Hospitalist fellowships

[NRAI2001]

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?

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[cabinbuilder]

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?

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.

 

[Rocco Reed]

waste of time

 

[primadonna22274]

I think it's cheap hospitalists in perpetuity for the place holding the fellowship.

 

[septoplasty]

I'd agree with cabinbuilder. Usually programs provide good inpatient experience as is (but again, this can vary).

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 environment.

Bottomline: Find a program that has more inpatient months if you haven't already.

 

[jm192]

Bumping this old thread instead of starting a new thread

I'm a 2nd year FM resident, and I feel quite comfortable with inpatient medicine. I'm still learning a lot of things. But, I think in the next 20 months, I'll be there.

That said, I've started looking at fellowships. Part of it is my own hesitency to leave residency and jump straight into practice.

But the other part: I've decided I want to work in the hospital in my college town. And they don't typically take FM as hospitalists. Do these fellowships typically open more doors?

 

[Crayola227]

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.

 

[VenturaResident]

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.

"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_B005...sherick&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.

 

[Crayola227]

I meant the doc right out of FM and IM residency now.

Obviously years of clinical practice out of residency and individual experience changes the game.

Conversely, if you said internists had nowhere near the amount of ambulatory experience to make them more attractive than a family med doc outpatient, I would have to agree. Unless it's an IM practice specifically FM docs out of residency have the edge.

 

[Crayola227]

I only meant to say that I don't know how much the hospitalist fellowship helps, but even IM docs out of residency often don't feel they had enough ambulatory experience to be outpt PCP, and BARELY enough inpt to be hospitalist attending.

So I don't know how much of a rockstar I would feel right out of FM to be hospitalist. As you said, there are plenty of advantages to having FM hospitalists.

More important, is what people are comfortable doing, what training is needed, and what the places hiring think.

 

[Crayola227]

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.

 

[bronx43]

"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.

WTF... are you f***ing serious? Did you really just invoke the cosmic bulls*** that nurses and NPs use to denigrate physician centered care?

Oh wise one - please explain, using specific clinical examples, what it means to have "more of a whole-person focus" than "pathology focus."

 

[jm192]

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.

 

[bronx43]

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.

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.

BUT, if you're looking to be a hospitalist at a smaller private hospital, then no. It doesn't matter at all if you're FM, IM, or if you trained at a big or small hospital.

As far as "opening more doors," it really depends on the employer and supply/demand. A lot of the places that have difficulty finding coverage would take ANYONE. The more attractive jobs have their pick and usually won't hire non-IM trained hospitalists. Fellowship or not.

 

[NurWollen]

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.

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?

 

[Crayola227]

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

That. If that is the case at a program, unless all your elective months are inpt, an FM residency with only that much time inpt pales in comparison to the typical IM residency, which is why these days a newly minted IM attending is pretty much only really qualified to be a hospitalist, and moreso than any other type of residents.

I think an FM and IM residency should prepare either to be inpt or outpt, but I can see why the older members say that with work hour restrictions either residency only marginally prepares you for one or the other, not both.

 

[NRAI2001]

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.

 

[cabinbuilder]

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.

I would agree that is pretty "soft". My residency had 6 months IM first year, 4 months 2nd year, and 3 months third year.

 

[primadonna22274]

Yikes if my program were that weak on inpatient medicine I would never have looked at it! We do 5 mos adult inpatient PGY1, 2 mos + 6 wk night float PGY2, and 3 mos PGY3. That's nearly a full year of a very busy always over capped service with open ICU and typically sick southern patients. Then we do 2 mos ICU in PGY2/3, 3 mos inpatient peds between PGY1/3 and 2 mos OB plus ob/peds night float 6 wk PGY1.
By the time we graduate we are read to work just about anywhere and there would be very little need for us to do a hospitalist fellowship, but some folks want that extra reassurance. I wouldn't mind more dedicated ICU time that wasn't interrupted by the need to run to clinic...but that's a systems issue.

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[NRAI2001]

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.

 

[NurWollen]

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.

Could you split your 6 electives between inpatient medicine and ICU? Do you think that would shore up your inpatient skills?

 

[NRAI2001]

Could you split your 6 electives between inpatient medicine and ICU? Do you think that would shore up your inpatient skills?

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?

 

[galactus]

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.

 

[NRAI2001]

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.

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.

 

[throw away]

To give you guys some perspective from an IM standpoint... my intern year I did:
- 2 months of MICU/CCU
- 4.5 months of general wards
- 0.5 months of oncology wards
- 0.5 months of telemetry wards (like lower-acuity CCU)
- 1.5 months inpatient consult services

This year as an R2, I have:
- 2 months MICU/CCU/liver ICU
- 2.5 months of general wards
- 0.5 months of oncology wards
- 0.5 months of telemetry wards
- 2 months of inpatient consult services
- 0.5 months of "hospitalist" rotation--independent wards without an intern and only peripheral overview from an attending
- 0.5 months inpatient neuro

R3 year: we'll see

This is why I'm in no way qualified for outpatient care. This is also why it will be difficult to compete for hospitalist positions with an IM resident.