Being a hospitalist sucks, and I'm quitting

[helpfulApu]

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Let me start by saying I respect all the hospitalists out there who have been grinding it out for years

The post that led me to start this thread is this one:

’ve been practicing inpatient medicine exclusively for over 20 years. The pace hasn’t slowed, and the profession doesn’t necessarily become more fulfilling with time. If anything, the demands have intensified.

Burnout doesn’t go away — it just becomes more familiar. While you gain confidence in clinical judgment, the emotional and systemic weight of the job only grows. You stay in it because you’re committed, but not because it gets easier. Resilience becomes the baseline.

Let me just start by saying - I think that patient's have lost their minds (and manners) post pandemic. Every working day, I am astounded by the absolute arrogance, entitlement, and sheer stupidity of patients and their families. It seems that the collective neurosis of the general population has boiled down to self-soothing via checking BP and blood glucose. Patients/families either delude themselves regarding end stage conditions because "his blood pressure is good!", or abuse me because their otherwise well mother who was kept NPO for a procedure had BG of 90, and "you can't starve a [type 2, obese, with extensive fat reserves] diabetic!"

The 21st Century CURES Act only catalyzed the collective deterioration into mass psychosis. We don't fully trust interns - graduated doctors, may I add - to reliably interpret labs and diagnostic studies. Now, any patient/family, regardless of education level, can accost you about a hemoglobin "falling", or an eGFR "that used to be >90, but now is 87???!!!!!" Almost every patient encounter feels like I am an academic attending teaching to pre-meds who think they are my boss. Patients/families expect the utmost of respect from their hospitalist, no matter how much they fail in holding up their end of 2-way courtesy. It's funny, because none of them would allow for being told how to do their own jobs (typically at some cushy public servant job, where there is no accountability). But if you dare insinuate that they shouldn't tell a physician how to do his/her job, their jaw drops in shock, and their eyes immediately scan your name tag (in order to run to the system and report you)

There can't be any job more infuriating than hospitalist other than being a bedside RN. My stint as a hospitalist has only made me more empathetic towards our bedside RNs. At least I can leave after a brief interaction with delusional families and their actively-dying-since-2010 loved ones. I can't imagine being helpless RN subject to the mercy/wrath of these freaks. This is not even to mention the absolute abuse endured by ancillary staff such as nurse techs and food service - the patients/families treat these people like simultaneous emotional punching bags.

The job would be better if there was any sense of collegiality. Instead, it seems like all the specialists, ER physicians, and hospitalists around me have descended into a "F*ck you, I got mine" mentality. There is no minimum standard of care that we are trying to achieve - everyone just seems to be scraping the bottom of the barrel: anchoring diagnoses on whatever the minimum wage EMT said, not seeing patients but documenting as if they did, documenting that workups/treatments are ordered but not ordering them, and failing to even look 2 days in the past at prior records in order to fit a story together. On this point, if I have to admit another 100 year old that is on beta-blockers and eliquis for symptomatic bradycardia and GI bleeding, I am going to lose my mind. It seems that nobody has any common sense that even a high-schooler could summon regarding our patients. Instead, we admit and have Cardiology, EP, and GI consultations, only to discharge on some weird mixture of follow up instructions involving checking in with a Cardiologist in 7-14 days on whether the patient born in the Great Recession should resume her eliquis for net negative -1% risk reduction in annual stroke prevention

Maybe the families could center us intellectual, ivory-tower physicians, with their grit and common sense. But no - MeeMaw is a fighter, and provides a $800 social security check that can be used for jet-ski leases. So full code, and every aggressive measure possible, please!

Soupbone (the quote I included above) would agree - this job has only deteriorated over the years. I suspect the deterioration must be more than tangentially related to an overall societal decline. From what I see, the only hospitalists who stick it out are those with a ton of resilience. But, in this context, resilience is being mistaken for emptiness.

Before I took this job, I was advised that "hospitalist is only for those with thick skin"

I thought I had thick skin, but this job showed me that "having thick skin" is more about becoming a numb and hollow shell of who you once were. I feel sorry for my fellow hospitalists who grind it out, day in and day out, being abused by various specialists, patients, families, insurance peer 2 peer scheduling agents at the call center, janitors, and pretty much everyone you can think of. We are simultaneously secretaries and "the doctor!", expected to solve any acute problem at a moment's notice while simultaneously attending to "families highly concerned about why there hasn't been a 14th CT Head ordered" and knowing our role by slinking away while the slick specialists give their recommendations (without having any clue what their partner recommended 1 day prior, because chart review is for suckers and hospitalists)

One of the greatest reliefs I ever felt was turning in my notice of leaving this field. I feel sorry for whoever has to stick it out in this grind. I look forward to the posters who are as equally delusional as our patients/families, who will chime in with snide remarks about how great their specific job is, and how they are respected, and how they get paid $1M / annum to see 2 patients per day. I'll call a Psychiatry consult in for you, only to get snubbed by the Mental Health ARNP who thinks they are smarter than me.

I'm leaving, and never looking back. Last warning to graduating residents: don't do it, unless you're catatonic.

-helpfulApu

 

[chessknt]

Pretty much everyone feels this way but, you know, has to actually work because they need money....

 

[DrMetal]

I'm leaving, and never looking back. Last warning to graduating residents: don't do it, unless you're catatonic.

-helpfulApu

You're not wrong about anything you said in your post. We've all made similar observations.

