Attending life...

[W19]

What's your life like as an IM attending compared to residency? How many hours per week you work on average? You can also talk about compensation and/or salary if you don't mind sharing.

I am about to start IM residency, so I am already looking forward to it...

There is a similar thread in the gas forum, but since I am going to be an IM resident/doc, I want to hear what lies ahead from IM attendings...

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[gutonc]

Non-procedural sub-specialist. I work 3 days a week and am on call 4 weekends a year. Academish job. I can teach as much as I want (which is very little) and have a couple of small grants and am PI on half a dozen clinical trials (including one of my own). Gross is $325K/y with some bonus potential.

I could make a lot more if I worked more. Or moved somewhere that I hated. I'm pretty happy with the current situation.

 

[wamcp]

Being an attending is so much better than residency

I've worked in 4 different hospitals as a day rounding hospitalist.

One: an academic center, one service with residents (14-16 encounters a day on average. Little grunt I had to do, residents did everything, I could come in and round/teach for 2 hours then simply go home if I wanted to, but pay averaged out to $90/hr)

Two: an academic center's attending only service (10-11 encounters a day on average, very sustainable, but pay averages out to $110/hr).

Third and fourth: community shops.
One place was very sustainable with average total encounters of 10-12 per day ($125/hr, 8-5PM shifts).
Another place averaged 14-16 encounters ($140/hr, 7-5PM shifts, quite busy)

None of these places utilized midlevels (PA/NPs) for hospitalists.

The take away for the hospitalist lifestyle:
many gigs are out there to fit your preferences, but you can't have it all.
You want to get paid the most per hour? Expect to burn out like crazy like the ER docs do. We're talking nonstop admits, pages, dispo nightmares/family meetings/RRTs to deal with throughout the day with census of 20+; not doable.
You want to round for 2 hours and go home (or at least get to chill out in a call room watching netflix all day)? Sure but your pay will be reduced.

Personally, I favor the sustainable route. I'm still young so I moonlight like crazy and I'm feeling zero burnout. 90+% of the shifts I work = come in at 8AM, pick up a list of 10-12 patients, round and finish all notes/discharges by 10:30 AM, eat an early lunch, sit in a call room and play video games or watch TV or nap, admit 1 or 2 patients in the afternoon, and then leave at 5PM. I worked 290 shifts total (9 hours each shift) in the past year and made >330K for basically jerkign off >75% of the time at work.

If you look at your ER colleagues, sure they can make 300K working 192 shifts at 9 hours each but vast majority are not vegging out in a call room, they're moving the meat at 2+ patients per hour, it's manual labor

 

[ortholegoo]

Being an attending is so much better than residency

I've worked in 4 different hospitals as a day rounding hospitalist.

One: an academic center, one service with residents (14-16 encounters a day on average. Little grunt I had to do, residents did everything, I could come in and round/teach for 2 hours then simply go home if I wanted to, but pay averaged out to $90/hr)

Two: an academic center's attending only service (10-11 encounters a day on average, very sustainable, but pay averages out to $110/hr).

Third and fourth: community shops.
One place was very sustainable with average total encounters of 10-12 per day ($125/hr, 8-5PM shifts).
Another place averaged 14-16 encounters ($140/hr, 7-5PM shifts, quite busy)

None of these places utilized midlevels (PA/NPs) for hospitalists.

The take away for the hospitalist lifestyle:
many gigs are out there to fit your preferences, but you can't have it all.
You want to get paid the most per hour? Expect to burn out like crazy like the ER docs do. We're talking nonstop admits, pages, dispo nightmares/family meetings/RRTs to deal with throughout the day with census of 20+; not doable.
You want to round for 2 hours and go home (or at least get to chill out in a call room watching netflix all day)? Sure but your pay will be reduced.

Personally, I favor the sustainable route. I'm still young so I moonlight like crazy and I'm feeling zero burnout. 90+% of the shifts I work = come in at 8AM, pick up a list of 10-12 patients, round and finish all notes/discharges by 10:30 AM, eat an early lunch, sit in a call room and play video games or watch TV or nap, admit 1 or 2 patients in the afternoon, and then leave at 5PM. I worked 290 shifts total (9 hours each shift) in the past year and made >330K for basically jerkign off >75% of the time at work.

If you look at your ER colleagues, sure they can make 300K working 192 shifts at 9 hours each but vast majority are not vegging out in a call room, they're moving the meat at 2+ patients per hour, it's manual labor

How common are gigs like this? Have been interested in going hospitalist route for my career for some time but always heard that the 7 on 7 off 12 hour in house shifts weren’t sustainable. Your schedule sounds amazing!

