Hospitalist Life not as good as it seems?

[Mad Jack]

In a bundled care model where an ACO gets X dollars per year per patient, do you think it's less or more risky for a specialty that is interchangeable with a nursing group? Think about that.

I don't think hospitalists will disappear, but it will evolve to include more supervision. You will have decreased job security, job opportunities, and lower salaries. That's the consequence of not being able to differentiate yourself from NP's. Anesthesia recognizes this and is trying to transform into periop specialists. They know the future is not on stool sitting.

You don't understand efficiency. If one patient from a midlevel gets readmitted back to the hospital and ends up on a vent under an ACO payment model, the average cost for their stay is $34,257 dollars. None of which will be paid for. If a hospitalist keeps just 6 patients from being landed in the ICU over the course of an entire year, they've paid for their whole salary. And that's excluding minor re-admits, which average $10,000 each. A midlevel only needs to screw up a couple times for their entire cost:benefit ratio to be completely blown to pieces, and that's excluding lawsuits.

As to who will get paid more by a bundled payment model, well, once everything's under the hospital's umbrella, they own you. Your services become a commodity. In a lot of markets, all of the decent hospitals are owned by large hospital networks, so they've got a lot of clout over the going rate in a given market, which will leave procedure-based specialists bargaining with hospitals over what they're worth, cutting each other down to the lowest bidder or leaving the market entirely. That'll probably drive wages through the floor in desirable markets, but we'll see.

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[Taurus]

That's why I keep saying that there is an optimal ratio and that physician will head the team. If you the physician cannot supervise your NP's and your team has a higher than average recall rate, you are out of a job.

I think you guys grossly underestimate how efficient and capable an experienced NP is. They are perpetual residents and many learn how to do their jobs very well. If they sucked as much as you guys suggest, why are they seeing patients on their own in clinic? Why are they getting autonomy from states? Etc. As someone said, medicine isn't that hard and after a while most people learn what's important and not. I'm not saying that they can replace physicians but they are not complete buffoons most of the time.

That's how the MBA will think. They will ask you to do more and more without any increase in benefits. Welcome to how medicine will be practiced in the future. Everyone will get paid less and you have to work harder and harder. At least I don't want to worry about some NP groups trying to get my job.

 

[RustBeltOnc]

Also keep in mind that medicine moves at a snail's pace- ... I doubt we'll be seeing unemployed internists within our working lifetimes, for numerous reasons.
behttp://www.todayshospitalist.com/index.php?b=articles_read&cnt=35

it is not moving at snail's pace now.

 

[Mad Jack]

it is not moving at snail's pace now.

<source>

 

[RustBeltOnc]

<source>

http://www.postandcourier.com/article/20150501/PC1601/150509881

"The pace of these closures has been accelerating, with more rural hospitals across the country shutting their doors in the past two years than in the previous 10 years combined, according to the National Rural Health Association. That could be just the beginning of what some health care analysts fear will be a crisis. An additional 283 rural hospitals in 39 states are vulnerable to shutting down, and 35 percent of rural hospitals are operating at a loss, according to iVantage Health Analytics, a Portland, Maine-based firm that works with hospitals."

MadJack --- in some ways this is a moot point because ... it's not possible to be a hospitalist for more then 4 or 5 years. Take it from someone who has been working for sometime. Anyone as engaged and interested in all this as you are, 36 months in, man, I don't think you will be very satisfied with your life.

 

[Gpan]

That's why I keep saying that there is an optimal ratio and that physician will head the team. If you the physician cannot supervise your NP's and your team has a higher than average recall rate, you are out of a job.

I think you guys grossly underestimate how efficient and capable an experienced NP is. They are perpetual residents and many learn how to do their jobs very well. If they sucked as much as you guys suggest, why are they seeing patients on their own in clinic? Why are they getting autonomy from states? Etc. As someone said, medicine isn't that hard and after a while most people learn what's important and not. I'm not saying that they can replace physicians but they are not complete buffoons most of the time.

That's how the MBA will think. They will ask you to do more and more without any increase in benefits. Welcome to how medicine will be practiced in the future. Everyone will get paid less and you have to work harder and harder. At least I don't want to worry about some NP groups trying to get my job.

