For traditional IM, key things to ask when interviewing for jobs

[cbrons]

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[VA Hopeful Dr]

When you say traditional, do you mean inpatient and outpatient?

 

[cbrons]

When you say traditional, do you mean inpatient and outpatient?

yes sir

 

[ThoracicGuy]

yes sir

That's a dying breed... I wish more would do both.

 

[Crayola227]

I think many would wish to, but most internists I talk to express that but also the significant barriers that exist for that kind of practice nowadays.

 

[VA Hopeful Dr]

So thinks to ask:

First things first: how many hospitals do you have to cover. If the answer is more than one, you probably don't want to do it. If its multiple hospitals but they are very close together, that might be OK. If you have to spend 30 minutes driving between them, pass.

What's specialty coverage at them like? If its a small hospital with no/minimal pulm/CC I'd stay away. You don't want to be missing any major specialists because you either than have to transfer often or just do your best without - neither are ideal.

How big is the group and are any of them over 60. You don't want to go from q4 to q3 6 months in because the 68 year old guy decides to retire.

Do you take overnight call? Lots of places will have the hospitalists admit/manage overnight so you're only responsible for care from like 6a-6-7p M-F and maybe weekend mornings. If you're 24/7, that sucks.

What's the daily schedule like? We have a group that in inpatient until about 10:30am and then clinic. We have another group that each person is basically the office hospitalist every 3rd week.

That's all the stuff specific to a traditional practice I can think of.

 

[VA Hopeful Dr]

That's a dying breed... I wish more would do both.

Nope.

Turns out that hospitalists save money and decrease LOS. Traditional docs tend to order fewer tests and have higher patient satisfaction scores but its not enough to offset the money saved from decreasing LOS.

Besides, hospital medicine has diverged significantly from general medicine so that its rare to find people who are good at both anymore. Its certainly possible, but it takes a pretty concerted effort that few are willing to make.

Plus you know that lifestyle...

 

[guitarguy23]

Do traditional IM folks earn enough? It seems that inpatient charges with RVUs would generate more income..

 

[rokshana]

Do traditional IM folks earn enough? It seems that inpatient charges with RVUs would generate more income..

define enough...

 

[VA Hopeful Dr]

Do traditional IM folks earn enough? It seems that inpatient charges with RVUs would generate more income..

Depends on how quickly you can get things done.

On an hourly basis, I can likely out earn an inpatient doctor if my schedule is busy enough.

 

[cbrons]

So thinks to ask:

First things first: how many hospitals do you have to cover. If the answer is more than one, you probably don't want to do it. If its multiple hospitals but they are very close together, that might be OK. If you have to spend 30 minutes driving between them, pass.

What's specialty coverage at them like? If its a small hospital with no/minimal pulm/CC I'd stay away. You don't want to be missing any major specialists because you either than have to transfer often or just do your best without - neither are ideal.

How big is the group and are any of them over 60. You don't want to go from q4 to q3 6 months in because the 68 year old guy decides to retire.

Do you take overnight call? Lots of places will have the hospitalists admit/manage overnight so you're only responsible for care from like 6a-6-7p M-F and maybe weekend mornings. If you're 24/7, that sucks.

What's the daily schedule like? We have a group that in inpatient until about 10:30am and then clinic. We have another group that each person is basically the office hospitalist every 3rd week.

That's all the stuff specific to a traditional practice I can think of.

Thanks for the reply. The jobs I'm looking at are in towns of a 20,000 people or less. Only 1 hospital, and usually the clinic is attached to the hospital or otherwise very close.

 

[VA Hopeful Dr]

Thanks for the reply. The jobs I'm looking at are in towns of a 20,000 people or less. Only 1 hospital, and usually the clinic is attached to the hospital or otherwise very close.

I have a high school classmate doing traditional FM in such a place... but they have a good transfer set up with the big place 20 miles over (same owner).

Biggest things to check are to make sure the ED knows what you can and can't manage. My wife was a hospitalist at a smaller hospital and was having to fight with the ED all the time. Stuff like "We don't have neuro so no I'm not admitting the patient you just got out of status epilepticus" or "we don't have a cath lab so no I won't admit that v-tach you just stabilized". And that there is a place you can transfer to that isn't a huge PIA to work with.