Convince me not to go the hospitalist route

[zegrated]

I just finished my MSIII year and after much internal debating I've come to the tentative conclusion that I would like to go into IM and become a hospitalist. Everything about that career path sounds great to me, so basically I want to know if I am missing something or if their lifestyle really is as good as it sounds on paper.

- I enjoy the role that a hospitalist plays being the patient's "primary" doctor in the hospital and coordinating and organizing their stay and what consults they get, what tests they get, etc. and developing that connection with them as a familiar face that they will see everyday.

- I don't mind note writing. One of the biggest complaints about being a hospitalist that I have seen is that their notes are so long. I actually don't mind this. Gives me time to be more thorough and really think about my DDx and plan.

- I enjoy complicated diagnostic work-up and puzzles.

-7 on 7 off schedule. I experienced this first hand when I had a rotation with a hospitalist who worked this schedule. She was extremely happy with her job and worked probably 7-4pm on her days on + some extra administration duties. She would then would go on trips on her weeks off. I realize 7-4 is probably not commonplace, but I think I could grind through 7am-7pm for 7 days if I knew I had a week off coming up. The flexibility of the schedule also provides ample opportunity to pick up extra shifts, and not necessarily even in the hospital setting. I know some docs who would go to SNFs and see patients there for some extra cash.

- Job market seems solid, especially in more rural-ish areas which I would not mind living in.

- Pay is decent, not amazing by any means but when you consider their hourly earnings it is right up there. Correct me if I'm wrong but just browsing this subforum, I think 180k-250k seems about the average, with 250k+ being possible in less desirable areas or by picking up extra shifts.

- If it ends up being completely terrible and I hate it, there are always options in IM. Specialize, start an outpatient clinic, etc.

I know I am only an MSIII so I have a long way to go before I'm an attending but being a hospitalist sounds like a pretty sweet gig to me. Most other doctors I've talked to in other specialties agree with me and you can tell they envy their schedule. So then what is the main reason for hospitalist dissatisfaction? Try to convince me that it's not as great a position as it sounds.

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[Successor12]

I can only speak for myself but the idea of returning pages, arguing with ER people over admissions, following up with nurses on so many stuff that won't be done on time just for the heck of it, NOTES too many of them, dealing with discharging persistent pressures, placement ! , being bossed around by consulting teams and having major decisions regarding my patients care dictated by stuff they'd recommend with out a clear or even realistic plan of getting done without delaying discharges and building up administrative push even MORE, and technically functions as a coordinator between different consultants, social workers, family members, ICU and CCU teams while having to justify decisions that you won't even be included in them while having your name all over the charts then getting time off on a random Tuesday with Low consistency to being able to have a sane social life on the side after pushing through tough 12hours shifts back to back for seven days!

To me all of the above was a deal breaker to me and neither the money nor the time off would justify the job... I don't like the lifestyle... I don't like the idea of being stuck in such a position especially knowing that getting back to a fellowship after being a hospitalist for sometime can get tricky unless you want to do nephrology (trust me you DO NOT want to do nephrology)

Mind you my experience is based on my residency and the hospitalist groups I worked with, the fact that I don't like the idea of being primary, I rather be focused on a fewer number of problems, and I just really think being a hospitalist burns you out faster than doing doing anything else!

So please allow some room for bias regarding my opinion!

 

[Jinxapotato]

I can only speak for myself but the idea of returning pages, arguing with ER people over admissions, following up with nurses on so many stuff that won't be done on time just for the heck of it, NOTES too many of them, dealing with discharging persistent pressures, placement ! , being bossed around by consulting teams and having major decisions regarding my patients care dictated by stuff they'd recommend with out a clear or even realistic plan of getting done without delaying discharges and building up administrative push even MORE, and technically functions as a coordinator between different consultants, social workers, family members, ICU and CCU teams while having to justify decisions that you won't even be included in them while having your name all over the charts then getting time off on a random Tuesday with Low consistency to being able to have a sane social life on the side after pushing through tough 12hours shifts back to back for seven days!

