Can you still do hospital medicine on top of an endocrine or rheum fellowship?

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Please_Stand_By

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I enjoy hospital medicine but also enjoy the work of these two sub-specialties. Is it possible to do both? Like a week of hospitalist per month as well as maybe 8 days of endocrine 4/week x 2? I know ID docs can be hospitalists as well as see their own clinic patients so the idea for other specialties doesn't seem as far-fetched.

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I enjoy hospital medicine but also enjoy the work of these two sub-specialties. Is it possible to do both? Like a week of hospitalist per month as well as maybe 8 days of endocrine 4/week x 2? I know ID docs can be hospitalists as well as see their own clinic patients so the idea for other specialties doesn't seem as far-fetched.
If you can find someone willing to let you work PT as a sub-specialist, you can do whatever you want the rest of the time.

You'll probably very quickly lose your desire for inpatient medicine once you get a taste of that sweet sub-specialty clinic based sauce though.
 
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If you can find someone willing to let you work PT as a sub-specialist, you can do whatever you want the rest of the time.

You'll probably very quickly lose your desire for inpatient medicine once you get a taste of that sweet sub-specialty clinic based sauce though.

Until I re-visit my student loan statement, then the motivation to pick up extra shifts dramatically increases.
 
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As an IM sub-specialist, you'll be welcomed to work in any number of primary care settings. But as mentioned, you're gonna' want to gnaw your arm off after a few months on the inpatient wards.
 
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Please_stand_by, I would recommend choosing one of the three options. Hospitalists are exclusively inpatient while Endo/Rheum is almost entirely outpatient (except consult services). You might be able to grab an academic gig and do consult medicine in one of those fellowships... but even then I doubt it. All three pay about the same, but the overall lifestyle of the endocrinologist/rheumatologist is better than the hospitalist (though some like the schedule). I think one that mixes better would be pulm/crit care and hospitalist. Some of my faculty do that. Finally, you could say become an endocrinologist and attend on service 1-2 months a year at certain institutions.
 
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I can't imagine a single rheumatologist who would EVER do this

The last day I wrote an order for DVT prophylaxis was a glorious day
 
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I have seen stranger things... at the Harvard rheumatology conference this year, one of the speakers was a part time hospitalist who was also a board certified ophthalmologist. My mind was blown.

But yeah, I haven't heard of a rheumatologist/hospitalist.
 
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I think the variety is fantastic and much prefer the hospital to outpatient at this time, but as I get older, would prefer outpatient beyond just general IM.
 
I enjoy hospital medicine but also enjoy the work of these two sub-specialties.

You don't. False.

Stick to "how are your sugars doing?" "They are still high" "Go up on the insulin. See you in three... no actually I'll see you in six months".
 
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I think the variety is fantastic and much prefer the hospital to outpatient at this time, but as I get older, would prefer outpatient beyond just general IM.
Yeah the variety great.

Between the drug seekers, admission for placement, social disasters, non-compliant heart failure patients, surgery dumps, I really had an intellectually stimulating year as a hospitalist. /sarc
 
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I have nothing against hospital medicine. I thank the Lord above for hospitalists every time I have to send a patient to the hospital and don't have to admit them myself

That said, if you think you like both hospital medicine AND rheumatology I would think carefully about what it is that really attracts you to both. Both specialties are quite different in terms of clinical matter, day to day practice, and practice management. It would be more or less like trying to practice both rheumatology and gastroenterology--it would be very hard to keep up on current practice skills and research in both specialties concurrently, particularly if you have a busy practice. One of the glorious (to me) features of rheumatology is that I more or less never have to set foot in the hospital. I might get 1 or 2 consults a month, and even many of those probably could be handled over the phone with close outpatient follow-up; it will be slightly more than that with endocrine but only slightly. From a purely practical standpoint, you will have to maintain an outpatient practice for your rheum/endo practice, and it will have to be open even during the weeks you work as a hospitalist. So that will mean overhead (rent, bills, staff, etc) that you are paying out of your hospitalist revenues for those weeks you aren't generating revenue in your outpatient practice. This would be less of an issue if you were in academics, where your clinic overhead is shared with other providers and covered by the university physician group; I'm sure most university IM programs would be more than happy for someone to cover one of the ward teams for a week per month, or a month per quarter, or whatever.

If you just like both hospital medicine as well as outpatient medicine, I would give serious thought to finding a "traditional" inpatient-outpatient IM position. This will be more common in smaller/less-urban areas, but you could probably make it happen anywhere. I also know people who've worked several years in hospital medicine, gotten tired of the grind, then transitioned into an outpatient-only IM practice and are happy with that. Obviously some people transition back the other way as well. But as far as combining rheum or endo with hospitalist practice, while I think you could theoretically do it, it would be tough
 
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I can't imagine a single rheumatologist who would EVER do this

The last day I wrote an order for DVT prophylaxis was a glorious day
I actually know a rheumatologist at my institution whose chair allows him to do a couple weeks per year of hospitalist work (plus some more via moonlighting). I believe he likes it, plus it helps pay the bills on that academic rheumatologist salary.
 
