Hospitalist Long Term Career Options

[Doc_Mcstuffins]

For those who are non academic/community hospitalists, what are you current long term career plans?

Obviously, there are those who will remain as hospitalists as they like what they are doing. But what else are people planning on doing? I ask because I'm considering a career in hospital medicine and while I have even been a hospitalist before, the 2-4 nights a month and 50% of the weekends weren't bad in the first couple years out of residency, I imagine it will be much less appeasing in 10-20 years when I have a family.

In the hospitals I've been in, the oldest hospitalist is late 30's and there are very few/no hospitalists who are older or have a family (1 or 2 have newborns, thats it) so I don't really know what happens to hospitalists after 10 years on the job. (I did know older hospitalists in academics but thats a different ball game. I'm taking community, non academic hospitalists) Is the fact that there are no 40-50 year old hospitalists or hospitalists with families a sign that they leave to do something else? What? Academics sure but thats a pay cut and not for everyone or everywhere. Move up to leadership? but theres only 1-2 positions usually at most hospitals for that unless you get a second degree (MBA etc) to become CFO or chief medical officer. Can you transition to primary care easily?

My biggest fear for joining a hospitalist program is what is the lifestyle in 7+, 10, 15 years down the road? Will I still want to give up 50% 0f holidays or weekends after 5 years of job? Will I still not mind being paged at 5am to admit a patient who doesnt need admitted while at age 45? For me, the answer is probably not. Any experiences or advice is appreciated?

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[Crayola227]

No expert but as I repeat the hearsay from IM attendings I have talked to on your very questions:
the great hospitalist movement isn't all that old, which might be why you don't see a lot of old hospitalists, up until not that long ago it was your outpatient PCP admitting and rounding, I've heard the movement is still young enough we don't really know where it's all going, we haven't grown many end-stage hospitalists at this point

I hear the transition to outpatient is not the easiest in general for internists, and is harder the further from residency you are, but never really impossible. Like a lot of things in medicine no one's going to stop you even if it is a bad idea, not that it is necessarily but all the attendings that didn't come from primary care tracks have told me moving outpt was more challenging/uncomfortable than they expected. Going outpatient to inpatient after a while is also difficult but IM training is more inpt heavy to begin with so it's more a rusty thing than lack of training.

So I guess my impression is hospitalist-ism isn't that old so there's not a lot of oldies, there's still quite a bit of outpatient providers doing the inpt stuff, and the great thing about IM is you can usually move between outpt and inpt PRN desperation rather than hang yourself although it may be with some difficulty, I've heard of people going back for non-competitive fellowships 5-10 years out. Also check out the drop out club, they have job postings that may explain where clinicians seem to be disappearing to.