Being a hospitalist sucks, and I'm quitting

[helpfulApu]

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Need to biopsy that BCC

blood glucose 205 on your VTAch hospice patient, please advise

 

[helpfulApu]

blood glucose 205 on your VTAch hospice patient, please advise

I think some of the copers here feel helpful or needed with inane pages like this, probably because he has very little life purpose. Otherwise, and that’s why they don’t mind

 

[MD46]

need a little time off? maybe sit with a shrink and discuss?

This is part and parcel of Medicine, basically to some degree in all fields. Nothing is perfect, however I agree with the sentiment of others that it isnt all bad, just here and there and you learn to adjust/navigate.

I think if you dont like hospitalist work, quit, go try urgent care, might be better. My friend who wasnt happy as a hospitalist in Hartford CT, very busy inpatient, he went to a small town urgent care getting paid 175$/hr for essentially seeing 10 patients a day is much more happier now.

Good luck.

 

[VA Hopeful Dr]

“ I have experienced essentially none of that so far this year”

Admits to experiencing essentially all of this year

That’s great that you all don’t care about annoying messages, annoying patients, annoying families ultimately the therapeutic alliance has been destroyed by adversarial patient/families and I don’t know why everybody is so adamant to deny that

I mean, stuff like that does happen sometimes. Its been a pretty quiet year so far though. Also a) its more rare than you're making it sound and b) I can deal with it in a way that causes me little/no stress.

Here's the thing, unless you find it boring then outpatient medicine doesn't have to be nearly as bad as its made out to be. I enjoy my job. Do all of my notes/inbox stuff between patients or over lunch if I've gotten behind (due to meetings or whatnot).

I have very few adversarial patient/family encounters. Unless there's a solid reason (just got diagnosed with cancer and not handling it well, for example), I can dismiss them from my practice. Most of my patients like me, trust me, and don't cause any trouble.

 

[bronx43]

I mean, stuff like that does happen sometimes. Its been a pretty quiet year so far though. Also a) its more rare than you're making it sound and b) I can deal with it in a way that causes me little/no stress.

Here's the thing, unless you find it boring then outpatient medicine doesn't have to be nearly as bad as its made out to be. I enjoy my job. Do all of my notes/inbox stuff between patients or over lunch if I've gotten behind (due to meetings or whatnot).

I have very few adversarial patient/family encounters. Unless there's a solid reason (just got diagnosed with cancer and not handling it well, for example), I can dismiss them from my practice. Most of my patients like me, trust me, and don't cause any trouble.

The biggest determining factor to whether this is a rare sighting versus an invasive species in your inbox is practice location.
When I was in a big city, 95% of the Mychart messages were nonsensical, attention-seeking drivel. But now, in a semi-rural area, it's essentially non-existent. If anything big is happening regarding patient care, my staff would notify me and I would address it then and there.

I would think this phenomenon is worse in rheumatology, but also quite applicable to primary care.

 

[bronx43]

No he never has and he never will because he trollin

He's probably just venting and knows he has no other options.

Trolls can make s*** up and claim to have bought 100k of BTC in 2013.

 

[glorifiedresident]

It's a genuine mystery how you've encountered nothing but annoying people. A baffling statistical anomaly, with no discernible common factor in any of those interactions (heh heh)

 

[gutonc]

It's a genuine mystery how you've encountered nothing but annoying people. A baffling statistical anomaly, with no discernible common factor in any of those interactions (heh heh)

I think I learned a version of this from @Apollyon many moons ago:

When you go through your day and you meet an a***ole, you've met an a***ole. When you go through your day and everyone you meet is an a***ole, you're the a***ole.

 

[VA Hopeful Dr]

I think I learned a version of this from @Apollyon many moons ago:

When you go through your day and you meet an a***ole, you've met an a***ole. When you go through your day and everyone you meet is an a***ole, you're the a***ole.

Spoken by someone who has never been to France

 

[VA Hopeful Dr]

The biggest determining factor to whether this is a rare sighting versus an invasive species in your inbox is practice location.
When I was in a big city, 95% of the Mychart messages were nonsensical, attention-seeking drivel. But now, in a semi-rural area, it's essentially non-existent. If anything big is happening regarding patient care, my staff would notify me and I would address it then and there.

I would think this phenomenon is worse in rheumatology, but also quite applicable to primary care.

Oh yeah, I get those now in a small-ish Southern town. But that's why I have a button that sends that message to my nurse with "Needs appt" written in and nothing else.

Plus I'm booked out a week or more at any given point which often gives the crazy time to either settle down or go to urgent care.

One of my partners actually has a great dot phrase he uses in these instances. When I get to work I'll post a copy of it. It really is a work of art for Mychart abusers.

 

[gutonc]

Oh yeah, I get those now in a small-ish Southern town. But that's why I have a button that sends that message to my nurse with "Needs appt" written in and nothing else.

Plus I'm booked out a week or more at any given point which often gives the crazy time to either settle down or go to urgent care.

This is my approach as well. I usually have a couple of open slots each week for urgent visits, but these people don't get them. My schedulers know to offer these people "next available, LOL" which is typically 2 weeks out.