 

[jdh71]

I don't know if I start by telling you about the cocaine or the hookers.

 

[VA Hopeful Dr]

I don't know if I start by telling you about the cocaine or the hookers.

I'd start with talking about doing cocaine off of the hookers

 

[Money Moniker]

What if you're more of a blue collar, methamphetamine guy? Will you be ostracized from the cocaine-snorting polite society as an attending?

 

[VA Hopeful Dr]

What if you're more of a blue collar, methamphetamine guy? Will you be ostracized from the cocaine-snorting polite society as an attending?

Depends where you practice

 

[Psai]

I'd start with talking about doing cocaine off of the hookers

What about doing hookers off cocaine

 

[jdh71]

What about doing hookers off cocaine

You need to go into investment banking to be able to afford that size of a pile of cocaine

 

[jdh71]

Ok seriously though. I'm PCCM (as most of you know). I work 180 "shifts" per year. We provide 24/7 in house intensivist coverage. A shift is a day in pulm clinic, a day in the ICU, or a night in the ICU (endo time can count towards these shifts). No 24 hour calls. We work in shifts. If you are in the ICU it's a 5 or 7 day stretch depending on who is going to cover the weekend. We run two folks during the day M-F. One covers the service over the weekend. We do inpatient pulm consults while in the ICU. Nights are worked as one person for a four night stretch or a three night stretch. Whatever shifts are left over I need to find time in clinic or endoscopy to see patients or do procedures (I currrntly have say in the specifics of the scheduling provided I get in my contracted number of shifts) . I do about half and half in and out. Last year I did too many nights (49) and got paid a little extra for it. I'm also medical director for resp therapy. Altogether doing a tiny bit over $400k but we could have a bad quality year and that could tank closer to $350. Also production can push that number higher but I like seeing my wife and kids. Plus I run and do crossfit.

Clinics weeks are 8-5. I usually do procedures Tuesday afternoons or Fridays. So if I have none these that is time off. With our current structure I only work 1/6 weekends (some of those are nights) so most off. When I'm busy in the ICU I'm busy. 80 hour weeks. It's a ~400 bed hospital a long ways from most university centers and we do everything that isn't transplant or VADs. Patients are and can be very sick. The hospital leans on us heavily. We take care of sick hearts and heads. Plus anything the gen surgeons or surgical subspecialists break or can't take care of or won't take care of. There is too much "super hospitalist" work but meh. Can't change that.

Overall I like it. I'm a bit of a workaholic. Some times I get a bit fried. But I'm able to schedule really nice long vacations. I'm currently posting this from a tropical spot. Poolside.

 

[Psai]

Ok seriously though. I'm PCCM (as most of you know). I work 180 "shifts" per year. We provide 24/7 in house intensivist coverage. A shift is a day in pulm clinic, a day in the ICU, or a night in the ICU (endo time can count towards these shifts). No 24 hour calls. We work in shifts. If you are in the ICU it's a 5 or 7 day stretch depending on who is going to cover the weekend. We run two folks during the day M-F. One covers the service over the weekend. We do inpatient pulm consults while in the ICU. Nights are worked as one person for a four night stretch or a three night stretch. Whatever shifts are left over I need to find time in clinic or endoscopy to see patients or do procedures (I currrntly have say in the specifics of the scheduling provided I get in my contracted number of shifts) . I do about half and half in and out. Last year I did too many nights (49) and got paid a little extra for it. I'm also medical director for resp therapy. Altogether doing a tiny bit over $400k but we could have a bad quality year and that could tank closer to $350. Also production can push that number higher but I like seeing my wife and kids. Plus I run and do crossfit.

Clinics weeks are 8-5. I usually do procedures Tuesday afternoons or Fridays. So if I have none these that is time off. With our current structure I only work 1/6 weekends (some of those are nights) so most off. When I'm busy in the ICU I'm busy. 80 hour weeks. It's a ~400 bed hospital a long ways from most university centers and we do everything that isn't transplant or VADs. Patients are and can be very sick. The hospital leans on us heavily. We take care of sick hearts and heads. Plus anything the gen surgeons or surgical subspecialists break or can't take care of or won't take care of. There is too much "super hospitalist" work but meh. Can't change that.

Overall I like it. I'm a bit of a workaholic. Some times I get a bit fried. But I'm able to schedule really nice long vacations. I'm currently posting this from a tropical spot. Poolside.