Because the Doctors who own those clinic only think about the dollar they save at present and not the consequences of malpractice later on. I know tons of Doctors who hire tons of NP/PA to basically run their multiple clinics in town to maximize the profit margin. Needless to say their pts are often mismanaged and go to the ER all the time for little crap like DM. If hospitals start to become this greedy and run this type of practice then I would NOT want to be associated with them either. My name and reputation is way way way more important than a $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Of course hospitals are not run by stupid, greedy bastards, well not all the time lol

 

[Mad Jack]

http://www.postandcourier.com/article/20150501/PC1601/150509881

"The pace of these closures has been accelerating, with more rural hospitals across the country shutting their doors in the past two years than in the previous 10 years combined, according to the National Rural Health Association. That could be just the beginning of what some health care analysts fear will be a crisis. An additional 283 rural hospitals in 39 states are vulnerable to shutting down, and 35 percent of rural hospitals are operating at a loss, according to iVantage Health Analytics, a Portland, Maine-based firm that works with hospitals."

MadJack --- in some ways this is a moot point because ... it's not possible to be a hospitalist for more then 4 or 5 years. Take it from someone who has been working for sometime. Anyone as engaged and interested in all this as you are, 36 months in, man, I don't think you will be very satisfied with your life.

If I go hospitalist, I'm looking to eventually do hospital management (MBA, MHA). I do know plenty of hospitalists that have been at it 10+ years that are happy with their lives, but they all work for the same group, so I don't know how easy that is to generalize.

 

[pulmoblast]

I want NPs to go independent, get their own malpractice insurance and get sued. They will be begging to be supervised by a MD in no time...

 

[Raryn]

MadJack --- in some ways this is a moot point because ... it's not possible to be a hospitalist for more then 4 or 5 years. Take it from someone who has been working for sometime. Anyone as engaged and interested in all this as you are, 36 months in, man, I don't think you will be very satisfied with your life.

[Citation Needed]

I know hospitalists who have been doing exclusively hospital based work since 1997. That's the ones I know personally... not including the ones who were in their department before they got hired.

It's not possible to have been a "hospitalist" much longer than that because the word itself was coined in the mid 90s, but there's plenty of people who have been hospitalists for more than a decade without any issues.

 

[RustBeltOnc]

[Citation Needed]

I know hospitalists who have been doing exclusively hospital based work since 1997. That's the ones I know personally... not including the ones who were in their department before they got hired.

Raryn -- OK you got me there. It is possible to work as a hospitalist for 18 years.

But, c'mon, man.

It is a young person's game from the physical perspective and getting back to the OP, it isn't something most university-trained, categorical medicine grads will find interesting/ rewarding after three, four years.

 

[chessknt]

I came in to this thread expecting to see a discussion of the long term effects of hospitalist life, but instead chicken little from another specialty (subspecializing in forum trolling it seems?) with the sixth sense occupied almost half the the thread. Two thumbs down.

 

[bronx43]

Raryn -- OK you got me there. It is possible to work as a hospitalist for 18 years.

But, c'mon, man.

It is a young person's game from the physical perspective and getting back to the OP, it isn't something most university-trained, categorical medicine grads will find interesting/ rewarding after three, four years.

I don't understand the whole "physical" argument against hospital medicine. It obviously isn't a cakewalk, but how is it MORE taxing physically than interventional cardiology, or even non-invasive cardiology? Or critical care, where you take Q3-4 call? Or even a busy primary care job?

 

[laserbeam]

I don't understand the whole "physical" argument against hospital medicine. It obviously isn't a cakewalk, but how is it MORE taxing physically than interventional cardiology, or even non-invasive cardiology? Or critical care, where you take Q3-4 call? Or even a busy primary care job?

Because some people do not have the insight to find gold, instead they blame the whole specialty.

 

[VA Hopeful Dr]

I don't understand the whole "physical" argument against hospital medicine. It obviously isn't a cakewalk, but how is it MORE taxing physically than interventional cardiology, or even non-invasive cardiology? Or critical care, where you take Q3-4 call? Or even a busy primary care job?

Because 7 12-hour days in a row is just plain exhausting. My wife has been at it for less than a year and is already pondering going part time.

 

[bashwell]

Can you do other combinations besides 7 x 12hr days? Or is that pretty standard everywhere?

 

[bronx43]

Because 7 12-hour days in a row is just plain exhausting. My wife has been at it for less than a year and is already pondering going part time.

