I'm doing hospitalist at a private hospital, so no residents etc yet the work load is very manageable
We just started taking <20 weeks pregnant pts at my job
How did this little titbit get by us? Internist with patient & most dangerous parasite called FETUS!!
Of course it is happening and will become more common in the future. Ask yourself, what can you do that an NP can't? For $250k, you could hire 3-4 NP's. It will be like the team model used in anesthesia where one physician to 4 NP's. This will drive down demand and salaries of hospitalists. That's inevitable consequence when you have no special skills that can differentiate from an NP. Look at what happened in anesthesia. I would argue that life and death decision makng in anesthesia is even smaller time window than in general medicine. Anyone who doesn't think that this will happen is in denial.
I was told most of the time anesthesia is like flying a plane.... take off and landing are where 99% of the crashes happen, that's what the pilot is for, but in the middle it's just autopilot. You have said yourself that the CRNAs just babysit patients while the attending does the 5% of the total time spent with the patient that actually matters
(I'm not ****ting on what that 5% takes, if I knew or could refuse, I would never let a CRNA touch me, maybe watch the monitors with a finger on the button for the MD, and he better be strides from the OR, I get this isn't what happens, we need more PR as in Public relations, I'll address below)
Hmm, well, a hospitalist can do everything there is to do for up to 20 very sick near death patients with 20 problems each of which the tx of one exacerbates the other, excepting procedures & sometimes needing a small handful of docs for a few q's on management, and are essentially either physically laying hands on the patient, thinking about the patient, and efficiently ordering interpreting tests, efficiently churning out the all important highest tier billable note (not that the floor generates income for the hospital, but that the MD's note still counts more than the NP's)
Like has been pointed out, even if you made the NP and MD's note still bill for the same, the NP is going to create more cost and waste in that complex system
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.
Again, is there something about your field's service that others can provide? Does that mean that is true for internal medicine?
And if the great "hospitalist bubble" as they've said bursts, I doubt there will be a shortage of jobs even if the NP competition now means everyone's being paid jack, because internists with not too much trouble can just go outpt
and if the zombies come, they'll eat all the CRNAs and the internists will still be able to trade services for strawberries like on the Walking Dead, and they will be smart enough to poison the NP competition in this zombie-eat-man world (sorry, spoilers)
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.
Thread is food for thought. Maybe a long term effect of hospitalist life is reading chicken little from another specialty trolling your forum.
Actually, there has been a lot of in depth information about different hospitals and how things are done
Sometimes you need someone from outside the box to ask the questions and infuriate you to spitting out answers you didn't know you had.
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?
Rounding. Walking. Standing. Sitting. Typing. You wouldn't think this would destroy you, but my body hurt almost as much after a ward month as it did when I did surgery.
Sleep deprivation vs various physical demands vs psychological grind vs abuse vs boredom, I dunno
On the other hand, distance walked and time standing are conversely related with longevity. I don't know for attendings, but med residents supposedly walk miles and miles around the hospital every day, and spend hours and hours slumped over a keyboard. Surgery is physically taxing but those guys all look all right. They would like us to believe they are made of tougher stuff. Maybe they are.
So maybe hospitalists will outlive everyone in misery
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.
Correction: it is a warm HUMID area. The HUMID climate. Give me desert any day. In the South you'll step outside and choke on air.
This is quite appropriate. I just sent my hospitalist my 5th admissions and she just said, "your admissions have been so vague". My job is great because i have the ultimate "get out of jail card" = Admit to medicine. I can now look forward to going home after my 7 hr shift.
I'm thinking expletives.
Touchy....
We admit lots of vague complaints b/c there is no way to get a diagnosis in 2-3 hrs. Thats the nature of ER medicine. Otherwise, what would be the point of a hospitalists? If I can get a diagnosis for Everything, then a PA could do 80% of your work. Treatment is usually the easy part. You guys get a "get out of jail card" too.... its called consulting.
BTW, the 2 vague pts are
1. 80 yo f with abdominal pain (thoroughly worked up) and anemic with hgb 5.
2. 40 Yo with SBP 230 and intractable vomiting and abdominal pain.
Not sure what was so vague.
I don't know why I wanted to say something here, except I know someone who went from IM to EM, because in IM they felt like an overglorified resident, that all the excitement had happened in the ED, and what's more, that most of the work up had been done so so had a lot of discovery, so basically they wanted to be at the start of the story not watching the credits and typing them up
Ah, to rebut this notion that EDs everywhere suck and do jack, and that actually they do clean their full plate sometimes
Granted, that was at academic ED centers, I don't know why at the community hospitals they haven't managed to give the strokes and MIs any ASA or septic patients IVF
like, sure, you don't have time for rational w/u, but do you have time to stabilize/initial tx on emergency?
Tl;dr:
The only hope of the masses against the tyranny of the few, the hospital admin, will be to strike when **** gets really bad. Not quite bad enough yet.
Our real hope, is that despite how much the American people have turned on Western med and MDs, is that they still, without being given good reason, just on faith/gut instinct/acculturation pure ignorance, from shows like ER, Dr. Quinn Medicine Woman, Grey's Anatomy, want to be treated by a DOCTOR
if we want to save our careers, as was said by Hippocrates, will have to preserve the knowledge and dignity of our profession and band together like brothers
The worst thing we could EVER do for ourselves is let anyone else in the hospital, or healthcare for that matter, be called DOCTOR or wear a WHITE COAT
I don't like DOCTORS of basketweaving, but at least I'm confident that they will not be charging for medical advice, so I guess I'll let that one slide
it sounds silly that what will save us is not skill, but ritual, prestige, and other sneaky sociological constructs
if that fails I'm waiting for someone to set fire to Rome and to start working for chickens in a 3rd world country as my back up plan
