Calling all hospitalists current/former - seeking advice

[timtebowner]

Hi everyone,

I am a recent graduate from residency. I took my first real job working as a hospitalist. I stupidly chose a schedule that is half days, half nights. I was supposed to be 1 week on/1 off which I thought would be ok and I'd be able to flip my sleep schedule around. The shifts are 7P-7A and vice versa for days. However, I'm sometimes scheduled to flip my schedule around 2 days after doing nights. It works out sometimes as I'll have 9-10 days off in a row at various times, but it's just grueling flipping my schedule around like this.

I was told the night shifts wouldn't be too bad, I'd be working with residents who would do a lot of the heavy lifting. I wanted to do some teaching, I enjoy working with residents so that's why I took this position. While that is partially true, I still get crushed most nights with a bunch of non-teaching admissions. There are tons of cross coverage pages, also cover some ICU, rapids/codes. I have to prep the lists and distribute patients as well as send a pretty lengthy email sign out of my admits after each night which takes a while to make. I thought if I was at an academic center and I decided to do a fellowship eventually that this would give me a good opportunity.

I'm not very far into this and I'm already exhausted. The day shifts seem to be easier/more chill. I'm just wondering if any of you have made the switch from inpatient to outpatient and how that turned out for you. I thought having whole weeks off at a time would be awesome (which it can be and maybe I need to give things more time since I spent a lot of my recent free time studying for ABIM), but sometimes I find myself feeling extremely jealous of those with normal weekends.

I'm just burned already. I've been burned out since I started med school. It's so hard to have any semblance of a life when I am working these hours. My body hurts physically. I'm exhausted. I need to exercise and eat healthy but I have zero energy to do anything during the weeks I'm working. I feel like I'm living half a life.

I only signed a one-year contract so thankfully I can change things up when that comes to a close, but I want to start planning now what to do.

Please let me know if you have any insights to help me. Was switching to outpatient better for your overall well-being? Should I just stick to day shifts? Should I be looking around for more of a round and go opportunity? Locums? Private practice? Tell me if you found yourself in a similar situation, and how did you get yourself into a better one.

Thanks everyone

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[end stage fibro]

That schedule is atrocious. I've known 2 hospitalists that frequently switched nights and days and their work sucked. My input :

1) you need to become extremely efficient. Multiple night docs or admitters i know are dictating or putting orders in while returning cross cover pages. Being on hold is not idle time- you need to be clicking buttons. Is there a swing shift? Can they help with cross cover? However many admits are you getting a night? How many beds are you covering?

2) round and go is key. I don't think being a hospitalist is sustainable if you're there 12hrs a day unless the cash is 300k+

3) why are you doing sign out on fresh admissions? You need to change the culture on that. Your sign out for every patient should be: see my h&p

4) how are your notes? Have a good plan. No one is reading your hpi unless it is an enigma of a case. No one will read it and will also roll their eyes if the hpi is much longer than 140 characters

 

[timtebowner]

That schedule is atrocious. I've known 2 hospitalists that frequently switched nights and days and their work sucked. My input :

1) you need to become extremely efficient. Multiple night docs or admitters i know are dictating or putting orders in while returning cross cover pages. Being on hold is not idle time- you need to be clicking buttons. Is there a swing shift? Can they help with cross cover? However many admits are you getting a night? How many beds are you covering?

2) round and go is key. I don't think being a hospitalist is sustainable if you're there 12hrs a day unless the cash is 300k+

3) why are you doing sign out on fresh admissions? You need to change the culture on that. Your sign out for every patient should be: see my h&p

4) how are your notes? Have a good plan. No one is reading your hpi unless it is an enigma of a case. No one will read it and will also roll their eyes if the hpi is much longer than 140 characters

Oh trust me I regret a great many things about this whole situation.

1) I try to be as efficient as possible. There is a swing that helps cover admissions. I cover 40-50 beds. I get 8-10 admits a night.

2) How do I find a job that is round and go? It's not something I see advertised a whole bunch.

3) This hospital and group have been around for decades and that's how they have always done it, I'm not gonna be able to pull rank and change their whole system

4) My notes are good. I try to keep things brief.

 

[chessknt]

Academia is famous for this pile of crap job that pays MGMA 25-50th but has horrible hours. Start looking for another job unless fellowship is a definite thing and you have an exit date to work toward.

