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Hospitalist life has been amazing

CaliforniaAppli

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I am moving on to oncology fellowship and will really miss being a hospitalist. I did this for a year with a 7/7 schedule without nights. This post is for anyone who is on the fence about being a hospitalist or have read bad things about being a hospitalist. I can say that the lifestyle is absolutely amazing. Pre covid I did so much traveling on my weeks off. I am not sure if I will ever have this amount of free time again. Granted I am posting this in the middle of my week off haha.

The key is to find a good group. There are a lot of crappy hospitalist jobs out there and you just have to be picky.

I almost don’t want to go to fellowship due to the schedule and the attending salary but I think I need to answer my calling.
 
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rokshana

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I am moving on to oncology fellowship and will really miss being a hospitalist. I did this for a year with a 7/7 schedule without nights. This post is for anyone who is on the fence about being a hospitalist or have read bad things about being a hospitalist. I can say that the lifestyle is absolutely amazing. Pre covid I did so much traveling on my weeks off. I am not sure if I will ever have this amount of free time again. Granted I am posting this in the middle of my week off haha.

The key is to find a good group. There are a lot of crappy hospitalist jobs out there and you just have to be picky.

I almost don’t want to go to fellowship due to the schedule and the attending salary but I think I need to answer my calling.

the time off was really the hardest part of going back into fellowship...more than the money. It was hard to switch from essentially 26 week of free time to 4 weeks of vacation time...hard to be spontaneous when you can't just take the time off when you want.
 
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blub1212

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Hahaha...

As OP is saying, some hospitalist jobs are amazing. I know a hospitalist who is out of the hospital by 5pm on weekdays and 10-11 am on weekends, granted she only makes ~220k/yr.

Emphasis on the "some" here. Just like any other specialty, there are places that are enjoyable to work and places that are not at all fun to work for. Some contracts are good, some are bad. For every good hospitalist gig out there, there is one that really sucks. As OP said, some are amazing and provide a good lifestyle. I know several of my classmates from residency that are hospitalists currently and love it. For personal reasons, I ended up having to take a gig that I really did not enjoy and am super happy to be going to fellowship in July.
 
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Splenda88

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Emphasis on the "some" here. Just like any other specialty, there are places that are enjoyable to work and places that are not at all fun to work for. Some contracts are good, some are bad. For every good hospitalist gig out there, there is one that really sucks. As OP said, some are amazing and provide a good lifestyle. I know several of my classmates from residency that are hospitalists currently and love it. For personal reasons, I ended up having to take a gig that I really did not enjoy and am super happy to be going to fellowship in July.
I am amazed at how much hospitalist jobs can vary. You will hear that some docs have jobs where the cap is ~15 and they have help from PA/NP while others have cap close ~25 with no NP/PA help. Why is that? How can one find these "good" jobs?
 
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blub1212

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I am amazed at how much hospitalist jobs can vary. You will hear that some docs have jobs where the cap is ~15 and they have help from PA/NP while others have cap close ~25 with no NP/PA help. Why is that? How can one find these "good" jobs?

I think that it depends on what the hospital is looking to get out of its hospitalists. When you start getting too many patients and are too busy to actually work up and diagnose them, then you just reflexively have to consult specialists to take care of it for you. In my admittedly very jaded opinion, administrators know this. So, admins that are looking to make the hospital more money will force their hospitalists to see too many patients. They hire less hospitalists and basically every patient is seen by a specialist, both of which significantly increase profits. As an example, I know a private hospital (not mine) in the city where I work where every patient that has chest pain is automatically seen by a cardiologist. The primary team doesn't even place the consult. If a patient complains of chest pain to the nurse, the nurse calls a cardiology consult as part of their protocol. In my opinion, not only is this very bad medicine, it unnecessarily inflates the cost of that hospital stay.

How can you find good jobs? Know exactly what you are willing to do and not do. Know where you draw the line between being overworked and being fairly compensated for your work. The answer will be personal to everyone. Once you know what you want and are willing to do, then make sure that you know exactly what is expected of you. What is your cap (if any)? Are you always admitting? How many admission on average? How is cross-cover handled? All the nitty-gritty details. Treat your job application process after residency as you treated your application to residency. Interview at a ton of places and try to find the place that you will be the happiest at.
 
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darklabel

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I am amazed at how much hospitalist jobs can vary. You will hear that some docs have jobs where the cap is ~15 and they have help from PA/NP while others have cap close ~25 with no NP/PA help. Why is that? How can one find these "good" jobs?

