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Hospitalist job market?

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unleash500

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There are so many people interested in hospitalism these days. Will the market explode? Will there still be jobs available in 5 years? 10 years? Oversaturation in metro areas?
 

chessknt

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    Nobody really knows the answer. If burnout wasnt so high it would be saturated by now.

    I forsee constriction as smaller hospitals begin to collapse/consolidate under the ACA leaving only critical care access hospitals staffed by EM people who double as EM and obs-level hospitalists in more remote locations.

    Good for EM, bad for IM. Luckily we have the fellowship drain to siphon some of our numbers off but we produce an enormous number of grads.
     
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    VA Hopeful Dr

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    In the 4 cities I've worked in here in SC, every hospital in all of those places are actively hiring hospitalists. We're talking 2 university hospitals, 2 non-university but have residency programs hospitals, and 3 decent sized but no trainees (200+ beds in all 3).

    Burn-out being the big reason. In my wife's group alone, in the last 2 years they've lost 3 people to outpatient medicine (her group only has 10 doctors, to put that in perspective).
     

    bronx43

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    Hospitalist job market is fine. Enough people leave the market to balance the supply and demand. The bigger problem is what happens once bundled payments start, and each specialty would have to fight over the crumbs. Would hospitalists have more or less leveraging power than the specialists? Would we then see a bigger infiltration of mid levels into the market as specialist groups hire them to perform day to day functions?

    Things to ponder...

    "Hospitalism" lol. I'm gonna have to use that one.
     
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    VA Hopeful Dr

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    Hospitalist job market is fine. Enough people leave the market to balance the supply and demand. The bigger problem is what happens once bundled payments start, and each specialty would have to fight over the crumbs. Would hospitalists have more or less leveraging power than the specialists? Would we then see a bigger infiltration of mid levels into the market as specialist groups hire them to perform day to day functions?

    Things to ponder...

    "Hospitalism" lol. I'm gonna have to use that one.
    My guess is not. Ortho can hire midlevel H&P monkeys all they want but they still don't want to have final responsibility for managing that hypertension or, heaven forbid, post-op hypotension. I think what we will see is the private groups who have their own surgery centers will start cherry picking healthy patients even more than they do now so they keep all the outpatient surgeries while the hospital owned groups get stuck with the complicated patients that require admission.
     

    PlutoBoy

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    Nobody really knows the answer. If burnout wasnt so high it would be saturated by now.

    I forsee constriction as smaller hospitals begin to collapse/consolidate under the ACA leaving only critical care access hospitals staffed by EM people who double as EM and obs-level hospitalists in more remote locations.

    Good for EM, bad for IM. Luckily we have the fellowship drain to siphon some of our numbers off but we produce an enormous number of grads.

    I agree with this. New grads will continue to be drawn into the schedule that hospitalists "enjoy" while the older hospitalists will continue to leave the field.
     
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    InvestingDoc

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    Even in some areas in Texas that have many graduates there is no problem finding a hospilist job. The only market that is tough right now is Austin but with enough weighting and willing to travel, it can be done.

    The market for hospitalist jobs in the future will most likely change and as a result we will change with it. You already see this happen as some IM people leave to do tele medicine or concierge medicine. Hospitalist jobs will be around for a while and I would not count on the market exploding or imploding. Like others have said, its a high turn over profession due to burn out or people changing career plans.
     

    InternalMedMD

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    Nobody really knows the answer. If burnout wasnt so high it would be saturated by now.

    I forsee constriction as smaller hospitals begin to collapse/consolidate under the ACA leaving only critical care access hospitals staffed by EM people who double as EM and obs-level hospitalists in more remote locations.

    Good for EM, bad for IM. Luckily we have the fellowship drain to siphon some of our numbers off but we produce an enormous number of grads.

    I'm IM trained & have worked in 4 states. I think IM will be ok. After 3 years of doing hospitalist work at a >800 bed hospitals in NYC, academic centers in MA and CA, and then a 40 bed hospital in rural Maine; I think there will be plenty of opportunities to go around for a very long time. Interestingly the rural Maine hospital actually had no EM docs at night - so I 'supervised' a ER PA, and then took care of 20+ patients on the floor. A few hospitals in NYC now have an ER obs unit where IM work to take care of chest pain, asthma etc.

    In upstate NY; in a group of 20 hospitalists - we had two NPs daily working on two teams. 1/ Medicine Consults - to be the first providers to see 'dumb' consults from Ortho and 2/ Rapid response team (this is despite the hospital having critical care docs on the team also).

    Also in more and more academic centers I see some surgical services not wanting to admit any of their patients/round on them only from a surgical perspective. E.g. UCSF now has a Neurosurgery co-management service with IM hospitalists.

