Can/Should I do IM after FM for hospitalist work in competitive areas (S.FL, S.CA)?

[Fococoroco22]

Hi SDN-IM. Thanks for your time.

I'm a rising PGY3 FM resident on a hospitalist training track wanting to do hospital medicine after graduation. I will graduate with approx 10 months of adult hospital medicine, 2 of which will be ICU. That's mod-high for FM, pretty low for IM, I believe.

My family live in two of the most competitive areas in the US: S. FL and S. CA. I've been away for a long time and my main goal is to be closer to them after training-- aging parents, brother and his kids, friends, etc. I know the issue of finding a job would be less difficult if they lived in more rural areas

Questions:

1. Is it UNreasonable to think that finding a solid hospitalist job, as an FM-trained freshly-minted grad, in or around LA/Miami is possible?

- If possible, do you have any job search resources or hunting advice?
- Do any of you commute 2 or more hours for your week on week off schedule? Is it rational to have two homes?
- Any thoughts on doing Locums for the first year out vs a perm job straight off?​

2. FM Hospitalist fellowship: I am strongly considering doing an FM hospitalist fellowship. However, I have no idea how much it will improve my marketability in my desired field and locations. Does it let me compete at the same level as a newly trained IM grad or will many places always hire IM only?

- If anyone here is on the hiring committee of your group would you please share how you view a FM hospitalist vs FM with hospitalist fellowship trained applicant? Would the fellowship open up a significant amount of doors in your opinion?​

3. IM Residency after FM: I am also seriously considering applying to IM residencies after graduation rather than do a 1year fellowship especially since it may be possible to get a year of credit for my FM residency. Is that a smart cost:benefit decision?

4. Second Residency funding: How much of an issue is funding going to be? I know I will only get 50% the usual medicaid/care funding but is that a fatal issue or will many places be able to absorb that cost?

- Can I fund the deficit on my own? Is that legal? Can I sell myself to IM programs as: "Dont pay me just train me?"​

PLEASE feel free to correct any faults in my understanding or expectations regarding what it's like out there for a FM hospitalist.

Thank you all for your time. I appreciate it.

====================
BACKGROUND if interested:
- DO
- Step I: 550, Step II: 605, Step III: 620.
- No fails, or red flags
- All excellent or high pass grades in school/clinical years.
- Fulbright Fellow to South Korea
- Fluent in Spanish
- Some other moderately interesting non-medical stuff.

My medicine attending and I are very close. He's IM BC and has helped me essentially build our program's hospitalist track-- I'll be the first. We run the Step Down Unit and admit/care for our own ICU pts (with CC/Pulm backup). I'm going to ask him these same questions. Still, his is just one opinion and I do honestly appreciate your input.

Briefly, why I didn't apply to IM:
# My FM advisors and mentors all were from a generation or two back where FM really could "do everything except sub-specialize". So I figured It'd be the best of all worlds. Maybe true a decade ago, not now.
# loved my adult medicine rotations the most but also enjoyed EM, OB (NOT anymore though!), some peds and definitely medical mission work. Again, thought FM would be the best fit.
# Critical Care would be the only sub-spec that I'd consider doing but tbh I'm not 100% sure about it yet. I learned a TON managing ICU patients but I still liked my hospitalist months better (we run the SDU floor as well as see our own ICU patients).
# After 2 years of residency I am 100% willing to give my other interests up in order to be a strong hospitalist: EM is cool but not for me long term, OB....never again, peds...go to a pediatrician.

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[rokshana]

Hi SDN-IM:

PGY2 (rising PGY3) FM resident on a hospitalist training track, wanting to do hospital medicine after graduation.

I'm here to ask you for information, insight and advice. I have gotten different opinions from each recruiter I've called (#5)-- some say IM vs FM wont matter too much for hospitalist jobs as long as I'm adequately trained, others say it will, others don't really care or know much. My medicine attending and I are very close. He's IM BC and has helped me essentially build our program's hospitalist track-- I'll be the first-- It's great because the acuity is relatively high: We run the Step Down Unit and admit/care for our own ICU pts (with CC/Pulm backup). I'm going to ask him these same questions. Still, his is just one opinion and I do honestly appreciate your input. I will graduate with approx 10months of adult hospital medicine, 2 of which will be ICU. That's mod-high for FM, pretty low for IM I believe.