How awesome can the pool be if you're still on sdn

 

[unnumzaan]

Ok seriously though. I'm PCCM (as most of you know). I work 180 "shifts" per year.

Overall I like it. I'm a bit of a workaholic. Some times I get a bit fried. But I'm able to schedule really nice long vacations. I'm currently posting this from a tropical spot. Poolside.

If you don't mind enlightening young minds while on vacation, how are your 180 shifts structured? Aka 7on/7off, 5/5, 4/3, willy nilly, etc. And how much vacation do you get on top of the off blocks?

 

[jdh71]

If you don't mind enlightening young minds while on vacation, how are your 180 shifts structured? Aka 7on/7off, 5/5, 4/3, willy nilly, etc. And how much vacation do you get on top of the off blocks?

I tried to explain it but I can see how it might not be super clear.

We staff the ICU schedule first. We cover the ICU in house 24/7. There are two of us on M-F days. One of those folks covers the weekend Sat/Sun. There is one of us on at night M-Th and Fr-Su. The shifts are 7a to 7p. One of the day guys leaves early during the week.

After we have filled the ICU schedule, you subtract those shifts from the amount required and those are your number of clinic day shifts. You make those up how you want, provided they get done.

You don't get formal "vacation". You schedule your time off around the shift schedule. It's actually better this way. Makes the contract and payment a much more "clean" process.

Was that a bit clearer?

 

[InvestingDoc]

I work about 40% of the hours I worked in residency and make about 6 times as much.

Life is great

 

[unnumzaan]

I tried to explain it but I can see how it might not be super clear.

We staff the ICU schedule first. We cover the ICU in house 24/7. There are two of us on M-F days. One of those folks covers the weekend Sat/Sun. There is one of us on at night M-Th and Fr-Su. The shifts are 7a to 7p. One of the day guys leaves early during the week.

After we have filled the ICU schedule, you subtract those shifts from the amount required and those are your number of clinic day shifts. You make those up how you want, provided they get done.

You don't get formal "vacation". You schedule your time off around the shift schedule. It's actually better this way. Makes the contract and payment a much more "clean" process.

Was that a bit clearer?

Crystal clear, thanks!

 

[medhead1990]

Being an attending is so much better than residency

I've worked in 4 different hospitals as a day rounding hospitalist.

One: an academic center, one service with residents (14-16 encounters a day on average. Little grunt I had to do, residents did everything, I could come in and round/teach for 2 hours then simply go home if I wanted to, but pay averaged out to $90/hr)

Two: an academic center's attending only service (10-11 encounters a day on average, very sustainable, but pay averages out to $110/hr).

Third and fourth: community shops.
One place was very sustainable with average total encounters of 10-12 per day ($125/hr, 8-5PM shifts).
Another place averaged 14-16 encounters ($140/hr, 7-5PM shifts, quite busy)

None of these places utilized midlevels (PA/NPs) for hospitalists.

The take away for the hospitalist lifestyle:
many gigs are out there to fit your preferences, but you can't have it all.
You want to get paid the most per hour? Expect to burn out like crazy like the ER docs do. We're talking nonstop admits, pages, dispo nightmares/family meetings/RRTs to deal with throughout the day with census of 20+; not doable.
You want to round for 2 hours and go home (or at least get to chill out in a call room watching netflix all day)? Sure but your pay will be reduced.

Personally, I favor the sustainable route. I'm still young so I moonlight like crazy and I'm feeling zero burnout. 90+% of the shifts I work = come in at 8AM, pick up a list of 10-12 patients, round and finish all notes/discharges by 10:30 AM, eat an early lunch, sit in a call room and play video games or watch TV or nap, admit 1 or 2 patients in the afternoon, and then leave at 5PM. I worked 290 shifts total (9 hours each shift) in the past year and made >330K for basically jerkign off >75% of the time at work.

If you look at your ER colleagues, sure they can make 300K working 192 shifts at 9 hours each but vast majority are not vegging out in a call room, they're moving the meat at 2+ patients per hour, it's manual labor

The first example was a similar schedule to what I saw my attending with residnets had. He would be in at 8 or 9ish and was almost always done by lunch. I thought he had just won the lottery and found a super cush job. Is that pretty much the status quo for most academic inpatient settings?

 

[DoubleBogey]

The first example was a similar schedule to what I saw my attending with residnets had. He would be in at 8 or 9ish and was almost always done by lunch. I thought he had just won the lottery and found a super cush job. Is that pretty much the status quo for most academic inpatient settings?

