hospitalist questions

[suckerfree]

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This is a question about hospitalist scheduling and lifestyle:

Is it possible that after 3 years of IM residency, I could be a hospitalist working 1 week on, 1 week off, pulling $120,000?

During that week off, would it be possible to do just morning clinic?

Just how flexible is scheduling if you decide to be a hospitalist?

Is there much demand in major cities for people interested in doing this type of shift work hospitlist practice?

 

[deleted87716]

Is it possible that after 3 years of IM residency, I could be a hospitalist working 1 week on, 1 week off, pulling $120,000?

During that week off, would it be possible to do just morning clinic?

We have some folks in our group who are "hybrid" hospitalists with outpatient practices. Their schedule is similar to what you've outlined. Most of them do considerably better than $120K/year.

 

[suckerfree]

what are their schedules like? What city is this?

Thanks for the response!

 

[deleted87716]

what are their schedules like? What city is this?

Thanks for the response!

I don't know their exact schedules, but the hybrids have some kind of weekly rotation. We're in Eastern Virginia.

 

[suckerfree]

considering the shift work nature of the field, why isn't there more interest in this?

What are some common drawbacks of being a hospitalist?

 

[deleted87716]

What are some common drawbacks of being a hospitalist?

You mean, aside from having to work in a hospital? 😉

 

[hurdle2kross]

It is tough to be hospitalist. U can make upto 150K easily working in small city or big city suburb. you have to be ready for very hard work to really enjoy it. sometimes u do enjoy it.

 

[suckerfree]

why is the work of a hospitlist any harder than a general internal medicine doc? Why is it harder than what what people do during internal residency? If you're an expert and are good at it, and well trained, then why should it necessarily be harder than anything else? Working 12 hours doesn't seem so bad when I know what I'm doing. I think I'd rather enjoy it. Could it possibly be any harder than surgery or OB/GYN? I don't see any qualitative difference between it and many other fields. If you have a IM specialty clinic in a hospital, you work from say, 8am until 5 pm, meaning you're out the door by 7 and are home by 6pm, at least 5 days a week for approx 47 - 48 weeks out of the year. As a hospitalist, you're shift can be 12 hours long, 7 days on, 7 off. I don't see any problem with that. Sounds like fun if you like Internal Medicine...I'm just trying to understand this here. Everyone is a legitimate patient because they are sick enough to be admitted. Sounds good to me...

 

[hurdle2kross]

I don't mean to discourage you but here are some answers, do it if u like it.
why is the work of a hospitlist any harder than a general internal medicine doc?
Because u deal with more acute pts, its a big responsibilty (compare to the residency), discharging pt is a problem sometime especially if they don't have a primary physician to follow with as an out pt. Pt turn over is high (which is good for the hospital) therefore if u don't d/c pt u r in truble, numbers can go upto 30s. Hospitalist usually deal with the sickest, non compliant pts who usually don't have a primary physician. U also deal with social issues a lot.

Why is it harder than what what people do during internal residency? If you're an expert and are good at it, and well trained, then why should it necessarily be harder than anything else? Working 12 hours doesn't seem so bad when I know what I'm doing. I think I'd rather enjoy it.
It is harder than residency , believe me.

Could it possibly be any harder than surgery or OB/GYN?
U will find urself working day and night while they are sleeping at night or sitting in their office during the day and in OR when they don't have clinics.

I don't see any qualitative difference between it and many other fields. If you have a IM specialty clinic in a hospital, you work from say, 8am until 5 pm, meaning you're out the door by 7 and are home by 6pm, at least 5 days a week for approx 47 - 48 weeks out of the year. As a hospitalist, you're shift can be 12 hours long, 7 days on, 7 off. I don't see any problem with that. Sounds like fun if you like Internal Medicine...I'm just trying to understand this here. Everyone is a legitimate patient because they are sick enough to be admitted. Sounds good to me...
There are many social admissions and DUMPS from surgery/psych/ortho etc

But again its a lot of fun too, you learn many new things, but doing it for long periods of time, I don't recommend.
hope this will help, ask other hospitalists too.

 

[Mumpu]

Suckerfree, the reason there is not more interest in hybrids is because most people who choose a career in hospital medicine do it specifically because they would rather start fights in biker bars with broken bottles or try to understand teh inteRn3tz l1ng0 typed by Hurdle than see a single primary care clinic patient. The average hospitalist income nationwide was 180k last year, more in private practice and if you chose to work nights and weekends. Obviously, do not expect huge schedule flexibility as a junior-most member of the practice.

 

[suckerfree]

I think hospitalist med sounds like a great profession. I'm specifically most interested in the disease entities in adult internal med, (not as interested by psych, by ob/gyn, surg, etc.). Also, the shift work angle sounds excellent with 1 week on (really busy 1 week which is exciting), and 1 week off, with a good salary. As an M3, I've carried 4 patients no problem. If I were much faster as an advanced clinician with no med students or interns/residents slowing me down, carrying 20 doesn't seem like it'd be as much of an issue. I think this sounds great. I enjoyed my internal medicine rotation just fine. As for getting "dumped on", that's just a pertinent (-); every field has pertinent (-)'s. In ER, you're a primary care doc for the indigent population. whoopity doo. Every field has some pluses and minuses. I really fail to see why so many people would be interested in ER, but so few people in comparison are interested in hospitalist medicine.

 

[signomi]

double post

 

[signomi]

In the hospitals here the hospitalists are rounding on anywhere between 25-50 (yes, fifty) patients per doctor. The 50 comes up on weekends when they are down a doc. I saw these numbers at 3 different hospitals.

