First attending job: outpatient, hospitalist, or traditional?

[SXMMD]

This is kind of a personal dilemma, could use some thoughts from more experienced folks. I am a PGY-3 FM resident from unopposed background looking for jobs. The problem I am running into is regarding practice type to pursue: hospitalist, outpatient only, or traditional inpt and outpt. I'm ok with hospitalist or outpatient only, but passionate about traditional. I am having a hard time finding traditional jobs within the geography/income range I am looking for (family and student loans are the limiting factors) and find myself having to make a decision: chase money and location and take the "OK" job, or take a big hit financially and do the job I want.

Did any of you guys who pursued outpatient only, or hospitalist only, practice ever regret or miss the other side? Is traditional medicine dying, should I focus my practice one way or the other in anticipation of that?

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[VA Hopeful Dr]

Traditional jobs outside rural areas are becoming very hard to find. If you're dead set on not going rural you can find those jobs but you'll have to look pretty hard for them.

 

[AMEHigh]

Are you interested in academics? My program actually didn’t have that model, but I know there are still academic places in non-rural areas where their FM doctors do both inpatient and outpatient.

The Indian Healty Services is another option that follows that model.

 

[hallowmann]

Are you interested in academics? My program actually didn’t have that model, but I know there are still academic places in non-rural areas where their FM doctors do both inpatient and outpatient.

The Indian Healty Services is another option that follows that model.

The FM program at my institution has docs doing inpatient and outpatient, but typically not in the traditional sense of you only treating your own patients inpatient. They work essentially like hospitalists, where they'll work say one week every month or two on the inpatient service but the rest of the time will be outpatient. They only admit people established with the FM department, but that's a huge census. Occasionally the attending will be on when one or two of their patients are admitted, but not always.

 

[brianmartin]

combined practices are quite rare in the real world, for many reasons. You can find them, but there will be sacrifices for it.
Coming out of residency everyone "wants" to keep doing inpatient, but most don't, and eventually feel like that is a good thing.
I liked inpatient medicine in residency, but thats because it was protected and a learning environment. In the real world hospitalists are just wage slaves for hospitals and have huge workloads for just okay compensation. Honestly, I'd just find something outpatient only. Then you can pick and choose from lots of different jobs/locations, etc. Do you have loans? What do you WANT to do? Where do you want to live?

 

[SXMMD]

Hey thanks for the responses.

Thought about academic medicine and may circle back in a few years to it, but just out of residency I want to experience the world outside the residency bubble first.

I'm coming to terms with the idea that my ideal job doesn't necessarily exist anymore, but there a

 

[Fatalis]

As someone fresh out of residency [6 months] and doing traditional practice....really think twice about doing it. You will be in clinic, running around and get called from the ED about an admission even when you are not on call. It really is a commitment, dont get me wrong, I like that I do but I cant see myself doing this forever

 

[Sardonix]

combined practices are quite rare in the real world, for many reasons. You can find them, but there will be sacrifices for it.
Coming out of residency everyone "wants" to keep doing inpatient, but most don't, and eventually feel like that is a good thing.
I liked inpatient medicine in residency, but thats because it was protected and a learning environment. In the real world hospitalists are just wage slaves for hospitals and have huge workloads for just okay compensation. Honestly, I'd just find something outpatient only. Then you can pick and choose from lots of different jobs/locations, etc. Do you have loans? What do you WANT to do? Where do you want to live?

As someone fresh out of residency [6 months] and doing traditional practice....really think twice about doing it. You will be in clinic, running around and get called from the ED about an admission even when you are not on call. It really is a commitment, dont get me wrong, I like that I do but I cant see myself doing this forever

As someone who also thinks they want to do inpatient/outpatient, this stuff is useful to hear.

 

[TableMD]

I can't imagine running an effective clinic and getting paged from the ED about admits.

 

[deleted87716]

I can't imagine running an effective clinic and getting paged from the ED about admits.

If you want to have a practice like that, your patients had better get used to waiting. Also, plan on working late.

 

[MedicineZ0Z]

If do stop inpatient, you won't be able to go back to it. You'll be a much stronger physician if you do hospitalist for a bit first (maybe with some urgent care mixed in) then move into outpatient rather than just doing outpatient only. Frankly, I feel like it's a waste of training too if your residency wasn't heavily outpatient focused.

 

[hallowmann]

If do stop inpatient, you won't be able to go back to it. You'll be a much stronger physician if you do hospitalist for a bit first (maybe with some urgent care mixed in) then move into outpatient rather than just doing outpatient only. Frankly, I feel like it's a waste of training too if your residency wasn't heavily outpatient focused.

To be completely honest everything we don't end up doing in practice is a waste of training. Are you also suggesting everyone do OB for a while? How about circs? The thing is, we're generalists and need to at least be familiar with all aspects, but there's nothing wrong with people choosing which areas they want to focus on. There are plenty of amazing FM physicians that never did inpatient after residency, same with regards to outpatient or OB for that matter. Hospitalist is not "the" bar.

