Hospitalist, question.

[lateness]

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I know they are the minority of FM docs, according to AAFP, but can an FM doc be a hospitalist, and if so, what would one do to search in that direction? ALso does a hospitalist only cover int med, or can you cover Peds as well? 😕

 

[skypilot]

I know they are the minority of FM docs, according to AAFP, but can an FM doc be a hospitalist, and if so, what would one do to search in that direction? ALso does a hospitalist only cover int med, or can you cover Peds as well? 😕

It can be done but if your main interest is in inpatient medicine, you might consider internal medicine or peds.

If you are in a more rural area the FPs will definitely be doing inpatient, outpatient, and ER! 🙂

Check out the AAFPs info on hospitalist training for FPs. There are also fellowships for FPs in hospitalist medicine.

http://www.aafp.org/fpm/981100fm/cover.html

 

[deleted87716]

can an FM doc be a hospitalist, and if so, what would one do to search in that direction? ALso does a hospitalist only cover int med, or can you cover Peds as well?

If you enjoy hospital medicine, you can certainly do it as an FP. If you have sufficient peds experience, you should be able to cover peds as well. It all depends on where you work and what you're comfortable with, not to mention what the hospital is comfortable credentialing you for.

If by "search in that direction" you mean job search, e-mail me (see my profile) if you've finished or are finishing your residency. We have a couple of hospitalists in our group (one FP and one dual-boarded in peds and FP) who are looking to add a partner.

 

[FamilyMD]

Yes, FP's most certainly can be hospitalists. In fact 2 of my buds are doing just that right now.

 

[lateness]

If you enjoy hospital medicine, you can certainly do it as an FP. If you have sufficient peds experience, you should be able to cover peds as well. It all depends on where you work and what you're comfortable with, not to mention what the hospital is comfortable credentialing you for.

If by "search in that direction" you mean job search, e-mail me (see my profile) if you've finished or are finishing your residency. We have a couple of hospitalists in our group (one FP and one dual-boarded in peds and FP) who are looking to add a partner.

😎
big thanks, to all of you guys, kent, sky, family,
just an intern, but will def consider it in a couple of years..

 

[deleted6669]

I work in a fairly large hospital and we have both fp and im docs on the hospitalist service here doing the same things. all peds are seen by a separate peds service, however.

 

[lateness]

I work in a fairly large hospital and we have both fp and im docs on the hospitalist service here doing the same things. all peds are seen by a separate peds service, however.

thanks again emedpa

 

[dr.smurf]

http://www.aafp.org/x42562.xml

 

[McDoctor]

I do think that hospitalist is the type of position that Med/Peds residency in definitley more geared toward. Of course family med CAN do it but if I were pre-residency and interested primarily in working as a hospitalist I would definitely look into Med/Peds. The day to day skills and thought processes required by a hospitalist are wholly different from an outpatient practitioner and not as thoroughly developed in FP program where the nature of the field dictates a major portion of training be devoted to outpatient/preventative care.

 

[sophiejane]

The day to day skills and thought processes required by a hospitalist are wholly different from an outpatient practitioner and not as thoroughly developed in FP program where the nature of the field dictates a major portion of training be devoted to outpatient/preventative care.

This is just not true. I've done a lot of research on FP program curricula, and I've found that he majority of training at FP programs (at least the unopposed ones) happens IN the hospital. If anything, there's not enough outpatient experience offered. At many programs, you have >9 months of your first year as inpatient, with one to two half-days/week on outpatient service. By third year, you are doing more specialty electives and FP outpatient at around 3-4 half days/week, but they still have hospital service even on specialty rotations.

 

[deleted87716]

This is just not true. I've done a lot of research on FP program curricula, and I've found that he majority of training at FP programs (at least the unopposed ones) happens IN the hospital.

Very true. When I finished residency, I was very comfortable working in the hospital, and would've had no problem taking care of hospitalized patients in practice, had I wanted to go that route.

 

[12R34Y]

I do think that hospitalist is the type of position that Med/Peds residency in definitley more geared toward. Of course family med CAN do it but if I were pre-residency and interested primarily in working as a hospitalist I would definitely look into Med/Peds. The day to day skills and thought processes required by a hospitalist are wholly different from an outpatient practitioner and not as thoroughly developed in FP program where the nature of the field dictates a major portion of training be devoted to outpatient/preventative care.

i couldn't agree more. when people think of hospitalists they think of IM or Peds.

Some programs may be very inpatient oriented, but many are not (my home program is very outpatient oriented). In reality most FP's work in a clinic ie outpatient setting primarily.

All of the FP groups in my region use hospitalitst for people they admit to the hospital (hospitalists typically refer to IM) as there is a fellowship or residency tract in hospital inpatient care available to them.

So if you plan on practicing FP in a urban, suburban system do not plan on being a hospitalist (hospitals are basically contracting with Hospitalists groups ie IM guys for that). Having someone there inhouse who only does inpatient medicine is better patient care.

