Hospitalist Goals

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Moogash

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Hi there,

I am an IM resident and currently considering hospitalist medicine as a career. I was initially 100% gunning for cards, but after seeing the lifestyle/stress of the fellows/attendings at my institution, I'd say I am definitely out of the race.

I genuinely enjoy IM and its breadth, and I enjoy thinking through cases.

As far as career/financial goals go, I want to be able to make good money at a job I enjoy while still being able to spend time with my family (...duh). Specifically, I'd like to hit 300k annually as a general IM doc (hospitalist or otherwise) while also not having to work half the weekends of the year - the 7/7 block schedule seems very unflattering to me, I think I'd do better with a 4/4 or 4/3 or some sort of flexible scheduling system. Also, the wife and I want to end up in the Carolinas eventually, most likely near or in a mid-size city (300-500k or so people).

Does anyone have insight on whether or not this is doable without having to work like crazy? Geography is fairly high on our priority list. I don't mind working a lot, but the thought of working half of the weekends of each year seems absolutely terrible to me.

Thank you all for your insight.
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What geography are you gunning for? 300K can be in done in smaller markets, harder to do in your NY/LA/Chicago locales, especially when you're just starting out (but not impossible of course).

Be prepared to work weekends and holidays..it's just the nature of the job. Hospitals are 365/24/7 operations, and everyone in your future groups(s) has to cover at some point or another. You will inevitably feel the sting of having to work a weekend and missing something important in your social life. It sucks whether that happens twice a year, or 20 times a year. Now the exact numbers may be negotiable, but if you become a stickler about it, that could drive your income down. There's no such thing as a hospitalist in New York City who makes $300K/year and doesn't have to work some weekends and holidays.
 
I think it's easier to discharge patients you admitted and cared for, and not to have to play catch up with the ones who were treated while you were gone and come back to. Average length of stay being what it is, I would actually expect a 7 on and 7 off to be more conducive to that than a 4/3. Hand offs suck, even for attendings.
 
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DrMetal said:
What geography are you gunning for? 300K can be in done in smaller markets, harder to do in your NY/LA/Chicago locales, especially when you're just starting out (but not impossible of course).

Be prepared to work weekends and holidays..it's just the nature of the job. Hospitals are 365/24/7 operations, and everyone in your future groups(s) has to cover at some point or another. You will inevitably feel the sting of having to work a weekend and missing something important in your social life. It sucks whether that happens twice a year, or 20 times a year. Now the exact numbers may be negotiable, but if you become a stickler about it, that could drive your income down. There's no such thing as a hospitalist in New York City who makes $300K/year and doesn't have to work some weekends and holidays.
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We want to end up in the Carolinas in a mid-size city - def not NY/LA/Chicago type of cities. I'm not saying I never want to work weekends, but 26 just sounds demoralizing at the moment. I suppose it will still be better than working >80% of weekends like in residency. 300k per year with ample time to spend with friends/family is my goal.
 
Moogash said:
We want to end up in the Carolinas in a mid-size city - def not NY/LA/Chicago type of cities. I'm not saying I never want to work weekends, but 26 just sounds demoralizing at the moment. I suppose it will still be better than working >80% of weekends like in residency. 300k per year with ample time to spend with friends/family is my goal.
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Definitely doable in the Carolinas (i'm in mid-atlantic southeast region, we get tons of solicitations to work anywhere in the southeast). Weekends, however, will likely be a 'must'. These hospitals are desperate for coverage. They'll pay you really well, but they will work you. It definitely wont be like residency.
 
DrMetal said:
Definitely doable in the Carolinas (i'm in mid-atlantic southeast region, we get tons of solicitations to work anywhere in the southeast). Weekends, however, will likely be a 'must'. These hospitals are desperate for coverage. They'll pay you really well, but they will work you. It definitely wont be like residency.
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That's great to hear! When you say, "it definitely won't be like reisdency," does that mean it will be worse or better haha?
 
Desolatelands said:
Best places to go to pay off loans?
Not necessarily a place having loan repayment but which asscrack of the US pays the most for hospital work? Don’t care how much the area sucks as long as it pays good since I grew up in asscracks (from the Deep South (think Alabama)
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You just need to live like a resident for a few years after finishing and pick up extra shifts...make 250...live on 50 and the other 100-150 can go to paying off your loans(the remaining 75-100 does go to Uncle Sam of course).
 
rokshana said:
They are presuming that they can always have the off days on weekends...not that that is likely to happen...part of being a hospitalist is working weekends and holidays.
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That’s what I was thinking.

4/4 or 4/3 just guarantees never having a long period of time off.
 
siliso said:
Consider a career in primary care. Talk to some practices or recruiters, anyway. Hospitalism is a grind, a decently remunerative one, that most people can tolerate for a few years.
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I've heard it is difficult to transition to an OP PCP setting after being a hospitalist. Not impossible, but somewhat difficult. How can you, as a hospitalist, make yourself more ready for such a transition?
 
I guess any kind of transition in practice will have some challenges, even coming straight out of residency - continuity clinic is not exact and complete preparation for being a full time PCP, but enough to get you started. My strategy is to do some of both (inpatient and outpatient) and stay flexible. My job is set up to let me do that, ie my partners cover my clinics and residents while I do x weeks of wards/yr and I do same for them. Don’t know how many such arrangements are out there still. It might also be possible to do some part time side gig to ease in. Or, do a lot of CME to keep up/catch up on what’s new in primary care or hospital medicine depending on the direction of transition. I do know that people do it successfully.
 
I interviewed at one of the programs near Myrtle Beach and they basically promised that salary and alluded to 350k being easy to do, a few years ago. Didn't take it but highly considered it. I also looked at some programs near Wilmington. Similar story. The job market is good in that whole area outside of individual failing hospitals. Find a good job with a supportive environment and then you can likely adjust your schedule as you see fit, especially as you gain some experience/seniority. If you are not specifically hired with many weekends off, you will be able to trade, but I wouldn't start right out of residency expecting more than half of weekends off, unless you're daytime rounder at a VA or something. You should find a place where you can 'round and go', have code pager coverage, and live relatively close to work. That way even if you're on for the weekend, you can still have a social life, just not travel too far or do anything too crazy in the odd event you have to come in at 4pm on a Sunday as you're watching football at home with the family.
 
how about doing 1099 gag to lower your tax and increase your take-home pay?
 
He figures he can write off enough things as business expenses to offset the extra SS taxes he’s paying.

There’s some really cool things you can do with retirement in a solo 401k, but I’m pretty happy being employed right now.
 
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