GI hospitalist beyond fellowship - words of wisdom

[Scope guy]

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I am considering a position where I will be doing non academic GI hospitalist work for half the year(M-F) and rest half of the year I will be doing clinic+outpatient scopes.

1. What are pros and cons of this model?
2. Is this model sustainable long term?
3. The employer seem to undermine the inpatient work and the RVUs that can be generated inpatients. Do ppl doing GI hospitalist work get RVU based pay or fixed pay per week? (outpatient work is RVU based pay)
4. What are some of the things I need to know before signing other than these? (they have couple mid levels covering inpatients, anaesthesia support, no admissions-only consult service)

Any words of wisdom about personal or friend's experience in GI hospitalist world would be appreciated

 

[IM2GI]

Do you have a PA? how busy is the service? How often do you take call?

Are you week on week off?

 

[GastriqueGraffin]

I am considering a position where I will be doing non academic GI hospitalist work for half the year(M-F) and rest half of the year I will be doing clinic+outpatient scopes.

1. What are pros and cons of this model?
2. Is this model sustainable long term?
3. The employer seem to undermine the inpatient work and the RVUs that can be generated inpatients. Do ppl doing GI hospitalist work get RVU based pay or fixed pay per week? (outpatient work is RVU based pay)
4. What are some of the things I need to know before signing other than these? (they have couple mid levels covering inpatients, anaesthesia support, no admissions-only consult service)

Any words of wisdom about personal or friend's experience in GI hospitalist world would be appreciated

Why would you want to do hospitalist work as a GI doc? I have never heard of such a thing and honestly don't understand the appeal of this. I really am curious.

 

[IM2GI]

Why would you want to do hospitalist work as a GI doc? I have never heard of such a thing and honestly don't understand the appeal of this. I really am curious.

They are not gen med hospitalist jobs. Essentially most models are like a week on/week off of only inpatient GI consults/procedures.

 

[GastriqueGraffin]

They are not gen med hospitalist jobs. Essentially most models are like a week on/week off of only inpatient GI consults/procedures.

So if you're not acting as primary on these patients then, which I guess means no admissions/discharges/other consults or pages about pain control,etc. then how is that different than being hospital employed GI consultant? Is it just a difference in the scheduling?

 

[IM2GI]

So if you're not acting as primary on these patients then, which I guess means no admissions/discharges/other consults or pages about pain control,etc. then how is that different than being hospital employed GI consultant? Is it just a difference in the scheduling?

yea you are not the primary on these patients. The term hospitalist is just used to mean that you are only doing inpatient work. Some models have you do some outpatient screening colons during the day depending on volume. It is the same thing as being an employed consultant if all you do is inpatient. If you are at a high volume center and seeing 15-20 consults a day you are gonna get burned out pretty quick.

 

[Redpancreas]

Why would you want to do hospitalist work as a GI doc? I have never heard of such a thing and honestly don't understand the appeal of this. I really am curious.

Just a resident but the pathology you see as an inpatient at an academic center vs. what you see doing scopes as an outpatient is night and day. I think OP so he/she can earn while enjoying the amazing pathology available in GI.

 

[GastriqueGraffin]

Since doing inpatient seems a lot more demanding and unpredictable than just outpatient, how does the pay compare of GI Hospitalist?

 

[Scope guy]

I dont think current graduates have synced to a GI hospitalist role yet. Typical service involves supervising 1-2 PAs, doing inpatient consults, procedures. Almost all these places ask for ERCP certification which is extremely hard in a 3 year fellowship. Dont see someone who took the pains to do an advanced year do just inpatient work, since there is no indication for inpatient EUS .

To answer your que - it seems comparable to guaranteed base for outpatient GI - 400-450k around

 

[nycscope]

I dont think current graduates have synced to a GI hospitalist role yet. Typical service involves supervising 1-2 PAs, doing inpatient consults, procedures. Almost all these places ask for ERCP certification which is extremely hard in a 3 year fellowship. Dont see someone who took the pains to do an advanced year do just inpatient work, since there is no indication for inpatient EUS .

To answer your que - it seems comparable to guaranteed base for outpatient GI - 400-450k around

Appreciate your outlook on the situation, certainly useful insights 🙂

Just wanted to say there are a few indications for inpatient EUS. Example: can't tell you how many times I've seen "negative" MRCPs (albeit on a 1.5 Tesla machine) turn out to have stones/sludge visible on EUS.

