Burned out as hospitalist - fellowship or new job?

[BlueOranges8888]

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I'm a hospitalist with a few years of experience and getting tired of a few aspects of the job. I went into medicine to treat medical issues, but all of these non-clinical tasks are burning me out. I'm thinking about doing a fellowship, but I'm not sure if specialists would also have the same issues? Can someone advise if consultants also have the following issues, or if I should try to find another hospitalist job instead?

Tired of metrics such as Length of Stay, Readmission rate, discharge before 11am, and patient satisfaction metrics. What's frustrating is that sometimes I have no control of these metrics. I'm assuming consultants are not held to these metrics? What metrics do consultants have?

Are consultants usually 7 on / 7 off as well? The hospitalist lifestyle is definitely nice.

Tired of being a punching bag for patients. Procedure delayed until tomorrow but has been NPO the entire day? Utilization review recommends observation instead of inpatient stay? Consultant recommending outpatient procedure instead of inpatient? Patient pretty much just yells at the hospitalist for everything.

Tired of follow up coordination. Specialist doesn't sign insurance paperwork for equipment PA and therefore increases your length of stay? Hospitalist has do it then. Emailing specality clinics to schedule follow-up? Hospitalist does it. Specific follow up instructions? Hospitalist has to write everything on discharge instructions. Calling families for updates? Hospitalist does it. Have to wait for both the patient's nurse and case management to be available before rounding on a patient? Hospitalists have to do this, not specialists.

Tired of idiotic admin practices to improve patient satisfaction. Our hospitalist group was told to smile more, sit down and speak with the patients, write out today's plan on paper to give to patients. There's barely any extra chairs in patient rooms already, what am I supposed to carry a chair with me?

Tired of other admin practices that consultants don't have to do. Such as documenting advanced directives for older folks, managing the problem list in the EMR, etc.

Can these issues be solved by switching jobs as a hospitalist, or should I pursue a fellowship?

 

[DrMetal]

Tired of being a punching bag for patients. Procedure delayed until tomorrow but has been NPO the entire day? Utilization review recommends observation instead of inpatient stay? Consultant recommending outpatient procedure instead of inpatient? Patient pretty much just yells at the hospitalist for everything.

Tired of follow up coordination. Specialist doesn't sign insurance paperwork for equipment PA and therefore increases your length of stay? Hospitalist has do it then. Emailing specality clinics to schedule follow-up? Hospitalist does it. Specific follow up instructions? Hospitalist has to write everything on discharge instructions. Calling families for updates? Hospitalist does it. Have to wait for both the patient's nurse and case management to be available before rounding on a patient? Hospitalists have to do this, not specialists.

I mean, you're basically describing the job (of a hospitalist). If you really don't like these things, then you should stop being one. I don't think switching to another hospitalist job will solve you're issues. (and you may be taking these things a little too personally).

Fellowship? Do it if you're interested in the subject matter. Grass is not always greener.

 

[chessknt]

Yea you think it is annoying having to do a bunch of nonsense and want to become a fellow? You get to do a bunch of nonsense, have to run everything you do by a grown up, and get paid as much as a Mcdonalds employee.

 

[anonperson]

I'm a hospitalist with a few years of experience and getting tired of a few aspects of the job. I went into medicine to treat medical issues, but all of these non-clinical tasks are burning me out. I'm thinking about doing a fellowship, but I'm not sure if specialists would also have the same issues? Can someone advise if consultants also have the following issues, or if I should try to find another hospitalist job instead?

Tired of metrics such as Length of Stay, Readmission rate, discharge before 11am, and patient satisfaction metrics. What's frustrating is that sometimes I have no control of these metrics. I'm assuming consultants are not held to these metrics? What metrics do consultants have?

Are consultants usually 7 on / 7 off as well? The hospitalist lifestyle is definitely nice.

Tired of being a punching bag for patients. Procedure delayed until tomorrow but has been NPO the entire day? Utilization review recommends observation instead of inpatient stay? Consultant recommending outpatient procedure instead of inpatient? Patient pretty much just yells at the hospitalist for everything.

Tired of follow up coordination. Specialist doesn't sign insurance paperwork for equipment PA and therefore increases your length of stay? Hospitalist has do it then. Emailing specality clinics to schedule follow-up? Hospitalist does it. Specific follow up instructions? Hospitalist has to write everything on discharge instructions. Calling families for updates? Hospitalist does it. Have to wait for both the patient's nurse and case management to be available before rounding on a patient? Hospitalists have to do this, not specialists.