Has your wife taken Q4 cath lab call, get called at 2AM, and usually not get a post call day? I much rather bust my ass for 7 12 hour days than get crappy or no sleep every fourth night for the rest of my career. And you can easily find gigs that aren't the full 12 hours. I did.

 

[bronx43]

Can you do other combinations besides 7 x 12hr days? Or is that pretty standard everywhere?

Yes, you can. My gig is 200 shifts total where you do a combination of rounding (you can go home at 3pm and cover pager at home), swing shift, or night shift. There are no 12 hour shifts here.

The private institution around town does 10 hour shifts.

 

[VA Hopeful Dr]

Has your wife taken Q4 cath lab call, get called at 2AM, and usually not get a post call day? I much rather bust my ass for 7 12 hour days than get crappy or no sleep every fourth night for the rest of my career. And you can easily find gigs that aren't the full 12 hours. I did.

I'm not saying that the hospitalist life style is worse than q4 call, just that its not as easy as you think. Heck, you haven't even tried the "standard" hospitalist schedule yet and by your response you don't ever plan to yet you already know its not physically difficult?

Snark aside, I applaud you taking a job with more flexibility. That's the key to staying happy in medicine to my mind.

 

[Mad Jack]

Has your wife taken Q4 cath lab call, get called at 2AM, and usually not get a post call day? I much rather bust my ass for 7 12 hour days than get crappy or no sleep every fourth night for the rest of my career. And you can easily find gigs that aren't the full 12 hours. I did.

The group I know of works as MD-midlevel teams, M-F, no weekends. The MD leaves whenever the rounding, notes, and admits are all done. Usually they pull 8-10 hour days, but some days they get out much earlier. They average just over 40 hours, and have nocturns and weekend staff that cover all of the off shifts. I don't know how they handle new admits on days they leave early, though I do know that the midlevels kick around for a set shift time, so maybe they cover until the nocturn arives?

 

[path or no path]

http://www.postandcourier.com/article/20150501/PC1601/150509881

"The pace of these closures has been accelerating, with more rural hospitals across the country shutting their doors in the past two years than in the previous 10 years combined, according to the National Rural Health Association. That could be just the beginning of what some health care analysts fear will be a crisis. An additional 283 rural hospitals in 39 states are vulnerable to shutting down, and 35 percent of rural hospitals are operating at a loss, according to iVantage Health Analytics, a Portland, Maine-based firm that works with hospitals."

MadJack --- in some ways this is a moot point because ... it's not possible to be a hospitalist for more then 4 or 5 years. Take it from someone who has been working for sometime. Anyone as engaged and interested in all this as you are, 36 months in, man, I don't think you will be very satisfied with your life.

What I don't get is where will all these people get care? I mean, people we'll still have their pneumonias, MIs, pyelos, etc. and need to be admitted to a hospital for treatment. Will all these closures just switch patients to bigger more centrally located medical centers?

 

[bronx43]

I'm not saying that the hospitalist life style is worse than q4 call, just that its not as easy as you think. Heck, you haven't even tried the "standard" hospitalist schedule yet and by your response you don't ever plan to yet you already know its not physically difficult?

Snark aside, I applaud you taking a job with more flexibility. That's the key to staying happy in medicine to my mind.

Wtf are you talking about?

I asked how hospitalist jobs are MORE physically taxing than interventional cardiology or taking Q4 call, and you responded that it's because your wife has been doing 7 12 hour shifts and is considering going part time. My question is a statement of COMPARISON, therefore, how else am I supposed to interpret your answer, other than in that context? You then respond by saying you didn't mean hospitalist is more taxing than taking call. So... you didn't actually respond with anything meaningful, did you? And I never said hospitalist is easy... in fact, I admitted that it wasn't a cakewalk.

Snark aside, people should just do whatever they think they can be content doing. In the end, it's all just a job, and if you find yourself able to do 7 12 hour shifts for the long haul, then all the power to you. If you want to take call for the rest of your life, then that's fine too.

 

[VA Hopeful Dr]

Wtf are you talking about?