But it's all about how your perceive things. In the same way you try to convince a chronic pain patient to get out of their own heads and stop perceiving every sensation as pain, I'd encourage you to stop perceiving every difficulty as a personal insult or injury.

I quote the great Albert Einstein: "Weak people revenge, strong people forgive, the intelligent ignore"

I'm definitely in the "ignore" phase at this point of life (middle-aged hospitalist).

Now pray tell: what is your alternative plan? I can guarantee you the grass isn't always greener.

I'll stick with hospital medicine. It's the beast I know.

 

[dozitgetchahi]

Let me start by saying I respect all the hospitalists out there who have been grinding it out for years

The post that led me to start this thread is this one:



Let me just start by saying - I think that patient's have lost their minds (and manners) post pandemic. Every working day, I am astounded by the absolute arrogance, entitlement, and sheer stupidity of patients and their families. It seems that the collective neurosis of the general population has boiled down to self-soothing via checking BP and blood glucose. Patients/families either delude themselves regarding end stage conditions because "his blood pressure is good!", or abuse me because their otherwise well mother who was kept NPO for a procedure had BG of 90, and "you can't starve a [type 2, obese, with extensive fat reserves] diabetic!"

The 21st Century CURES Act only catalyzed the collective deterioration into mass psychosis. We don't fully trust interns - graduated doctors, may I add - to reliably interpret labs and diagnostic studies. Now, any patient/family, regardless of education level, can accost you about a hemoglobin "falling", or an eGFR "that used to be >90, but now is 87???!!!!!" Almost every patient encounter feels like I am an academic attending teaching to pre-meds who think they are my boss. Patients/families expect the utmost of respect from their hospitalist, no matter how much they fail in holding up their end of 2-way courtesy. It's funny, because none of them would allow for being told how to do their own jobs (typically at some cushy public servant job, where there is no accountability). But if you dare insinuate that they shouldn't tell a physician how to do his/her job, their jaw drops in shock, and their eyes immediately scan your name tag (in order to run to the system and report you)

There can't be any job more infuriating than hospitalist other than being a bedside RN. My stint as a hospitalist has only made me more empathetic towards our bedside RNs. At least I can leave after a brief interaction with delusional families and their actively-dying-since-2010 loved ones. I can't imagine being helpless RN subject to the mercy/wrath of these freaks. This is not even to mention the absolute abuse endured by ancillary staff such as nurse techs and food service - the patients/families treat these people like simultaneous emotional punching bags.

The job would be better if there was any sense of collegiality. Instead, it seems like all the specialists, ER physicians, and hospitalists around me have descended into a "F*ck you, I got mine" mentality. There is no minimum standard of care that we are trying to achieve - everyone just seems to be scraping the bottom of the barrel: anchoring diagnoses on whatever the minimum wage EMT said, not seeing patients but documenting as if they did, documenting that workups/treatments are ordered but not ordering them, and failing to even look 2 days in the past at prior records in order to fit a story together. On this point, if I have to admit another 100 year old that is on beta-blockers and eliquis for symptomatic bradycardia and GI bleeding, I am going to lose my mind. It seems that nobody has any common sense that even a high-schooler could summon regarding our patients. Instead, we admit and have Cardiology, EP, and GI consultations, only to discharge on some weird mixture of follow up instructions involving checking in with a Cardiologist in 7-14 days on whether the patient born in the Great Recession should resume her eliquis for net negative -1% risk reduction in annual stroke prevention

Maybe the families could center us intellectual, ivory-tower physicians, with their grit and common sense. But no - MeeMaw is a fighter, and provides a $800 social security check that can be used for jet-ski leases. So full code, and every aggressive measure possible, please!

Soupbone (the quote I included above) would agree - this job has only deteriorated over the years. I suspect the deterioration must be more than tangentially related to an overall societal decline. From what I see, the only hospitalists who stick it out are those with a ton of resilience. But, in this context, resilience is being mistaken for emptiness.

Before I took this job, I was advised that "hospitalist is only for those with thick skin"

I thought I had thick skin, but this job showed me that "having thick skin" is more about becoming a numb and hollow shell of who you once were. I feel sorry for my fellow hospitalists who grind it out, day in and day out, being abused by various specialists, patients, families, insurance peer 2 peer scheduling agents at the call center, janitors, and pretty much everyone you can think of. We are simultaneously secretaries and "the doctor!", expected to solve any acute problem at a moment's notice while simultaneously attending to "families highly concerned about why there hasn't been a 14th CT Head ordered" and knowing our role by slinking away while the slick specialists give their recommendations (without having any clue what their partner recommended 1 day prior, because chart review is for suckers and hospitalists)

One of the greatest reliefs I ever felt was turning in my notice of leaving this field. I feel sorry for whoever has to stick it out in this grind. I look forward to the posters who are as equally delusional as our patients/families, who will chime in with snide remarks about how great their specific job is, and how they are respected, and how they get paid $1M / annum to see 2 patients per day. I'll call a Psychiatry consult in for you, only to get snubbed by the Mental Health ARNP who thinks they are smarter than me.

I'm leaving, and never looking back. Last warning to graduating residents: don't do it, unless you're catatonic.

-helpfulApu

I ended up specializing because residency made it clear that being a hospitalist would suck. I’ve never understood why some docs like it so much. That said, I encounter a lot of this nonsense daily as an outpatient rheumatologist too. Complaints about pure nonsense, patients obsessing over irrelevant and meaningless things, nasty and unpleasant patients, etc. The “general public” has become horrible to deal with.