Tired of idiotic admin practices to improve patient satisfaction. Our hospitalist group was told to smile more, sit down and speak with the patients, write out today's plan on paper to give to patients. There's barely any extra chairs in patient rooms already, what am I supposed to carry a chair with me?

Tired of other admin practices that consultants don't have to do. Such as documenting advanced directives for older folks, managing the problem list in the EMR, etc.

Can these issues be solved by switching jobs as a hospitalist, or should I pursue a fellowship?

How do the other hospitalists feel about this?

Are they burned out as well or do they have work arounds?

Admin can't force you to smile or write stuff out. They can suggest all they want.

Don't let patients take their frustrations out on you. Leave the room. Not your problem if a specialist has to reschedule something.

My main questions:
How's the pay? Usually people are dissatisfied with jobs when they feel they aren't compensated well enough.

Are there other jobs in the surrounding area?

Fellowship is an option but you will give up some years of earning and each specialty has it's own issues.

I would say, don't take the job personally in general. Do your time and go home and enjoy life.

 

[glorifiedresident]

the quicker you come to peace with being a glorifiedresident, the happier and more content you will be with your job. hospitalist here for almost 20 years.

 

[collegestud2013]

I'm a hospitalist with a few years of experience and getting tired of a few aspects of the job. I went into medicine to treat medical issues, but all of these non-clinical tasks are burning me out. I'm thinking about doing a fellowship, but I'm not sure if specialists would also have the same issues? Can someone advise if consultants also have the following issues, or if I should try to find another hospitalist job instead?

Tired of metrics such as Length of Stay, Readmission rate, discharge before 11am, and patient satisfaction metrics. What's frustrating is that sometimes I have no control of these metrics. I'm assuming consultants are not held to these metrics? What metrics do consultants have?

Are consultants usually 7 on / 7 off as well? The hospitalist lifestyle is definitely nice.

Tired of being a punching bag for patients. Procedure delayed until tomorrow but has been NPO the entire day? Utilization review recommends observation instead of inpatient stay? Consultant recommending outpatient procedure instead of inpatient? Patient pretty much just yells at the hospitalist for everything.

Tired of follow up coordination. Specialist doesn't sign insurance paperwork for equipment PA and therefore increases your length of stay? Hospitalist has do it then. Emailing specality clinics to schedule follow-up? Hospitalist does it. Specific follow up instructions? Hospitalist has to write everything on discharge instructions. Calling families for updates? Hospitalist does it. Have to wait for both the patient's nurse and case management to be available before rounding on a patient? Hospitalists have to do this, not specialists.

Tired of idiotic admin practices to improve patient satisfaction. Our hospitalist group was told to smile more, sit down and speak with the patients, write out today's plan on paper to give to patients. There's barely any extra chairs in patient rooms already, what am I supposed to carry a chair with me?

Tired of other admin practices that consultants don't have to do. Such as documenting advanced directives for older folks, managing the problem list in the EMR, etc.

Can these issues be solved by switching jobs as a hospitalist, or should I pursue a fellowship?

Switching to another hospitalist job may less the administrative burden but will still have some of these issues, but maybe to a smaller extent. Some hospitals may not push metrics as hard as others (or at least not tie quality metrics to compensation ), or the patient volume may be lower. These can help lessen burnout. The other options besides fellowship would be to go somewhere where you can only do daytime admitting shifts, or just become a nocturnist/nighttime admitter. These will lift you off the burden of being responsible for discharge planning headaches, but will come with other new headaches like have an unpredictable workflow everyday when admitting from the ED, and not being able to go home early on any shift since you're admitting from the ED until late. And while most will pay more for nocturnist, many places won't pay more for the daytime admitting shifts than rounding shifts either.

By consultants, I'm assuming you mean subspecialists. They may not have as many metrics or the same from the hospital than an IM/FM hospitalist, especially if they are not hospital or system employed (many work in PP through contract with the hospital), but they will have other challenges. For example, for many specialties, they will be required to be on ED call overnight which can significantly increase workload and mess up sleep schedule, depending on the specialty. Any if they do any outpatient work, they'll have probably have more insurance paperwork to deal with than the typical hospitalist (since in outpatient world, just about everything has to go through insurance to get done), and a bunch inbox messages to respond to each day.

I think the most one can get away with administrative stuff and do just pure medicine (besides being in a non-patient facing specialty like radiology or pathology) would inpatient subspecialty hospitalist job that works at a hospital where they do not have to be the primary admitting service (and can just be a consult service). Neurohosptialist, cardiology hospitalist, ID hospitalist, heme/onc hospitalist are some common ones that many places have that come to mind. But while as a consult service they won't have to discharge anyone, they have their own challenges that can lead to burnout, like having to see new consults everyday (which makes workflow a lot more unpredictable), in some cases have to round at multiple hospital sites per day, and being on call at night after a full workday.