I asked how hospitalist jobs are MORE physically taxing than interventional cardiology or taking Q4 call, and you responded that it's because your wife has been doing 7 12 hour shifts and is considering going part time. My question is a statement of COMPARISON, therefore, how else am I supposed to interpret your answer, other than in that context? You then respond by saying you didn't mean hospitalist is more taxing than taking call. So... you didn't actually respond with anything meaningful, did you? And I never said hospitalist is easy... in fact, I admitted that it wasn't a cakewalk.

Snark aside, people should just do whatever they think they can be content doing. In the end, it's all just a job, and if you find yourself able to do 7 12 hour shifts for the long haul, then all the power to you. If you want to take call for the rest of your life, then that's fine too.

I was responding to the part where you said "I don't understand the whole "physical" argument against hospital medicine". That's all. The rest of your post was about comparison, so perhaps I should have truncated your post to the part I was specifically speaking to.

 

[Jonassen]

Meanwhile the EM guy makes $150-200/hr with a note that says "Medicine consulted."

 

[Gpan]

 

[Raryn]

Raryn -- OK you got me there. It is possible to work as a hospitalist for 18 years.

But, c'mon, man.

It is a young person's game from the physical perspective and getting back to the OP, it isn't something most university-trained, categorical medicine grads will find interesting/ rewarding after three, four years.

There's roughly 7000 internists graduating yearly. There's approximately half that many fellowship spots of some stripe or another. That means only half of internists can/will subspecialize. Of the other half, the majority become hospitalists... and most of them do it for any number of years. Really, the only reason you don't see too many old hospitalists is because the field has been around for <20 years. While you personally may know a number of people quitting, most others I know are quite happy with their lifestyle, compensation, what have you. Hell, I'm still thinking long and hard about doing it instead of the less-lucrative fellowship I'm interested in.

Unless you have thousands of internists retiring exceptionally young or a resurgence of interest amount our peers in doing primary care, your anecdotes can't correlate with the data.

 

[metopic]

http://www.abim.org/about/examInfo/data-fellow/chart-03.aspx

There were 4700 first year fellows and 7500 3rd year IM residents in 13-14. So roughly 2800 not going on to fellowship which is 37%. Obviously that's ballpark because a plenty of the new fellows will be people who are prior graduates so >40% of new grads aren't going onto fellowship. Just for those who are curious.

 

[Mad Jack]

http://www.abim.org/about/examInfo/data-fellow/chart-03.aspx

There were 4700 first year fellows and 7500 3rd year IM residents in 13-14. So roughly 2800 not going on to fellowship which is 37%. Obviously that's ballpark because a plenty of the new fellows will be people who are prior graduates so >40% of new grads aren't going onto fellowship. Just for those who are curious.

I wouldn't be surprised if well over half of those 2,800 that didn't do a fellowship went into outpatient practice. Hospitalist medicine isn't for everyone.

 

[W19]

Meanwhile the EM guy makes $150-200/hr with a note that says "Medicine consulted."

It seems like IM is the dumping ground in most hospitals...

 

[Bostonredsox]

I don't know what your Hospitalists are like, but if they have no special skills or differences in quality of care performed then NPs then you sir have some ****ty Hospitalists.

 

[Bostonredsox]

And your point is what? I have been saying hybrid team model with physician supervising 3-4 NP's. Hospitals will want this for medico legal reasons.

Let's think about this. Even if those NP's are being supervised, it means fewer jobs for physician hospitalists. You won't need as many of them.

I don't think this is rocket science. This is Econ 101.

Most of you guys are missing the most important argument and to which you have no solution for. You can't differentiate yourself enough from an NP. Very risky position to be in the future when all 50 states allow NP autonomy and NP's demand more and more autonomy in the hospital.

If your seeing a Hospitalist supervise 4 nps and 80 patients write their name down so you can google the lawsuits that pile up and strip their license. No physician will agree to supervise 4 mid levels. It's not possible. Every single patient seen by a mid level, every order they write, every document they dictate, has to be personally reviewed by a physician. Not sure about you, but it's. Long enough day trying to see 25+ pts, you think we're going to see 80??? Maybe you'll find some **** Hospitalists that will just glance at the pt seen by the NP and consign there note without actually seeing and examining the pt and making sure everything's correct, but after a few bad outcomes they'll refuse working with the np. The most I have seen anywhere is one mid level on a team of 4 Hospitalists where the mid level helps triage admissions or paperwork for discharges, and most places I've been have no mid levels at all. There quality of care, critical care skills, and efficiency are just so poor in comparison to an attending physician. Hospitals do care about the bottom line you are correct, but they also care about outcomes and bad PR. NPs cannot do what I do with the anywhere near the same quality of care and expertise, as you would expect, because they're not doctors... Several places I have been the Hospitalists flat out refused to work with mid levels. So unless the hospital is going to let the Nps work unsupervised, which they may, until the M and M cases start piling up and the efficiency plummets, there will not be any encroachment.