 

[helpfulApu]

is there any clinical field that has less longitudinal training than emergency medicine? These guys have absolutely no clue or experience about what happens to the floor admissions. It’s bad enough that they spend 30 seconds to two minutes with the patient in most cases. Internal medicine and family medicine rotate in the ER to at least get a superficial understanding of the pressures ER docs face and why they might do certain things a certain way.

But these guys should also be required to do a month of floors, considering the vast majority of their admissions are to the floors. They have absolutely no clue why we care about certain things and still insist on forcing admissions and circumventing our concerns. At least now I understand why they spam orders based off of a triage cc after my brief rotation with them. They could be a little more well rounded by seeing what actually happens to the soft admissions they push through 15 min before their shift ends. But their field is really good about cushioning themselves in comfort and protecting from scutt so it’ll never happen even though it would actually be in the best interest.

 

[helpfulApu]

and no, there 2–3 months of ICU during their three years don’t count. During which the ER senior and intern goof off in a corner, claim they don’t carry patients in are only there to do procedure procedures. And even if it did, the major majority of their admits are to floors so they should see that instead

 

[VA Hopeful Dr]

The biggest determining factor to whether this is a rare sighting versus an invasive species in your inbox is practice location.
When I was in a big city, 95% of the Mychart messages were nonsensical, attention-seeking drivel. But now, in a semi-rural area, it's essentially non-existent. If anything big is happening regarding patient care, my staff would notify me and I would address it then and there.

I would think this phenomenon is worse in rheumatology, but also quite applicable to primary care.

As promised:

MYCHART USE POLICY

MyChart is a secure online platform designed to enhance communication between patients and their healthcare providers. It allows patients to access their health information, request appointments, and communicate with their healthcare team. To ensure the portal is used effectively and efficiently, we have established the following guidelines:

Appropriate Use: MyChart should be used for non-urgent medical issues. These include clarification of instructions, prescription refill requests, appointment scheduling, and accessing test results. For urgent issues, please call our office directly or seek emergency care.

Response Time: Our team will strive to respond to portal messages within 48 hours. If an issue requires an urgent response, please contact our office directly or seek emergency care.

Frequency: Please limit your MyChart messages to no more than 1-2 new messages per day and avoid sending multiple messages about the same issue. This helps us manage the volume of communications and ensures timely responses. Allow 48 hours for a response before sending follow-up messages.

Message Content: Be concise and specific in your messages to help us address your concerns efficiently.

Privacy and Security: Do not share your portal login credentials with others. Ensure your contact information is up-to-date to receive notifications and responses.

 

[helpfulApu]

fighting fire with fire. or should i say, fighting karens with karenese. love it.

 

[LoudBark]

is there any clinical field that has less longitudinal training than emergency medicine? These guys have absolutely no clue or experience about what happens to the floor admissions. It’s bad enough that they spend 30 seconds to two minutes with the patient in most cases. Internal medicine and family medicine rotate in the ER to at least get a superficial understanding of the pressures ER docs face and why they might do certain things a certain way.

But these guys should also be required to do a month of floors, considering the vast majority of their admissions are to the floors. They have absolutely no clue why we care about certain things and still insist on forcing admissions and circumventing our concerns. At least now I understand why they spam orders based off of a triage cc after my brief rotation with them. They could be a little more well rounded by seeing what actually happens to the soft admissions they push through 15 min before their shift ends. But their field is really good about cushioning themselves in comfort and protecting from scutt so it’ll never happen even though it would actually be in the best interest.

Why don't you go to the Emergency Medicine forum here and post this and see what kind of responses you get.

 

[helpfulApu]

I don’t need to, it’ll just be replies full of logical fallacy, maybe ad hominem, “ who hurt you?”, “ which ER doc broke up your marriage?” , unbothered, chill guys suggesting going hiking, without actually addressing the points I’m making.

 

[LoudBark]

I don’t need to, it’ll just be replies full of logical fallacy, maybe ad hominem, “ who hurt you?”, “ which ER doc broke up your marriage?” , unbothered, chill guys suggesting going hiking, without actually addressing the points I’m making.

All of us are very chill. You are the one uptight about how awful being a hospitalist is. Without addressing your points? How about you addressing what your plans are since you no longer plan on being a hospitalist? You are so evasive answering that it is pretty clear you are not quitting.

 

[helpfulApu]

there are dozens of people in this thread, who agree with me

 

[gutonc]

there are dozens of people in this thread, who agree with me

?

I only scanned the last 4 pages, but, at best, a couple of people have said "yeah, sometimes this job is a drag but 🤷‍♂️".

 

[NotAProgDirector]

Many of the issues you're complaining of are real problems. But the frequency at which you'll face them is highly dependent on the patient population, practice structure, and specialty. As you've seen in posts on this thread, most of us don't face these challenges at great frequency.

Practice structure will have a big impact. If you're a PCP and have a private practice, then any patient that drives you crazy like this can be dismissed. These types of issues tend to follow the 80/20 rule, where 20% of the people cause 80% of the problem, and removing a few people causing the most issues will often make things much better. Patient demographics often make a big difference also -- although demanding patients can come from across the socioeconomic spectrum.