 

[Nocturnist]

I'm a hospitalist with a few years of experience and getting tired of a few aspects of the job. I went into medicine to treat medical issues, but all of these non-clinical tasks are burning me out. I'm thinking about doing a fellowship, but I'm not sure if specialists would also have the same issues? Can someone advise if consultants also have the following issues, or if I should try to find another hospitalist job instead?

Tired of metrics such as Length of Stay, Readmission rate, discharge before 11am, and patient satisfaction metrics. What's frustrating is that sometimes I have no control of these metrics. I'm assuming consultants are not held to these metrics? What metrics do consultants have?

Are consultants usually 7 on / 7 off as well? The hospitalist lifestyle is definitely nice.

Tired of being a punching bag for patients. Procedure delayed until tomorrow but has been NPO the entire day? Utilization review recommends observation instead of inpatient stay? Consultant recommending outpatient procedure instead of inpatient? Patient pretty much just yells at the hospitalist for everything.

Tired of follow up coordination. Specialist doesn't sign insurance paperwork for equipment PA and therefore increases your length of stay? Hospitalist has do it then. Emailing specality clinics to schedule follow-up? Hospitalist does it. Specific follow up instructions? Hospitalist has to write everything on discharge instructions. Calling families for updates? Hospitalist does it. Have to wait for both the patient's nurse and case management to be available before rounding on a patient? Hospitalists have to do this, not specialists.

Tired of idiotic admin practices to improve patient satisfaction. Our hospitalist group was told to smile more, sit down and speak with the patients, write out today's plan on paper to give to patients. There's barely any extra chairs in patient rooms already, what am I supposed to carry a chair with me?

Tired of other admin practices that consultants don't have to do. Such as documenting advanced directives for older folks, managing the problem list in the EMR, etc.

Can these issues be solved by switching jobs as a hospitalist, or should I pursue a fellowship?

It's not a hospitalist problem, it's a rounding problem. Become an admitter and every single problem you've described goes away. Well, I do have a couple metrics as an admitter but they're silly and more just so everyone can pretend I 'worked' to get 100% of my quality bonus.

short of that, some of the annoyances you've described may be improved by switching hospitals depending on the amount of support staff.

Re some of the practices for patient satisfaction...I had an attending in residency who ran a clinical study on sitting and patient's perception of how long he was in their room. He carried a $15 collapsible camping chair on rounds. He was actually kind of a prick in person, but turned out just looking patients at eye level, they felt he was in the room 2-3 times longer and satisfaction went through the roof. Don't forget that ultimately we're partially in the service industry. It honestly wasnt until the script was flipped when I was in the hospital when my kids were born, i realized the value of a simple smile and good attitude from my providers.

I cant speak for the specialists but my suspicion is the grass is always greener and every specialty has its BS. Whether trading the devil you know for at the very least another 2-3 or more years of 80 hour work weeks and minimum wage, only you can decide.

 

[VA Hopeful Dr]

It's not a hospitalist problem, it's a rounding problem. Become an admitter and every single problem you've described goes away. Well, I do have a couple metrics as an admitter but they're silly and more just so everyone can pretend I 'worked' to get 100% of my quality bonus.

short of that, some of the annoyances you've described may be improved by switching hospitals depending on the amount of support staff.

Re some of the practices for patient satisfaction...I had an attending in residency who ran a clinical study on sitting and patient's perception of how long he was in their room. He carried a $15 collapsible camping chair on rounds. He was actually kind of a prick in person, but turned out just looking patients at eye level, they felt he was in the room 2-3 times longer and satisfaction went through the roof. Don't forget that ultimately we're partially in the service industry. It honestly wasnt until the script was flipped when I was in the hospital when my kids were born, i realized the value of a simple smile and good attitude from my providers.

I cant speak for the specialists but my suspicion is the grass is always greener and every specialty has its BS. Whether trading the devil you know for at the very least another 2-3 or more years of 80 hour work weeks and minimum wage, only you can decide.

Yep. Also body language, when they patient is telling you their story lean towards them just a touch and make eye contact. All of a sudden you are the best listener in the world.