Location is really key from talking with hospitalists. Places that are popular are going to be where those crappy jobs tend to be. Looking even just outside of major cities you'll get good offers. If you're willing to do procedures and are ok with working in open ICUs then you're worth goes up (though so does your workload). If you're ok with taking a pay cut towards the 200k then you can have a good lifestyle.

I hate that I have such an enormous debt load though. I would be more flexible in my job search without it as I'd prefer to work outside of the hospital as much as possible.
 
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DrSnips

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As an example, I know a private hospital (not mine) in the city where I work where every patient that has chest pain is automatically seen by a cardiologist. The primary team doesn't even place the consult. If a patient complains of chest pain to the nurse, the nurse calls a cardiology consult as part of their protocol. In my opinion, not only is this very bad medicine, it unnecessarily inflates the cost of that hospital stay.

I thought I was familiar with ridiculous hospital policies, but the well of insanity is much deeper than I had imagined.
 
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tantacles

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They hire less hospitalists and basically every patient is seen by a specialist, both of which significantly increase profits. As an example, I know a private hospital (not mine) in the city where I work where every patient that has chest pain is automatically seen by a cardiologist. The primary team doesn't even place the consult. If a patient complains of chest pain to the nurse, the nurse calls a cardiology consult as part of their protocol. In my opinion, not only is this very bad medicine, it unnecessarily inflates the cost of that hospital stay.

I don't know, man. Given the way some hospitalists order extra tests, could this potentially be a cost-saving measure since a cardiologist might not immediately get a troponin for every 20 year old with chest pain?
 
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tantacles

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Part of the protocol is the nurse orders a troponin, EKG, and calls a cardiology consult......

I mean, that all seems standard. But is the cardiologist more or less likely than a hospitalist to trend that troponin to peak in an ESRD or heart failure patient with a baseline troponin of 0.06?
 

tantacles

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No...what hospitalists have you been exposed to? NPs?

You know as well as I do that dumb as bricks “do all the tests” hospitalists exist everywhere. I’ve seen one at my very hospital. And if there’s an NP covering, this policy might save some money due to someone saying “please stop trending that. It doesn’t need to go to zero.”
 

wjs010

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You know as well as I do that dumb as bricks “do all the tests” hospitalists exist everywhere. I’ve seen one at my very hospital. And if there’s an NP covering, this policy might save some money due to someone saying “please stop trending that. It doesn’t need to go to zero.”
In residency, ordering a million tests for no reason is rewarded because it shows you “thought of all the differentials.”
 
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Nespresso

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In residency, ordering a million tests for no reason is rewarded because it shows you “thought of all the differentials.”

Two fold. It is quicker to order all of the tests instead of laying out your rationale in a note. You also can dodge the "Failure to Diagnose" Crap in court if you ordered them without having to argue pre-test probabilities.
 

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Just to add, I'm about a year into my hospitalist gig out of residency and I've absolutely loved it. You're helping people in a very vulnerable time and it is meaningful work. Don't underestimate the value of that time off and having shift work. When you leave at the end of your stretch of shifts, you're done. You don't have an absurd inbasket that is waiting for you when you come back from a 2 week vacation. You return to a fresh list of 11-13 patients (at least in my job). But, as has been emphasized, there are good and horrible jobs depending on the group. The best measure of picking a job out of residency, in my opinion, is looking at group turnover rate.
 
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CaliforniaAppli

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It seems like it's hard to find a 'good' hospitalist job that also pays well...

Yeah, I think that is the holy grail of hospitalist jobs. Usually quality of life and pay are inversely proportional. Some of my friends work like dogs but churn out so much $$$. I was happy making less for a less hectic job.
 
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blue.jay

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I love part of my job (hate nights). Average census around 14. I do POCUS rounds daily. It's interesting to manage the bread and butter of all specialities. I don't consult unnecessarily or order unnecessary tests, esp with increasing age of our population and too many comorbidities most times less is more. Some of these patients might live longer if we actually don't do stuff to them. I love make those bigger decisions and try to avoid specialist opinion if that won't change the prognosis.
Overall, a true internal medicine job is hard with lot of thinking. It's low paid and highly complex and it doesn't make sense to replace doctors with midlevels. Midlevels can function well in narrow algorithm based specialities like writing notes for GI while they scope, titrate rate control meds for AFib, stroke f/u for neurology etc.
Ordering gazillion tests, giving antibiotics for everyone and consulting every specialist is not good use of resources, it can also harm patients. If a hospital thinks about making money by using midlevels I would rather not work for such place.
 