To me all of the above was a deal breaker to me and neither the money nor the time off would justify the job... I don't like the lifestyle... I don't like the idea of being stuck in such a position especially knowing that getting back to a fellowship after being a hospitalist for sometime can get tricky unless you want to do nephrology (trust me you DO NOT want to do nephrology)

Mind you my experience is based on my residency and the hospitalist groups I worked with, the fact that I don't like the idea of being primary, I rather be focused on a fewer number of problems, and I just really think being a hospitalist burns you out faster than doing doing anything else!

So please allow some room for bias regarding my opinion!

Would you mind explaining what's wrong with nephrology? I am also a medical student looking into a career in Nephrology. Thank you so much.

 

[gutonc]

Would you mind explaining what's wrong with nephrology? I am also a medical student looking into a career in Nephrology. Thank you so much.

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[DrSnips]

Also, be aware that the 7 on / 7 off is quickly becoming unpopular in hospital medicine. Some people have kids / other responsibilities where they can't be away for 7 days straight. Most people don't want to work every other weekend either. In the last edition of ACP Hospitalist I think they mentioned only ~40% of hospitalist groups are still doing 7 on / 7 off, which I see as progress. Mon through Fri with rotating weekends covered partially by moonlighters is MUCH better if you're in for the long haul.

Also, I don't know many in my group complain about note writing. Most of us hammer out quick notes that are billable and call it a day. What we complain about are the depressing dispo issues where there's no medical problem to solve and it's just "how can I convince this unrealistic family member to make this oriented x 0, non-verbal, contractured, bedsore-laden, taxdollar-wasting, dementia patient DNR and comfort care?" Deal with five of those in one day and see how you feel.

Anyway, every job has pros and cons. The particular pros and cons of hospital medicine make it a good fit for me. Maybe for you too. But it's definitely not all sunshine and unicorn frappucinos.

 

[Mad Jack]

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They make the posters in path and anesthesiology sound like Bob Ross in comparison.

 

[Mad Jack]

I can only speak for myself but the idea of returning pages, arguing with ER people over admissions, following up with nurses on so many stuff that won't be done on time just for the heck of it, NOTES too many of them, dealing with discharging persistent pressures, placement ! , being bossed around by consulting teams and having major decisions regarding my patients care dictated by stuff they'd recommend with out a clear or even realistic plan of getting done without delaying discharges and building up administrative push even MORE, and technically functions as a coordinator between different consultants, social workers, family members, ICU and CCU teams while having to justify decisions that you won't even be included in them while having your name all over the charts then getting time off on a random Tuesday with Low consistency to being able to have a sane social life on the side after pushing through tough 12hours shifts back to back for seven days!

To me all of the above was a deal breaker to me and neither the money nor the time off would justify the job... I don't like the lifestyle... I don't like the idea of being stuck in such a position especially knowing that getting back to a fellowship after being a hospitalist for sometime can get tricky unless you want to do nephrology (trust me you DO NOT want to do nephrology)

Mind you my experience is based on my residency and the hospitalist groups I worked with, the fact that I don't like the idea of being primary, I rather be focused on a fewer number of problems, and I just really think being a hospitalist burns you out faster than doing doing anything else!

So please allow some room for bias regarding my opinion!

But do you enjoy hating your life?

 

[obiwan]

One thing about being a hospitalist is that after a while, it becomes very mundane.

 

[gutonc]

One thing about being a hospitalist physician is that after a while, it becomes very mundane.

Fixed that for you.

 

[IM2GI]

Just wait and see what your intern year is like.

Hospital medicine is the easiest to transition into because it is exactly what you are comfortable and used to be doing.

There is a certain amount of pain with being the "first page" and dealing with all the social/dispo nightmares. Particularly if you are at a quaternary referral center.

 

[Jinxapotato]

Swing on over here and meet some of the happiest people in medicine.

well holy cow.....

