about how much she wanted me and fought for me to get more money because she knows I'm so special and blah blah blah. She put down a contract that said 205K base.

Hospitalist out the gate was 260.

Schedules a little more frustrating. But I absolutely make more money doing hospital than I would have Primary care. Add in that fact that I don't enjoy primary care at all, and it's an easy decision.

 

[VA Hopeful Dr]

Does outpatient make more money?

I interviewed for Primary care where I did residency. The lady put on a show about how much she wanted me and fought for me to get more money because she knows I'm so special and blah blah blah. She put down a contract that said 205K base.

Hospitalist out the gate was 260.

Schedules a little more frustrating. But I absolutely make more money doing hospital than I would have Primary care. Add in that fact that I don't enjoy primary care at all, and it's an easy decision.

Yes, we often do. Outpatient usually has a lower base but higher potential if paid on production.

For example: every single one of my full-time partners in my hospital owned clinic is going to break 400k this year. We all take at least 30 days off per year (usually a few days above that). We all work 4.5 days per week, which when you include lunch and everything actually works out to around 32 hours of work per week.

Now obviously if you don't like primary don't do it. And if you really like the hospitalist schedule, stick with that. But this whole "pcp's don't make any money" thing just isn't accurate these days. And with the increasing importance of quality care, I expect us to start doing even better as time goes on.

 

[Osteoth]

Does outpatient make more money?

I interviewed for Primary care where I did residency. The lady put on a show about how much she wanted me and fought for me to get more money because she knows I'm so special and blah blah blah. She put down a contract that said 205K base.

Hospitalist out the gate was 260.

Schedules a little more frustrating. But I absolutely make more money doing hospital than I would have Primary care. Add in that fact that I don't enjoy primary care at all, and it's an easy decision.

I’m actively applying and getting the same $ for both PCP and hospitalist jobs.

PCP jobs are also way more common in big cities and will more frequently have partnership tract, leading to more ancillary $.

It’s nice as a hospitalist to leave early, but any change in management can nix that. It also doesn’t scale.

 

[HemeOncHopeful19]

For example: every single one of my full-time partners in my hospital owned clinic

Sorry to derail but something of a pet peeve for me… what is a “partner” if the clinic is owned by the hospital? That sounds more like “coworker” to me.

 

[VA Hopeful Dr]

Sorry to derail but something of a pet peeve for me… what is a “partner” if the clinic is owned by the hospital? That sounds more like “coworker” to me.

Left over from the old days?

That and I do think physicians working together are more than just co-workers in the majority of settings.

 

[rockstar88]

Yes, we often do. Outpatient usually has a lower base but higher potential if paid on production.

For example: every single one of my full-time partners in my hospital owned clinic is going to break 400k this year. We all take at least 30 days off per year (usually a few days above that). We all work 4.5 days per week, which when you include lunch and everything actually works out to around 32 hours of work per week.

Now obviously if you don't like primary don't do it. And if you really like the hospitalist schedule, stick with that. But this whole "pcp's don't make any money" thing just isn't accurate these days. And with the increasing importance of quality care, I expect us to start doing even better as time goes on.

It's really nice to hear that you guys make so much as PCPs. I hate that PCP is looked at as an undesirable and low-paying job. Yes, anyone can be a generic PCP, but a really good PCP can make a really huge difference to the community. And they should get compensated appropriately.

 

[dozitgetchahi]

Po-tay-to/Po-tah-to

When I lived in Alabama, the local clueless health department would call almost every single person I screened for hepatitis with a positive hep B surface antibody and nothing else (aka vaccinated) and breathlessly tell them they had hep B. Since I’m a rheumatologist, I did a lot of these screenings - and thus I had the pleasure of talking down dozens of panicked patients who called my office thinking they had hepatitis.

I would have loved if they’d been a bit lazier.

 

[dozitgetchahi]

Can outpatient PCP beat that? I guess to each its own...

I can't imaging myself going from 'cubicle' to 'cubicle' to see patients for 5-10 mins and then write notes.