 

[calvnandhobbs68]

Just throwing this out there but I'm thinking one of the main reasons you're unhappy is because you're getting hosed making only 150k. If that's all you can expect to pull down, might as well go to the tons of outpatient jobs where you'll get all your weekends and holidays off (and might even make more to boot). Most people I've encountered who do hospitalist or consider it, do it because of the pay and time off, not in spite of the pay and working a bunch of holidays.

 

[Taurus]

When I first started talking about this NP problem in 2005, I heard many of the same comments. I'm overreacting. Only a handful of states allow them autonomy. NPs and CRNAs will never be a threat. This is in 2005. Look up my old posts from that era and see how people responded. Unfortunately, a lot of what I predicted is coming true.

10 years later. The NPs created the DNP. Then Obamacare. Then more and more states are giving them full autonomy. Assume that all 50 states will give them autonomy. In that environment, you better pick a specialty that allows you to be differentiated from an NP or CRNA. If not, the MBAs in hospital administration will figure out what minimal physician supervision is needed to staff the various services. Anyone who doesn't see that is in denial, inexperienced, or naive.

Nobody has given a convincing argument as to how a physician hospitalist is differentiated enough from an NP. Physicians are more knowledgeable, efficient, etc. Then why are states giving NPs full autonomy? Why are they allowed to work independently? If they are so bad and incompetent, that wouldn't be happening. From a medico legal point of view, I think physician hospitalists will leading a team of NPs, nurses, pharm, etc. Days of physician only hospitalists are numbered.

 

[chessknt]

I think you haven't worked as a hospitalist and have no idea what will happen because it isn't something you actually are knowledgeable about. You make a handful of assumptions and extrapolate based on things that have happened to a different specialty (that you also don't know anything about).

 

[Taurus]

Lol. I did a prelim medicine internship. I already did 1/3 the training of a hospitalist. Hospitalists do the same work as senior medicine residents. They're like PGY4's.

I interact with hospitalists daily. I read their H&P and progress notes, etc. I admit that our service is guilty of dumping patients onto to them when it's 5 pm and patient has small complication like pneumothorax after thoracentesis and needs to be admitted. Why does this patient needed to be admitted? Because the I am not credentialed to admit patients for more than 24 hours. I feel sorry for them.

 

[path or no path]

When I first started talking about this NP problem in 2005, I heard many of the same comments. I'm overreacting. Only a handful of states allow them autonomy. NPs and CRNAs will never be a threat. This is in 2005. Look up my old posts from that era and see how people responded. Unfortunately, a lot of what I predicted is coming true.

10 years later. The NPs created the DNP. Then Obamacare. Then more and more states are giving them full autonomy. Assume that all 50 states will give them autonomy. In that environment, you better pick a specialty that allows you to be differentiated from an NP or CRNA. If not, the MBAs in hospital administration will figure out what minimal physician supervision is needed to staff the various services. Anyone who doesn't see that is in denial, inexperienced, or naive.

Nobody has given a convincing argument as to how a physician hospitalist is differentiated enough from an NP. Physicians are more knowledgeable, efficient, etc. Then why are states giving NPs full autonomy? Why are they allowed to work independently? If they are so bad and incompetent, that wouldn't be happening. From a medico legal point of view, I think physician hospitalists will leading a team of NPs, nurses, pharm, etc. Days of physician only hospitalists are numbered.

Perhaps because there is a tremendous shortage of physicians?

 

[path or no path]

When I first started talking about this NP problem in 2005, I heard many of the same comments. I'm overreacting. Only a handful of states allow them autonomy. NPs and CRNAs will never be a threat. This is in 2005. Look up my old posts from that era and see how people responded. Unfortunately, a lot of what I predicted is coming true.

