As a FM physician, how often do you see your hospitalized patients?

[Metamorphosis.DO]

Planning on applying to FM, I am wondering about inpatient medicine. While I dont plan on being a hospitalist, I find hospital medicine highly interesting.

How realistic is it to think I could treat only certain types of patients when hospitalized? I ask because a FM mentor mentioned he transitioned from treating nearly all his pts when admitted to seeing fewer and fewer while approaching retirement. I’ve since lost contact with him to ask more now that I’m a medical student.

So in a smaller, community hospital, is it realistic to think I could treat all of my geriatric patients or any diabetes-related hospitalizations or other groups based on pathology or age group like I mentioned and then defer to hospitalists for all others or if I am unavailable?

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[5150man]

I'm 13 years into private practice. Our local hospital got hospitalists 9 years ago. When they started I was planning to continue seeing my own patients and just not admit or round on my partners' patients when on call. That lasted about a week after they came. You could definitely see your own patients in a small community hospital. To do so you'd have to be ok with the money you lose by going back and forth to the hospital and not being in clinic, along with the sleep you lose by being on call for lame nurse calls at 1 am. Also, if you're private practice you'll have to be cool with the corporate bullcrap and crappy hospital EMR that you rarely use and slows down your work. I still see babies in the local hospital and they forced us to start using their EMR a few years ago. I curse it every time I have to see a baby. Oh and if you like government regulations take what you deal with in clinic and multiply by 1000 for what you have to deal with in the hospital.
Hospitalists were the best thing that happened to my life. It is worth every penny I've lost over the past 10 years.
As for cherry picking certain diagnoses. Can't imagine that would ever be accepted by any hospitalist group. Either they will see all your patients or none of your patients.

 

[Metamorphosis.DO]

I'm 13 years into private practice. Our local hospital got hospitalists 9 years ago. When they started I was planning to continue seeing my own patients and just not admit or round on my partners' patients when on call. That lasted about a week after they came. You could definitely see your own patients in a small community hospital. To do so you'd have to be ok with the money you lose by going back and forth to the hospital and not being in clinic, along with the sleep you lose by being on call for lame nurse calls at 1 am. Also, if you're private practice you'll have to be cool with the corporate bullcrap and crappy hospital EMR that you rarely use and slows down your work. I still see babies in the local hospital and they forced us to start using their EMR a few years ago. I curse it every time I have to see a baby. Oh and if you like government regulations take what you deal with in clinic and multiply by 1000 for what you have to deal with in the hospital.
Hospitalists were the best thing that happened to my life. It is worth every penny I've lost over the past 10 years.
As for cherry picking certain diagnoses. Can't imagine that would ever be accepted by any hospitalist group. Either they will see all your patients or none of your patients.

This makes sense! Thanks for the thorough reply. A bit disappointing but very helpful.

 

[FrustratedFamDoc]

How cool is your spouse with having night and evening calls from the hospital?

 

[Metamorphosis.DO]

How cool is your spouse with having night and evening calls from the hospital?

Not. 😆

 

[absolutdokta]

I work in a private practice in a small-ish community (about 12,000 with a few smaller outlying communities). We have a hospitalist that works M-Th during the day. F-Su one of the family med docs (I think there are 8 of us in the group) works as hospitalist and also covers night calls during for the week (7 days total “on call”). Most night calls are just the ER saying they want to admit someone and if it’s nothing terribly acute I just say “sounds good” and then let the hospitalist know in the morning that he has an admit (unless of course it’s F-Su, then I have to do it).

We are also on call for c-sections and assist with those. We see newborns that don’t have a doctor yet or who’s PCP doesn’t have privileges.

The hospital pays us as contract workers for that week of call and in the grand scheme of things it’s quite decent. Depending on how busy it is my paycheck for the week will be anywhere from 3,000-5,000. Of course there are always those nights that are disasters where a real sick patient will come in during the night or a newborn isn’t doing well and needs transfering. Luckily those are few and far between.

When I’m not on call I do admit my own patients. I feel like inpatient medicine keeps me thinking and learning. Plus I get to know what’s going on with my patients. Only a few docs in our group admit and care for their own patients when they aren’t on call. The others enjoy just having one week of call every 9 weeks and then never having to be back in the hospital. At times it can be a pain if I have a couple of my own patients admitted and have to go in early and round before my clinic day starts. Not gonna lie, I also like the extra pay for hospital care on my patients. Of course i don’t double dip and bill for my patients I care for while I’m on call and getting paid by the hospital.

The EMR in the hospital isn’t too bad and the hospital system is actually not too BS-ish. The hospital administrator is an awesome guy as are pretty much all the staff. A lot of it probably has to do with the community size. Some hospital employees are my patients, many others have family members that are my patients, I also went to high school with some of the nurses that work there now. All in all it’s not too bad. I do have to change my ring tone every couple of months though because after a week of calls at night I get real annoyed when I hear that ring tone after my call week ends

 

[Metamorphosis.DO]

I work in a private practice in a small-ish community (about 12,000 with a few smaller outlying communities). We have a hospitalist that works M-Th during the day. F-Su one of the family med docs (I think there are 8 of us in the group) works as hospitalist and also covers night calls during for the week (7 days total “on call”). Most night calls are just the ER saying they want to admit someone and if it’s nothing terribly acute I just say “sounds good” and then let the hospitalist know in the morning that he has an admit (unless of course it’s F-Su, then I have to do it).

