ibarne242

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So I've been pretty much realizing that I want to be a hospitalist. I always used to like outpatient medicine, and I still don't mind it. But now the only thing I find even mildly interesting is inpatient, because things actually happen there and I like adult medicine. I literally don't care about ob or peds at all, no offense, I think they're wonderful field for very special individuals, they're just not for me.

I'm in residency in south jersey, moved here from med school in nyc. I ultimately want to get a hospitalist job closer to nyc (like within 40 miles of manhattan ideally). My program for FM is supposedly a little bit medicine heavy (6.5 months inpatient medicine, 1 month ICU, and 3 months cards/pulm inpt) but I'm planning on doing a couple extra medicine rotations as electives. I'm also thinking about switching to IM. But either way, how hard would it be to get a hospitalist job from FM in my target area? Thanks.

Edit: Thanks for all the responses. We take a fair amount of medicine call as well, which I forgot to mention.
 
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AMEHigh

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To be honest I think "if there's a will there's a way" in many things in FM.
I went to residency in the general vicinity and to be honest my program wasn't SUPER inpatient heavy, but one of my co-residents really wanted to do hospitalist so he did electives and just studied on his own and that's what he does now. I believe he had multiple job offers.

There were multiple hospitalists where we rotated that were FM that weren't affiliated with our residency program as well.

You could also do a fellowship if you feel like you need an extra year of training to be comfortable.
And going the academic route is also an option. My first job out of residency was working closely with a FM academic program (again in the general vicinity you mention) and there were multiple attendings that did mostly hospitalist work.

It doesn't seem like it'd be worth it to switch to IM unless you want to do an IM fellowship or you just prefer the rotations that an IM residency offers. Have to figure out if losing a year or 2 would be worth it for you.
 

MedicineZ0Z

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Lots of jobs that are open to FM. You shouldn't have any problem finding something good to be honest.
 
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VA Hopeful Dr

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Lots of jobs that are open to FM. You shouldn't have any problem finding something good to be honest.
Yep. There will be some jobs that aren't open to you as FM but far more will be willing to consider you - especially if you do extra electives in residency that show you're serious about being a hospitalist (more ICU time, more inpatient time, stuff like that).
 
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MedicineZ0Z

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Yep. There will be some jobs that aren't open to you as FM but far more will be willing to consider you - especially if you do extra electives in residency that show you're serious about being a hospitalist (more ICU time, more inpatient time, stuff like that).
Yeah more electives, especially for personal comfort - but definitely no fellowship. The latter is just an excuse to get paid a lower salary while working almost like an attending.
 
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SXMMD

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With exception to a a few hospitals I had no trouble finding and securing a hospitalist job (midwest). I'm a recent grad, have been told by longer practicing physicians that 2-3 years into hospitalist practice it becomes even easier to get hospitalist jobs.

I think for the most part you should not have trouble with an fm background getting a hospitalist job. There may be more competition/ candidates (IM especially) for jobs in your target region though
 
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VA Hopeful Dr

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Yeah more electives, especially for personal comfort - but definitely no fellowship. The latter is just an excuse to get paid a lower salary while working almost like an attending.
I could see it if either your residency program was very light on inpatient (a new HCA program in my state has a total of 6 months of adult inpatient across the whole program, by contrast mine had 10) or if there were specific procedural skills you wanted to get the required numbers on - central lines being the most common.

But I'd say the vast majority of programs have the ability to prepare you adequately for hospital work.
 

styphon

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I had a hospital heavy FM rotation, then went into primary care + urgent care/ER for 6 years. I went back to hospitalist last year. I am the only family med MD on the service of +40 doctors, and I feel I am just as qualified/trained as the IM doctors.
 

AFMD

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I think 2/8 of our graduating residents went straight into hospitalist all four years I was around (counting the outgoing class when I started). It's probably pretty regional, this was in the mountain west at an inpatient heavy FM residency. Very doable. I did hospitalist shifts for about a year after, and I was pretty comfortable doing it, it was lucrative but just wasn't my thing.
 

Cuze

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im thinking the same thing but I honestly cannot tell if my program is inpatient heavy soft or what. We do 5 total months of inpatient but other then that we do 4 months night float 2 months icu along with cross covering inpt team while doing obgyn/peds. Are you guys counting those as well?
 

MedicineZ0Z

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I could see it if either your residency program was very light on inpatient (a new HCA program in my state has a total of 6 months of adult inpatient across the whole program, by contrast mine had 10) or if there were specific procedural skills you wanted to get the required numbers on - central lines being the most common.

But I'd say the vast majority of programs have the ability to prepare you adequately for hospital work.
I think if it's a couple specific procedures - you can just get that via a combo of elective exps + maybe a course on top of that. Or even courses and having someone to help out initially when you start (this is an option at some smaller hospitals in general).

If at a very light inpatient program where you also don't see many cases and the autonomy is low - then yep for sure agree.
 

VA Hopeful Dr

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im thinking the same thing but I honestly cannot tell if my program is inpatient heavy soft or what. We do 5 total months of inpatient but other then that we do 4 months night float 2 months icu along with cross covering inpt team while doing obgyn/peds. Are you guys counting those as well?
Night float/ICU absolutely.