 

[Mehena]

Agreed—and I could easily switch the title to “Being an Oncologist,” and the post would still make sense. It doesn’t get better in the outpatient setting. It’s not just the general public that’s difficult; as physicians, we’ve become so fragmented and balkanized. The system is overrun with too many “Karens and Kens,” making it even harder to focus on the core of practicing medicine. Gone are the days of pure clinical work and mutual respect for the value we provide.

 

[VA Hopeful Dr]

You're not wrong about anything you said in your post. We've all made similar observations.

But it's all about how your perceive things. In the same way you try to convince a chronic pain patient to get out of their own heads and stop perceiving every sensation as pain, I'd encourage you to stop perceiving every difficulty as a personal insult or injury.

I quote the great Albert Einstein: "Weak people revenge, strong people forgive, the intelligent ignore"

I'm definitely in the "ignore" phase at this point of life (middle-aged hospitalist).

Now pray tell: what is your alternative plan? I can guarantee you the grass isn't always greener.

I'll stick with hospital medicine. It's the beast I know.

I feel like this is true for almost every physician. If a patient is a jerk or another specialist is shirking their responsibilities, my response is kinda "meh". I will do my job as I always have but if someone else is causing a problem I remind myself that its not MY problem.

Also as my former hospitalist wife says, being a hospitalist is like being a very well-paid resident. If you're OK with that, its not a bad gig.

 

[helpfulApu]

I don’t think being a specialist or solely outpatient is amazing compared to the pitfalls of being a hospitalist, and never said that. In fact, my stent as a hospitalist only convinced me not to specialize, as you only trade the pain points of hospitalist with another set i.e. my chart messages. I’ll never forget how a family members eyes widened in shock and then narrowed in order to read my name tag (to report me, I’m sure) when I told him I would not be discharging and later, sending a my chart message with the discharge instructions once I finally hear fromthe specialist who we hadn’t been able to get a hold of and was expecting us to read his mind. although, whereas hospitalist don’t really have anyone to lash out on besides nursing staff, I suppose – which will only make your life harder as you rely on them heavily as your eyes and ears – the specialist frequently can lash out directly or indirectly at hospitalists as one way of punching down. It feels like half my day is spent either chasing them down for Recs or trying to get them to address the questions that patient specifically have for them that weren’t addressed because they popped their head in from the door for all four seconds.

The underlying issue was clearly the exaggerated expectations of a patient population that has been hammered into believing that their personal health is a national priority, and they use that in a Weaponized fashion, by either spamming my chart messages from their couch, or showing up at the ER, for reasons usually ranging from trying to win an argument, get attention, or to shirk their familial responsibilities for a holiday weekend getaway. of course, in between, will slip through a true case of pathology which you have to attend to while getting hammer paged about blood pressures 150 and why has home lisinopril not been resumed, daughter at bedside, “ highly concerned”, in her mother, (who’s here with AKI by the way) and wants to discuss right now, and also the insurance has given you one hour to call back for the peer to peer and are foaming at the mouth to blame you for the denial because you didn’t call back. Not to even mention that case is a train wreck, and if they even successfully get approved for inpatient rehab, will be back in two days with a CHF exacerbation anyway.

The Karen and Ken thing is so true. Apparently, intellectual debates about semantics of a defensive radiologists verbiage can reverse axonal injuries – or so families seem to think. I would reconsult the neurologist that the family is demanding to talk to, but I’m afraid I won’t get any recs other than continue with atorvastatin,

 

[dozitgetchahi]

I don’t think being a specialist or solely outpatient is amazing compared to the pitfalls of being a hospitalist, and never said that. In fact, my stent as a hospitalist only convinced me not to specialize, as you only trade the pain points of hospitalist with another set i.e. my chart messages. I’ll never forget how a family members eyes widened in shock and then narrowed in order to read my name tag (to report me, I’m sure) when I told him I would not be discharging and later, sending a my chart message with the discharge instructions once I finally hear fromthe specialist who we hadn’t been able to get a hold of and was expecting us to read his mind. although, whereas hospitalist don’t really have anyone to lash out on besides nursing staff, I suppose – which will only make your life harder as you rely on them heavily as your eyes and ears – the specialist frequently are there lash out directly or indirectly by ignoring or being unresponsive to patients. It feels like half my day is spent either chasing them down for Recs or trying to get them to address the questions that patient specifically have for them that weren’t addressed because they popped their head in from the door for all four seconds.

The underlying issue was clearly the exaggerated expectations of a patient population that has been hammered into believing that their personal health is a national priority, and they use that in a Weaponized fashion, by either spamming my chart messages from their couch, or showing up at the ER, for reasons usually ranging from trying to win an argument, get attention, or to shirk their familial responsibilities for a holiday weekend getaway. of course, in between, will slip through a true case of pathology which you have to attend to while getting hammer paged about blood pressures 150 and why has home lisinopril not been resumed, daughter at bedside, “ highly concerned”, in her mother, (who’s here with AKI by the way) and wants to discuss right now, and also the insurance has given you one hour to call back for the peer to peer and are foaming at the mouth to blame you for the denial because you didn’t call back. Not to even mention that case is a train wreck, and if they even successfully get approved for inpatient rehab, will be back in two days with a CHF exacerbation anyway.