    Burn out is real, but can definitely can be managed with some creative scheduling. Week on/week off may get old after a few years, but one group i worked with had 5 days - 5 days - 7 days - week off; and seemed to have people working into their late 50s and very happy with 3 out of 4 weekends off.
     

    Renegade44

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    I'm IM trained & have worked in 4 states. I think IM will be ok. After 3 years of doing hospitalist work at a >800 bed hospitals in NYC, academic centers in MA and CA, and then a 40 bed hospital in rural Maine; I think there will be plenty of opportunities to go around for a very long time. Interestingly the rural Maine hospital actually had no EM docs at night - so I 'supervised' a ER PA, and then took care of 20+ patients on the floor. A few hospitals in NYC now have an ER obs unit where IM work to take care of chest pain, asthma etc.

    In upstate NY; in a group of 20 hospitalists - we had two NPs daily working on two teams. 1/ Medicine Consults - to be the first providers to see 'dumb' consults from Ortho and 2/ Rapid response team (this is despite the hospital having critical care docs on the team also).

    Also in more and more academic centers I see some surgical services not wanting to admit any of their patients/round on them only from a surgical perspective. E.g. UCSF now has a Neurosurgery co-management service with IM hospitalists.

    Burn out is real, but can definitely can be managed with some creative scheduling. Week on/week off may get old after a few years, but one group i worked with had 5 days - 5 days - 7 days - week off; and seemed to have people working into their late 50s and very happy with 3 out of 4 weekends off.

    PGY-3 here. Just had a job offer of 260, 000 starting salary. No procedures; open ICU. Is that a good deal?
     

    dozitgetchahi

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    Hospitalist job market is fine. Enough people leave the market to balance the supply and demand. The bigger problem is what happens once bundled payments start, and each specialty would have to fight over the crumbs. Would hospitalists have more or less leveraging power than the specialists? Would we then see a bigger infiltration of mid levels into the market as specialist groups hire them to perform day to day functions?

    Things to ponder...

    "Hospitalism" lol. I'm gonna have to use that one.

    Yep.

    That said, the 'burnout' issue is that being a hospitalist is one of those jobs where you're basically being paid to be **** on by everyone else. And those jobs always, always suck. Whenever you see so much traffic going into/out of a particular specialty, ya gotta ask yourself why that's happening.

    Not to mention that the whole 'hospitalism' movement is rife for takeover from midlevels. Administrators who see hospitalists as money pits are going to eventually look to hire the dirt cheapest people possible to do the job (and it doesn't help that general hospital medicine is often seen as being total cookbook stuff that can be done by any trained monkey).
     

    rokshana

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    Yep.

    That said, the 'burnout' issue is that being a hospitalist is one of those jobs where you're basically being paid to be **** on by everyone else. And those jobs always, always suck. Whenever you see so much traffic going into/out of a particular specialty, ya gotta ask yourself why that's happening.

    Not to mention that the whole 'hospitalism' movement is rife for takeover from midlevels. Administrators who see hospitalists as money pits are going to eventually look to hire the dirt cheapest people possible to do the job (and it doesn't help that general hospital medicine is often seen as being total cookbook stuff that can be done by any trained monkey).
    exactly how much hospitalist experience have you had?
     
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    Renegade44

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    If it's w2 it's decent assuming medmal with tail covered. If not then it's meh. Also depends on what kind of market you're in. If you already signed it's too late anyways.

    Not yet signed. Holding back due to their open ICU with intensivist consult policy. Heard those can make the day really hectic especially if you have a very very sick patient. Any experience with open ICU?
     

    Suit

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    An attending once told me that as a hospitalist you can work anywhere in the US within a 5 mile radius of desired location. It would be even closer but u need good schools for the kids right?
     
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    dozitgetchahi

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    exactly how much hospitalist experience have you had?

    Absolutely none - and I don't care to have any, either. The horror stories of friends who have done it and washed out are more than enough for me.

    How much have you had?
     

    rokshana

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    Absolutely none - and I don't care to have any, either. The horror stories of friends who have done it and washed out are more than enough for me.