 

[Trogghunter]

If you can come to terms with not fixing most people but just tuning them up then you'll absolutely love hospitalist medicine. There's nothing more satisfying than bringing those red numbers on my emr back down to blue. I love treating an aki...it's like McDonald's......I'm lovin' it. Don't have insurance or complicated dispo? That's fine, I'll say 'hey' while you hang around with that dc order in while SW and CC figure it out and give the ole 'good morning, and if I don't see ya good afternoon, good evening, and goodnight'. Don't make it personal.

 

[Gastrapathy]

I'm glad there are hospitalists around.

 

[psychMDhopefully]

They make the posters in path and anesthesiology sound like Bob Ross in comparison.

Can you blame them, they go through hell, and 3 extra years of residency just to have a worse job market and get paid less than primary care. I'm shocked anybody is going into nephrology, seems like a bad deal even for IMGs.

 

[Mad Jack]

Can you blame them, they go through hell, and 3 extra years of residency just to have a worse job market and get paid less than primary care. I'm shocked anybody is going into nephrology, seems like a bad deal even for IMGs.

Don't blame them a bit. It's tragic what dialysis companies did to both the quality of dialysis care and to the job market for nephrologists.

 

[Medstart108]

I just finished my MSIII year and after much internal debating I've come to the tentative conclusion that I would like to go into IM and become a hospitalist. Everything about that career path sounds great to me, so basically I want to know if I am missing something or if their lifestyle really is as good as it sounds on paper.

- I enjoy the role that a hospitalist plays being the patient's "primary" doctor in the hospital and coordinating and organizing their stay and what consults they get, what tests they get, etc. and developing that connection with them as a familiar face that they will see everyday.

- I don't mind note writing. One of the biggest complaints about being a hospitalist that I have seen is that their notes are so long. I actually don't mind this. Gives me time to be more thorough and really think about my DDx and plan.

- I enjoy complicated diagnostic work-up and puzzles.

-7 on 7 off schedule. I experienced this first hand when I had a rotation with a hospitalist who worked this schedule. She was extremely happy with her job and worked probably 7-4pm on her days on + some extra administration duties. She would then would go on trips on her weeks off. I realize 7-4 is probably not commonplace, but I think I could grind through 7am-7pm for 7 days if I knew I had a week off coming up. The flexibility of the schedule also provides ample opportunity to pick up extra shifts, and not necessarily even in the hospital setting. I know some docs who would go to SNFs and see patients there for some extra cash.

- Job market seems solid, especially in more rural-ish areas which I would not mind living in.

- Pay is decent, not amazing by any means but when you consider their hourly earnings it is right up there. Correct me if I'm wrong but just browsing this subforum, I think 180k-250k seems about the average, with 250k+ being possible in less desirable areas or by picking up extra shifts.

- If it ends up being completely terrible and I hate it, there are always options in IM. Specialize, start an outpatient clinic, etc.

I know I am only an MSIII so I have a long way to go before I'm an attending but being a hospitalist sounds like a pretty sweet gig to me. Most other doctors I've talked to in other specialties agree with me and you can tell they envy their schedule. So then what is the main reason for hospitalist dissatisfaction? Try to convince me that it's not as great a position as it sounds.

Kudos for you for doing a job I would never want to do! Thank you!

 

[VA Hopeful Dr]

You're going to work every other holiday and approximately every other weekend. If you're single or even married without kids that may not be an issue, with kids it kinda sucks. For example: my kids wake up at around 7am and are asleep by 7pm. If I was a hospitalist, there's a good chance I wouldn't have seen them at all.

You are the dumping ground for every other specialist in the hospital.

12 hour days are long, especially several of them in a row.

Hospitals see you as more of a commodity than any other doctor excepting EM docs. You don't bring in lots of money and you don't have a loyal patient base that follows you wherever you go. Part of your job is keeping the doctors that do have those things happy.