 

[Gastrapathy]

GI hospitalist jobs are a way for partners to stay in clinic and you to stay in an endless employed position

 

[Scope guy]

Appreciate your outlook on the situation, certainly useful insights 🙂

Just wanted to say there are a few indications for inpatient EUS. Example: can't tell you how many times I've seen "negative" MRCPs (albeit on a 1.5 Tesla machine) turn out to have stones/sludge visible on EUS.

yup let me take that back. most indications for EUS are outpatient

 

[Scope guy]

GI hospitalist jobs are a way for partners to stay in clinic and you to stay in an endless employed position

yup so the productive guys can just stay productive. Inpatient guy gets a lower than avg salary and deal with the craziness

 

[IM2GI]

Appreciate your outlook on the situation, certainly useful insights 🙂

Just wanted to say there are a few indications for inpatient EUS. Example: can't tell you how many times I've seen "negative" MRCPs (albeit on a 1.5 Tesla machine) turn out to have stones/sludge visible on EUS.

The EUS +/- ERCP is a very ivory tower approach that you will rarely see outside of big academic centers. Partly due to logistics and EUS availability, partly because you barely get paid for the EUS part. If the MRCP is negative, and clinical suspicion is high enough based on LFT trend or dilated duct, most of these folks will just get an ERCP or go for lap chole with IOC, although most surgeons will balk at doing that.

As far as I know, there is no data that an ERCP after the lap chole is any worse than pre-op. Surgeons will tell you they worry about blowing out the stump but I don't think theres data to support it. Many hospitals have no EUS capability but can manage choledocho just fine.

 

[GastriqueGraffin]

I think every hospital should be able to do EUS without being referred to a “tertiary care center” for the procedure. How many people you need for those is probably not more than 1-2 depending on the size. Many EUS cases are not emergent but that doesn’t mean it shouldn’t be done at that site and often on that admission.

 

[Gastrapathy]

That would lead to lots of 25 a year doctors. Hospitals don’t do procedures, doctors do. You can’t be on call all the time. Referral has a role. There are no EUS emergencies. Those positive EUS cases with sludge likely would have been fine with an IOC. In fact, the literature doesn’t support ERCP 0ver LCBDE despite nearly everyone’s practice model.

 

[GastriqueGraffin]

That would lead to lots of 25 a year doctors. Hospitals don’t do procedures, doctors do. You can’t be on call all the time. Referral has a role. There are no EUS emergencies. Those positive EUS cases with sludge likely would have been fine with an IOC. In fact, the literature doesn’t support ERCP 0ver LCBDE despite nearly everyone’s practice model.

Almost any ER would admit a symptomatic painless jaundice with weight loss, etc and the primary hospitalist would want a biopsy before discharge. This is a pretty simple example of why any group should have at least 1 person who can do EUS. Not emergent but not referral outside either.

 

[Gastrapathy]

So transfer. Or do the ERCP and discharge with a referral.

 

[IM2GI]

Almost any ER would admit a symptomatic painless jaundice with weight loss, etc and the primary hospitalist would want a biopsy before discharge. This is a pretty simple example of why any group should have at least 1 person who can do EUS. Not emergent but not referral outside either.

Who cares what the hospitalist wants? Put a stent in them and refer them to your local multidisciplinary tumor board.

Not every hospital/group can or should do everything. Sometimes it makes sense to consolidate volume. In your example the patient is no better served by getting an EUS before they go home.

Do you do EUS? Half the EUS trained people I know hate doing it. You also need to have volume to keep your skills up.

 

[GastriqueGraffin]

Who cares what the hospitalist wants? Put a stent in them and refer them to your local multidisciplinary tumor board.

Not every hospital/group can or should do everything. Sometimes it makes sense to consolidate volume. In your example the patient is no better served by getting an EUS before they go home.

Do you do EUS? Half the EUS trained people I know hate doing it. You also need to have volume to keep your skills up.

There are other numerous examples where EUS can be done, whether it’s a pseduocyst that qualifies for drainage or as part of a cancer/mass eval or whatever. My only point is every group that have GIs working inpatient and outpatient should have at least someone who can do certain things that don’t necessarily pay well (read capsules, do RFAs, place PEGs, read manometry and impedance studies, etc) so that you (or the group or hospital) don’t risk losing patients to those who do have someone. You are welcome to disagree but I get why they prefer* someone that can do EUS along with ERCPs.