 

[BlueOranges8888]

You all make valid points. I'm definitely taking things a little too personally when things I feel should be handled by specialists (i.e. specialty clinic followup, special equipment prior auths such as CPAP machines to wound vacs), are pushed onto hospitalists, when we already have so much non-clinical things to do already. And agreed, I shouldn't care that much when patients blame me for things that are not in my control, but it does wears on you.

It's not a hospitalist problem, it's a rounding problem. Become an admitter and every single problem you've described goes away. Well, I do have a couple metrics as an admitter but they're silly and more just so everyone can pretend I 'worked' to get 100% of my quality bonus.

short of that, some of the annoyances you've described may be improved by switching hospitals depending on the amount of support staff.

Re some of the practices for patient satisfaction...I had an attending in residency who ran a clinical study on sitting and patient's perception of how long he was in their room. He carried a $15 collapsible camping chair on rounds. He was actually kind of a prick in person, but turned out just looking patients at eye level, they felt he was in the room 2-3 times longer and satisfaction went through the roof. Don't forget that ultimately we're partially in the service industry. It honestly wasnt until the script was flipped when I was in the hospital when my kids were born, i realized the value of a simple smile and good attitude from my providers.

I cant speak for the specialists but my suspicion is the grass is always greener and every specialty has its BS. Whether trading the devil you know for at the very least another 2-3 or more years of 80 hour work weeks and minimum wage, only you can decide.

Good point. I'm not opposed to sitting down to speak with patients, and I definitely agree it's better bedside manners, but it's a pain to ask us to carry camping chairs during rounds. Props to that attending though. Half the time the couches are too far from the patient and other times there's no where to sit. I think I'd prefer if admin at least supported us a little bit instead of just stating, "you go figure out where to sit yourself".

It's all very valid points about smiling, leaning in when speaking, and making eye contact. They are examples of great bedside manners and they help prevent you from being sued if something goes wrong.

Switching to another hospitalist job may less the administrative burden but will still have some of these issues, but maybe to a smaller extent. Some hospitals may not push metrics as hard as others (or at least not tie quality metrics to compensation ), or the patient volume may be lower. These can help lessen burnout. The other options besides fellowship would be to go somewhere where you can only do daytime admitting shifts, or just become a nocturnist/nighttime admitter. These will lift you off the burden of being responsible for discharge planning headaches, but will come with other new headaches like have an unpredictable workflow everyday when admitting from the ED, and not being able to go home early on any shift since you're admitting from the ED until late. And while most will pay more for nocturnist, many places won't pay more for the daytime admitting shifts than rounding shifts either.

By consultants, I'm assuming you mean subspecialists. They may not have as many metrics or the same from the hospital than an IM/FM hospitalist, especially if they are not hospital or system employed (many work in PP through contract with the hospital), but they will have other challenges. For example, for many specialties, they will be required to be on ED call overnight which can significantly increase workload and mess up sleep schedule, depending on the specialty. Any if they do any outpatient work, they'll have probably have more insurance paperwork to deal with than the typical hospitalist (since in outpatient world, just about everything has to go through insurance to get done), and a bunch inbox messages to respond to each day.

I think the most one can get away with administrative stuff and do just pure medicine (besides being in a non-patient facing specialty like radiology or pathology) would inpatient subspecialty hospitalist job that works at a hospital where they do not have to be the primary admitting service (and can just be a consult service). Neurohosptialist, cardiology hospitalist, ID hospitalist, heme/onc hospitalist are some common ones that many places have that come to mind. But while as a consult service they won't have to discharge anyone, they have their own challenges that can lead to burnout, like having to see new consults everyday (which makes workflow a lot more unpredictable), in some cases have to round at multiple hospital sites per day, and being on call at night after a full workday.

Thanks for the options. Yeah each option has it's plusses and minuses. I did a few nocturinst shifts and they were physically very demanding with the sleep schedule changes. An extra 50-100k a year isn't worth it, especially after taxes.

 

[BlueOranges8888]

Any tips on managing patient expectations for outpatient workup when they're demanding inpatient workup?

For example, just a few days ago had a GI bleeder that is stable, hemoglobin 10s, etc. GI consulted and planning for outpatient EGD/colonoscopy, but patient is very upset about not getting it done inpatient. Kept saying, "You're making tons of money and not doing anything to help me". We've already spoken extensively about this for multiple days, and I just snapped on the day of discharge when again, the patient was very verbally abusive.

She immediately changed tunes when I snapped, but I felt pretty bad about it. I understand their frustration, but it's also hard when I've already spoken to them multiple times and they keep yelling at me for a GI decision that I have no control over.