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blue.jay

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POCUS made my job much more interesting. Not to brag but sometimes I could manage fluid status better than cardiology or Nephrology.
I do quick bedside echos to assess IVC and mitral inflow patterns so I know the real time volume status of the patient while the cardiologist/nephrologist have to wait for 24 hrs to see the BUN/creatinine rise.
It's also easy to diagnosis gallstones, SBO, hydronephrosis, pleural effusion, pulmonary edema and lower love consolidations with ultrasound.
There is so much we can do as hospitalists but it depends on the group and census. My days are 7:30-4:30 I leave around 3:30 on weekends. I work one week days and 5 15hr nights a month. I hate nights it just makes me feel like a security guard.
 
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tantacles

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In residency, ordering a million tests for no reason is rewarded because it shows you “thought of all the differentials.”

Right, so just to circle back to what the actual point was: A cardiology consult for chest pain could save you a lot of money if thinking of a broad differential and ordering all the tests is the standard at your hospital.
 

aafisahar

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No...what hospitalists have you been exposed to? NPs?
Every not trained in cardiology trends troponins. I've seen 6 troponins drawn and finally get consulted when one hits above 1. Hospitalists, even at academic institutions, consult like crazy and most consults from hospitalists are lazy and poorly thought out. It's for them to do less work and offload liability and they know we can't refuse because we are fellows when they would definitely not call an attending about a trop of 0.08 in a guy with pneumococcus bacteremia.
 

rokshana

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Every not trained in cardiology trends troponins. I've seen 6 troponins drawn and finally get consulted when one hits above 1. Hospitalists, even at academic institutions, consult like crazy and most consults from hospitalists are lazy and poorly thought out. It's for them to do less work and offload liability and they know we can't refuse because we are fellows when they would definitely not call an attending about a trop of 0.08 in a guy with pneumococcus bacteremia.

You probably need to adjust that poor opinion before you get out in the real world...but sounds like you are at a crap program...

Yes, as a fellow, I too would roll my eyes at some of the silly consults I would get, but my one of my attendings said... people consult you because they need help... either it’s because they are stumped, don’t know what to do, or just need help.

That indeterminate or slightly elevated troponin will be the easy consult once you are out in the real world...it’s certainly not going to bring you in to the hospital in the middle of the night and easy enough for you or your mid level to see.

Have you actually worked as a hospitalist? Or did you just go straight into fellowship? Just as cards gets the bad rap for cathing for dollars to pay for their inground pool, people want to say hospitalists consult everyone cuz they are lazy... until you have walked in their shoes, hold your judgement...remember they are the ones that will consult you for your future pts... specialists are still dependent on primary care for referrals... you get the reputation as “that guy”, they will call the other cards group for their pts.
 
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CCM-MD

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Every not trained in cardiology trends troponins. I've seen 6 troponins drawn and finally get consulted when one hits above 1. Hospitalists, even at academic institutions, consult like crazy and most consults from hospitalists are lazy and poorly thought out. It's for them to do less work and offload liability and they know we can't refuse because we are fellows when they would definitely not call an attending about a trop of 0.08 in a guy with pneumococcus bacteremia.

Trust me.. they would. There are no fellows in the community. Also, by calling you for that troponin consult, how are they doing less work?
 

Splenda88

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The other day another I argued with my attending about trending trop... Had a patient admitted for septic shock with a trop of 0.04 (normal in our institution is < 0.03). He suggested that we start trending it. I asked him for a rational, his answer was that patient trop has always been negative on previous labs... Different attendings do different things when it comes to trending trop.
 
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jdh71

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You probably need to adjust that poor opinion before you get out in the real world...but sounds like you are at a crap program...

Yes, as a fellow, I too would roll my eyes at some of the silly consults I would get, but my one of my attendings said... people consult you because they need help... either it’s because they are stumped, don’t know what to do, or just need help.

That indeterminate or slightly elevated troponin will be the easy consult once you are out in the real world...it’s certainly not going to bring you in to the hospital in the middle of the night and easy enough for you or your mid level to see.

Have you actually worked as a hospitalist? Or did you just go straight into fellowship? Just as cards gets the bad rap for cathing for dollars to pay for their inground pool, people want to say hospitalists consult everyone cuz they are lazy... until you have walked in their shoes, hold your judgement...remember they are the ones that will consult you for your future pts... specialists are still dependent on primary care for referrals... you get the reputation as “that guy”, they will call the other cards group for their pts.

While sometimes a consult can feel like "thinking for idiots" anyone out of fellowship and working knows that if it really is that stupid of a consult, then it's an easy consult. You see the patient, put in a quick note, and bill. This does add up. At some point of time a weasel wearing a suit and calling themselves an "administrator" will try and find a way to pay you less, don't ever give them that reason.
 
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