    How much have you had?
    about 4 years...
    the "burnout" could be real...some places are horrible...too many patients, not enough respect, unrealistic expectations on the part of administration, but many that go into hospital medicine go into it as a short term experience...many are going into it right after residency to take a break from training and go into fellowship a year or 2 later, others go into it because they ARE young, single, want to have free time and the 7 on/7 off 12 hour schedule isn't that vastly different that what residency was like...just with a lot more money...and few years later when they are looking to get married or have kids, the hospitalist schedule doesn't fit...and many hospitalist groups are moving away form the 7 on/7off schedules and accommodating lifestyle needs for long term retention.

    but the midlevel take over that you think is coming, IMHO that won't happen...mid levels are really used more as supplements not in place of MDs in the hospitals that i have been in to handle some of the more straight forward pts (CP r/o MI, simple PNA, etc,...and in many places they aren't even used...

    hospital medicine is relatively new and is continually evolving...will the money still stay high? eh it may not stay at the 250-350k that is easy to find, but it will still have a demand as IM continues split into a outpatient IM and inpatient IM dynamic....the old school mindset of seeing your patients both inpt and outpt is dwindling...many hospitals are creating hospitalist groups (or contracting to them) so the demand will be there..
     
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    microtome

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    How long after your interview do you receive an offer of employment? I interviewed at a hospital last Monday (the 1st), and the interview went well, but I've yet to hear anything back....
     

    Renegade44

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    How long after your interview do you receive an offer of employment? I interviewed at a hospital last Monday (the 1st), and the interview went well, but I've yet to hear anything back....
    2-4 weeks at most places from my recent experience.
     

    scpod

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    PGY-3 here. Just had a job offer of 260, 000 starting salary. No procedures; open ICU. Is that a good deal?

    Partly depends on where you are located and cost of living. Also, do you pay state taxes? If you are being paid straight salary it will suck. That 18 to 20 patient load will easily become 25 to 28 and you won't get a dime more. You need to be paid based on RVU's or salary/hourly plus RVU's so that you really get paid for how much work you do. Best bet is to be paid as an independent contractor and form your own corporation. You will make too much money to get any of the deductions on your taxes that you used to get... but the corporation can deduct darned near anything. If they offer you bonuses are they really obtainable? Have any other hospitalists actually gotten bonuses in the last few years? Do you have to work the entire fiscal year before you are eligible for bonuses?How do they split up the census in the AM? If you discharge 8 patients, are you getting 8 new ones while the guy next to you dc'd none and gets to see all the same patients again and no new ones? How is admit call split up? How often do you have to take call? Are you working nights and days? Do you have mid-level support at any time? Are you required to be on site all the hours you are being paid for, or can you leave when you are finished? Do you have to do procedures? Are you part of the code team? Do you get to work extra days if you want? How are those paid? There are a lot of things to consider more than just the salary.
     
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    DaTruMD

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    Partly depends on where you are located and cost of living. Also, do you pay state taxes? If you are being paid straight salary it will suck. That 18 to 20 patient load will easily become 25 to 28 and you won't get a dime more. You need to be paid based on RVU's or salary/hourly plus RVU's so that you really get paid for how much work you do. Best bet is to be paid as an independent contractor and form your own corporation. You will make too much money to get any of the deductions on your taxes that you used to get... but the corporation can deduct darned near anything. If they offer you bonuses are they really obtainable? Have any other hospitalists actually gotten bonuses in the last few years? Do you have to work the entire fiscal year before you are eligible for bonuses?How do they split up the census in the AM? If you discharge 8 patients, are you getting 8 new ones while the guy next to you dc'd none and gets to see all the same patients again and no new ones? How is admit call split up? How often do you have to take call? Are you working nights and days? Do you have mid-level support at any time? Are you required to be on site all the hours you are being paid for, or can you leave when you are finished? Do you have to do procedures? Are you part of the code team? Do you get to work extra days if you want? How are those paid? There are a lot of things to consider more than just the salary.
    Saved for future reference.
     
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    gi2014

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    I do think midlevel encroachment will affect all aspects of medicine, and hospitalists more so than some other areas due to the potential cost savings in this area. I foresee an anesthesia model where one hospitalist is overseeing several NPs or PAs. Hospitalists have become consult machines. Partly because they are overworked, partly because of a CYA mentality, and partly bec of laziness. The field has been overtaken by the bottom of class of the residents who graduate every year. Midlevels are already a supplement in every hospitalist program. It will only be a matter of time until this role is expanded and hospitalists transition into more of a supervisory/consigning role, thus decreasing the amount needed, and hopefully weeding out the bad ones. It doesn't take an MD to pan consult every service in the hospital.
     

    Renegade44

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    Good luck finding a hospitalist who will supervise 2-3 NPs carrying 15-20 patients each.
     

    flipmd

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    Tried it at our hospital, did not work and led to MDs departing, and they eventually had to scrap it. I guess it's possible for very low acuity places, but our hospital had quite high acuity, and the midlevels couldn't get enough patients in their panel that comprised only of low acuity patients (eg., just completing antibiotics, psychiatry holds, placement, etc).