 

[Splenda88]

I mean, you're basically describing the job (of a hospitalist). If you really don't like these things, then you should stop being one. I don't think switching to another hospitalist job will solve you're issues. (and you may be taking these things a little too personally).

Fellowship? Do it if you're interested in the subject matter. Grass is not always greener.

Well, not all the job are created equal. I do some of the stuff OP describe, not most of them. I don't worry about metrics. I do my job well and let these things take care of themselves. Yes, I tell the patients (and/or family member) my plan. That is what all docs do (not just hospitalists).

I do sit in the room to talk to few patients (or families) because it gives them the perception that you spend much more time with them (there are studies on that)

Signing papers is the easiest part of the job. I tell SW/CM and our 5-6 secretaries that I am not filling out anything that is not a medically related question. They fill them out; I take a look at it and then sign it.

Again, the job is not perfect but not many doc jobs out there enjoy the flexibility that we do. As you say, the grass is NOT always greener.

 

[Splenda88]

Any tips on managing patient expectations for outpatient workup when they're demanding inpatient workup?

For example, just a few days ago had a GI bleeder that is stable, hemoglobin 10s, etc. GI consulted and planning for outpatient EGD/colonoscopy, but patient is very upset about not getting it done inpatient. Kept saying, "You're making tons of money and not doing anything to help me". We've already spoken extensively about this for multiple days, and I just snapped on the day of discharge when again, the patient was very verbally abusive.

She immediately changed tunes when I snapped, but I felt pretty bad about it. I understand their frustration, but it's also hard when I've already spoken to them multiple times and they keep yelling at me for a GI decision that I have no control over.

These things are easy to handle in my opinion as long as you do your job.

Had sitiuation like that last year. Young military veteran in his late 30s presented with c/o chest pain. Workup was non actionable. Then he demanded an EGD. I told him I will schedule an outpatient follow up for him with GI in 2-4 wks after I explained to him why I am doing that.

He was upset and ranting about how could I treat him like that after he fought for the country in Iraq etc... I placed the follow up with GI and told the charge nurse to call and schedule the appointment. Discharge order placed and did not engage in any further discussions with the patient.

 

[shouldigomd]

I am an Interventional Cardiologist and I feel for you because I wouldn't be able to be a hospitalist in todays system. That being said the grass is always greener so keep that in mind. Now that you have experience you should carefully weigh the pro's vs con's of doing fellowship as it can definitely be worth it. I moonlighted as a hospitalist during my fellowship thus I will give you my perspective of some of the pro's of hospitalist and some of the con's of my specialty that may or may not be realized. That being said I love my specialty and wouldn't trade it for any other.

Hospitalist
-more time off with 7 on : 7 off (I would have so many side hustles) and predictable schedule
-don't have to deal with outpatient issues
-can be the hospitalist that tries to manage everything or simply sit back and consult everyone. If GI doesn't want to scope inpatient that is their decision and that's it. It is your job to help coordinate care but not your job to defend a decision you aren't making or inform patients of said decision.
-not on call
-usually part of a big group which can be a headache but can also be helpful
-lower stress / predictability of daily routine / always someone else you can call.

IC
-outpatients that I am responsible for no matter what I am doing: Issues with meds, procedural related issues, refills, coordinating care with other providers, communicating with outpatient providers, networking with other providers, travel to various clinics, prior authorizations
-the constant balance of fighting the pressure of corporate healthcare to make them money, maintain your job / reputation and do the best for your patients
-depending / waiting on a consultant can be annoying but the flip side of always being "needed" can be tough: being 3 patients behind in clinic with a STEMI in the ER, a hospitalist bugging you to pre-op a hip fracture so the patient can go to the OR the same day and trying to figure out if you will be able to pick up your kid after school ....
-the end all be all decisions can be tough.
-offering services that aren't "widely available" is rewarding but also a pain when scheduling time off.

Anyway just some thoughts. GL

 

[dozitgetchahi]

I'm a hospitalist with a few years of experience and getting tired of a few aspects of the job. I went into medicine to treat medical issues, but all of these non-clinical tasks are burning me out. I'm thinking about doing a fellowship, but I'm not sure if specialists would also have the same issues? Can someone advise if consultants also have the following issues, or if I should try to find another hospitalist job instead?

Tired of metrics such as Length of Stay, Readmission rate, discharge before 11am, and patient satisfaction metrics. What's frustrating is that sometimes I have no control of these metrics. I'm assuming consultants are not held to these metrics? What metrics do consultants have?

Are consultants usually 7 on / 7 off as well? The hospitalist lifestyle is definitely nice.