10 years later. The NPs created the DNP. Then Obamacare. Then more and more states are giving them full autonomy. Assume that all 50 states will give them autonomy. In that environment, you better pick a specialty that allows you to be differentiated from an NP or CRNA. If not, the MBAs in hospital administration will figure out what minimal physician supervision is needed to staff the various services. Anyone who doesn't see that is in denial, inexperienced, or naive.

Nobody has given a convincing argument as to how a physician hospitalist is differentiated enough from an NP. Physicians are more knowledgeable, efficient, etc. Then why are states giving NPs full autonomy? Why are they allowed to work independently? If they are so bad and incompetent, that wouldn't be happening. From a medico legal point of view, I think physician hospitalists will leading a team of NPs, nurses, pharm, etc. Days of physician only hospitalists are numbered.

I believe Bostonredsox just gave a well-articulated response as to why the model where a hospitalist supervises multiple NPs won't work. At my place, a group of about 20 hospitalists employs one PA, who basically functions at the level of R1-R2. He doesn't do any procedures, doesn't do any critical care.

If you think about it, on a teaching team, you have an attending who supervises one R2 and 2 R1s. That's 3 residents, who are functioning roughly speaking at a level slightly higher than an NP or PA. The whole team has a cap of about 16-18 pts. I agree with Bostonredsox, there is no way in hell a hospitalist would supervise multiple (4) NP/PAs.

 

[Silent Cool]

If your seeing a Hospitalist supervise 4 nps and 80 patients write their name down so you can google the lawsuits that pile up and strip their license. No physician will agree to supervise 4 mid levels. It's not possible. Every single patient seen by a mid level, every order they write, every document they dictate, has to be personally reviewed by a physician. Not sure about you, but it's. Long enough day trying to see 25+ pts, you think we're going to see 80??? Maybe you'll find some **** Hospitalists that will just glance at the pt seen by the NP and consign there note without actually seeing and examining the pt and making sure everything's correct, but after a few bad outcomes they'll refuse working with the np. The most I have seen anywhere is one mid level on a team of 4 Hospitalists where the mid level helps triage admissions or paperwork for discharges, and most places I've been have no mid levels at all. There quality of care, critical care skills, and efficiency are just so poor in comparison to an attending physician. Hospitals do care about the bottom line you are correct, but they also care about outcomes and bad PR. NPs cannot do what I do with the anywhere near the same quality of care and expertise, as you would expect, because they're not doctors... Several places I have been the Hospitalists flat out refused to work with mid levels. So unless the hospital is going to let the Nps work unsupervised, which they may, until the M and M cases start piling up and the efficiency plummets, there will not be any encroachment.

Isn't this exactly what anesthesiologists do with CRNAs?

 

[bashwell]

Isn't this exactly what anesthesiologists do with CRNAs?

Yeah, very sad (seriously)!

 

[YankeeCandle1141]

When I first started talking about this NP problem in 2005, I heard many of the same comments. I'm overreacting. Only a handful of states allow them autonomy. NPs and CRNAs will never be a threat. This is in 2005. Look up my old posts from that era and see how people responded. Unfortunately, a lot of what I predicted is coming true.

10 years later. The NPs created the DNP. Then Obamacare. Then more and more states are giving them full autonomy. Assume that all 50 states will give them autonomy. In that environment, you better pick a specialty that allows you to be differentiated from an NP or CRNA. If not, the MBAs in hospital administration will figure out what minimal physician supervision is needed to staff the various services. Anyone who doesn't see that is in denial, inexperienced, or naive.

Nobody has given a convincing argument as to how a physician hospitalist is differentiated enough from an NP. Physicians are more knowledgeable, efficient, etc. Then why are states giving NPs full autonomy? Why are they allowed to work independently? If they are so bad and incompetent, that wouldn't be happening. From a medico legal point of view, I think physician hospitalists will leading a team of NPs, nurses, pharm, etc. Days of physician only hospitalists are numbered.

The same way that an iphone is better than a flip phone.

Yes you can carry 5 flip phones to save money, and yes they essentially do the same thing..... But nobody is doing it.

The fact that you have been predicting this for over a decade is proof that you are just wrong. It wont ever happen. Just because states are giving them autonomy doesn't mean a damn thing. States are also legalizing marijuanna, that doesn't mean everyone will have to start smoking it soon.

 

[Brigade4Radiant]

Isn't this exactly what anesthesiologists do with CRNAs?