 

[CCM-MD]

Many 7 on/off hospitalist gigs don't require you to be in house for the full 12 hours and there are several alternative hospitalist staffing models which are not 7 on/off that are becoming popular. Moreover, hospitalists aren't the only doctors working evenings and weekends, many other medical specialties come to mind. You can expect to be working at least one weekend per month in CCM, cards, nephro, ID... maybe heme/onc, endocrine, rheum or pulm (without ccm) practices can get away with having to work less than 1 weekend a month or no weekends at all.

The legitimate negatives of being a hospitalist in my opinion are the "dumping ground" and "coordinator" aspects. But every specialty has its positives and negatives, and you have to decide which one has a favorable balance that is acceptable to you. Luckily, there are many physicians who practice hospitalist medicine and have a favorable view of the specialty.

I don't think the SDN population will have a favorable view of hospitalist work because of the type of personalities that are attracted to using this website in the first place. Many are browsing the IM section because they are already pursuing/planning to pursue subspecialties. I think you should go into residency with an open mind and if you end up liking hospital medicine, its not a bad career option both financially and lifestyle wise.

 

[IM2GI]

I think that being a hospitalist is comfortable and familiar. It is an easy transition from residency to hospitalist, and probably a good job for 5 years.

I just worry that over the course of a career between burnout/schedule/job frustrations it is not the kind of thing you want to do for 30 years.

 

[CCM-MD]

Although I know of unhappy hospitalists, I have also seen a number frustrated and burnt out subspecialists. At the same time I also know hospitalists who are 15-20 years into their career and enjoy what they do. There is a lot more to burnout than one's medical specialty.

 

[chessknt]

Compensation plays a big role in job satisfaction. If you feel underpaid every annoying aspect of your job is magnified 10 fold and the compensation model for hospital medicine is unfortunately seen as a liability by management due to poor billing capacity of internists. Like to earn 50th percentile pay (250k 14 shifts per month) currently you need to bill approximately 9 admits or 14 level 2 follow ups, which feels like a full day. But that just pays your salary, for your employer to not lose out on covering benefits that number goes up even more. If you expect to break 300k you need to up tgat by an extra 2 admits or 3 followups.

It makes the mbas ponder ways to reduce the line item cost you've become which invariably turns in to reducing staffing to levels that are barely acceptable most of the time and dangerous the rest of the time (think 25 patients per day with no midlevel). But your pay won't really go up because the savings the mbas created go to the hospital to keep it's ridiculous administration afloat in an era of increasingly difficult to collect claims and declining reimbursements and stupid medicare quality rules. You'll eventually understand this yourself if you do it long enough or accept midlevel pay and work in a place that shields you from this.

 

[psychMDhopefully]

Compensation plays a big role in job satisfaction. If you feel underpaid every annoying aspect of your job is magnified 10 fold and the compensation model for hospital medicine is unfortunately seen as a liability by management due to poor billing capacity of internists. Like to earn 50th percentile pay (250k 14 shifts per month) currently you need to bill approximately 9 admits or 14 level 2 follow ups, which feels like a full day. But that just pays your salary, for your employer to not lose out on covering benefits that number goes up even more. If you expect to break 300k you need to up tgat by an extra 2 admits or 3 followups.

.

So why is hospitalist compensation steadily increasing? Aren't they in-part compensated because of their ability to free up beds in the hospital, so that the real billing gods, the specialist, can keep patients moving?

 

[chessknt]

So why is hospitalist compensation steadily increasing? Aren't they in-part compensated because of their ability to free up beds in the hospital, so that the real billing gods, the specialist, can keep patients moving?

All physicians are compensated by billing alone. Discharging people from the hospital isn't an easy metric to gauge value.

And if compensation is higher than collections you are a net loss to the bean counters. Supply demand mismatches are temporary and the billing reality will eventually come to roost.

 

[JP2740]

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OMG...

I'm ****ing dying over here... I have never seen such a thing on the SDN boards.

That thread is a "fellowship application cycle" thread. Like it's meant for people applying at that very same time! Yet, RIGHT AWAY, it starts out with describing the horror story of nephrology. That is quite simply incredible. I keep reading it! Cannot wait to show this to my buddies.