 

[DrMetal]

Hi everyone,

I am a recent graduate from residency. I took my first real job working as a hospitalist. I stupidly chose a schedule that is half days, half nights. I was supposed to be 1 week on/1 off which I thought would be ok and I'd be able to flip my sleep schedule around. The shifts are 7P-7A and vice versa for days. However, I'm sometimes scheduled to flip my schedule around 2 days after doing nights. It works out sometimes as I'll have 9-10 days off in a row at various times, but it's just grueling flipping my schedule around like this.

I was told the night shifts wouldn't be too bad, I'd be working with residents who would do a lot of the heavy lifting. I wanted to do some teaching, I enjoy working with residents so that's why I took this position. While that is partially true, I still get crushed most nights with a bunch of non-teaching admissions. There are tons of cross coverage pages, also cover some ICU, rapids/codes. I have to prep the lists and distribute patients as well as send a pretty lengthy email sign out of my admits after each night which takes a while to make. I thought if I was at an academic center and I decided to do a fellowship eventually that this would give me a good opportunity.

I'm not very far into this and I'm already exhausted. The day shifts seem to be easier/more chill. I'm just wondering if any of you have made the switch from inpatient to outpatient and how that turned out for you. I thought having whole weeks off at a time would be awesome (which it can be and maybe I need to give things more time since I spent a lot of my recent free time studying for ABIM), but sometimes I find myself feeling extremely jealous of those with normal weekends.

I'm just burned already. I've been burned out since I started med school. It's so hard to have any semblance of a life when I am working these hours. My body hurts physically. I'm exhausted. I need to exercise and eat healthy but I have zero energy to do anything during the weeks I'm working. I feel like I'm living half a life.

I only signed a one-year contract so thankfully I can change things up when that comes to a close, but I want to start planning now what to do.

Please let me know if you have any insights to help me. Was switching to outpatient better for your overall well-being? Should I just stick to day shifts? Should I be looking around for more of a round and go opportunity? Locums? Private practice? Tell me if you found yourself in a similar situation, and how did you get yourself into a better one.

Thanks everyone

What part of the country are you in? (That might come into play, determining your options

Honor your contract, serve it out, then renegotiate or leave.

As far as 'burning out' goes, we all burn out in this rat race, I think irrespective of the schedules we have. (Yes of course nights are tough, and switching back and forth is even tougher).

 

[timtebowner]

Academia is famous for this pile of crap job that pays MGMA 25-50th but has horrible hours. Start looking for another job unless fellowship is a definite thing and you have an exit date to work toward.

very true unfortunately. It's ass backwards.

 

[timtebowner]

What part of the country are you in? (That might come into play, determining your options

Honor your contract, serve it out, then renegotiate or leave.

As far as 'burning out' goes, we all burn out in this rat race, I think irrespective of the schedules we have. (Yes of course nights are tough, and switching back and forth is even tougher).

I am in the NE near Philly.

 

[collegestud2013]

Hi everyone,

I am a recent graduate from residency. I took my first real job working as a hospitalist. I stupidly chose a schedule that is half days, half nights. I was supposed to be 1 week on/1 off which I thought would be ok and I'd be able to flip my sleep schedule around. The shifts are 7P-7A and vice versa for days. However, I'm sometimes scheduled to flip my schedule around 2 days after doing nights. It works out sometimes as I'll have 9-10 days off in a row at various times, but it's just grueling flipping my schedule around like this.

I was told the night shifts wouldn't be too bad, I'd be working with residents who would do a lot of the heavy lifting. I wanted to do some teaching, I enjoy working with residents so that's why I took this position. While that is partially true, I still get crushed most nights with a bunch of non-teaching admissions. There are tons of cross coverage pages, also cover some ICU, rapids/codes. I have to prep the lists and distribute patients as well as send a pretty lengthy email sign out of my admits after each night which takes a while to make. I thought if I was at an academic center and I decided to do a fellowship eventually that this would give me a good opportunity.

I'm not very far into this and I'm already exhausted. The day shifts seem to be easier/more chill. I'm just wondering if any of you have made the switch from inpatient to outpatient and how that turned out for you. I thought having whole weeks off at a time would be awesome (which it can be and maybe I need to give things more time since I spent a lot of my recent free time studying for ABIM), but sometimes I find myself feeling extremely jealous of those with normal weekends.