Tired of being a punching bag for patients. Procedure delayed until tomorrow but has been NPO the entire day? Utilization review recommends observation instead of inpatient stay? Consultant recommending outpatient procedure instead of inpatient? Patient pretty much just yells at the hospitalist for everything.

Tired of follow up coordination. Specialist doesn't sign insurance paperwork for equipment PA and therefore increases your length of stay? Hospitalist has do it then. Emailing specality clinics to schedule follow-up? Hospitalist does it. Specific follow up instructions? Hospitalist has to write everything on discharge instructions. Calling families for updates? Hospitalist does it. Have to wait for both the patient's nurse and case management to be available before rounding on a patient? Hospitalists have to do this, not specialists.

Tired of idiotic admin practices to improve patient satisfaction. Our hospitalist group was told to smile more, sit down and speak with the patients, write out today's plan on paper to give to patients. There's barely any extra chairs in patient rooms already, what am I supposed to carry a chair with me?

Tired of other admin practices that consultants don't have to do. Such as documenting advanced directives for older folks, managing the problem list in the EMR, etc.

Can these issues be solved by switching jobs as a hospitalist, or should I pursue a fellowship?

Do you like outpatient?

I say this because I’m a 100% outpatient PP rheumatologist and overall I’m pretty happy with work as it stands right now. I don’t think I’d be as happy as a PCP (or definitely not as a hospitalist, because I detest inpatient work for many of the same reasons you listed).

Pros of outpatient only rheumatology:
- life is simple. One practice environment. Structured schedule. See the patients, write the notes, go home. No hospital rounding.
- If you’re in a PP, you have the advantage of largely being able to set your own boundaries without a lot of pushback or admin BS.
- You have support staff that can handle a lot of the calls, care coordination, and other busywork for you.
- I made about $750k last year working 4.5 days a week.
- It can be complex and cerebral, which means you get to use your brain to figure out interesting patient situations.
- You can help patients. The newer meds in rheumatology are really helpful.

Cons:
- Rheumatology is one of these specialties where lots of other specialties dump their trash. A lot of my time is spent screening out BS consults, and then dealing with seeing the BS consults that snuck through the screening process.
- It can be complex and cerebral, which means some cases are time consuming and mentally draining.
- There are a lot of “grey zones” and vagueness in rheumatology, which means patients are sometimes frustrated that you can’t deliver a precise diagnosis for them.
- A fair number of rheumatology patients have a certain kind of personality…one that is either clingy and needy or strangely overbearing and demanding. (Sometimes all of the above.) The core issue with all of these types of patients is *anxiety*, which for whatever reason is very prevalent among rheumatology patients. Dealing with all these anxious/obnoxious patients on a daily basis can definitely wear you down a bit.

Overall, I think it’s a good specialty, and I think I’d like doing it more than being a hospitalist.

 

[glorifiedresident]

These things are easy to handle in my opinion as long as you do your job.

Had sitiuation like that last year. Young military veteran in his late 30s presented with c/o chest pain. Workup was non actionable. Then he demanded an EGD. I told him I will schedule an outpatient follow up for him with GI in 2-4 wks after I explained to him why I am doing that.

He was upset and ranting about how could I treat him like that after he fought for the country in Iraq etc... I placed the follow up with GI and told the charge nurse to call and schedule the appointment. Discharge order placed and did not engage in any further discussions with the patient.

I would have consulted GI and let them make the call.

 

[VA Hopeful Dr]

Any tips on managing patient expectations for outpatient workup when they're demanding inpatient workup?

For example, just a few days ago had a GI bleeder that is stable, hemoglobin 10s, etc. GI consulted and planning for outpatient EGD/colonoscopy, but patient is very upset about not getting it done inpatient. Kept saying, "You're making tons of money and not doing anything to help me". We've already spoken extensively about this for multiple days, and I just snapped on the day of discharge when again, the patient was very verbally abusive.

She immediately changed tunes when I snapped, but I felt pretty bad about it. I understand their frustration, but it's also hard when I've already spoken to them multiple times and they keep yelling at me for a GI decision that I have no control over.

Sometimes you have to snap at patients. It shouldn't be your go to move, but it shouldn't be a never event either.

 

[dozitgetchahi]

Sometimes you have to snap at patients. It shouldn't be your go to move, but it shouldn't be a never event either.

I try not to “snap” per se, but I can be very direct when needed. There comes a point where you’ve said your piece, you’ve heard their point of view, and you’re not able to change what is going on (and you need to be able to move on to the next patient etc). You can’t just sit there while they rail at you. You have to be able to break off the conversation and move on.