The Karen and Ken thing is so true. Apparently, intellectual debates about semantics of a defensive radiologists verbiage can reverse external injuries – or so families seem to think. I would reconsuly the neurologist that the family is demanding to talk to, but I’m afraid I won’t get any recs other than continue with atorvastatin,

Don’t get me wrong - I think being an OP specialist is pretty good overall. I don’t have a lot of complaints with my current gig, aside from also noticing that the general level of politeness and pleasantness among patients is declining.

 

[DrMetal]

I don’t think being a specialist or solely outpatient is amazing compared to the pitfalls of being a hospitalist, and never said that. In fact, my stent as a hospitalist only convinced me not to specialize, as you only trade the pain points of hospitalist with another set

Ok, so what are you gonna do?

You may be taking things a little too personally. When patients threaten to complain, I encourage them to write down my name and spell it correctly on said complaint. My brain then moves on to the next thought, usually about by my golf swing, next guitar, or next whiskey purchase.

 

[helpfulApu]

I am not threatened by their presumable reports and am transparent with the spelling of my name as well, because I recognize the chasm between what the general population's expectation of standard of care is versus what the standard of care really is. And I am generally confident in my ability to meet it.

That's great that you compartmentalize your interactions and are ostensibly unbothered by the unpleasant ones. I do too now (though I was completely unequipped to do so when I started, and my personal life suffered immensely as a result). I would say that having such a split between encounters with the people I signed up to serve, and who I really am, led me to worry about where I was headed - from a psychologic perspective - if I continued on this path. Patching holes on sinking ships makes holes in my own ship.

Doesn't matter what I'm doing. It's not this thats for sure

 

[sloh]

Agreed—and I could easily switch the title to “Being an Oncologist,” and the post would still make sense. It doesn’t get better in the outpatient setting. It’s not just the general public that’s difficult; as physicians, we’ve become so fragmented and balkanized. The system is overrun with too many “Karens and Kens,” making it even harder to focus on the core of practicing medicine. Gone are the days of pure clinical work and mutual respect for the value we provide.

Agreed, this isn’t specialty specific. As @RustedFox would say, “the problem is the patient.”

 

[helpfulApu]

I would say there has to be some specificity towards specialty as there is a reason – or many – for the competitiveness of various fields and the trends in residency and fellowship matching. If there was no specialty specific complaints there would be a uniform distribution of FMG‘s in Mohs surgery, breast, radiology and hospitalist.

 

[sloh]

I would say there has to be some specificity towards specialty as there is a reason – or many – for the competitiveness of various fields and the trends in residency and fellowship matching. If there was no specialty specific complaints there would be a uniform distribution of FMG‘s in Mohs surgery, breast, radiology and hospitalist.

The competitiveness is largely driven by compensation differences between specialties though. If a physician gets paid enough, they’ll put up with a lot of headaches.

 

[sloh]

Also, do you mind answering the question of what you’re doing for money now that you are quitting hospitalist medicine?

 

[helpfulApu]

I feel like this is true for almost every physician. If a patient is a jerk or another specialist is shirking their responsibilities, my response is kinda "meh". I will do my job as I always have but if someone else is causing a problem I remind myself that its not MY problem.

Also as my former hospitalist wife says, being a hospitalist is like being a very well-paid resident. If you're OK with that, its not a bad gig.

it is YOUR / MY problem, as the listed attending/primary, when you have to see these patients every day and answer to them for the failings of others.

And, as a senior resident, what I lacked in time/income, was made up for with camaraderie and communication across the various services. Trainees are generally held to a standard – probably out of fear of repercussion – of accountability that I find nowhere in the real world aside from isolated encounters with colleagues who still have some spark left in them.

 

[Crayola227]

Lol at arguing with this guy how much being a hospitalist truly sucks, and doing so by saying how much it sucks in all fields, while also saying it isn't that bad

Also overall irony saying the solution is to stop being a doctor that cares

 

[DrMetal]

Also overall irony saying the solution is to stop being a doctor that cares

That's the spirit! It's tough to care about things you have no control over.

 

[thumbz]

But like... what's better?

Working at Home Depot and getting yelled at by entitled customers?

Getting coffee thrown at you in Starbucks?

Working for Google and getting randomly laid off while being expected to work 60-70 hours a week if you want to keep your job?

Every job out there can suck. The goal is to find a job you can tolerate in a field you enjoy doing. I love medicine, and happened to find a job that I can tolerate (well actually I enjoy it). Hopefully your next adventure will allow you to find this as well!

 

[anonperson]

I would say there has to be some specificity towards specialty as there is a reason – or many – for the competitiveness of various fields and the trends in residency and fellowship matching. If there was no specialty specific complaints there would be a uniform distribution of FMG‘s in Mohs surgery, breast, radiology and hospitalist.

Specialty differences are due to numerous factors but these are the big two:
Compensation
Work life balance
Competitiveness of specialty which is due to the above and also the number of spots

Internal medicine has a massive number of spots so much easier to match compared to derm/ rads.

If hospitalists were paid Ortho money, I'm sure your tolerance for BS would be high.

 

[anonperson]

I am not threatened by their presumable reports and am transparent with the spelling of my name as well, because I recognize the chasm between what the general population's expectation of standard of care is versus what the standard of care really is. And I am generally confident in my ability to meet it.

That's great that you compartmentalize your interactions and are ostensibly unbothered by the unpleasant ones. I do too now (though I was completely unequipped to do so when I started, and my personal life suffered immensely as a result). I would say that having such a split between encounters with the people I signed up to serve, and who I really am, led me to worry about where I was headed - from a psychologic perspective - if I continued on this path. Patching holes on sinking ships makes holes in my own ship.

