Do you make more money having residents as a hospitalist?

[NuttyEngDude]

If so, how does this break down? the more teaching you do per patient per hour? if they carry all or few of your patients? does anyone have more information?

---

Members don't see this ad.

 

[jdh71]

If so, how does this break down? the more teaching you do per patient per hour? if they carry all or few of your patients? does anyone have more information?

You don't make "more" money. How could you? Residents will increase your work generally as you have to teach and double check their work.

Teach because you want to teach. It's not a cynical ploy to make money. Ffs.

 

[GastriqueGraffin]

I think what you’re thinking of is having NPs, not residents.

 

[xoggyux]

My perspective is from what I have observed and discussed with my attendings as I am a resident at the moment. At my hospital (which is a non-academic teaching hospital with both teaching vs non-teaching hospitalists groups), there is no pay differential between teaching vs non-teaching attending except for a couple that has additional titles (e.g. program coordinator, etc).
On a first glance, it might appear as if non-teaching attendings have a benefit. They don't have to take their time to teach, they sure can round way faster than teaching attendings and presumably, they could spend that extra saved time or energy either working more hours or being more productive.
However, teaching attendings have big perks. For instance, they have a filter (residents and interns) so they usually get far fewer calls than non-teaching. In addition, they can delegate menial and boring tasks to residents/interns/medical students. The very act of teaching also helps keep the attending sharp and focused so presumably this would mean better performance on board certifications without having to necessarily spend extra time and effort to prepare every time this comes along. The bulk of the teaching is actually done by the residents in my program ( I cannot speak for other programs), the attending is mostly for supervision and experience, they do a little bit of teaching but the bulk is resident -> Intern -> Medical student.
All things considered, the best way I see it as of now based on my observations and discussions with my attendings is that the difference boils down to whether you want to spend more time writing notes, dealing with case managers and nurses, receiving calls vs more time supervising, rounding, discussing with residents/interns and teaching. All things being equal I'd tend to favor the later.
One of the big perks of teachings attendings at our hospital is that whenever they finish rounding, assuming we are not on call (and it is not their day to be "backup") they can leave. It is not uncommon for most of my attendings to be done at 2pm (we start rounding around 8:30, finish rounding at 12-1pm and they stay a bit longer doing administrative stuff). They can afford to just be available over the phone because there are residents in-house to finish dealing with CM, discharges or even problems that may arise with patients during the rest of the shift. Hospitalist at my place are not responsible for codes so there is really no benefit from them to be physically inhouse vs available over the phone.

 

[rokshana]

My perspective is from what I have observed and discussed with my attendings as I am a resident at the moment. At my hospital (which is a non-academic teaching hospital with both teaching vs non-teaching hospitalists groups), there is no pay differential between teaching vs non-teaching attending except for a couple that has additional titles (e.g. program coordinator, etc).
On a first glance, it might appear as if non-teaching attendings have a benefit. They don't have to take their time to teach, they sure can round way faster than teaching attendings and presumably, they could spend that extra saved time or energy either working more hours or being more productive.
However, teaching attendings have big perks. For instance, they have a filter (residents and interns) so they usually get far fewer calls than non-teaching. In addition, they can delegate menial and boring tasks to residents/interns/medical students. The very act of teaching also helps keep the attending sharp and focused so presumably this would mean better performance on board certifications without having to necessarily spend extra time and effort to prepare every time this comes along. The bulk of the teaching is actually done by the residents in my program ( I cannot speak for other programs), the attending is mostly for supervision and experience, they do a little bit of teaching but the bulk is resident -> Intern -> Medical student.
All things considered, the best way I see it as of now based on my observations and discussions with my attendings is that the difference boils down to whether you want to spend more time writing notes, dealing with case managers and nurses, receiving calls vs more time supervising, rounding, discussing with residents/interns and teaching. All things being equal I'd tend to favor the later.
One of the big perks of teachings attendings at our hospital is that whenever they finish rounding, assuming we are not on call (and it is not their day to be "backup") they can leave. It is not uncommon for most of my attendings to be done at 2pm (we start rounding around 8:30, finish rounding at 12-1pm and they stay a bit longer doing administrative stuff). They can afford to just be available over the phone because there are residents in-house to finish dealing with CM, discharges or even problems that may arise with patients during the rest of the shift. Hospitalist at my place are not responsible for codes so there is really no benefit from them to be physically inhouse vs available over the phone.

yes, well...once you are no longer a resident, you may see things differently...

 

[whoknows2012]

yes, well...once you are no longer a resident, you may see things differently...

From my co residents who are Hospitalists now the reaching service is way more burdensome. Much easier on non teaching.

 

[lulu09]

From personal experience residents are actually worse at writing notes that conform to the max billing standards (meeting the required ROS and PE) compared to NPs and PAs, so I had to more carefully addend the residents' notes. The other big difference is that NPs/PAs tend to be very detail-oriented and literally come in daily with a checklist ad just check things off during the course of the day -- if everything is checked, then their work is done. Residents (at least the good ones) tend to be more big-picture and think about the overall trajectory of care and hospital course, which leads them to anticipate problems and roadbumps earlier. I also appreciate the more intellectual back-and-forth with residents -- many NPs and PAs will never disagree with you simply because you're the attending.

And about being "first call," as long as you have a NP or PA on non-teaching it's essentially the same as having residents (rounds are faster because you don't need to teach). I think direct-care hospitalists (where you're the only person on call for the patient) is immensely tiring because you'll be paged constantly about blood sugars and such and simply not worth the effort unless the census is very low (<10) or the pay is ridiculously high.

To answer your original question, almost all of the hospitals I interviewed at (including the one I currently work at) had all hospitalists work non-teaching and teaching weeks (the more senior you are the more teaching you can have if you want). The pay does not depend on how much teaching time you get at these hospitals but more dependent on seniority and how many admin roles you choose to take on.

 

[NuttyEngDude]

Thank you everyone for the responses!

 

[DrSnips]

This is a tricky question. In our program the patients are triaged to teaching vs non-teaching on the basis of acuity (higher acuity to the former). Because higher acuity patients get higher level of service notes, and because we get RVU based bonuses, you do technically make more money supervising residents on the teaching service. That said, it is much more intense work, and the hourly pay rate is probably lower overall despite making more.

 

[NITRAS]

I'll mostly echo what the above have said.

At my institution, we have 4 teaching teams, like 12 non-teaching services of which there are 4 with PAs, and a consult/procedure service. Dedicated teaching attendings are on 2 of the teaching teams, one is a 3rd year "hospitalist", and the other is traditional team that floats through the hospital.

The resident teams are usually limited to the number of patients by the various "rules" by the department (more stringent than ACGME). Sooo the resident teams see fewer patients. If your senior resident is good and your interns want to learn, it can be a lot of fun. . . but if your senior resident sucks and your interns are only interested in super duper spancy specialty (like 70% of our residents). . . . its more of a chore. And they can do some stupid stuff.

Most of our PAs have been around for a few years, and you know the good ones, and the ones that need more attention. . . .but they are just easier to bill, easier to manage, and our relationship is better.