ICU's are becoming "closed ICU's" meaning that only intensivists can write orders and take care of these patients b/c the studies are there to back up that closed ICU's have improved patient outcomes.

If you work rural or small sized city you may be able to see your inpatients and manage them as well as well as see all your clinic patients etc...take call blah blah. that's not a life most FP guys want now adays. You are busy enough with your busy office practice to be taking call on your inpatients, rounding on them, writing orders every morning, seeing them again after your clinic closes etc...

good luck,

later

 

[deleted87716]

(hospitalists typically refer to IM) as there is a fellowship or residency tract in hospital inpatient care available to them.

There are FP fellowships in critical care and hospital medicine, as well. See: http://www.aafp.org/fellowships/other.html

 

[sophiejane]

Having someone there inhouse who only does inpatient medicine is better patient care.

I would argue that an FP with strong inpatient training (and you can't say that your limited experience at your "home program" is the norm--there are many unopposed community hospital programs turning out FPs who provide excellent inpatient care) is the best person equipped to care for their patient, because they know them.

Hospitalists have their place, but they are in many respects just another piece of the fragmented puzzle that medicine has become. We are farming our patients out right and left. Patients are getting frustrated, and rightly so.

If you take care of patients on an outpatient basis that are getting admitted to the hospital more than once every few years, I think you need to be seeing them in the hospital. If you don't like hospital work, IMHO, don't take on sicker patients.

 

[deleted87716]

If you take care of patients on an outpatient basis that are getting admitted to the hospital more than once every few years, I think you need to be seeing them in the hospital. If you don't like hospital work, IMHO, don't take on sicker patients.

In many cases, the decision to go or not go to the hospital involves more variables than whether or not a doctor "likes it", although that's a pretty important part of the equation. Economics also play a huge role, particularly since hospitalized patients tend to be sicker, and most local standards of care pretty much mandate consultation of specialty services for certain conditions (e.g., neuro for strokes, GI for bleeds, cardiology for MIs, etc.), which often leaves the admitting physician doing things like repleting potassium and handling the discharge. For those who don't know, two physicians can't bill for the same service on the same day. As the admitting physician, you also have to field calls from the hospital during the course of your (usually very hectic) office day, and any emergency trips to the hospital (sometimes necessary) in the middle of the day throw a huge monkey wrench into the works. Then there's night call. Sure, it's possible to work out coverage arrangements with your partners to help minimize some of these things (having one person in the hospital all week, for example), but cross-coverage defeats the whole idea of taking care of your own patients in the first place.

Let's face it...it's a lot harder to be Marcus Welby in 2006 than it was in 1969. 😉 My hat's off to anyone who can manage to do it all while still retaining some semblance of a life outside of medicine; it's a tall order these days.

 

[dr_almondjoy_do]

i couldn't agree more. when people think of hospitalists they think of IM or Peds.

Some programs may be very inpatient oriented, but many are not (my home program is very outpatient oriented). In reality most FP's work in a clinic ie outpatient setting primarily.

All of the FP groups in my region use hospitalitst for people they admit to the hospital (hospitalists typically refer to IM) as there is a fellowship or residency tract in hospital inpatient care available to them.

So if you plan on practicing FP in a urban, suburban system do not plan on being a hospitalist (hospitals are basically contracting with Hospitalists groups ie IM guys for that). Having someone there inhouse who only does inpatient medicine is better patient care.

ICU's are becoming "closed ICU's" meaning that only intensivists can write orders and take care of these patients b/c the studies are there to back up that closed ICU's have improved patient outcomes.

If you work rural or small sized city you may be able to see your inpatients and manage them as well as well as see all your clinic patients etc...take call blah blah. that's not a life most FP guys want now adays. You are busy enough with your busy office practice to be taking call on your inpatients, rounding on them, writing orders every morning, seeing them again after your clinic closes etc...

good luck,

later

Whether you are an FP or into IM, if you become a hospitalist, then your job is only in the hospital. There is no office or outpatient work for a hospitalist.

And many Hospitalist groups do employ FP trained doctors that want to become hospitalists, so that is not an issue, and many hospitals that employ hospitalists, especially if its a hospital that has FP residents, will hire FP hospitalists. You do not have to be in a "small rural hospital where you are the CEO and admitting attending where your night call is Q1-2" to be an FP hospitalist.

As far as closed ICU's, I fully agree that wards with intensivists have better outcomes, but that restriction applies to all primary care specialties, not just FP hospitalists. It is extremely difficult even for a hospitalist in house to manage an ICU patient when they have a 20 patient load on the regular floors, including those on telemetry. Even they have to give their ICU patient up to the intensivist.

And people seem to forget how most IM docs work in the outpatient office setting, doing the same work as outpatient FPs. They have the same issues when their patients get hospitalized, and they gladly pass them onto hospitalist services too.

