I would think it would be overkill. We had 5 months of hospitalist rotations in intern year alone!! You would need to make sure you do some ICU rotations and learn lines and vent management. I would not do a fellowship personally.What do you guys think of hospitalist fellowships post an FM residency? Worth it? Did your programs give you enough inpatient IM to be confident in a hospitalist job?
"Even then?..."Good question.
Tho FM docs saying 18 months total or 5 as intern inpt makes you just as prepared to be a hospitalist compared to the typical IM residency is kidding themselves.
There's enough IM docs most places to just hire them to be hospitalists.
Not saying FM docs can't be hospitalists but the internists are a shoe in unless it's your own patient outpt and even then.
WTF... are you f***ing serious? Did you really just invoke the cosmic bulls*** that nurses and NPs use to denigrate physician centered care?"Even then?..."
You might try explaining that to some of our FM hospitalists who write books about inpatient medicine (http://www.amazon.com/s/ref=la_B005XQ98U4_B005XQ98U4_sr?rh=i:books&field-author=Joseph+S.+Esherick&sort=relevance&ie=UTF8&qid=1444196195) and travel nationally to teach inpatient procedures (http://www.hospitalprocedures.org/faculty)
Beyond just being "up to snuff", I know many patient who prefer working with our FM hospitalists, who tend to have more of a whole-person focus (rather than pathology-focus) compared to their IM colleagues as result of the breadth of their training. The trees are important, but so is the forest.
Thanks for your opinion, feel free to head back over to the IM forum.
To be honest, if you trained at a smaller hospital (either IM or FM), you would not be well equipped to practice in a large tertiary care center where the floor patients are more complex than MICU patients at the smaller places. You'll probably get used to it after awhile, but the first few years will be ROUGH. A few of our new hires that came from smaller private hospitals look like they are getting hit repeatedly by the whole Denver Bronco offensive line when they are on service. Graduates from big centers come right in and act like it ain't no thang.Lol
So now that we've gotten that out of our system...
Back to the original question. Does a fellowship open more doors?
Alternatively, I could do a year with the hospitalist group at my residency site.
I'm just curious, what makes you say 'five months intern?' From what I have seen, it seems most FM programs upwards on 8 or 9 months of inpatient medicine, not counting inpatient surgery, ICU, etc. Am I wrong on this? Also, couldn't an FM resident interested in hospital medicine do extra time in the ICU and extra time on the wards for electives?With work hour restrictions there is more talk of extending FM. AND. IM programs to 4 yrs, and more and more IM programs are offerring hopitaliist and primary care tracks.
I'm not trying to hate on anyone.
But 5 months inpt intern does not a hospitalist make.
For Example: A friend of mine who is in a program in Iowa has 6 months of inpatient medicine the first year, totaling to 18 months over the course of the residency.
My program has 2 months Inpatient medicine, but we do ICU, CCU & Geriatrics the first year. Provides a great training
I mostly ask bc my FM program is honestly not the most intense on inpatient medicine. I may even go as far as saying its weak on it. Much more of an outpatient emphasis... And like many FM programs it IMO has way too much of an emphasis on OB.
I m only an intern right now but from the 1 month of medicine I ve done so far I don't think I would be prepared after the three years. We do three months of IM during first year and probably a total of 6 weeks of IM during 2nd year and 6 weeks of a watered down inpatient FM service third year.
So a total of 4.5 months of IM, 1.5 weeks of inpatient FM, 1.5 weeks of night float medicine ....over the course of our residency. And there pretty "soft" inpatient experience.
Could you split your 6 electives between inpatient medicine and ICU? Do you think that would shore up your inpatient skills?Yea it sucks in someways.. I ve never been in an environment where everyone was SO nice and nurturing though!
I guess one awesome thing about our program is we have 6 months of electives. 2 months can be away. We have a large urgent care near by where we can do A LOT of moonlighting at.. Urgent care was another field I was very interested at. I knew it was on the softer side when it came to inpatient medicine.. But I told my self if at the end of three years I still felt I wasn't prepared inpatient or anyother aspect of FM or if I was still even interested in it.. I could always do a fellowship for a year or two.
I guess one could do that.. But honestly our inpatient is pretty soft, even a few more months of it wouldn't make a huge difference IMO, but I could be wrong.. I think from my program to do any significant inpatient work you would have to do a fellowship or do something else to make up for it. Maybe go do a year or two of IM or geriatrics? We have a pretty good ER though and that could be another option?Could you split your 6 electives between inpatient medicine and ICU? Do you think that would shore up your inpatient skills?
If I came from an inpatient heavy or even inpatient "medium" program.. I would be very happy do to inpatient moonlighting... But our inpatient is pretty light IMO.. I m just an intern so maybe things will change but I don't think I would feel comfortable running an inpatient service on my own as a third year down the road... And from what I m seen of the second and third years at my program I don't think they could either... Not even the strongest of them probably could without experiencing a very steep learning curve.A good way to increase your inpatient skills: moonlight as a hospitalist/nocturnist. I came from an inpatient heavy FM residency and continued to moonlight as a weekend coverage hospitalist during my sports med fellowship (if I'm not covering games of course!). Actually come to think of it everyone in my graduating residency class is still doing inpatient, and half of them are hospitalists.
So do you need a fellowship? not really, but hey if you come from a residency that does not do a lot of inpatient, you can get your feet wet by doing a few inpatient night shifts to gain experience.