 

[LoudBark]

You all make valid points. I'm definitely taking things a little too personally when things I feel should be handled by specialists (i.e. specialty clinic followup, special equipment prior auths such as CPAP machines to wound vacs), are pushed onto hospitalists, when we already have so much non-clinical things to do already. And agreed, I shouldn't care that much when patients blame me for things that are not in my control, but it does wears on you.


Good point. I'm not opposed to sitting down to speak with patients, and I definitely agree it's better bedside manners, but it's a pain to ask us to carry camping chairs during rounds. Props to that attending though. Half the time the couches are too far from the patient and other times there's no where to sit. I think I'd prefer if admin at least supported us a little bit instead of just stating, "you go figure out where to sit yourself".

It's all very valid points about smiling, leaning in when speaking, and making eye contact. They are examples of great bedside manners and they help prevent you from being sued if something goes wrong.


Thanks for the options. Yeah each option has it's plusses and minuses. I did a few nocturinst shifts and they were physically very demanding with the sleep schedule changes. An extra 50-100k a year isn't worth it, especially after taxes.

What fellowships would you consider? You never mentioned which ones. You obviously look like you are looking for a way out of being a hospitalist and considering a fellowship (of anything?) more because you hate being a hospitalist than because you want to do any one particular specialty because you like that specialty.

 

[glorifiedresident]

i will not let patient or patient's family harangue me, but also i will try and go along and accommodate any requests within reason. If they want to stay another day, that's fine. I find things work better when you try and play nice with patients and families, rather than take a default attitude that you are the doctor and they are the patient mentality.

 

[Splenda88]

I would have consulted GI and let them make the call.

We have a pretty busy GI service that is run by locum. It would have taken GI 24 hrs to even see the guy because it's not urgent. And they will say nothing to do.

 

[Splenda88]

i will not let patient or patient's family harangue me, but also i will try and go along and accommodate any requests within reason. If they want to stay another day, that's fine. I find things work better when you try and play nice with patients and families, rather than take a default attitude that you are the doctor and they are the patient mentality.

I do that when they are reasonable, but I will not put up with your nonsense if you are an as[insert].

 

[IM_to_ortho_hopeful]

We have a pretty busy GI service that is run by locum. It would have taken GI 24 hrs to even see the guy because it's not urgent. And they will say nothing to do.

Why doesn’t your shop hire full time GI docs?

 

[Splenda88]

Why doesn’t your shop hire full time GI docs?

One locum hospitalist who work here told me they interviewed his uncle and the offer was only ~680k for 7 on/off.

His uncle said for a small town (or city) like ours, GI docs won't work for < 800k/yr.

They hired two outpatient GI over a year ago just to scope everyday and I was told from a reliable source that these guys got paid 820k/yr.

Amazing that they are willing to pay outpatient GI a lot more than inpatient ones.

 

[IM_to_ortho_hopeful]

One locum hospitalist who work here told me they interviewed his uncle and the offer was only ~680k for 7 on/off.

His uncle said for a small town (or city) like ours, GI docs won't work for < 800k/yr.

They hired two outpatient GI over a year ago just to scope everyday and I was told from a reliable source that these guys got paid 820k/yr.

Amazing that they are willing to pay outpatient GI a lot more than inpatient ones.

Sounds like OP should do a GI fellowship. Scoping all day is much more tolerable than getting yelled at because a GI doc doesn’t want to scope an inpatient

 

[WIFEL585]

This is why i never do rounding shifts (other than the rare occasion) and basically exclusively do swing / night shifts (pure admit and cross coverage).

Not having to see and deal with these annoying as f*** administrators / case management people is heavenly.

 

[Meerkatology]

Can these issues be solved by switching jobs as a hospitalist, or should I pursue a fellowship?

i am working as a full time nocturnist and rarely need to deal with the issues u mentioned.
the onlything i had to deal with is metrics like ER triage/HCC as i work for an HMO. but to my knowledge many
private groups don't care about this kind of stuff.

IM is still a dumping ground for various things but i often dont need to deal with nonmedical issues at night.

if ur fine working night hours, i strongly recommend you to consider this.

i've been out of residency for 10 years and i can't imagine going back to do a fellowship and then maintain board certifications for both IM and the subspeciality :\

 

[gutonc]

i am working as a full time nocturnist and rarely need to deal with the issues u mentioned.
the onlything i had to deal with is metrics like ER triage/HCC as i work for an HMO. but to my knowledge many
private groups don't care about this kind of stuff.