 

[sophiejane]

As the admitting physician, you also have to field calls from the hospital during the course of your (usually very hectic) office day, and any emergency trips to the hospital (sometimes necessary) in the middle of the day throw a huge monkey wrench into the works. Then there's night call. Sure, it's possible to work out coverage arrangements with your partners to help minimize some of these things (having one person in the hospital all week, for example), but cross-coverage defeats the whole idea of taking care of your own patients in the first place.

You make some good points, ones I hadn't really considered. I just imagined going to hospital before clinic, making rounds, then rounding again after clinic before going home...but it's true that you would be getting calls all day (and now that I remember my rural FP clerkship, he did get a lot of hospital calls all day...) and have to deal with stuff in the middle of the night too.

Something to think about!

 

[lateness]

This is just not true. I've done a lot of research on FP program curricula, and I've found that he majority of training at FP programs (at least the unopposed ones) happens IN the hospital. If anything, there's not enough outpatient experience offered. At many programs, you have >9 months of your first year as inpatient, with one to two half-days/week on outpatient service. By third year, you are doing more specialty electives and FP outpatient at around 3-4 half days/week, but they still have hospital service even on specialty rotations.

thats true, sophie. i had some people (when i intved)tell me that they were concerned, about the level of outpatient exposure, and were worried there wasnt enough, comparing programs etc etc.. not the opposite.

 

[lateness]

Whether you are an FP or into IM, if you become a hospitalist, then your job is only in the hospital. There is no office or outpatient work for a hospitalist.

And many Hospitalist groups do employ FP trained doctors that want to become hospitalists, so that is not an issue, and many hospitals that employ hospitalists, especially if its a hospital that has FP residents, will hire FP hospitalists. You do not have to be in a "small rural hospital where you are the CEO and admitting attending where your night call is Q1-2" to be an FP hospitalist.

As far as closed ICU's, I fully agree that wards with intensivists have better outcomes, but that restriction applies to all primary care specialties, not just FP hospitalists. It is extremely difficult even for a hospitalist in house to manage an ICU patient when they have a 20 patient load on the regular floors, including those on telemetry. Even they have to give their ICU patient up to the intensivist.

And people seem to forget how most IM docs work in the outpatient office setting, doing the same work as outpatient FPs. They have the same issues when their patients get hospitalized, and they gladly pass them onto hospitalist services too.

i have a q?
so let me get this straight, an hospitalist doesnt nec have ICU privaleges?

 

[deleted87716]

so let me get this straight, an hospitalist doesnt nec have ICU privaleges?

As has been mentioned, it depends on the hospital.

 

[McDoctor]

I would argue that an FP with strong inpatient training (and you can't say that your limited experience at your "home program" is the norm--there are many unopposed community hospital programs turning out FPs who provide excellent inpatient care) is the best person equipped to care for their patient, because they know them.

Hospitalists have their place, but they are in many respects just another piece of the fragmented puzzle that medicine has become. We are farming our patients out right and left. Patients are getting frustrated, and rightly so.

If you take care of patients on an outpatient basis that are getting admitted to the hospital more than once every few years, I think you need to be seeing them in the hospital. If you don't like hospital work, IMHO, don't take on sicker patients.

I more or less agree with this, but the original post raises the question as to whether or not family medicine training is a viable route to becoming a hospitalist. (Which, of course, I believe it is, just not the best route in my opinion).
I guess alot depends on how sure the OP is in his/her desire to work as a hospitalist. Family medicine certainly keeps alot of options open from a standpoint of moving on to a more varied practice setting once the grind of continuous inpatient care begins to eat away at the soul.

 

[sophiejane]

Family medicine certainly keeps alot of options open from a standpoint of moving on to a more varied practice setting once the grind of continuous inpatient care begins to eat away at the soul.

🙂 I am learning that there is a lot of truth to this.

(I also think fluorescent lights are to blame for a large part of the soul-snatching. Seriously. They are evil and they make people depressed and crazy).

 

[dr.smurf]

i feel like i need to help distinguish something here. not all hospitalists are employed by the hospital or a group. some family physicians or any PCP for that matter actually do all the hospital medicine for his/her group. these physicians often have their office hours in the afternoon after they have rounded that morning. i know of some PCP's who have an office and are private hospitalists for certain physicians who have given up rounding for whatever reason.

essentially this is what happens. dr. x's pt goes to the ER w/ chest pain and is admitted to r/o MI. dr. x is paged and notified and tells the er doc thank you for notifying me but dr. z does my inpt care. dr. z therefore gets the call and the pt is admitted. both dr. x and z are aware the pt is in. dr. z assumes the hospital care and touches base with dr. x. when the pt is discharged dr. x follows up. dr. z does all the hospital billing. dr. z is not necessarily a hospital staffed doc, but has priviledges which allow him to admit who he wants. this is common practice where i am in the midwest. now there are hospitalist groups and hospitalists paid by the hospital, but also private practice hospitalists.

thus, you can see there is a broad range or routes to go. hope this helped. i just felt like from the above posts that some thought a hospitalist meant a hospital employed doc only and thats not the case.