Doesn't matter what I'm doing. It's not this thats for sure

People are annoying. Doesn't matter which specialty.

Hospitalist work sucking is because it takes place in a hospital. Being in a hospital is terrible in general because a significant number of patients are degenerates and hospitals can be dysfunctional places.

Couple that with the potentially long shifts and having to deal with the ED etc. It shouldn't be a big surprise to any resident.

But it's a job and you can become a millionaire a few times over relatively easily which isn't bad.

 

[Crayola227]

But like... what's better?

Working at Home Depot and getting yelled at by entitled customers?

Getting coffee thrown at you in Starbucks?

Working for Google and getting randomly laid off while being expected to work 60-70 hours a week if you want to keep your job?

Every job out there can suck. The goal is to find a job you can tolerate in a field you enjoy doing. I love medicine, and happened to find a job that I can tolerate (well actually I enjoy it). Hopefully your next adventure will allow you to find this as well!

Point taken.

I mean, he said he was quitting being a hospitalist, not not using the MD at all. Why is this a choice between working at Home Depot and hospitalist? 🤣 are we sure being a hospitalist is better than working at home depot? 🤣 as a construction contractor's wife we spend inordinate amounts of time at Home Depot, it doesn't seem that bad? 😅

I mean I think it's a little silly to suggest we are the only ones with the best job in the world as a cope for the suck. I have lots of friends doing other things, they don't make as much money, but money isn't everything. Anyway lots of my friends do other things and it sounds better than this guy's job.

 

[Crayola227]

I mean I think there's an argument for what this guy is saying, as there is for all the other points. The suck is real though. Happiness is not assured anywhere, but it misery dies exist within hospitalist and happiness can exist outside.

For my part, my frustration was the pace. To me most of what he talked about is more manageable and with more sense of "feel good" if only there is enough time, which there isn't. Time to educate families, to talk. Time to do a complete job. Lack of autonomy, fast pace and long hours is a killer in any job, for sure.

 

[DrMetal]

The problem with us physicians (and what leads us to this point) is that we don't know how to have a life outside of medicine.

We're so engrained in what we do, we work so hard (as pre-meds, medical students, trainees, attendings), that we really don't know much else in life.

I know physician friends who grew up in California, who have no idea where the state of Oregon is. No idea what decade WW2 was fought in. No idea who John Lennon was, or how he died (look him up).

When asked what their hobbies are, they'll reply "spending time with family" . . . not understanding the concept of a hobby (which is a purposefully-selfish act, something you do only for yourself).

This is what leads to burnout. It's not the job, it's the lack of everything else.

 

[sloh]

When asked what their hobbies are, they'll reply "spending time with family" . . . not understanding the concept of a hobby (which is a purposefully-selfish act, something you do only for yourself).

This is what leads to burnout. It's not the job, it's the lack of everything else.

This. The job can be much more bearable (and even enjoyable) once you separate your identity from it. It's a job to put food on the table, support your family financially, just like any other job. Do your job and your part, and don't get too worked up over things you can't control. Find meaning outside of work.

 

[HemeOncHopeful19]

But like... what's better?

Working at Home Depot and getting yelled at by entitled customers?

Getting coffee thrown at you in Starbucks?

Working for Google and getting randomly laid off while being expected to work 60-70 hours a week if you want to keep your job?

Every job out there can suck. The goal is to find a job you can tolerate in a field you enjoy doing. I love medicine, and happened to find a job that I can tolerate (well actually I enjoy it). Hopefully your next adventure will allow you to find this as well!

Nurse management seems like a pretty good gig lol

 

[HemeOncHopeful19]

I mean I think there's an argument for what this guy is saying, as there is for all the other points. The suck is real though. Happiness is not assured anywhere, but it misery dies exist within hospitalist and happiness can exist outside.

For my part, my frustration was the pace. To me most of what he talked about is more manageable and with more sense of "feel good" if only there is enough time, which there isn't. Time to educate families, to talk. Time to do a complete job. Lack of autonomy, fast pace and long hours is a killer in any job, for sure.

Agree 100% the pace of my job in the face of declining reimbursement and pressure to see more more more to keep up with the pay that was available 10 years ago 25% fewer patient encounters per day is probably the worst part of my job in the big picture

 

[dozitgetchahi]

That's the spirit! It's tough to care about things you have no control over.

It really is an important strategy.

Now I’m not saying “don’t care about anything that pertains to being a doctor”. I’ve encountered some really lazy, ****ty doctors who clearly don’t care about anything anymore, including performing their job to an acceptable level (that’s part of what OP is complaining about, and I agree).

But patient beefs? Nonsense with insurance companies? Navigate the situation as quickly and easily as you can, and move on. I try not to let any of that stuff take up more than 30 seconds of brainspace or bandwidth.

 

[gutonc]

It really is an important strategy.

Now I’m not saying “don’t care about anything that pertains to being a doctor”. I’ve encountered some really lazy, ****ty doctors who clearly don’t care about anything anymore, including performing their job to an acceptable level (that’s part of what OP is complaining about, and I agree).

But patient beefs? Nonsense with insurance companies? Navigate the situation as quickly and easily as you can, and move on. I try not to let any of that stuff take up more than 30 seconds of brainspace or bandwidth.