IM is still a dumping ground for various things but i often dont need to deal with nonmedical issues at night.

if ur fine working night hours, i strongly recommend you to consider this.

i've been out of residency for 10 years and i can't imagine going back to do a fellowship and then maintain board certifications for both IM and the subspeciality :\

The good news is that you don't have to do that. You need active IM BC to sit for your initial subspecialty exam. But after that, you can forget it.

 

[Ryuzaki]

I'm a hospitalist with a few years of experience and getting tired of a few aspects of the job. I went into medicine to treat medical issues, but all of these non-clinical tasks are burning me out. I'm thinking about doing a fellowship, but I'm not sure if specialists would also have the same issues? Can someone advise if consultants also have the following issues, or if I should try to find another hospitalist job instead?

Tired of metrics such as Length of Stay, Readmission rate, discharge before 11am, and patient satisfaction metrics. What's frustrating is that sometimes I have no control of these metrics. I'm assuming consultants are not held to these metrics? What metrics do consultants have?

Are consultants usually 7 on / 7 off as well? The hospitalist lifestyle is definitely nice.

Tired of being a punching bag for patients. Procedure delayed until tomorrow but has been NPO the entire day? Utilization review recommends observation instead of inpatient stay? Consultant recommending outpatient procedure instead of inpatient? Patient pretty much just yells at the hospitalist for everything.

Tired of follow up coordination. Specialist doesn't sign insurance paperwork for equipment PA and therefore increases your length of stay? Hospitalist has do it then. Emailing specality clinics to schedule follow-up? Hospitalist does it. Specific follow up instructions? Hospitalist has to write everything on discharge instructions. Calling families for updates? Hospitalist does it. Have to wait for both the patient's nurse and case management to be available before rounding on a patient? Hospitalists have to do this, not specialists.

Tired of idiotic admin practices to improve patient satisfaction. Our hospitalist group was told to smile more, sit down and speak with the patients, write out today's plan on paper to give to patients. There's barely any extra chairs in patient rooms already, what am I supposed to carry a chair with me?

Tired of other admin practices that consultants don't have to do. Such as documenting advanced directives for older folks, managing the problem list in the EMR, etc.

Can these issues be solved by switching jobs as a hospitalist, or should I pursue a fellowship?

Honestly, feel your pain about that readmission rate and patient satisfaction, as if somehow my care is going to change the trajectory of that ILD patient on their 7th admission in the last 2 months (refusing hospice). The optics are none of these are a true reflection of the physician capabilities but more an underlying problem with the facility, patient's lack of understanding/refusal to accept disease process, patient care, dietitian or nursing care complaints. Most of the time, people just leave a long email/grievance and its usually complaining about the food, not being changed quick enough rarely is it ever the physician didn't explain to me what is wrong with me.

I've only been doing this for a few years as well, however, typically, I don't tolerate rude behavior, yelling/swearing and etc. I simply just tell them to find another physician who is willing to take them, if they are unhappy and I'd be more than glad to get rid of them. It's not ideal, but I tell them coming to a hospital isn't a choice it's a privilege. Most patients pipe down quickly, occasionally you have the ones that are out of this world.

 

[BlueOranges8888]

Honestly, feel your pain about that readmission rate and patient satisfaction, as if somehow my care is going to change the trajectory of that ILD patient on their 7th admission in the last 2 months (refusing hospice). The optics are none of these are a true reflection of the physician capabilities but more an underlying problem with the facility, patient's lack of understanding/refusal to accept disease process, patient care, dietitian or nursing care complaints. Most of the time, people just leave a long email/grievance and its usually complaining about the food, not being changed quick enough rarely is it ever the physician didn't explain to me what is wrong with me.

I've only been doing this for a few years as well, however, typically, I don't tolerate rude behavior, yelling/swearing and etc. I simply just tell them to find another physician who is willing to take them, if they are unhappy and I'd be more than glad to get rid of them. It's not ideal, but I tell them coming to a hospital isn't a choice it's a privilege. Most patients pipe down quickly, occasionally you have the ones that are out of this world.

Yes the food...I'm so tired about the food complaints. First, you're in the hospital so the food sucks anyway. Second, it's only 9am and you're already complaining about being NPO. Like bro, it's 9am.

I'm sure the policy of discharging before 11am also affects patient satisfaction scores. I've had to tell multiple patients that they can't wait in their room for a few extra hours for their ride. Hospital makes people wait in a public room. I'd honestly be so pissed if I just went through something horrific and can't wait even in a private room during discharge.

 

[Soupbone]

’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.