When I did academic Hospitalist at where I trained, they would have teaching and non-teaching. Typically teaching weeks were much easier than non-teaching service. At an academic center, attendings have to place all their orders, call c/s and take pushback from residents on speciality services and nursing staff/social work is slow (training center for all healthcare workers). Doesn’t pay well at all, but much easier lifestyle and fun teaching during rounds.

 

[deleted103644]

I don't know if I start by telling you about the cocaine or the hookers.

Why choose?

 

[Psai]

The first example was a similar schedule to what I saw my attending with residnets had. He would be in at 8 or 9ish and was almost always done by lunch. I thought he had just won the lottery and found a super cush job. Is that pretty much the status quo for most academic inpatient settings?

That's what I thought and then I caught one of my attendings there at 9 pm going over everything we did that day

 

[W19]

I work about 40% of the hours I worked in residency and make about 6 times as much.

Life is great

That will put me above the 300k mark... Life is going to be good 🙂

 

[TrueConjecture]

Subspecialist attending. The difference between residency/fellowship and attending life is incredibly noticeable almost immediately. The obvious: My annual income went up about 3x-3.5x just in Year 1, which helped me sleep much easier about 95% of the time.

Also:
* Fewer people breathing down my neck... actually, almost nobody.
* When rounding, I can now eat or take a poop literally whenever I damn well please.
* Others in the healthcare team can be so respectful now it's almost uncomfortable. Being called "sir" still feels weird.
And about 50 other things.

There are a few drawbacks, but just a few. They are small and obvious.

 

[wamcp]

Subspecialist attending. The difference between residency/fellowship and attending life is incredibly noticeable almost immediately. The obvious: My annual income went up about 3x-3.5x just in Year 1, which helped me sleep much easier about 95% of the time.

Also:
* Fewer people breathing down my neck... actually, almost nobody.
* When rounding, I can now eat or take a poop literally whenever I damn well please.
* Others in the healthcare team can be so respectful now it's almost uncomfortable. Being called "sir" still feels weird.
And about 50 other things.

There are a few drawbacks, but just a few. They are small and obvious.

3-3.5x seems awfully low after fellowship. First year as hospitalist I made 6x residency income...

 

[CatFactorial]

3-3.5x seems awfully low after fellowship. First year as hospitalist I made 6x residency income...

 

[W19]

Assuming the poster was making 50k/yr as a PGY3, that's 300k/yr as a hospitalist. This is not atypical.

 

[CatFactorial]

Assuming the poster was making 50k/yr as a PGY3, that's 300k/yr as a hospitalist. This is not atypical.

Your grasp of arithmetic impresses me.

 

[W19]

Your grasp of arithmetic impresses me.

Thank God I am not an accountant...😛

 

[Money Moniker]

3-3.5x seems awfully low after fellowship. First year as hospitalist I made 6x residency income...

WAMPC made a very legitimate point. 3 times the salary of a resident/fellow is a whopping 180k max, which is pretty pathetic to show for 3 years of residency + X years of fellowship. Not sure why you're bringing the snark. Only reason I even mention this is because if we accept and are happy with lowball salaries, that's all we're going to be offered.

 

[TrueConjecture]

3-3.5x seems awfully low after fellowship. First year as hospitalist I made 6x residency income...

Two points:
1.) When I ended fellowship, I was also moonlighting on top of my PGY salary and grossing a hefty amount from that.
2.) Hospitalist and subspecialty attending salaries are apples and oranges. I am thankful that people are hospitalists and able to stomach the things I wouldn't want to spend my time doing. Even if that means I trained a bit longer to get paid a little less in the beginning.

 

[Melchizedek]

How awesome can the pool be if you're still on sdn

I think you underestimate jdh’s SDN addiction. It’s worse than his hookers and blow habit

 

[CatFactorial]

WAMPC made a very legitimate point. 3 times the salary of a resident/fellow is a whopping 180k max, which is pretty pathetic to show for 3 years of residency + X years of fellowship. Not sure why you're bringing the snark. Only reason I even mention this is because if we accept and are happy with lowball salaries, that's all we're going to be offered.

Sorry I can’t control my micro aggressions, I hope you and WAMPC will be okay

 

[Money Moniker]

Sorry I can’t control my micro aggressions, I hope you and WAMPC will be okay

It's not a microaggression, it's stupidity.

 

[IMreshopeful]

It's not a microaggression, it's stupidity.

Well that escalated quickly