This is the key to maintaining happiness (or at least sanity) in medicine these days. There are things to get upset about and things that just aren't worth your trouble. Not to say that there aren't some patient behavior issues that need to be dealt with directly or insurance nonsense that rises to the level of me getting really worked up and taking extra steps/time to deal with because I believe it's worth it. But in general, I put my head down, take care of patients based on best available data and guidelines and go home at the end of the day and enjoy the rest of my life.

 

[shouldigomd]

The system is breaking medicine. Endless hoops to jump through and mindless regulations set in place by clueless organizations. Defensive medicine has taken over with patient care being an afterthought. The incredible amount of documentation fatigue. The lack of trust that many people have for physicians. The malignancy that often occurs between healthcare providers / staff. Resources / staff are lacking and people are overworked and underpaid. Insurance companies and hospital business admin are sucking resources dry and dictating patient care whilst patients maintain the illusion that docs are rich money hungry monsters. The beauty of caring for patients and helping them is now such a small piece of healthcare.

 

[Crayola227]

The system is breaking medicine. Endless hoops to jump through and mindless regulations set in place by clueless organizations. Defensive medicine has taken over with patient care being an afterthought. The incredible amount of documentation fatigue. The lack of trust that many people have for physicians. The malignancy that often occurs between healthcare providers / staff. Resources / staff are lacking and people are overworked and underpaid. Insurance companies and hospital business admin are sucking resources dry and dictating patient care whilst patients maintain the illusion that docs are rich money hungry monsters. The beauty of caring for patients and helping them is now such a small piece of healthcare.

This reads like a tragic poem. I feel like an excerpt should be a tattoo on some doc's forearm

 

[MifflinDunder]

I don’t think being a specialist or solely outpatient is amazing compared to the pitfalls of being a hospitalist, and never said that. In fact, my stent as a hospitalist only convinced me not to specialize, as you only trade the pain points of hospitalist with another set i.e. my chart messages.

I’m a heme onc fellow and I ignore any job postings that use EPIC. The thought of mychart driven patient care, especially with how annoying people are these days, is nauseating.

 

[gutonc]

I’m a heme onc fellow and I ignore any job postings that use EPIC. The thought of mychart driven patient care, especially with how annoying people are these days, is nauseating.

I think this is short sighted and somewhat ill informed, but you do you.

I've been in practice for 13 years. All of them using Epic. I average <2 MyChart messages a day in my busy rural solo practice (and the number was similar in my busy urban large group practice). And anything that requires more than a brief, 1-2 second response, or generates an attempt at a back and forth discussion results in my SmartPhrase that says: "This is a topic best discussed in person, my scheduler will reach out to you to schedule an appointment with me soon.". And we're done.

I won't deny that there are people who take advantage of it, but it's easy enough to manage appropriately.

 

[helpfulApu]

good for you. i personally know docs who get 5+ a day (with organizational expectations to reply by end of day or first thing in AM depending on when it was sent) with patients basically berating the doc / staff for not answering quickly enough to their demands for tests / meds or writing 7 paragraphs about a twinge they felt and whether that's expected after surgery or needs attention.

sure , you can spam "see me in clinic". its still demoralizing

 

[Crayola227]

Gone are the Doctor Quinn Medicine Woman & Doc Martin days. That's what I went into medicine for. It's all demoralizing lol

 

[VA Hopeful Dr]

good for you. i personally know docs who get 5+ a day (with organizational expectations to reply by end of day or first thing in AM depending on when it was sent) with patients basically berating the doc / staff for not answering quickly enough to their demands for tests / meds or writing 7 paragraphs about a twinge they felt and whether that's expected after surgery or needs attention.

sure , you can spam "see me in clinic". its still demoralizing

Is it though? I hit that button, the message goes away, and I don't think about it again.

 

[MifflinDunder]

Is it though? I hit that button, the message goes away, and I don't think about it again.

I had two complaints to my PD because I didn’t reply to their message in 24 hours. Someone actually showed up to the front last week because I didn’t explain their scan that had resulted in the morning. I’m sure this exists in the PCP world too but in oncology, 24 hour access is dangerous. I’ll strictly be looking for an inpatient heavy career, preferably non-epic.

 

[HemeOncHopeful19]

I had two complaints to my PD because I didn’t reply to their message in 24 hours. Someone actually showed up to the front last week because I didn’t explain their scan that had resulted in the morning. I’m sure this exists in the PCP world too but in oncology, 24 hour access is dangerous. I’ll strictly be looking for an inpatient heavy career, preferably non-epic.

Picking an inpatient heavy career is surely a great and well thought out pathway to avoiding burnout in Oncology

(I may or may not be on call right now)

 

[gutonc]

I had two complaints to my PD because I didn’t reply to their message in 24 hours. Someone actually showed up to the front last week because I didn’t explain their scan that had resulted in the morning. I’m sure this exists in the PCP world too but in oncology, 24 hour access is dangerous. I’ll strictly be looking for an inpatient heavy career, preferably non-epic.

We've been through this before, but it's about expectation setting. Start early and be persistent. And then recognize that some people are just douchecanoes, there's nothing you can do about it and move on with your life.

I honestly don't care what kind of job you get once you finish fellowship, although I truly hope it's one you love. I just think you're using odd metrics to make that decision and I worry that your job satisfaction will reflect that.

 

[HemeOncHopeful19]

We've been through this before, but it's about expectation setting. Start early and be persistent. And then recognize that some people are just douchecanoes, there's nothing you can do about it and move on with your life.