My family live in two of the most competitive areas in the US: S. FL and S. CA. I've been away for a long time and my main goal is to be closer to them after training-- aging parents, brother and his kids who I don't spend time with, etc. If they lived in more rural areas I know the issue of finding a job would be less difficult.

Questions: ** Please humor my ignorance of what the "real world" is like. Each phase of my medical training has made me realize just how little I actually know about the day to day mechanics of "real medicine"**

1. Is it highly, moderately, slightly or not at all unreasonable to think that finding a solid hospitalist job as an FM-trained freshly-minted grad in or around LA/Miami is possible?
- If possible, do you have any job search resources or hunting advice?
- Do any of you commute 2 or more hours for your week on week off schedule? Is it rational to have two homes?
- Any thoughts on doing Locums for the first year out vs a perm job straight off?

2. If it's not really possible OR if it will eternally be an uphill battle taking the left-overs or more toxic jobs (even after you've "put in your time in the trenches") what would you suggest?

3. Thoughts on quantifiable (and qualitative) benefits to finding a desirable job/being more marketable if I do a FM 1 year hospitalist medicine fellowship?

4. Thoughts on a more masochistic but possibly higher yield plan: Finish FM residency, work in any reasonable hospitalist job I can get, wherever it is, and use that year to get attending salary, more experience AND apply to the 2020 ERAS cycle for IM residency in my home states?
- I've heard I may be able to get a year of credit from my FM residency. Any experience?

5. Thoughts on just getting any hospital job available, perm or locums, ideally in home states (FL, CA) and work my way closer to home over the months or years as I get more experience?

6. How much of an issue is funding going to be? I know I will only get 50% the usual medicaid/care funding but is that a fatal issue or will many places be able to absorb that cost?
- CAN I fund the deficit on my own? Is that legal? Can I sell myself to IM programs as: "Dont pay me just train me?"

7. PLEASE feel free to correct any faults in my understanding or expectations regarding what it's like out there for a FM hospitalist.

8. Do you think I'll get flagged if I post this in the FM Resident/Attending forum as well?

Thank you all for your time. I appreciate it.

=========
BACKGROUND if interested:
- DO
- Step I: 550, Step II: 605, Step III: 620.
- No fails, or red flags
- All excellent or high pass grades in school/clinical years.
- Fulbright Fellow to South Korea
- Fluent in Spanish
- Some other moderately interesting non-medical stuff.

Briefly, why I didn't apply to IM:
1. My first exposure to medicine was on a medical mission led by FM docs who were absolute bada**es out in the jungle.
2. My FM advisors and mentors all were from a generation or two back where FM really could "do everything except sub-specialize". So I figured It'd be the best of all worlds. Maybe true a decade ago, not now.
3. I loved my adult medicine rotations the most but also enjoyed EM, OB (NOT anymore though!), some peds and definitely medical mission work. Again, thought FM would be the best fit.
4. Critical Care would be the only sub-spec that I'd consider doing but tbh I'm not 100% sure about it yet. I learned a TON managing ICU patients but I still liked my hospitalist months better (we run the SDU floor as well as see our own ICU patients).
5. After 2 years of residency I am 100% willing to give my other interests up in order to be a strong hospitalist: EM is cool but not for me long term, OB....never again, peds...go to a pediatrician.

Its certainly possible to be a Hospitalist coming out of FM, however, there are going to be places that will prefer IM over FM...larger, more desirable cities will m/l have enough IM trained applicants to choose from, so that could be harder.

It probably would help to do the Hospital Medicine Fellowship..its not an absolute at the moment , but down the line, it may become more of a requirement and it will give you more exposure to inpatient medicine.

 

[Fococoroco22]

Its certainly possible to be a Hospitalist coming out of FM, however, there are going to be places that will prefer IM over FM...larger, more desirable cities will m/l have enough IM trained applicants to choose from, so that could be harder.

It probably would help to do the Hospital Medicine Fellowship..its not an absolute at the moment , but down the line, it may become more of a requirement and it will give you more exposure to inpatient medicine.

My main decision then is in figuring out the cost:benefit of doing a FM hospitalist fellowship vs IM residency. Does the fellowship allow me to compete in the eyes of hiring groups at the same level as a recent IM grad? Of course if will help me be more proficient in the hospital as well.

 

[smq123]

Cross posted in the FM forum. Please go there to comment.

Closing.