Being a hospitalist prevents you from curating your practice. It's one of the big downsides of HM. The only way you can curate your patients is by being a hospitalist somewhere else. It's very likely you'd find a different hospital a completely different experience. You're going to be caring for patients with substance issues and seriously screwed up social situations no matter where you are a hospitalist, but they will be a minority in most settings. If you work in a busy urban center, then perhaps less so. It's just the nature of the beast.

Specialty is also very important. Many patients absolutely love and trust their specialists when they have a chronic illness. The relationship is completely different to the short-stay-and-done we have with HM.

I can't remember if I've already put this here on the thread (we're on page 7 and I'm not looking back), but all specialties have their psychosocial issues. Whether it's fibromyalgia, irritable bowel syndrome, chronic headaches, etc. My advice to my prior residents (and in fact to my kids who are not in medicine at all) is this: whatever is widely seen as the WORST part of your job, if you can find some challenge in it, you will be much happier. In HM, that's often discharge management. You don't have to love it -- but framing it as a challenge to work towards tends to yield better results.

As a hospitalist myself, I can also state that your experience is not mine. Sure, there is usually one or two "challenging" (not in a medical way) patients or families on my team. My experience is that these families are usually terrified and confused -- and that get's expressed as overinvolvement, lots of questions (many of which might be considered "inane"), etc. The key is not to get frustrated, but instead to understand that they are just scared, and if you proactively work with them you can usually make things much better.

i hate eliquis so much. i think its probably responsible for 90% of medicare hospitalization costs. for what exarctly? some tiny net negative stroke risk reduction that probably came from a ivory tower cardiology study that had the data sliced to make p value skim below the .05 cutoff probably

Although I can commiserate with your other complaints (although I don't find the severity of them anywhere near as problematic as you), this I don't understand. DOAC's are so much better than warfarin - less bleeding, easier to manage, etc. Discharging patients on warfarin is a nightmare. Are you suggesting that anticoagulating AF isn't worth it? Because that data is rather solid: Number needed to treat for net effect of anticoagulation in atrial fibrillation: Real-world vs. clinical-trial evidence - PubMed This is just one study, but a 4% ARR per year is nothing to sneeze at. NNT is 25, rises to 32 including harms -- which we should do, but personally if I had the choice between a bleed and a stroke, I'd take the bleed (if it's anywhere but intracranial, can be fixed).

You're clearly very burned out. You need to do something. It's obvious you're miserable. Consider an LOA? If you can get disability income for a month or two and treatment, perhaps that will get you in a better place. And then consider a new job -- there are good places to work, if you're really at a terrible place.

(ED residents) ...should also be required to do a month of floors, considering the vast majority of their admissions are to the floors.

Most do, it's part of their residency.

 

[helpfulApu]

your CBT hocus pocus wont work on me and convince me that I'm the problem and need to change myself rather than my circumstances are the problem. and yeah it's a 4% ARR but 3% annual risk of major bleeding resulting in a net positive 1% risk reduction after harm, thanks for trying though. your fancy studies might fool yourself and your patience but won't fool me. experiences may vary across different patient demographics but the walls are closing in and soon everybody will be on chat GPT listening in as their AI patient advocate

 

[helpfulApu]

and lol at " I'll take a bleed as long as it's not intracranial". Cool, cuz you get to decide? and maybe you won't take it after all after your 10th admission same calendar year for diverticular bleeding. thanks for trying

 

[helpfulApu]

and I am leaving. I'll never look back at the mess that modern medicines / internal medicine has become. I don't need to take a LOA and get put on zombifying SSRIs in order to deal with this.

 

[helpfulApu]

and since you want to act fancy with your statistics, which I could easily dunk on you with since your level of statistics likely approaches skimming abstractd and taking a "p value less than 05 means significnt" as gospel, and you have no understanding of any distribution other than normal, I will add that NNT of 25+, based on your own cited work, is absolutely abysmal considering the financial strain it laces on patients (you do know Eliquis costs 500 a month, or over 15% of average Americans AGI per annum, right? or are you a VA primadonna with infinite money printing music therapy resources available at your disposal ?)and decreased QOL they suffer as a result of it

 

[helpfulApu]

" My experience is that these families are usually terrified and confused -- and that get's expressed as overinvolvement, lots of questions (many of which might be considered "inane"), etc. ". LMAO. they're not terrified. they're not confused. they know that they have 60 years of IHOP, cruise buffets, couch recliners, NIMBYism, yelling at clouds, panicking at immigration/fox news, and the BG spikes and aftermath of apple glazedham, and snake oil orthopedic / spinal surgeries as onefix curealls that inevitably fail instead of losing weight and being mobile to contend with. and instead of facing the music, they choose to lash out and argue about hemoglobins and blood pressures, and report you and if you give even a hint of not cow towing to their demands. Nice virtue singaling bro. you "seem" really empathetic and understanding in your post though you have no empathy or understanding for me, hope that gets you far in your life

 

[gutonc]

Due to abusive behavior, the OP has been banned. As such, this thread is being closed.