We are also on call for c-sections and assist with those. We see newborns that don’t have a doctor yet or who’s PCP doesn’t have privileges.

The hospital pays us as contract workers for that week of call and in the grand scheme of things it’s quite decent. Depending on how busy it is my paycheck for the week will be anywhere from 3,000-5,000. Of course there are always those nights that are disasters where a real sick patient will come in during the night or a newborn isn’t doing well and needs transfering. Luckily those are few and far between.

When I’m not on call I do admit my own patients. I feel like inpatient medicine keeps me thinking and learning. Plus I get to know what’s going on with my patients. Only a few docs in our group admit and care for their own patients when they aren’t on call. The others enjoy just having one week of call every 9 weeks and then never having to be back in the hospital. At times it can be a pain if I have a couple of my own patients admitted and have to go in early and round before my clinic day starts. Not gonna lie, I also like the extra pay for hospital care on my patients. Of course i don’t double dip and bill for my patients I care for while I’m on call and getting paid by the hospital.

The EMR in the hospital isn’t too bad and the hospital system is actually not too BS-ish. The hospital administrator is an awesome guy as are pretty much all the staff. A lot of it probably has to do with the community size. Some hospital employees are my patients, many others have family members that are my patients, I also went to high school with some of the nurses that work there now. All in all it’s not too bad. I do have to change my ring tone every couple of months though because after a week of calls at night I get real annoyed when I hear that ring tone after my call week ends

This is very helpful. I’m seeing that location really matters.

 

[Ironheme]

Agree with the above. Can't cherry pick admits. I like hospital medicine because it is a different beast to master. I also like the different environment from outpatient. During COVID peaks though it was completely draining and being off call was a huge relief. If you were planning on seeing your own patients inpatient, likely you'd want to join an outpatient group that has a rotating call schedule unless you're in a very small community where they won't call you very frequently in the middle of the night. If you want to keep on top of hospital medicine while working full time private practice, your other option is picking up hospital shifts here and there.

 

[Splenda88]

Find a M-Thurs outpatient gig and pick up some inpatient shifts.

There are a few outpatient FM/IM docs where I work as a hospitalist who do that.

 

[FamilymedMD]

In the last 20 years our local semi-rural hospital went from everyone seeing their own inpatients to no one. With the EMR and workflow changes, I don't think you could easily see your own inpatients now even if you had call coverage. It would be simpler to moonlight as a hospitalist occasionally, they like to hire competent local docs rather than pay much more for a locums to cover shortages.

I did that for a while to fund my DPC start up but now simply make social rounds on some of my sicker inpatients. I think I'm the only local doc who does that though.

 

[BigSib]

Work in a somewhat rural community with two hospitals nearby. Our hospital-employed group has a 'secondary' hospitalist program where we see 3-5ish pts in the morning to help out the primary hospitalist, sometimes 5-8 if a weekend or holiday. If our pts are there we see them. There are a few NPs there to help out as well; they mostly maintain this program to satisfy us and pull providers from the pool when **** hits the fan or someone gets sick or something. Most rural hospitals in the Midwest that I looked at had opportunities if you asked, although most were nocturnist or weekend primary roles.

We also see newborns and peds admissions which is a separate call group rotation for neo resuscitation. So I'm in the hospital about one week per month at least before clinic. ER is an option too but the acuity is too high for my taste.

I work Mon-Thu in the office. I don't feel overworked but am something of a busy bee so perhaps it is a lot for someone, but it's very nice to get 3 day weekends throughout the year. Easily netting 250-325k/yr and not even fully booked out in the office.

We are hiring and badly need help!!

 

[Ironheme]

Work in a somewhat rural community with two hospitals nearby. Our hospital-employed group has a 'secondary' hospitalist program where we see 3-5ish pts in the morning to help out the primary hospitalist, sometimes 5-8 if a weekend or holiday. If our pts are there we see them. There are a few NPs there to help out as well; they mostly maintain this program to satisfy us and pull providers from the pool when **** hits the fan or someone gets sick or something. Most rural hospitals in the Midwest that I looked at had opportunities if you asked, although most were nocturnist or weekend primary roles.

We also see newborns and peds admissions which is a separate call group rotation for neo resuscitation. So I'm in the hospital about one week per month at least before clinic. ER is an option too but the acuity is too high for my taste.

I work Mon-Thu in the office. I don't feel overworked but am something of a busy bee so perhaps it is a lot for someone, but it's very nice to get 3 day weekends throughout the year. Easily netting 250-325k/yr and not even fully booked out in the office.

We are hiring and badly need help!!

If you don't mind sharing, how many clinic patients are you seeing per day and I presume most of that is 99214's if you're running 250-325k/yr. Does that amount include your hospitalist shifts?

 

[BigSib]

Clinic has probably 18-25 per day. It's busy. I need a scribe to keep up. There is compensation for neonatal coverage beyond the RVUs generated for seeing patients. Also compensation for supervising midlevels and other administrative work related to keeping the clinic a rural health center.