Hospitalist Procedures and Positions

[zeloc]

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What procedures should hospitalists know how to do and how much will it limit job availability if they are not known?

I am now at a hospital where all intubations are done by anesthesia or the intensivist and central lines/art lines are put in by residents or intensivists. Hospitalists really do not do any procedures except maybe lumbar punctures but is this different at other places? Is the compensation more for doing procedures, either on a per-procedure basis or as part of the overall package?


How does one find out about out-of-state positions? Do people generally use recruiters or is it more phone calls, e-mails, sending out CVs, etc? As I am more interested in the number of hours I will be working, number of shifts, number of pts to see a day, and work responsibilities and environment, I plan to find out as much of this as I can through e-mail and over the phone and then start filling out applications/scheduling interviews once I have a better sense of specific programs.

 

[elwademd]

there's a lot of questions here.

do you need to know how to do procedures? no.

does it help you? sure, as you can more quickly care for your patient.

do you get paid for it? if you're salaried, probably not (i didn't when i was with an hmo). if you're private, then you can bill the insurance company or medicare and get paid for it.

procedures i do: intubation, thoracentesis, and paracentesis. i haven't placed a line as an attending (finished residency june '08), and i haven't done a lumbar puncture.

central lines can be done by the picc line team, interventional radiology, vascular surgery, anesthesia.
lp's can be done by interventional radiology.
thoracentesis can be done by interventional radiology.
paracentesis can be done by interventional radiology.

again, you may or may not get paid for the procedure. it depends on your contract. i'd argue that whether or not you get paid for the procedure is irrelevant... but not everyone would agree. i do a procedure because i have the skill to do it, and the patient needs it... rather than because i'm going to get paid for it. hopefully that makes sense.

as far as out of state positions, the answer would seem to be rather straight forward. how do you expect to hear of something if you're not there?

whether a recruiter is involved or not, how would you expect to get your information to the recruiter? or the individual/group itself?

emails, snail mail, phone calls, etc.

 

[diphenyl]

Unfortunately for me, the hospitalists at the hospital I'm currently working at are salaried. None of them do any procedures. They call the ER doc to come do them. So in addition to running a department, the EM physician is responcible for all the lines, intubations and codes upstairs in a 400 bed hospital. Really sucks when there's only two docs on at night with a daily census of 250. There is only one hospitalist who will do any procedures but he is and EM attending half time.

 

[dragonfly99]

I think some internists are not comfortable with procedures, either because they don't like working with their hands, or were not taught. Currently a lot of IM residencies don't like their house staff to do many procedures at all, and at least one I know of doesn't let the residents do central lines (almost at all) so it's no wonder they don't know how. This problem is likely to get worse if the liability situation doesn't change. I always thought it was stupid as a medicine resident how we had to fight to get our procedures...ER or surgical residencies would never have this attitude and would consider it their duty to teach these skills to their house staff.

I think at a lot of hospitals one could be a hospitalist and not do any procedures. Usually if you look at the help wanted ads they will mention if the want someone who can do central lines, intubate, etc.

I thought it was really interesting how someone posted above that he/she does intubations but not central lines. Personally, I wouldn't be caught dead trying to intubate someone b/c I'd probably fail and knock their teeth out to boot...we just didn't learn that b/c at our hospital it was very subspecialized and anesthesia and MAYBE pulm. fellows would do the intubations, not IM residents.
-cardiology fellow