Cross cover while on another service, depends on what your responsibilities are.
 

jm192

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im thinking the same thing but I honestly cannot tell if my program is inpatient heavy soft or what. We do 5 total months of inpatient but other then that we do 4 months night float 2 months icu along with cross covering inpt team while doing obgyn/peds. Are you guys counting those as well?

At the end of the day, it's a question of how comfortable are you?

You need to know the bread and butter stuff. You need to recognize emergent things (true anywhere).

I considered our program inpatient heavy. We had 4 months of Inpatient service. We had 3 months with the Hospitalist group--two "IM" and 1 ICU. But even on IM, we'd see ICU patients.

We had Cards, GI, Urology, Nephrology which had an inpatient component.

We had two months of general surgery, which was a lot inpatient.

We took two nights a month of overnight call where you just covered the hospital patient's/did admits.

AND THEN. We had this continuity set up. If your clinic patient got admitted to the hospital, you would come round on them at 5 or 6 AM before your rotation. Everyone had their own frequent fliers.
 
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AMEHigh

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At the end of the day, it's a question of how comfortable are you?

You need to know the bread and butter stuff. You need to recognize emergent things (true anywhere).

I considered our program inpatient heavy. We had 4 months of Inpatient service. We had 3 months with the Hospitalist group--two "IM" and 1 ICU. But even on IM, we'd see ICU patients.

We had Cards, GI, Urology, Nephrology which had an inpatient component.

We had two months of general surgery, which was a lot inpatient.

We took two nights a month of overnight call where you just covered the hospital patient's/did admits.

AND THEN. We had this continuity set up. If your clinic patient got admitted to the hospital, you would come round on them at 5 or 6 AM before your rotation. Everyone had their own frequent fliers.

Oh my, that sounds like torture!
 
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cj_cregg

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For comparison: My program has about 50% of grads doing hospitalist only or a mix of inpatient and outpatient. The ones I know who aren't doing it don't want to. We have 9-10 months of inpatient medicine blocks which includes open ICU, running codes/RATs, etc, 2 weeks of dedicated ICU/pulm, and then of course some additional specialty rotations that involve inpatient care as well (though with less responsibility). We also do the thing jm192 mentioned above where we round on our own patients if they are admitted.
 
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cj_cregg

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Oh my, that sounds like torture!
My program also does this and I actually love it. It can definitely be annoying on days where you're already busy and getting pages at all hours of the day if they are not behaving. But also the patients love that their own doctor sees them, the continuity and follow up are excellent, and it's fantastic learning to manage the transition between outpatient to inpatient and back to outpatient. It's usually not too awful or time consuming since you generally know the patient well, unless it's one of those cases where they're just very medically complex or it's a patient with poor clinic follow up so you've never met them.
 
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KnuxNole

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Maybe I'm naïve but I was under the assumption ALL programs had you follow your clinic patients in the hospital in some form, whether writing a PCP note as a consult or seeing them in the AM and taking pages throughout the day for continuity requirements. ACGME wants residents to see the same patients in multiple phases of care. But...maybe I'm wrong.

I think it promotes learning, you know your patient the best, and you can see progression of diseases and it enhances your inpatient training. Plus, your patient will love that their family doctor is seeing them instead of only a bunch of strangers who they may not trust.
 

VA Hopeful Dr

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Maybe I'm naïve but I was under the assumption ALL programs had you follow your clinic patients in the hospital in some form, whether writing a PCP note as a consult or seeing them in the AM and taking pages throughout the day for continuity requirements. ACGME wants residents to see the same patients in multiple phases of care. But...maybe I'm wrong.

I think it promotes learning, you know your patient the best, and you can see progression of diseases and it enhances your inpatient training. Plus, your patient will love that their family doctor is seeing them instead of only a bunch of strangers who they may not trust.
You are wrong, but there's such variety in FM programs no one can know how every program does things.

In my program if you were on inpatient and one of your patients got admitted they automatically went to you. If you weren't on inpatient, you had to round on them at least once during their hospitalization (basically courtesy rounding as you didn't have to be at formal rounds with the inpatient team).
 
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AMEHigh

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Maybe I'm naïve but I was under the assumption ALL programs had you follow your clinic patients in the hospital in some form, whether writing a PCP note as a consult or seeing them in the AM and taking pages throughout the day for continuity requirements. ACGME wants residents to see the same patients in multiple phases of care. But...maybe I'm wrong.

I think it promotes learning, you know your patient the best, and you can see progression of diseases and it enhances your inpatient training. Plus, your patient will love that their family doctor is seeing them instead of only a bunch of strangers who they may not trust.

No that's not how my program worked.
All of our patients would get admitted to the same service and taken care of by residents from the FM program. However, if you weren't on service you weren't obligated to round on them or write any notes. If it was convenient we would stop by to do a "courtesy" visit, but never actively putting in orders or anything like that if we weren't on service. Most of us while on service would coincdentally get our own patients at times though.
 
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In my program if you were on inpatient and one of your patients got admitted they automatically went to you. If you weren't on inpatient, you had to round on them at least once during their hospitalization (basically courtesy rounding as you didn't have to be at formal rounds with the inpatient team).

That’s how it worked in my program, too, except you were expected to round DAILY. God forbid one of your patients turned into a “rock.” You could end up rounding for weeks/months. It happened to me a couple of times.
 
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