    Problem with inpatient medicine is the complexity. Lets take the example of IV Lasix, you won't find two hospitalists (much less Cardiologists / Nephrologists) to agree on a dose to give one patient (nevermind whether the patient needs Lasix or fluid). You can't delegate something like this, as it's the supervising physician's license on the line. Not just that, I would never want my loved ones cared for by a midlevel, regardless of "supervision".

    It MAY work if you want the midlevel to be a consult machine, and generate $$$ for the other physicians. This would actually INCREASE total cost of care in the big picture (I mean nationally, not just for the hospital/practice), not decrease it.
     
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    gi2014

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    Good luck finding a hospitalist who will supervise 2-3 NPs carrying 15-20 patients each.

    ...said every anesthesiologist ever.

    When someone else is signing your checks, you don't have much bargaining room once the movement takes hold.
     

    bronx43

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    I do think midlevel encroachment will affect all aspects of medicine, and hospitalists more so than some other areas due to the potential cost savings in this area. I foresee an anesthesia model where one hospitalist is overseeing several NPs or PAs. Hospitalists have become consult machines. Partly because they are overworked, partly because of a CYA mentality, and partly bec of laziness. The field has been overtaken by the bottom of class of the residents who graduate every year. Midlevels are already a supplement in every hospitalist program. It will only be a matter of time until this role is expanded and hospitalists transition into more of a supervisory/consigning role, thus decreasing the amount needed, and hopefully weeding out the bad ones. It doesn't take an MD to pan consult every service in the hospital.

    You don't know what you're talking about if you think midlevels "are already a supplement in every hospitalist program." I was a hospitalist in a relatively large midwest city and worked in several of the hospital systems here. Only one group had any midlevels at all, and even they only used them sparingly. They offered some benefit to the MDs, but not significant when you consider their six figure salaries. The other hospital systems were not even talks of getting midlevels. In fact, the subspecialists are seeing a much higher rate of midlevel encroachment than the hospitalists or the general IM folks. I know many other hospitalists around the country and most of them echo these sentiments.
     

    gi2014

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    In fact, the subspecialists are seeing a much higher rate of midlevel encroachment than the hospitalists or the general IM folks.

    In the subspecialties, midlevels function to free up the specialist to practice their specialty - scope, cath, bronch etc. Midlevels do the low paying office visit so the specialist can focus on higher paying procedures. Not really what I would consider encroachment, especially as it is the subspecialist who is hiring them.
     

    bronx43

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    In the subspecialties, midlevels function to free up the specialist to practice their specialty - scope, cath, bronch etc. Midlevels do the low paying office visit so the specialist can focus on higher paying procedures. Not really what I would consider encroachment, especially as it is the subspecialist who is hiring them.
    Here's some econ 101.
    What you described really only benefits the older, established guys... just like in anesthesia. The anesthesiologists who were there when the ACT model started got 7-8 figure payouts for their practices, while the younger generation is stuck supervising 4 rooms and getting paid pennies on the dollar.
    Demand for health care is finite, and in a desirable market, there can only be so many players. So, while the midlevels aren't doing the actual procedures, they are still doing the foundational work (which supplies the proceduralist with business) that used to be done by the proceduralist himself. Therefore, the actual market becomes smaller for new grads trying to enter. In other words, the midlevels are effectively stealing market share away from younger docs.

    And that's the thing. When you're in a position of power and establishment, midlevels help you make money because you are able to leverage their labor. This is true in EVERY specialty - even hospital medicine. The group in town that employs midlevels is owned by a handful of hospitalists. If the midlevel thing actually worked out, they would be the ones pocketing the profit (savings).
    And lastly, I wouldn't count on procedures being highly paid going into the medium/long term (GI got heavy duty cuts in 2016). It's a trend that will only accelerate with time.
     
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    gi2014

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    Bronx thanks for the reply and the Econ 101 lesson. I can only speak for the GI job market but it is strong. Every group I have interviewed at has midlevels, and still has enough demand to expand. Maybe they just haven't hit the saturation point you are predicting yet. We will see how it plays out over the next 5 or 10 years. Thanks again for the Econ 101 lesson. You are very smart.
     

    bronx43

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    Bronx thanks for the reply and the Econ 101 lesson. I can only speak for the GI job market but it is strong. Every group I have interviewed at has midlevels, and still has enough demand to expand. Maybe they just haven't hit the saturation point you are predicting yet. We will see how it plays out over the next 5 or 10 years. Thanks again for the Econ 101 lesson. You are very smart.
    I agree that the GI demand is very strong, which is probably due to the fact that the supply of gastroenterologists is still catching up to the colonoscopy trend that started almost 20 years ago. But even then, from what I understand, large cities are very saturated. There's still a lot of money to be made in GI and probably will be for the medium term. However, long term is a concern for all specialties.
     
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