Anesthesia is different. Each CRNA see's only one patient they have to be there and they help with the induction and extubation. How would the hospitalist supervise 80 patients?

 

[Bostonredsox]

Anesthesia is different. Each CRNA see's only one patient they have to be there and they help with the induction and extubation. How would the hospitalist supervise 80 patients?

This.

It's about volume.

 

[pH74]

Recent graduate who started a job as an academic hospitalist in a large east coast city. Wasn't in love with hospitalist but thought it would be a good lifestyle and job choice and didn't see myself doing any fellowship or outpatient.

Very surprised to find myself not enjoying it at all despite not being on the job for so long. I enjoyed my ward months during residency but attending life is much less enjoyable. Any other hospitalists with these feelings? Interested in hear other's thoughts. Seems like its an easy job to get burned out.
-Sure, the time off is nice (work about 2/3 of weeks a year and have to come in a couple other days a year for educational stuff, meetings) but having a random tues morning off doesn't make up for the fact that i have to work 13-14 full weekends a year. Thats 1/4 of all weekend at hospital and when I'm there, its usually a solid 12-14 hr days so I'm there much longer pretty much anyone else in hospital (residents, sub specialist attendings). Not to mention that come holidays, I've had to spent 12-14 hr days on while the other attendings in subspecialty come in for 2-3 hours (its academic) or outpatient are off completely. Not to mention, the hours worked doesn't come anywhere close to the salary I receive (150K).

-Other thing that bothers is constantly feeling "dumped on" or being the bottom of barrel in hospital. Both here and other hospitals, the hospitalists get every patient, the social admits, the complicated patients yet the constant argument is hospitalists don't make $$$ for the hospital, so the money goes to the cardiologist who do caths or the surgeons or the GI doing colonoscopies. Maybe its just my area, but hospitalists are seen as glorified residents IMO and i wonder if thats something that other hospitalists are always fighting for their deserved respect and recognition. Thankful for any responses.

Your lifestyle and income is certainly better than sub specialists like Nephrologist or ID.

 

[Cirrus83]

Recent graduate who started a job as an academic hospitalist in a large east coast city. Wasn't in love with hospitalist but thought it would be a good lifestyle and job choice and didn't see myself doing any fellowship or outpatient.

Very surprised to find myself not enjoying it at all despite not being on the job for so long. I enjoyed my ward months during residency but attending life is much less enjoyable. Any other hospitalists with these feelings? Interested in hear other's thoughts. Seems like its an easy job to get burned out.
-Sure, the time off is nice (work about 2/3 of weeks a year and have to come in a couple other days a year for educational stuff, meetings) but having a random tues morning off doesn't make up for the fact that i have to work 13-14 full weekends a year. Thats 1/4 of all weekend at hospital and when I'm there, its usually a solid 12-14 hr days so I'm there much longer pretty much anyone else in hospital (residents, sub specialist attendings). Not to mention that come holidays, I've had to spent 12-14 hr days on while the other attendings in subspecialty come in for 2-3 hours (its academic) or outpatient are off completely. Not to mention, the hours worked doesn't come anywhere close to the salary I receive (150K).

-Other thing that bothers is constantly feeling "dumped on" or being the bottom of barrel in hospital. Both here and other hospitals, the hospitalists get every patient, the social admits, the complicated patients yet the constant argument is hospitalists don't make $$$ for the hospital, so the money goes to the cardiologist who do caths or the surgeons or the GI doing colonoscopies. Maybe its just my area, but hospitalists are seen as glorified residents IMO and i wonder if thats something that other hospitalists are always fighting for their deserved respect and recognition. Thankful for any responses.

Even on the east coast there are better paying jobs than what you're quoting, and I know plenty of attendings on the east coast who leave at 3pm to go "pick up their kids" or go to the gym or whatnot. You will have to work weekends though in almost every specialty I can think of except maybe dermatology. In my experience though some new attendings who complain about how long they're staying are slow at seeing their patients. Where I work they're supposed to do a half day every other saturday or sunday where you round on a limited number of patients (usually like 8 or 9 people) and then you can sign out and go home around noon, but one new attending was staying until 8 or 9 PM every time they had a half day shift scheduled, and it would take them 2-3 hours to do see one admission when new admissions came in on other days. Nobody else ever stayed until 9PM on a half day, even moonlighting fellows and residents were out of there by the early afternoon.

