Can a hospitalist practice family medicine?

[brucecanbeatyou]

I have this romantic notion of working internal medicine in a big hospital in Boston or NYC until I'm 40, then moving to a rural area and being a PCP. Is this a viable vision?

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[Hernandez]

Yes and no. Most Hospitalists are IM trained with some FPs doing this as well. You can as an Internist be a PCP, however, you won't be seeing kids unless you went FP or did something crazy like IM/Peds

 

[Captain Fantastic]

I have this romantic notion of working internal medicine in a big hospital in Boston or NYC until I'm 40, then moving to a rural area and being a PCP. Is this a viable vision?

Most internists practice primary care in the outpatient setting. The hospitalist movement hasn't consumed all of them, yet.

You'll see adults -- no kids, no catching babies -- but absolutely you can do this.

 

[cpants]

As an IM-hospitalist you can definitely shift to primary care in a rural area. You cannot shift to "family medicine" though. Family medicine involves pediatrics and ob/gyn which internists are not qualified to practice.

 

[PeepshowJohnny]

I know some hospitalist positions that have been filled by Family Medicine resident graduates, however this is in considerably less competitive locations than Boston and New York, not sure if it would hold up.

If you do Internal Medicine, as others have stated, you can be a primary care physician but your patient base will probably have no kids and no OB/GYN.

 

[Tiger26]

You'll be an MD and and long as you have privileges, hell, you could do neurosurgery using rockets if you wanted to.

If psychiatrists can open outpatient derm clinics, then you do FP work pretty easily as in internist

 

[Dirt]

You'll be an MD and and long as you have privileges, hell, you could do neurosurgery using rockets if you wanted to.

If psychiatrists can open outpatient derm clinics, then you do FP work pretty easily as in internist

Where can psychiatrists open up derm clinics?

That sounds more ridiculous than neurosurgery with rockets.

 

[DrJosephKim]

You can practice general internal medicine but I doubt that most internists would feel very comfortable seeing infants and children.

 

[phospho]

If psychiatrists can open outpatient derm clinics, then you do FP work pretty easily as in internist

but insurance companies will not reimburse him...

also, is that even legal?

 

[brucecanbeatyou]

Thanks for all the responses! This is very interesting.

 

[rachmoninov3]

a third option is to be a family practice hospitalist (yes, they do exist). I know there's a residency that does this in maricopa county (phoenix) arizona. The residency program in the northern part of my state also has a dedicated FP hospitalist, but this hasn't been encorporated into the residency yet (but hopefully will be in two more years!)
This way you get to catch babies, treat sick kids as well as sick adults, and then can retire to the clinics when you want to.

 

[NewAndImproved]

but insurance companies will not reimburse him...

also, is that even legal?

I asked a similar question in one of the other forums a while back. The gist of the responses was that you can legally do whatever you want (my question was whether or not an ER doc could work a few years then open his own clinic out in the community). Hell, around here, I see dentist offices that do botox injections, etc. So frankly, a psychiatrist doing derm outpatient wouldn't surprise me.

You are right about the reimbursements, though. I don't have details - if someone does, please post! How do insurance companies decide what they will and won't reimburse? If a doc is boarded in, say, IM, do they look at a particular procedure and say, "We won't reimburse for that because it is defined as a family practice procedure." Obviously this isn't an issue for the psychiatrists/dentists who are charging cash directly to patients but what about for the rest of us?

 

[allymunro]

Ooo that's exactly what I'd like to do as well. Except as a pediatric hospitalist and then a pediatric PCP. I love the hospital lifestyle now but I'm not sure I'll still be so keen in my 40s and 50s!!

 

[Re3iRtH]

Ooo that's exactly what I'd like to do as well. Except as a pediatric hospitalist and then a pediatric PCP. I love the hospital lifestyle now but I'm not sure I'll still be so keen in my 40s and 50s!!

What exactly is "the hospital lifestyle"?

 

[Tiger26]

I asked a similar question in one of the other forums a while back. The gist of the responses was that you can legally do whatever you want (my question was whether or not an ER doc could work a few years then open his own clinic out in the community). Hell, around here, I see dentist offices that do botox injections, etc. So frankly, a psychiatrist doing derm outpatient wouldn't surprise me.