I'm just burned already. I've been burned out since I started med school. It's so hard to have any semblance of a life when I am working these hours. My body hurts physically. I'm exhausted. I need to exercise and eat healthy but I have zero energy to do anything during the weeks I'm working. I feel like I'm living half a life.

I only signed a one-year contract so thankfully I can change things up when that comes to a close, but I want to start planning now what to do.

Please let me know if you have any insights to help me. Was switching to outpatient better for your overall well-being? Should I just stick to day shifts? Should I be looking around for more of a round and go opportunity? Locums? Private practice? Tell me if you found yourself in a similar situation, and how did you get yourself into a better one.

Thanks everyone

Sounds like switching to a job with only day shifts may help with a lot of your burnout issues. Also, if you can find a job where you're covering patients with the help of residents or midlevels (eg to take calls from nurses, put in orders, write notes, do discharges) instead of by yourself, that would be even better. However, non-teaching services with PAs will often expect you to see very high patient volumes to just the salaries of both you and the midlevel. Also, working 7 days in a row can lead to burnout but there are jobs that can change your schedule up a bit. Fore example, 5-on-5-off may be more doable for some.

Oh trust me I regret a great many things about this whole situation.

1) I try to be as efficient as possible. There is a swing that helps cover admissions. I cover 40-50 beds. I get 8-10 admits a night.

2) How do I find a job that is round and go? It's not something I see advertised a whole bunch.

3) This hospital and group have been around for decades and that's how they have always done it, I'm not gonna be able to pull rank and change their whole system

4) My notes are good. I try to keep things brief.

Round and go is not something that's usually written out in the job description. It's more of something that's done informally at some places if you get your work done early (and you're doing a shift where you don't take any new admissions and the list you start the day with can only get smaller). But after all if you're being paid for a 12 hr shift you're technically responsible for the patients for all 12 hrs, but people who round and leave if everyone is tucked it.

 

[bronx43]

Academia is famous for this pile of crap job that pays MGMA 25-50th but has horrible hours. Start looking for another job unless fellowship is a definite thing and you have an exit date to work toward.

Academia is dead. It’s all FAKEdemia at this point - private hospital workload for researcher pay. It only works for the boomers who landed their cushy positions before the system started to exploit younger grads.

 

[chessknt]

Academia is dead. It’s all FAKEdemia at this point - private hospital workload for researcher pay. It only works for the boomers who landed their cushy positions before the system started to exploit younger grads.

The one advantage is being in a nexus of up to date practice and lectures so it is much easier to stay up to date yourself. The trade off is definitely not worth it however. Very exploitative.

 

[wjs010]

The one advantage is being in a nexus of up to date practice and lectures so it is much easier to stay up to date yourself. The trade off is definitely not worth it however. Very exploitative.

Luckily one does not need this type of environment to stay up to date. That’s a personal thing

 

[fooli_doc]

I work Monday through Thursday outpatient primary care. It is really nice and was especially appreciated when I was more fresh out of residency. Of course now that this is my life I still have times where I feel burnt out but it could be much, much worse. I was never a hospitalist but if you can see yourself doing outpatient medicine, you can have a very regular/banker's hours type life or better. A 3 day weekend is always around the corner no matter how bad my Tuesday sucks.

 

[aafisahar]

The one advantage is being in a nexus of up to date practice and lectures so it is much easier to stay up to date yourself. The trade off is definitely not worth it however. Very exploitative.

Yep, as someone who moonlights in a CAH, so much renal dopamine.

 

[timtebowner]

I work Monday through Thursday outpatient primary care. It is really nice and was especially appreciated when I was more fresh out of residency. Of course now that this is my life I still have times where I feel burnt out but it could be much, much worse. I was never a hospitalist but if you can see yourself doing outpatient medicine, you can have a very regular/banker's hours type life or better. A 3 day weekend is always around the corner no matter how bad my Tuesday sucks.

That sounds really nice. Was it advertised as a 4-day a week thing or did you negotiate that?

 

[fooli_doc]

That sounds really nice. Was it advertised as a 4-day a week thing or did you negotiate that?

It wasn't advertised that way. I had interest in a location and I sought out multiple options there. Some of the other doctors in town under the same employer were doing 4 days so I knew it was possible. I went 100% production based income after 1 year so my employer is more lenient on allowing me to adjust my schedule within reason. There were other jobs that told me it wasn't possible, but there are plenty out there that will. Primary care docs should always have the leverage in negotiations.