Are the other hospitalists in your group also staying there for 12-14 hour days every day, or are you the only one who's working 12 hours each shift? It's very easy to burn out if you're stuck there 14 hours a day. Are you the only hospitalist there when you have shifts or something? If you're really getting an obscene number of patients per day to admit and round on then I would look for a different job, there are definitely hospitals out there with relatively low volume positions even on the east coast, and you could do a little better on base pay and get a bonus and whatnot.

 

[efex101]

Although NP's are setting UP shop in SOME states they are only seeing very healthy/simple patients in the outpatient setting anything with 3 or more comorbid conditions get sent to a full fledged physician. NO hospitalist that I know of and I know plenty would be able to SAFELY see 80+ patients which is the scenario that would occur if one MD had 3+ NP's not happening unless it is shoddy medicine in podunk USA. To the question what does a physician bring that an NP cannot - CRITICAL THINKING SKILLS/DIAGNOSIS/DIFFERENTIAL. Nursing model is cook book type medicine - algorithms they do not possess the skills that a physician has because they do not have the depth and breadth of knowledge that we do. Not saying they could NOT, but that they did not TRAIN that way. Comparing an NP to MD/DO is like comparing apples to oranges. I cannot believe some of you believe that NP = MD/DO.

 

[Gpan]

Although NP's are setting UP shop in SOME states they are only seeing very healthy/simple patients in the outpatient setting anything with 3 or more comorbid conditions get sent to a full fledged physician. NO hospitalist that I know of and I know plenty would be able to SAFELY see 80+ patients which is the scenario that would occur if one MD had 3+ NP's not happening unless it is shoddy medicine in podunk USA. To the question what does a physician bring that an NP cannot - CRITICAL THINKING SKILLS/DIAGNOSIS/DIFFERENTIAL. Nursing model is cook book type medicine - algorithms they do not possess the skills that a physician has because they do not have the depth and breadth of knowledge that we do. Not saying they could NOT, but that they did not TRAIN that way. Comparing an NP to MD/DO is like comparing apples to oranges. I cannot believe some of you believe that NP = MD/DO.

Only idiots do...sadly

 

[medrest]

Well, I AM A HOSPITALIST and I LIKE MY WORK. I ACTUALLY ENJOY MY WORK.

 

[olivarynucleus]

The only thing I'm learning from this thread, is that more physicians in a region ( northeast) or specialty (pathology), means way less money. So just avoid oversaturated areas and specialties and should be able to make 300k easily. The south may have a lot of racist, overly religious, simple folk but its a warm beautiful area of the country with mountains, beaches, etc. The climate and COL is worth tolerating the people.

 

[olivarynucleus]

Most medicine specialists cannot be replaced by NP's, ie, cards, GI, heme/onc, etc. They are more secure than hospitalists.

I think many people have been lured into being hospitalists because of the high salaries and plentiful job opportunities that exist now. I doubt it will last. At some point, the hospitals will realize that they can save money by using a hybrid team model.

I've always believed that if you do something make sure that no other can provide the same service. If they can, then it's a race to the bottom.

Nurses will never do hospitalist medicine, people sick enough to be in the hospital are usually complex patients, and nurses just aren't smart enough, or efficient enough to see a lot of complex patients. I would honestly say IM and surgery are the most protected fields from mid level encroachment. I really like how surgery protected their field, Anesthesiologist sold out their field and its sad to see.

 

[W19]

Nurses will never do hospitalist medicine, people sick enough to be in the hospital are usually complex patients, and nurses just aren't smart enough, or efficient enough to see a lot of complex patients. I would honestly say IM and surgery are the most protected fields from mid level encroachment. I really like how surgery protected their field, Anesthesiologist sold out their field and its sad to see.

They will do it if hospitals will hire them. These people have big ego. They think they know as much as MD/DO.

 

[olivarynucleus]

They will do it if hospitals will hire them. These people have big ego. They think they know as much as MD/DO.

I read an article that said NP hospitalist would complain about having 5 WHOLE patients to take care of, while the Physician was handling 20. Honestly, internal medicine is a specialty where you actually have to know stuff and think, and nurses don't have the knowledge or speed. Now, they can sit on their butts and push a couple buttons, thus the CRNA crisis in anesthesiology.