You are right about the reimbursements, though. I don't have details - if someone does, please post! How do insurance companies decide what they will and won't reimburse? If a doc is boarded in, say, IM, do they look at a particular procedure and say, "We won't reimburse for that because it is defined as a family practice procedure." Obviously this isn't an issue for the psychiatrists/dentists who are charging cash directly to patients but what about for the rest of us?

All of these out pt derm places popping up are cash only and they have docs from every specialty (ex. EM, IM, gas, surgery, psych, etc.). Basically, all you need to do is learn the procedures and then advertise. You're licensed as an MD in your state. Granted you probably couldn't get away with it in a hospital since they wouldn't credential you, but if you set up your own shop you'd be good to go.

 

[allymunro]

I simply meant hospital lifestyle in terms of antisocial hours, on call time and flexibility. Also the feeling of being a cog in someone else's wheel rather than self-autonomy. I'm actually currently a student outside of the US so perhaps I'm wrong that that is also the case there.

 

[montessori2md]

This is funny, b/c I just had a pt. yesterday say that when Dr. X (a Gastro doc) decides to practice primary care, she wanted him to be her doc. His wife was like, That's NEVER going to happen. NEVER.

Look at the FM boards, hospitalists are not uncommon there, and aafp loves to run around saying EM residencies are never going to be able to supply every ED in the country, unless they figure out a way to never retire and live for 100 years. And I personally wouldn't get too bent out of shape about peds and ob if you feel like IM is a better fit for you. Most MDs won't pay the malpractice for baby-catching, and peds -well, in our neck of the woods, a lot of the kids go to CHCs b/c they have medicaid, or they go to a pediatrician until they are teens. Most FPs see at most 20% kids in their practice (about the same % as kids are of the general pop), and most of those are school-age (though, once again, most kids ARE school age, statistically). And even peds can be problematic, b/c of details, for ex., it can be impractical to keep all the vaccines stocked when your peds pop is small.

And rural areas need specialists too. It may not be the same as FP, but rural specialists have a different lifestyle, I imagine, compared to large urban areas.

I personally have this vision of going to a rural practice once a week to help out an MD who has an established practice and could use a day off, or has a few too many pts to handle solo, and then going back to my practice in the 'hood.

 

[stixx]

So if you've had a career as a medicine sub-specialist (e.g. a cards guy approaching retirement), could you still find work as an IM hospitalist?

 

[PeepshowJohnny]

So if you've had a career as a medicine sub-specialist (e.g. a cards guy approaching retirement), could you still find work as an IM hospitalist?

...I'm sure you could, but doing this would make zero sense.

If you've devoted yourself to the study of cardiology, in all its variety and with the current competitive environment, you've pretty much you're a person who enjoys that type of medicine vs. being a hospitalist. So I don't think many cardiologists would find being a hospitalist all that exciting.

Plus, the lifestyle of a hospitalist is MUCH worse than that of a senior cardiology attending. Even if he's in private practice, it'd be very easy for such an individual to cut down on the parts of his job he likes less and focus on what he really enjoys: Whether it be echos or EKGs or skipping those things and just doing outpatient visits, whatever he wants. Academics would make it even easier. Compare that with jumping into a hospitalist lifestyle, killing yourself for a week or two at a time with tons of admits and trying to get your patients better and out as fast as you can to keep your list manageable and costs down. It's hella stressful.

Plus, even though good cardiologists are going to be reading JAMA/NEJM and probably be abreast of most developments of internal medicine in the interval since they trained, they probably won't be as up to date as hospitalists who've been in the trenches and learning as they go. A cardiologist doing this wouldn't be dangerously out of date, but definitely not optimized.

 

[smq123]

However, if you're during fellowship training or recently graduated, you could probably still do hospitalist work pretty well. Most of the attendings of IM at my hospital did a fellowship. Some of them work as Internists to earn extra cash during their fellowship years. It's legal and because of the variety of their fellowship upbringing, different doctors view things a bit differently.

This is not feasible in the US.

Fellowship training takes up ALL of your time - leaving you little time leftover to do general IM stuff. If needed, you can supervise a resident putting in a central line or something, but you can't do both a fellowship AND general IM at the same time. There is moonlighting, but that is something very different, again. Moonlighting isn't the same as hospitalist work.