 

[Gastrapathy]

So now you’re claiming it’s a business imperative? It’s not. It’s easy to refer for specialized procedures to the academic center. If they “steal” the patient, you refer somewhere else the next time. These docs know better or, if they don’t, they wonder whey their amazing center gets fewer referrals than the one up the road.

From a business perspective, EUS/Mano in particular are not beneficial. Do you really think a 60 day hospitalization before and after drainage of WON in an alcoholic is profitable? A private GI group doesn’t see revenue from the downstream med onc/rad onc care. The small groups that are hiring all these new grads from adv endo programs are happy to bring them in, but they aren’t subsidized. So, they make less than the old partners and that’s why you see them dropping EUS.

You’re biased by the ivory tower. That’s ok.

 

[IM2GI]

So now you’re claiming it’s a business imperative? It’s not. It’s easy to refer for specialized procedures to the academic center. If they “steal” the patient, you refer somewhere else the next time. These docs know better or, if they don’t, they wonder whey their amazing center gets fewer referrals than the one up the road.

From a business perspective, EUS/Mano in particular are not beneficial. Do you really think a 60 day hospitalization before and after drainage of WON in an alcoholic is profitable? A private GI group doesn’t see revenue from the downstream med onc/rad onc care. The small groups that are hiring all these new grads from adv endo programs are happy to bring them in, but they aren’t subsidized. So, they make less than the old partners and that’s why you see them dropping EUS.

You’re biased by the ivory tower. That’s ok.

Exactly. To a healthcare system, subsidizing EUS and other low-yield test/procedures makes sense due to all of the secondary income that patient provides. To the private GI group, unless they have negotiated a deal to provide extra payment to provide this service, its not often worth the effort.

This guy is clearly in the deep throws of academia which is fine, but you have to be able to see there is another side to the issue that isn't just evil/lazy/greedy private practice docs.

 

[poopythrowaway]

Is GI hospitalist locums a reasonable option immediately post-fellowship? I'd like to take some time off before starting my first job out of fellowship (probably like 6 months before I will start) and want to be able to work a little, make some money, and keep my endoscopy skills. If so, how does one go about finding GI hospitalist locums jobs?

 

[1Cor1557]

Is GI hospitalist locums a reasonable option immediately post-fellowship? I'd like to take some time off before starting my first job out of fellowship (probably like 6 months before I will start) and want to be able to work a little, make some money, and keep my endoscopy skills. If so, how does one go about finding GI hospitalist locums jobs?

If you haven't been bombarded by recruiters already, all the typical hives are crawling with them, gicareersearch, jama career center, practicelink, LinkedIn, indeed, even Merritt Hawkins and Jackson who usually recruit permanent posts do so for health systems that currently rely on locums, so they can serve as an indirect database for hospitals to contact

 

[ShiShiMD]

Is GI hospitalist locums a reasonable option immediately post-fellowship? I'd like to take some time off before starting my first job out of fellowship (probably like 6 months before I will start) and want to be able to work a little, make some money, and keep my endoscopy skills. If so, how does one go about finding GI hospitalist locums jobs?

Just sign on to Doc Cafe and state you want to do GI Locum GI Hospitalist

 

[poopythrowaway]

Thanks for your replies. Good to know

 

[GIMD1429]

Any idea what the GI Hospitalist (7on/7off) pay is in TX? Also, do they offer bonus or RVU?

 

[ShiShiMD]

Any idea what the GI Hospitalist (7on/7off) pay is in TX? Also, do they offer bonus or RVU?

550+ plus based on 8200 or if you negotiate 7900 wRVU after hitting wRVU threshold ask for 68.75$ per wRVU

But I seen some at 650 at 8800 and 65$ after that.

seen some for 725 on 9000 63$ after that.

GI hospitalist is something in demand right now if you can do ERCP, rFA, EUS your looking at 850 on 10000 and after that 70$ maybe 77$ per wRVU

it all depends on your negotiation skills and lawyer (highly recommend to get one if you are not a good negotiator).

but if you going to take a job for less than 550 don’t even consider it

 

[Suprep]

550+ plus based on 8200 or if you negotiate 7900 wRVU after hitting wRVU threshold ask for 68.75$ per wRVU

But I seen some at 650 at 8800 and 65$ after that.

seen some for 725 on 9000 63$ after that.