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I actually know a rheumatologist at my institution whose chair allows him to do a couple weeks per year of hospitalist work (plus some more via moonlighting). I believe he likes it, plus it helps pay the bills on that academic rheumatologist salary.

OK I stand corrected, there is one

As I said above academics is really about the only place I could imagine someone doing this; and as you implied it is probably because his base pay as an academic rheumatologist is bad. If he were in private practice that would be much less motivating, and the logistics of doing so would be difficult to surmount anyway
 
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I actually know a rheumatologist at my institution whose chair allows him to do a couple weeks per year of hospitalist work (plus some more via moonlighting). I believe he likes it, plus it helps pay the bills on that academic rheumatologist salary.
Yes, you can totally pull this off in academia.

These are some of the most dangerous and feared (from the house staff side of things) attendings on the inpatient Gen Med service.
 
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If your loved one is hospitalized with a long list of medical issues, do you want them taken care of by a rheumatologist (or any sub-specialist) who does inpatient medicine for only 2 weeks per year? I didn't think so.

And if you think that a sub-specialist has done 3 years of IM and should be able to manage inpt medicine easily, just wait until you're a few years out of residency and you're in fellowship or working outpatient. The amount of stuff that you quickly forget will blow your mind. Just the other day I stared at a patient's labs for like 15 minutes trying to figure out (what I used to think was) a simple hyponatremia case.
 
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If your loved one is hospitalized with a long list of medical issues, do you want them taken care of by a rheumatologist (or any sub-specialist) who does inpatient medicine for only 2 weeks per year? I didn't think so.

And if you think that a sub-specialist has done 3 years of IM and should be able to manage inpt medicine easily, just wait until you're a few years out of residency and you're in fellowship or working outpatient. The amount of stuff that you quickly forget will blow your mind. Just the other day I stared at a patient's labs for like 15 minutes trying to figure out (what I used to think was) a simple hyponatremia case.
Doesn't a similar issue arise when subspecialists (in pulm, ID, etc.) who spend nearly all their time in the lab go on service for just a handful of weeks per year?
 
I believe the former chair of medicine at Indiana is also a gastroenterologist who staffs the medicine wards. The IM PD is ID and also does medicine wards. Definitely do able. Just have to be in the right setting
 
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Yes, you can totally pull this off in academia.

These are some of the most dangerous and feared (from the house staff side of things) attendings on the inpatient Gen Med service.
Haha they are the most feared because rheumatology has some of the craziest cases in medicine and most residency programs don't get enough volume to make house staff comfortable with them. They are like the zoologists of the inpatient side. When you consult them it's usually about a zebra autoimmune case, SLE or some biological medication you have never prescribed or seen in your life.
 
Haha they are the most feared because rheumatology has some of the craziest cases in medicine and most residency programs don't get enough volume to make house staff comfortable with them. They are like the zoologists of the inpatient side. When you consult them it's usually about a zebra autoimmune case, SLE or some biological medication you have never prescribed or seen in your life.
No, the problem is that the senior rheumatologist is perfectly comfortable with those zebras, but hasn't taken care of a COPD exacerbation in a few years.

Subspecialists doing wards is great if they kept up with their general medicine, but these things get rusty if not used.

I'm a subspecialty fellow and I moonlight as a hospitalist. I feel perfectly comfortable now... But I'm 6 months out. Give it a few years without reading the newest updates on CHF management and even if I remember everything I know now perfectly, my management style might be somewhat out of date.

A few decades? No question about it.

Would I be willing to continue general medicine work when I'm done training? Maybe. But I would make the effort to continue significant reading if that were the case. Not everyone would IMO.
 
I think the bottom line is that hospital medicine is increasingly a subspecialty in its own right, with its own set of literature, best practices, and practical skills

To be a competent hospitalist AND rheumatologist/endocrinologist/gastroenterologist/etc would be like trying to be a competent cardiologist AND gastroenterologist/rheumatologist/endocrinologist/etc. Someone out there could do it, I'm sure, but not as a "side gig"
 
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I have seen stranger things... at the Harvard rheumatology conference this year, one of the speakers was a part time hospitalist who was also a board certified ophthalmologist. My mind was blown.

But yeah, I haven't heard of a rheumatologist/hospitalist.

it probably says too much to say I think I know EXACTLY who you are referring to & know them quite well
 
To original poster. Actually I know a number of IMGs who end up with such gigs. But its not their choice though. After ID and Rheumatology fellowship its kind of difficult to get a waiver job which will sponsor visa just for endocrine or rheumatology. And the way around it is typically to do part time hospitalist.

But if you are not on a visa, like most already said its rare because a lot of the people who go into Rheum value their quality of life
 
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People actually easily find waiver jobs in rheumatology!
 
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