considering primary care track programs and wanting to become a hospitalist

[ULTRA nerves]

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I have seen physicians who alternate their time being hospitalists and also spend time in outpt clinics. I am a MS4 now and, likewise, my career goal is to become a hospitalist and f/u on my patients in outpt clinics.

My question is: given my career goal, should I apply to IM primary care track programs? I am interested in primary care track because I want to have a good outpt learning experience as well as good inpt experience.

Are primary care track programs for people specifically wanting to have outpt practices or can they be applied to me as well?

Will primary care track programs frown upon my career plan of becoming a hospitalist?

 

[NotAProgDirector]

If you graduate from a primary care track, you can certainly become a hospitalist.

It is difficult to "be a hospitalist" and "follow up on your patients". Either you have a continuity practice, or you don't. Some hospitalist programs include a post discharge clinic, where you see complex patients 1-2 times to be sure they do well post discharge. If you try to have a continuity practice, your hospitalist office will not be of much help -- there will not be a nurse to help with phone calls, and your colleagues will not be interested in covering your patients during any absence.

You can be an outpt doc and hospitalist in some academic practices. It's tough, though -- while you are on the inpatient service you continue to need to take care of your clinical practice. Inpt and Outpt medicine are like a ship floating away from a dock -- having one foot on each is getting increasingly precarious.

You can also be an outpt doc who admits their own patients. This is also very difficult to do. You can certainly visit your patients in house, without billing.

If you tell most primary care track PD's that you want to be a hospitalist, they will discard your application. You could state that you want an academic mixed practice, especially if that model exists at the program.

 

[drfunktacular]

Could aPD and others comment more generally on the +/-'s of primary care tracks?

I am on the fence about general medicine vs. fellowships, and if I end up doing one, it will probably be in a more outpatient-based specialty like allergy or rheum. That, coupled with the fact that the PC track at my program buys you a couple more call-free months and a few less inpatient months (both advantages as far as I'm concerned), tempts me to join the PC track.

 

[ULTRA nerves]

Hi aProgDirector,

Thanks you for your insights on the current status of hospitalists vs. outpt practice. The hospitalist attendings at the institution i rotated have their own outpt clinics 2-3 days a week and that is how I became interested in doing both. They are on inpt service for 2-4 weeks at a time. You are right though; the docs are always very busy and also rely on the residents during the clinic hours. If this kind of setting took place at non-academic centers where residents do not look after the inpt service, I can see that having both would be extremely difficult.

Ok. I am an idealist/perhap even greedy. If I still want to shoot for a balance on being a hospitalist and carrying a continuity clinic, being an attending at a academic institution might be the solution to the problem.

How should I set myself up for residency if i want to be a hospitalist at an academic centers? Should I be considering a fellowship in academic medicine and university based internal medicine program? I am not very familiar with fellowships in academic medicine but know that they exists. Will I need to be a top star to get a spot at an academic center?

 

[NotAProgDirector]

Could aPD and others comment more generally on the +/-'s of primary care tracks?

I am on the fence about general medicine vs. fellowships, and if I end up doing one, it will probably be in a more outpatient-based specialty like allergy or rheum. That, coupled with the fact that the PC track at my program buys you a couple more call-free months and a few less inpatient months (both advantages as far as I'm concerned), tempts me to join the PC track.

Primary care residents do just as well in the fellowship match as categorical residents, especially for allergy/rheum/endo etc. The decreased inpt experience is usually balanced by an increase in your outpatient responsibilities. Although you might not see it now, that can often be more work in the long run.

Hi aProgDirector,

Thanks you for your insights on the current status of hospitalists vs. outpt practice. The hospitalist attendings at the institution i rotated have their own outpt clinics 2-3 days a week and that is how I became interested in doing both. They are on inpt service for 2-4 weeks at a time. You are right though; the docs are always very busy and also rely on the residents during the clinic hours. If this kind of setting took place at non-academic centers where residents do not look after the inpt service, I can see that having both would be extremely difficult.

Ok. I am an idealist/perhap even greedy. If I still want to shoot for a balance on being a hospitalist and carrying a continuity clinic, being an attending at a academic institution might be the solution to the problem.

How should I set myself up for residency if i want to be a hospitalist at an academic centers? Should I be considering a fellowship in academic medicine and university based internal medicine program? I am not very familiar with fellowships in academic medicine but know that they exists. Will I need to be a top star to get a spot at an academic center?

All you need to do is a residency in a university program. A really good, well known community program could be OK also. You will not need a fellowship. These jobs are not very popular at present.