GI hospitalist is something in demand right now if you can do ERCP, rFA, EUS your looking at 850 on 10000 and after that 70$ maybe 77$ per wRVU

it all depends on your negotiation skills and lawyer (highly recommend to get one if you are not a good negotiator).

but if you going to take a job for less than 550 don’t even consider it

MGMA South RVUs are roughly 57-60 depending on who you ask. Most places use that as a guide. South is the lowest MGMA zone of all. The MGMA numbers you quote are more of west coast and midwest numbers. I doubt if places will start at 550k if one doesn't do ERCP. Perhaps 500k is reasonable starting number x 2 years, with RVU threshold at 8700, anything beyond, will be compensated at the prevailing RVU rate. Honestly haven't seen numbers north of 650k as straight salary. But once someone does cross that threshold based on RVU, sky is the limit. It does get taxiing to do beyond 10000 RVUs and especially young GI should try to focus on life style balance and avoid work based injuries early on, that will curtail a long career soon. Also GI hospitalist is high malpractice issue, given most inpatients are sicker and chances of a complication is much higher than outpatient screening.

 

[ShiShiMD]

MGMA South RVUs are roughly 57-60 depending on who you ask. Most places use that as a guide. South is the lowest MGMA zone of all. The MGMA numbers you quote are more of west coast and midwest numbers. I doubt if places will start at 550k if one doesn't do ERCP. Perhaps 500k is reasonable starting number x 2 years, with RVU threshold at 8700, anything beyond, will be compensated at the prevailing RVU rate. Honestly haven't seen numbers north of 650k as straight salary. But once someone does cross that threshold based on RVU, sky is the limit. It does get taxiing to do beyond 10000 RVUs and especially young GI should try to focus on life style balance and avoid work based injuries early on, that will curtail a long career soon. Also GI hospitalist is high malpractice issue, given most inpatients are sicker and chances of a complication is much higher than outpatient screening.

will the way GI hospitalist works is paid is calculated on a daily basis. you are your own best advocate. From Jan 2020 there will be increase for both outpatient and inpatient consult and procedures.

for instance one is the colon cancer-screening going up from 50$ to almost 200$ and many more procedures. Specially with consult now being coupled and can be billed as level 5 with minimal questions (ROS, FH, CC, CS and add a prevention measure) if billing level 3 than (CC and FH and maybe prevention measure 10 minutes) after that you be doing 5 EGD an hour or 3 colon an hour or 1 ercp and EUS an hour.

GI hospitalist I know for instance in Mississippi or Alabama or even Texas are making 17000 wRVU some hitting the 21000.

so even if they pay 55 after 7900 you still in the 7 digit zone. Since the base is 550k if not don’t take the job. If 500K than is 60 after 7900. Plus the quality.

is a nice lifestyle actually. 7/7 plus 5 weeks of PTO and 7 days CME in couple of years you generate enough.

I know people who are making 21000 in the south and they own multiple properties in NE area and a vacation home in Florida or Bahamas. Paid all loans and mortgages off. Some are in 4th year of doing the job and saving this years income to open a huge ASC due to the new regulation and funding for infusion center (IBD and Cancer) and nutrition, Motioity, IBD and diet clinic.

so if the job pays well and you see the potential of 7 figures take it for 3-4 years. If not you can still make the same but you got to work harder.

smaller cities I talk about. Not in Houston.

 

[GIMD1429]

MGMA South RVUs are roughly 57-60 depending on who you ask. Most places use that as a guide. South is the lowest MGMA zone of all. The MGMA numbers you quote are more of west coast and midwest numbers. I doubt if places will start at 550k if one doesn't do ERCP. Perhaps 500k is reasonable starting number x 2 years, with RVU threshold at 8700, anything beyond, will be compensated at the prevailing RVU rate. Honestly haven't seen numbers north of 650k as straight salary. But once someone does cross that threshold based on RVU, sky is the limit. It does get taxiing to do beyond 10000 RVUs and especially young GI should try to focus on life style balance and avoid work based injuries early on, that will curtail a long career soon. Also GI hospitalist is high malpractice issue, given most inpatients are sicker and chances of a complication is much higher than outpatient screening.

will the way GI hospitalist works is paid is calculated on a daily basis. you are your own best advocate. From Jan 2020 there will be increase for both outpatient and inpatient consult and procedures.

for instance one is the colon cancer-screening going up from 50$ to almost 200$ and many more procedures. Specially with consult now being coupled and can be billed as level 5 with minimal questions (ROS, FH, CC, CS and add a prevention measure) if billing level 3 than (CC and FH and maybe prevention measure 10 minutes) after that you be doing 5 EGD an hour or 3 colon an hour or 1 ercp and EUS an hour.