I honestly don't care what kind of job you get once you finish fellowship, although I truly hope it's one you love. I just think you're using odd metrics to make that decision and I worry that your job satisfaction will reflect that.

Yeah, I’m trying to think of a way to word this but you just have to realize that a not insignificant % of humans have personality disorders and you are statistically destined to encounter a few from time to time

 

[VA Hopeful Dr]

I had two complaints to my PD because I didn’t reply to their message in 24 hours. Someone actually showed up to the front last week because I didn’t explain their scan that had resulted in the morning. I’m sure this exists in the PCP world too but in oncology, 24 hour access is dangerous. I’ll strictly be looking for an inpatient heavy career, preferably non-epic.

Oh, you're still in training? That explains it.

In the attending world complaints don't typically actually make it to us. That's why we have office managers. It's their problem, rarely ours.

 

[wamcp]

Let me start by saying I respect all the hospitalists out there who have been grinding it out for years

The post that led me to start this thread is this one:



Let me just start by saying - I think that patient's have lost their minds (and manners) post pandemic. Every working day, I am astounded by the absolute arrogance, entitlement, and sheer stupidity of patients and their families. It seems that the collective neurosis of the general population has boiled down to self-soothing via checking BP and blood glucose. Patients/families either delude themselves regarding end stage conditions because "his blood pressure is good!", or abuse me because their otherwise well mother who was kept NPO for a procedure had BG of 90, and "you can't starve a [type 2, obese, with extensive fat reserves] diabetic!"

The 21st Century CURES Act only catalyzed the collective deterioration into mass psychosis. We don't fully trust interns - graduated doctors, may I add - to reliably interpret labs and diagnostic studies. Now, any patient/family, regardless of education level, can accost you about a hemoglobin "falling", or an eGFR "that used to be >90, but now is 87???!!!!!" Almost every patient encounter feels like I am an academic attending teaching to pre-meds who think they are my boss. Patients/families expect the utmost of respect from their hospitalist, no matter how much they fail in holding up their end of 2-way courtesy. It's funny, because none of them would allow for being told how to do their own jobs (typically at some cushy public servant job, where there is no accountability). But if you dare insinuate that they shouldn't tell a physician how to do his/her job, their jaw drops in shock, and their eyes immediately scan your name tag (in order to run to the system and report you)

There can't be any job more infuriating than hospitalist other than being a bedside RN. My stint as a hospitalist has only made me more empathetic towards our bedside RNs. At least I can leave after a brief interaction with delusional families and their actively-dying-since-2010 loved ones. I can't imagine being helpless RN subject to the mercy/wrath of these freaks. This is not even to mention the absolute abuse endured by ancillary staff such as nurse techs and food service - the patients/families treat these people like simultaneous emotional punching bags.

The job would be better if there was any sense of collegiality. Instead, it seems like all the specialists, ER physicians, and hospitalists around me have descended into a "F*ck you, I got mine" mentality. There is no minimum standard of care that we are trying to achieve - everyone just seems to be scraping the bottom of the barrel: anchoring diagnoses on whatever the minimum wage EMT said, not seeing patients but documenting as if they did, documenting that workups/treatments are ordered but not ordering them, and failing to even look 2 days in the past at prior records in order to fit a story together. On this point, if I have to admit another 100 year old that is on beta-blockers and eliquis for symptomatic bradycardia and GI bleeding, I am going to lose my mind. It seems that nobody has any common sense that even a high-schooler could summon regarding our patients. Instead, we admit and have Cardiology, EP, and GI consultations, only to discharge on some weird mixture of follow up instructions involving checking in with a Cardiologist in 7-14 days on whether the patient born in the Great Recession should resume her eliquis for net negative -1% risk reduction in annual stroke prevention

Maybe the families could center us intellectual, ivory-tower physicians, with their grit and common sense. But no - MeeMaw is a fighter, and provides a $800 social security check that can be used for jet-ski leases. So full code, and every aggressive measure possible, please!

Soupbone (the quote I included above) would agree - this job has only deteriorated over the years. I suspect the deterioration must be more than tangentially related to an overall societal decline. From what I see, the only hospitalists who stick it out are those with a ton of resilience. But, in this context, resilience is being mistaken for emptiness.

Before I took this job, I was advised that "hospitalist is only for those with thick skin"

I thought I had thick skin, but this job showed me that "having thick skin" is more about becoming a numb and hollow shell of who you once were. I feel sorry for my fellow hospitalists who grind it out, day in and day out, being abused by various specialists, patients, families, insurance peer 2 peer scheduling agents at the call center, janitors, and pretty much everyone you can think of. We are simultaneously secretaries and "the doctor!", expected to solve any acute problem at a moment's notice while simultaneously attending to "families highly concerned about why there hasn't been a 14th CT Head ordered" and knowing our role by slinking away while the slick specialists give their recommendations (without having any clue what their partner recommended 1 day prior, because chart review is for suckers and hospitalists)

One of the greatest reliefs I ever felt was turning in my notice of leaving this field. I feel sorry for whoever has to stick it out in this grind. I look forward to the posters who are as equally delusional as our patients/families, who will chime in with snide remarks about how great their specific job is, and how they are respected, and how they get paid $1M / annum to see 2 patients per day. I'll call a Psychiatry consult in for you, only to get snubbed by the Mental Health ARNP who thinks they are smarter than me.

I'm leaving, and never looking back. Last warning to graduating residents: don't do it, unless you're catatonic.