 

[lowbudget]

Hi aProgDirector,

Thanks you for your insights on the current status of hospitalists vs. outpt practice. The hospitalist attendings at the institution i rotated have their own outpt clinics 2-3 days a week and that is how I became interested in doing both. They are on inpt service for 2-4 weeks at a time. You are right though; the docs are always very busy and also rely on the residents during the clinic hours. If this kind of setting took place at non-academic centers where residents do not look after the inpt service, I can see that having both would be extremely difficult.

Ok. I am an idealist/perhap even greedy. If I still want to shoot for a balance on being a hospitalist and carrying a continuity clinic, being an attending at a academic institution might be the solution to the problem.

How should I set myself up for residency if i want to be a hospitalist at an academic centers? Should I be considering a fellowship in academic medicine and university based internal medicine program? I am not very familiar with fellowships in academic medicine but know that they exists. Will I need to be a top star to get a spot at an academic center?

In private practice, a hospitalist will get cut off by outpatient doctors if there is even a perception or a rumor that they are stealing/diverting their patients post-discharge.

 

[ULTRA nerves]

In private practice, a hospitalist will get cut off by outpatient doctors if there is even a perception or a rumor that they are stealing/diverting their patients post-discharge.

If the patients did not have any PCP prior to admission, following-up would be ethical, right? I surely do not want to steal any patients...thank you for pointing out the gray zone to avoid!

Why are the hospitalist positions at academic settings not so popular, b/c of low pay, demanding schedules etc? I wish that I can find more about the job prospects; where could I find good articles to read on this topic?

Thank you so much for answering my questions!

 

[pedronavaja2005]

I'm a graduate of a primary care internal medicine program now working as a hospitalist in a major university based hospital and will be going for a renal fellowship at a major university program next year...I have not felt at a disadvantage compared to my categorical counterparts. Both tracks at my programs were fully integrated and we rotated at the same hospitals but the categorical got 2 more unit months and more elective overall and we did more ambulatory blocks than electives. We also had more one-on-one time with your program directors and mentors as primary care residents. Our curriculum was more well rounded than the categoricals. Just make sure that if you choose a primary care track your directors will support you 100% independently of whether you stay in primary care, hospitalize or pursue a fellowship.

 

[old_boy]

Why are the hospitalist positions at academic settings not so popular, b/c of low pay, demanding schedules etc?

Just did 2 months on the hospitalist service as a 3rd year. The hospitalists at at my school (a top university program) complain of demanding schedules (often 14 days in a row), pay barely above NPs, and being treated like residents by consulting specialists. The last complaint seems to be the biggest issue, especially for some of the younger hospitalists who have not built their reputation and are poor at saying no. Our hospital is run by the specialists, and the hospitalists who do not stick up for themselves get treated like minions. Kind of depressing. Hospitalists sometimes get stuck managing patients that they have no business managing (eg, post-op patient that "also has a medical problem"). I've also seen hospitalists yelled at and hung up on by their specialist colleagues: very unprofessional and unfortunate. That being said, some of the better hospitalists manage to navigate the ivory tower and seem to have high job satisfaction, especially if they enjoy teaching and like complicated medical cases (we get plenty of those).

 

[Mental Gymnast]

aPD or any others:

I am wondering if it's advisable to apply to both primary care and categorical IM tracks within the same program? All programs state that you can apply to as many tracks as you want (eg categorical, research, global health, primary care, etc) within the IM program. But is this not viewed negatively?

For example, Yale explicitly states that applicants should apply to both tracks and decide which one is a better fit after interview day. BWH states that if you are interested in the primary care track that you must also apply to categorical. As for other programs without specific instructions, does applying to multiple tracks risk you being perceived negatively or not having made up your mind?

Thanks!

 

[pedronavaja2005]

aPD or any others:

I am wondering if it's advisable to apply to both primary care and categorical IM tracks within the same program? All programs state that you can apply to as many tracks as you want (eg categorical, research, global health, primary care, etc) within the IM program. But is this not viewed negatively?

For example, Yale explicitly states that applicants should apply to both tracks and decide which one is a better fit after interview day. BWH states that if you are interested in the primary care track that you must also apply to categorical. As for other programs without specific instructions, does applying to multiple tracks risk you being perceived negatively or not having made up your mind?

Thanks!

Yes, it is advisable to apply to both tracks if you really like the program. I applied to both tracks at my program and ranked them 1 and 2 respectively and matched with no problem

 

[hk721]

.

 

[michaelrack]

I have seen physicians who alternate their time being hospitalists and also spend time in outpt clinics. I am a MS4 now and, likewise, my career goal is to become a hospitalist and f/u on my patients in outpt clinics.

A hospitalist primarily sees patients in the hospital. What the OP is describing sounds similar to traditional primary care (which isn't so common anymore).