GI hospitalist I know for instance in Mississippi or Alabama or even Texas are making 17000 wRVU some hitting the 21000.

so even if they pay 55 after 7900 you still in the 7 digit zone. Since the base is 550k if not don’t take the job. If 500K than is 60 after 7900. Plus the quality.

is a nice lifestyle actually. 7/7 plus 5 weeks of PTO and 7 days CME in couple of years you generate enough.

I know people who are making 21000 in the south and they own multiple properties in NE area and a vacation home in Florida or Bahamas. Paid all loans and mortgages off. Some are in 4th year of doing the job and saving this years income to open a huge ASC due to the new regulation and funding for infusion center (IBD and Cancer) and nutrition, Motioity, IBD and diet clinic.

so if the job pays well and you see the potential of 7 figures take it for 3-4 years. If not you can still make the same but you got to work harder.

smaller cities I talk about. Not in Houston.

Thank you to you both for the detailed reply. LOL.....I am specifically looking for numbers in Houston. I have to go to the negotiating table with info on hand for a GI Hospitalist 7on/7off. In my informal talks with them, there is no mention at all about wRVU's. I am being offered a flat salary north of $500k and healthcare benefits and CME $ (not days); nothing else (no wRVU, no bonus). I have spoken to a few colleagues locally but they have no clue bec Houston is all about private practices.

 

[ShiShiMD]

Thank you to you both for the detailed reply. LOL.....I am specifically looking for numbers in Houston. I have to go to the negotiating table with info on hand for a GI Hospitalist 7on/7off. In my informal talks with them, there is no mention at all about wRVU's. I am being offered a flat salary north of $500k and healthcare benefits and CME $ (not days); nothing else (no wRVU, no bonus). I have spoken to a few colleagues locally but they have no clue bec Houston is all about private practices.

unless is only 12 hour shifts for 7 days and no call 500k is good but you need to bring on bonus.

no one throws numbers down like this with no wRVU. Specially in Houston where the wRVU is totally set and reviewed like every 6 months.

 

[ShiShiMD]

In Houston as of now 650K is set at 8800 with 60$ after that but in private practice with parternship and ancillary income of 450 to 750K+ extra

 

[GIMD1429]

unless is only 12 hour shifts for 7 days and no call 500k is good but you need to bring on bonus.

no one throws numbers down like this with no wRVU. Specially in Houston where the wRVU is totally set and reviewed like every 6 months.

In Houston as of now 650K is set at 8800 with 60$ after that but in private practice with parternship and ancillary income of 450 to 750K+ extra

I have to take call from home when I am 7/on till the next morning. Will be paid $200 per hour if I have to go to the hospital after hours.

 

[ShiShiMD]

I have to take call from home when I am 7/on till the next morning. Will be paid $200 per hour if I have to go to the hospital after hours.

Good deal. Negotiate the base and make sure on your days off you are allowed to do whatever you want and make sure there is no compete or other clauses in the contract. But the base is too low. Unless you doing like one scope every 45 minutes.

 

[Suprep]

negotiate a RVU bonus beyond 500k, its doable as hospitalist.
I am not sure about 15000 RVU plus a year with 26 weeks work. that is almost 600 RVU a week which is a lot. One can possibly do 15-18k RVUs by working close to 40 weeks.
Plus inpatient EGD and colons are not as straight forward as outpatient one. In my limited experience, can do 3 EGD or 2 colon an hour for the right indication.
If someone is doing 15k rvus by working 26 weeks a year, either they are burning themselves out or doing unethical progress notes on everyone everyday long after GI issue has resolved.

 

[GIMD1429]

negotiate a RVU bonus beyond 500k, its doable as hospitalist.
I am not sure about 15000 RVU plus a year with 26 weeks work. that is almost 600 RVU a week which is a lot. One can possibly do 15-18k RVUs by working close to 40 weeks.
Plus inpatient EGD and colons are not as straight forward as outpatient one. In my limited experience, can do 3 EGD or 2 colon an hour for the right indication.
If someone is doing 15k rvus by working 26 weeks a year, either they are burning themselves out or doing unethical progress notes on everyone everyday long after GI issue has resolved.

^^^ THIS ^^^

100% agree with the above. I checked my RVU numbers and they are infact less than what you have mentioned with 26 work weeks. I have roughly 400 RVU per week.

If no bonus or wRVU is provided what is a good base salary to negotiate?

 

[HepGI2]

I recommend looking into resolve.com. they have a fee for service lawyer who will negotiate and review your contract based on local market data. May be worth the $.