-helpfulApu

99% of this is avoided by working nocturnist shifts.

I deal with nearly none of the nonsense you struggle with on rounds…it is so easy to deflect when you just have to admit pt at night, the family wants to go home and sleep, no one is going to be nitpicking on this and that blood pressure…code status is usually a breeze, no need to be pushy- just ask it, document and move on.
If my admit is acutely ill and dying, then sure let’s have a bigger discussion that 99% leads to DNR or, if full code, punt them to the intensivist and the pt ain’t my problem anymore!
Only rounders really have to tussle with goals of care in a longitudinal manner.

Working nights mean i also don’t care about discharges, follow up coordinations, chasing down consultants all day, calling families daily to update, or mychart messages….

Of course if you cannot physically tolerate nights then this is not helpful.
I’m glad I can, i have built a perfect routine where going to work at night is a stress relieving activity: yes I may spend 3-4 hours of my shift seeing pt/typing notes, but the remaining 7-8 hours I can choose to nap, read books, watch tv, play pc games. Hell, last night at work I watched Andor, Warfare, and Mickey 17. And put in a couple hours of gaming.

 

[Crayola227]

99% of this is avoided by working nocturnist shifts.

I deal with nearly none of the nonsense you struggle with on rounds…it is so easy to deflect when you just have to admit pt at night, the family wants to go home and sleep, no one is going to be nitpicking on this and that blood pressure…code status is usually a breeze, no need to be pushy- just ask it, document and move on.
If my admit is acutely ill and dying, then sure let’s have a bigger discussion that 99% leads to DNR or, if full code, punt them to the intensivist and the pt ain’t my problem anymore!
Only rounders really have to tussle with goals of care in a longitudinal manner.

Working nights mean i also don’t care about discharges, follow up coordinations, chasing down consultants all day, calling families daily to update, or mychart messages….

Of course if you cannot physically tolerate nights then this is not helpful.
I’m glad I can, i have built a perfect routine where going to work at night is a stress relieving activity: yes I may spend 3-4 hours of my shift seeing pt/typing notes, but the remaining 7-8 hours I can choose to nap, read books, watch tv, play pc games. Hell, last night at work I watched Andor, Warfare, and Mickey 17. And put in a couple hours of gaming.

SurfingDoc was just wondering how you were terminally online...

The medical world can be an oyster for the night person.

 

[wamcp]

SurfingDoc was just wondering how you were terminally online...

The medical world can be an oyster for the night person.

Yeah i’m in the best kind of job to get paid to surf the internet

 

[NITRAS]

99% of this is avoided by working nocturnist shifts.

I deal with nearly none of the nonsense you struggle with on rounds…it is so easy to deflect when you just have to admit pt at night, the family wants to go home and sleep, no one is going to be nitpicking on this and that blood pressure…code status is usually a breeze, no need to be pushy- just ask it, document and move on.
If my admit is acutely ill and dying, then sure let’s have a bigger discussion that 99% leads to DNR or, if full code, punt them to the intensivist and the pt ain’t my problem anymore!
Only rounders really have to tussle with goals of care in a longitudinal manner.

Working nights mean i also don’t care about discharges, follow up coordinations, chasing down consultants all day, calling families daily to update, or mychart messages….

Of course if you cannot physically tolerate nights then this is not helpful.
I’m glad I can, i have built a perfect routine where going to work at night is a stress relieving activity: yes I may spend 3-4 hours of my shift seeing pt/typing notes, but the remaining 7-8 hours I can choose to nap, read books, watch tv, play pc games. Hell, last night at work I watched Andor, Warfare, and Mickey 17. And put in a couple hours of gaming.

Want to work nights for us? No game time. They are almost always 10 behind. Our ICU punts extremely sick and tenuous people to the floor because they don’t need pressors for the time being and not intubated.

 

[dozitgetchahi]

I think this is short sighted and somewhat ill informed, but you do you.

I've been in practice for 13 years. All of them using Epic. I average <2 MyChart messages a day in my busy rural solo practice (and the number was similar in my busy urban large group practice). And anything that requires more than a brief, 1-2 second response, or generates an attempt at a back and forth discussion results in my SmartPhrase that says: "This is a topic best discussed in person, my scheduler will reach out to you to schedule an appointment with me soon.". And we're done.

I won't deny that there are people who take advantage of it, but it's easy enough to manage appropriately.

Epic is by far the best and most efficient EMR I have ever used. Many efficiency-focused features in Epic allow me to save literally hours every day over the awful EMRs I was using previously (Centricity, Intergy). If a new doc cares at all about efficiency and getting their **** done quickly, they would be a fool to avoid Epic. I haven’t seen any other EMR thus far that gets you out the door faster.

I have no idea why so many people hate Epic. Regardless of MyChart messages, the rest of it is fabulous. And the MyChart message dynamic is easy to manage.

 

[gutonc]

Epic is by far the best and most efficient EMR I have ever used. Many efficiency-focused features in Epic allow me to save literally hours every day over the awful EMRs I was using previously (Centricity, Intergy). If a new doc cares at all about efficiency and getting their **** done quickly, they would be a fool to avoid Epic. I haven’t seen any other EMR thus far that gets you out the door faster.

I have no idea why so many people hate Epic. Regardless of MyChart messages, the rest of it is fabulous. And the MyChart message dynamic is easy to manage.

To paraphrase Winston Churchill: Epic is the worst EMR out there, except for all the others.