Crossroads between outpatient and inpatient

[Sardonix]

PGY3 FM here.

I am fielding interviews for both 100% outpatient and 100% inpatient positions. Looking for hearing others' experiences when it came to deciding and if it's actually practical to switch down the line.

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[Ironheme]

Why not do a mix? Colleague of mine switched from 100% inpatient to 100% outpatient after trying it for a couple of years - no issues. If you're not sure, you can always pick up extra shifts of the other to keep your skills sharp or to see if you like the other side more. I think it may be harder to switch from one to the other if you wait many years and then you are rusty.

Usually comes down to
Outpatient - always more to do (results, f/u, keeping up with screenings), but you build the long term relationship with patients. Also more likely to be the 'eat what you kill' model. Less hours, more flexibility about your own schedule. Heavier with the paperwork/charting.

Inpatient - Occasionally unpredictable workload, but when you're off, you're off. You don't build that long term relationship. Usually longer hours when you're on, but more days off in between.

 

[cj_cregg]

Agreed, if you like both and are willing to be flexible on location...why not do traditional family practice? You can keep both skill sets sharp and always switch to 100% one or the other later if that's what you end up wanting to do.

 

[InternistDO]

I would love to do some sort of mix of inpatient and outpatient, but at least in larger cities it's fairly difficult to find. Some will allow for weekend moonlighting (which is fine for extra cash but I didn't do primary care to work a bunch of weekends), I found one that will tentatively let me do a month of inpatient a year in NYC, and then there are a reasonable amount of academic jobs that have both, but at the cost of having most of your clinical time be supervisory as opposed to having your own patients.

Also in big NE cities outpatient is paying more these days. Too many IM residents afraid of primary care I guess.

 

[Fatalis]

If you are doing a mix as others suggested [I did it and it was horrible as I was in a small town] remember you essentially have to be 2 places at once and there will be days where you are in the hospital taking care of a sick patient while your outpatient clinic is expecting you to be there... it gets really annoying after awhile, especially when the admin gets pissed that "your clinic had to be cancelled".
Also it gets annoying getting called while you are in clinic regarding inpatient issues...again mentally, 2 places at once.
Stick with one, you will be much happier.
Currently doing 7on/7off hospitalist and enjoying it!

 

[AMEHigh]

If you want to do both working at a residency program is a good way to do that.
I think it’s possible to switch after a couple years if you’re really dedicated to it, but def could be difficult.

I don’t practice full spectrum family med anymore and I’m only a few years out, and I do try to read aafp articles but even the nuances of managing diabetes I have forgotten since there are so many new meds now. If I really wanted to go back to outpatient primary care it would definitely take a lot of reading and reaching out to colleagues. I def couldn’t go back to inpatient!

At first I thought I wanted my job out of residency/fellowship to still be "full spectrum" so I wouldn’t lose so much knowledge right away and could narrow things down over the years, but ultimately I’m happy that I’ve found my little niche and am very happy that I was family med trained.

One of the FM hospitalists that would help out during residency said she had plans to go in to outpatient, but 10+ years later she was still doing inpatient and didn’t feel like she could switch without significant effort.

 

[retroflex]

If you want to do both working at a residency program is a good way to do that.
I think it’s possible to switch after a couple years if you’re really dedicated to it, but def could be difficult.

I don’t practice full spectrum family med anymore and I’m only a few years out, and I do try to read aafp articles but even the nuances of managing diabetes I have forgotten since there are so many new meds now. If I really wanted to go back to outpatient primary care it would definitely take a lot of reading and reaching out to colleagues. I def couldn’t go back to inpatient!

At first I thought I wanted my job out of residency/fellowship to still be "full spectrum" so I wouldn’t lose so much knowledge right away and could narrow things down over the years, but ultimately I’m happy that I’ve found my little niche and am very happy that I was family med trained.

One of the FM hospitalists that would help out during residency said she had plans to go in to outpatient, but 10+ years later she was still doing inpatient and didn’t feel like she could switch without significant effort.

When you say niche do you mean outpatient FM, or do you have a specific focus in clinic?

 

[AMEHigh]

When you say niche do you mean outpatient FM, or do you have a specific focus in clinic?

I am not an outpatient primary care doctor. I have a more specific focus.

 

[Cranjis McBasketball]

PGY3 FM here.

I am fielding interviews for both 100% outpatient and 100% inpatient positions. Looking for hearing others' experiences when it came to deciding and if it's actually practical to switch down the line.

I cant believe youre PGY-3. I remember asking you about boards haha time flies

 

[jacobus1919]

I got buddies who do both inpatient/Hospital Medicine and outpatient medicine. Seems they love it and do pretty good work.

 

[Drrrrrr. Celty]

It just depends on the hospital system and the hiring environment.

But I personally know someone who switched from palliative after 20 years and went to being a hospitalist. They managed fine. Though I can't imagine how stressful it was to just sit down and learn how to put in admission orders again or to adapt to the hospital's culture regarding testing and consults. Like being a hospitalist is a lot of knowing how not to step on a land mine and how cover all your bases.

That being said I don't believe that being a hospitalist is not a sustainable career. It inherently has disruptive elements, has dead time space which most people end up finding a side hustle to do with and becoming even more tired. Furthermore adapting to comfort and familiarity makes switching fields hard unless it's borderline impossible to practice that field anymore.

 

[Sleepingdoc]

PGY3 FM here.

I am fielding interviews for both 100% outpatient and 100% inpatient positions. Looking for hearing others' experiences when it came to deciding and if it's actually practical to switch down the line.

I would say go after the best contract that fits your lifestyle... You are no longer in training/Residency so you have a lot of control..Dont be tempted by the salesman. Dont go after the first contract you are offered, field multiple offers and negotiate, say "no" to bad contracts- you dont want to be a punchbag to a company... Family medicine has lots of opportunities.. You can find one in any corner of the country and get paid a lot of money

Go after better lifestyle and best money... dont just look at doing more work for the jack A44es and getting paid less just because its your "passion"... These "passionate" people ruin pays for everyone. Remember- you are now in control and no longer in residency.

 

[Sardonix]

I would say go after the best contract that fits your lifestyle... You are no longer in training/Residency so you have a lot of control..Dont be tempted by the salesman. Dont go after the first contract you are offered, field multiple offers and negotiate, say "no" to bad contracts- you dont want to be a punchbag to a company... Family medicine has lots of opportunities.. You can find one in any corner of the country and get paid a lot of money

Go after better lifestyle and best money... dont just look at doing more work for the jack A44es and getting paid less just because its your "passion"... These "passionate" people ruin pays for everyone. Remember- you are now in control and no longer in residency.

But who do I precept my patients with???

 

[dr_shark]

PGY3 FM here.

I am fielding interviews for both 100% outpatient and 100% inpatient positions. Looking for hearing others' experiences when it came to deciding and if it's actually practical to switch down the line.

You're a PGY3 in FM?

Dawg, I've seen you in every thread for as long as I've known about SDN like pre-med school? Good God like are you sure? Pretty sure you should be an attending 10 years in the game at least.

Sincerely,

A 2nd year FM hospitalist attending.

WHEW!

 

[dr_shark]

I am not an outpatient primary care doctor. I have a more specific focus.

What do you do?