Today, I got to work ~7 am, spend 45 mins eating breakfast in the physician lounge while talking with my co-workers and doing chart review; then see patients until 10 am. Watched the world cup final for 3 hrs and then write notes until 4pm. After that, I watched American football and left work at 5:30pm.

Hospital medicine is 8 hours of ACTUAL work at worst and 5-6 hrs at best.

I think people underestimate the flexibility of hospital medicine. However, no job is perfect.

So I’m curious: are you responsible for doing *everything* for admitted patients, including codes and such? I ask this because wards as a resident sucked hard - I was busting my ass for an entire shift, constantly drowning in crap to do. However, my understanding is that a lot of community hospitalists don’t have to do all the crap we did as residents - they don’t do codes, they don’t admit every time they’re on, some can “round and go”, and such. That makes things much easier.

 

[Splenda88]

So I’m curious: are you responsible for doing *everything* for admitted patients, including codes and such? I ask this because wards as a resident sucked hard - I was busting my ass for an entire shift, constantly drowning in crap to do. However, my understanding is that a lot of community hospitalists don’t have to do all the crap we did as residents - they don’t do codes, they don’t admit every time they’re on, some can “round and go”, and such. That makes things much easier.

This is not residency. I dont answer to codes. If it's my patient, I need to be there to tell the intensivist about the patient. I don't request records (except putting an order for the RN to get it). I dont fax papers. I spend 5 minutes with social workers to let them know when patient might be ready for discharge. I admit 1 patient per day on average.

Things can be a lot easier in other places. For instance, my former co-resident in a small town in Missouri told me he would get to work by 9:30-10 am and be out by 4pm for 300k/yr.

 

[FutureInternist]

So I’m curious: are you responsible for doing *everything* for admitted patients, including codes and such? I ask this because wards as a resident sucked hard - I was busting my ass for an entire shift, constantly drowning in crap to do. However, my understanding is that a lot of community hospitalists don’t have to do all the crap we did as residents - they don’t do codes, they don’t admit every time they’re on, some can “round and go”, and such. That makes things much easier.

This job is ONLY worth it, if you can do “round and go”.

No codes.. except if I happen to be on the floor that it got called on, so ofcourse will go.

No procedures.

Admits - have an admitter that handles that, and if they get tok many they ask rounders for help (maybe once every 2-3 weeks, I’ll get an admit)

But..,, we need PCPs so if one has even a slight inkling towards it, please do it…. Cos I need someone to take care of me in about a decade 😏

 

[BicepsTriceps]

This job is ONLY worth it, if you can do “round and go”.

No codes.. except if I happen to be on the floor that it got called on, so ofcourse will go.

No procedures.

Admits - have an admitter that handles that, and if they get tok many they ask rounders for help (maybe once every 2-3 weeks, I’ll get an admit)

But..,, we need PCPs so if one has even a slight inkling towards it, please do it…. Cos I need someone to take care of me in about a decade 😏

1000%

Perfect hospitalist job:
Round & Go.
Reasonable census, acuity & specialists doing their part of the management.
Dedicated admitter.

Otherwise it's really one way ticket to burnout town.

Perfect PCP job is one where patients can't send messages beyond simple Meds or labs clarification.
If you have questions, symptoms, concerns ... Etc you need to book an appointment.
Enough time to finish dictation with patient in the room.
Staff to help with paper work.
3-4 days per week.

 

[Prehealth1011]

How hard is it to find round and go jobs?

 

[Splenda88]

How hard is it to find round and go jobs?

Probably not too hard. But easy to find in small towns.

Even at my residency hospital, which was at one of the most desirable cities in the country, hospitalists were allowed to leave at 3pm. Patient cap was 13 but the pay was ridiculous (210k/yr).

 

[BicepsTriceps]

Probably not too hard. But easy to find in small towns.

Even at my residency hospital, which was at one of the most desirable cities in the country, hospitalists were allowed to leave at 3pm. Patient cap was 13 but the pay was ridiculous (210k/yr).

Where is that?

I don't care about the pay I need a low census, no day admissions and appropriate acuity job.

My current job, J1 waiver job, is making me lose my mind and I can't wait to jump ship as soon as I'm liberated.