It can be nice at places that have caps, but remember that not all places have caps. The hospitalist last night admitted 29 patients and he has to keep them all!

 

[suckerfree]

50 patients would suck.

I finished neonatology and heard that NICU pt. loads can get that high for an attending, and thought...that is rediculous. At this school, our IM teams cap at 20 pts.

 

[JoBlo]

50 patients would suck.

10 mins per patient and it would still take 8 hours to round.... 🙁

 

[suckerfree]

You know what though...if you really like what you're doing, and you're good at it, I still don't see that it is a problem. The majority of places will have patient caps, but if you're working 12 - 15 hours straight every day for 1 week, and you have an aggressive personality, then I still think it can be fun. This just sounds to me like internal medicine on steroids. I think it sounds pretty cool. Besides, out of 25 pt's, not all of them are going to be emergencies. When I was on my last clerkship month, the last group of patients I was simultaneously carrying had 1) primary sclerosing cholangitis, 2) advanced Crohn's disease, 3) osteomyelitis, 4) Sickle cell crisis. I'm just a scrawney 3rd year med student but doing 5 - 6 times that amount doesn't seem like it'd be so bad if I were not slowed down by anyone else and I knew medicine already. During my week off, I'd chill/relax, eat out, chillax some more, read a few hours every day, and then continue to chillax. This sounds great!

 

[brc12]

Work load for a hospitalist will vary tremendously from program to program, and is definitely something to consider when weighing various job opportunities. My previous position I usually saw about 18 patients daily and did 2 admissions. My current job has much more stringent caps - maximum of 12 patient encounters per day, with 0 admissions when on rounding teams. The # of encounters can go as high as 20, but thats only when I'd have a resident team. If you look at the survey data from the society of hospital medicine, the average # of encounters for a hospitalist is about 12.5 or so per day. Any program that is asking you to see 25-30+ a day is a significant outlier, and will have major problems with recruitment and retention and should be avoided.

 

[ThinkingIM]

Work load for a hospitalist will vary tremendously from program to program, and is definitely something to consider when weighing various job opportunities. My previous position I usually saw about 18 patients daily and did 2 admissions. My current job has much more stringent caps - maximum of 12 patient encounters per day, with 0 admissions when on rounding teams. The # of encounters can go as high as 20, but thats only when I'd have a resident team. If you look at the survey data from the society of hospital medicine, the average # of encounters for a hospitalist is about 12.5 or so per day. Any program that is asking you to see 25-30+ a day is a significant outlier, and will have major problems with recruitment and retention and should be avoided.

brc12,

With that kind of a workload how do you feel day-to-day and week-to-week? Is that a good mix of a demanding job but still enough time for yourself? Also, are you on a block schedule? If so what has your impression of the block scheduling life been so far?

Thanks.

 

[brc12]

Well, I've only been at my new position for 1 month, but it's definitely much more sustainable in terms of balancing work/life. I am usually in the hospital from 730 until about 5 or so. Having to see only 12 patients (and often, its been about 10 or so) leaves me plenty of time to see patients again, meet with families, take care of paperwork etc. When I was seeing 20+ a day and doing admissions, you really had to work as fast as possible to be able to get done by a reasonable time, and it was definitely pretty stressful by the end of the week since I'd be pretty exhausted. I'm not sure what you mean by demanding - the work itself is basically the same whether you see 10 or 20 patients in a day. Myself I prefer to go at a more relaxed pace and spend time with individual patients. Schedules for hospitalists can vary quite a bit. Currently I do a week on/week off, with usually 1 or 2 day, evening, or night admitting shifts on my week off. Work about 18 days a month total. I really do love having the extra time off. The only problem with the block schedules is if your friends/sig other have the typical M-F schedule your days off don't always mesh well.

 

[suckerfree]

Many people have said that all you do as the hospitalist is tweak BP and antiasthmatic meds. Personally, I think this is the dumbest thing I've ever heard. Also, people have told me that the hospitalist gets the "uninteresting" cases and the good cases go to the attending teams. I don't know what an "uninteresting" internal medicine case would be if the patient was deemed to be genuinely sick enough to require hospital admission. I think this fuirther confirms my theory that people want to drink too much hatorade and just think that what they do is best.

 

[lateness]

This is a question about hospitalist scheduling and lifestyle:

Is it possible that after 3 years of IM residency, I could be a hospitalist working 1 week on, 1 week off, pulling $120,000?

During that week off, would it be possible to do just morning clinic?

Just how flexible is scheduling if you decide to be a hospitalist?

Is there much demand in major cities for people interested in doing this type of shift work hospitlist practice?

sure,. i met a hospitalist who was doing way more than that, 😎

 

[babyruth]

You can look into this more by checking out the Society of Hospital Medicine website. Just google it and it should come up. They also have their own journal called The Hospitalist. There is also another hospitalist journal out there as well but I forget the name.

This is a very feasible profession and is dependent on the area. Hospitalist medicine, if you look at the stats, has really taken off over the last few years. They even have docs that only do nocturnal hospital work, for the night owls, and make really good money.

You need to find a good group of doctors that are willing to work as a team and take up for each other. The group I rotated with had docs that would work part-time shifts as well because they had kids or were teaching, etc. These docs usually had a census less than 20 patients/doc and would even have intenral medicine residents, family practice residents, and PAs helping out.

I really want to do hospitalist medicine too and have looked through some of the research for it. You should also do this too if you really like it. I think the SHM even breaks the statistics down by state and will show individual practice profiles of different practices. Good luck!