 

[MedicineZ0Z]

To be completely honest everything we don't end up doing in practice is a waste of training. Are you also suggesting everyone do OB for a while? How about circs? The thing is, we're generalists and need to at least be familiar with all aspects, but there's nothing wrong with people choosing which areas they want to focus on. There are plenty of amazing FM physicians that never did inpatient after residency, same with regards to outpatient or OB for that matter. Hospitalist is not "the" bar.

I was speaking in the context of OP's interests. He/she wants to do inpatient work and given the very difficult transition from outpatient --> inpatient, they have nothing to lose by first doing hospitalist (at least for a while). But would give up being a quality inpatient doc if they just went straight into clinic work only.
So it's really a balance between your interests and what you were trained to do.

 

[hallowmann]

I was speaking in the context of OP's interests. He/she wants to do inpatient work and given the very difficult transition from outpatient --> inpatient, they have nothing to lose by first doing hospitalist (at least for a while). But would give up being a quality inpatient doc if they just went straight into clinic work only.
So it's really a balance between your interests and what you were trained to do.

Fair enough, I agree with that.

For your last post:

...You'll be a much stronger hospitalist if you do hospitalist for a bit first (maybe with some urgent care mixed in) then move into outpatient rather than just doing outpatient only...

Ftfy

 

[deleted87716]

To be completely honest everything we don't end up doing in practice is a waste of training.

Not necessarily. OB training will help ensure that you don't overlook pregnancy complications in the office. Likewise, you may never take out anyone's appendix, but doing a surgical rotation certainly helps you recognize it.

 

[VA Hopeful Dr]

Not necessarily. OB training will help ensure that you don't overlook pregnancy complications in the office. Likewise, you may never take out anyone's appendix, but doing a surgical rotation certainly helps you recognize it.

This can't be overstated. Just having more experience with pregnancy in general helps for the pregnant women that come in with non-pregnancy problems as well.

 

[Fatalis]

I can't imagine running an effective clinic and getting paged from the ED about admits.

they call me only if it is one of my patients that is getting admitted. the ED docs put the orders in and obviously keep them stable or else they are shipped out. During lunch or after clinic I go and do the HPI, etc....exactly why I am saying it sucks and don't do traditional/ you can only do it for so long

 

[hallowmann]

Not necessarily. OB training will help ensure that you don't overlook pregnancy complications in the office. Likewise, you may never take out anyone's appendix, but doing a surgical rotation certainly helps you recognize it.

I don't disagree, I was actually commenting on the previous poster's assertion that not working inpatient out of residency was a waste of training at an inpatient heavy residency. My post was meant to state that based on that assertion you could say everything we don't end up doing is a waste. If you read the rest of my post, I say pretty clearly that we are generalists and should be familiar with things even if we don't use it in practice.

 

[Perrotfish]

The FM program at my institution has docs doing inpatient and outpatient, but typically not in the traditional sense of you only treating your own patients inpatient. They work essentially like hospitalists, where they'll work say one week every month or two on the inpatient service but the rest of the time will be outpatient. They only admit people established with the FM department, but that's a huge census. Occasionally the attending will be on when one or two of their patients are admitted, but not always.

The FM department at my current institution also offers this. You can't be traditional, but you can be 0.5 FTE hospitalist and 0.5 FTE clinic.

 

[KeikoTanaka]

The FM department at my current institution also offers this. You can't be traditional, but you can be 0.5 FTE hospitalist and 0.5 FTE clinic.

Is this common for smaller hospitals that have trouble recruiting people?

 

[FamilymedMD]

If you're not ready to give up your inpatient privileges, consider locations where you can work part time as a hospitalist and part time in an office. I doubt that you'd be able to stay happy balancing those two but that would give you a couple more years to decide what to do.

I did something similar while setting up my current practice. I enjoyed the inpatient work and the income but not mixing night and day work.

 

[SLC]

My setup is regular clinic, and inpatient on the weekends. I do extra inpatient call so some of the less enthusiastic people in our group don’t have to. Right now I do 2 consecutive weekends every 6 weeks.

I love it that way.

 

[BigSib]

Figure out where you want to live and then call the surrounding hospitals, asking to speak with HR or the physician recruiter. That's what I did and every single one of them was hiring. Otherwise find a recruiter to do that part of the leg work for you. As others have said traditional work may be hard to come by in urban areas, but most larger community hospitals that have a hospitalist program still do have some community docs that admit.

 

[scharnhorst]

Has any FP docs here done exclusively outpatient for a few yrs out of training and then gone back and done inpatient again ?
If so what challenges you faced ?
And if you have not, please elaborate why not ? Why did you choose to remain just outpatient?

 

[MedicineZ0Z]

Has any FP docs here done exclusively outpatient for a few yrs out of training and then gone back and done inpatient again ?
If so what challenges you faced ?
And if you have not, please elaborate why not ? Why did you choose to remain just outpatient?

There's so much you would forget. Even private docs who admit nowadays (fm/im/peds) can do silly things cause they aren't doing inpatient that much.