Hospitalist Thread

[naseeha]

Fresh grad who started last year. Anyone in the same boat? It's definitely different being alone.

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[ortholegoo]

Different as in better or worse? Starting IM residency this year and planning on going hospitalist route. You wish you did fellowship or happy so far?

 

[naseeha]

it's better and worse at the same time. better since now we're making more money and schedule is good. Worse since now I'm alone and second guess my self with the decisions I make and have doubts, but this is more due to lack of experience. A lot of my time is spent on social and family issues so I'm consulting because sometimes I just don't have the time to sit down and think about the medical decisions. I'm hoping this will get better as well with experience. The job can also get mentally draining on the 6th and 7th day.

I'm happy with where I am and what I'm doing. I probably wouldn't do a fellowing even if I was given the opportunity to pick any specialty.

 

[IMreshopeful]

it's better and worse at the same time. better since now we're making more money and schedule is good. Worse since now I'm alone and second guess my self with the decisions I make and have doubts, but this is more due to lack of experience. A lot of my time is spent on social and family issues so I'm consulting because sometimes I just don't have the time to sit down and think about the medical decisions. I'm hoping this will get better as well with experience. The job can also get mentally draining on the 6th and 7th day.

I'm happy with where I am and what I'm doing. I probably wouldn't do a fellowing even if I was given the opportunity to pick any specialty.

This is exactly why I didn’t want to be a hospitalist and why I did a fellowship. I hate not being able to utilize my medical knowledge and consulting out of stress or fatigue. Sounds like your practice environment is kinda tough though.

 

[naseeha]

My hospital is pretty good. We're a large group, see average 15 to 16 patients a day with only 1-2 admits a day and can leave by like 4 if your work is done.

 

[Trogghunter]

Fresh grad who started last year. Anyone in the same boat? It's definitely different being alone.

I love it. I think my training was robust and we have a good bit of backup as far as consultants go where I work, but definitely not like where I trained. No Endo/derm/etc. The first 4 months were tough but now I got into a rhythm, got on some committees, enjoying those weeks off.

I've learned to step back more and allow those social/non medical problems to either reveal themselves entirely or sort themselves out. Not much point running in circles for things you can't fix.

 

[Funke]

I love it. I think my training was robust and we have a good bit of backup as far as consultants go where I work, but definitely not like where I trained. No Endo/derm/etc. The first 4 months were tough but now I got into a rhythm, got on some committees, enjoying those weeks off.

I've learned to step back more and allow those social/non medical problems to either reveal themselves entirely or sort themselves out. Not much point running in circles for things you can't fix.

What was your job search like out of residency? Were you able to pretty easily find hours/pt load/salary/vacation that you wanted?

 

[naseeha]

I've learned to step back more and allow those social/non medical problems to either reveal themselves entirely or sort themselves out. Not much point running in circles for things you can't fix.

This is what I have to work on. I probably do too much to try to get my patients out.

 

[Trogghunter]

What was your job search like out of residency? Were you able to pretty easily find hours/pt load/salary/vacation that you wanted?

I found the geographic area that I liked, found the hospitals in the area that suited what I was looking for, and I emailed the recruitment chairs at the hospitals. Only 1 hospital was not hiring hospitalists for days, but they're in a prime location. The hospital recruiters were transparent with their schedule and benefits even before the interview, I never asked. I did not go through 3rd party recruiters/spammers. Regarding schedule/salary/patient load... I don't get vacations because I work 7on/7 off and after night shifts (3 weeks a year) I get about 10 days off for a total of ~180 shifts a year. Most places can/will negotiate what your schedule will be if you do not want to do strictly 7/7. I negotiated some terms in my salary and got it easily. Whatever patient load you're told, add 10-20% to that in the winter months, but consider that your census will vary depending on your efficiency and that also means that you wont actually be there until whenever shift ends, usually an hour or 2 earlier, and maybe even earlier on weekends.

 

[siliso]

This is what I have to work on. I probably do too much to try to get my patients out.

Agree with this. I have come to understand my comparative value is in treating medical problems and that I have no special powers or expertise in solving nonmedical problems - the social workers do and I lean on them and show them my undying gratitude. And until they can fix it I just keep writing the Patient Stable Waiting Placement note day by day.

 

[FutureInternist]

Another thing to check for is how overnight pts are distributed to the rounding teams.

A lot of locums I talked to say that places they have worked have a “top up” model i.e everyone gets topped up to the (relativey) same census, which sucks for efficient docs since if you DC 6 pts on Mon, you’re getting 6 new ones on Tues.
Additionally, this makes some docs hold on to pts until their last day and then do mass DC’s.

My job has an “equal distribution” model, which means everyone, regardless of census, gets the same number of overnight pts. This helps the efficient ones, since if you DC a bunch of pts on any given day, the rest of your rounding cycle will be much easier, and the slower ones keep shooting themselves in the foot by not DC’ing their pts.

 

[naseeha]

I was wondering if we can take this thread in another direction. I was hoping we can post some pearls in patient management about the common problems we face.

 

[Siggy]

Another thing to check for is how overnight pts are distributed to the rounding teams.

A lot of locums I talked to say that places they have worked have a “top up” model i.e everyone gets topped up to the (relativey) same census, which sucks for efficient docs since if you DC 6 pts on Mon, you’re getting 6 new ones on Tues.
Additionally, this makes some docs hold on to pts until their last day and then do mass DC’s.

My job has an “equal distribution” model, which means everyone, regardless of census, gets the same number of overnight pts. This helps the efficient ones, since if you DC a bunch of pts on any given day, the rest of your rounding cycle will be much easier, and the slower ones keep shooting themselves in the foot by not DC’ing their pts.

Is there some sort of relief mechanism where doctors with patients who are undischargable for some reason (inability to get outpatient set up due to lack of insurance, as an example) aren't overloaded?

How does signout occur? It would suck to be the efficient doc who gets a 30 patient dump from the inefficient doc who couldn't find the discharge button with 2 hands, a map, and GPS.

 

[FutureInternist]

Is there some sort of relief mechanism where doctors with patients who are undischargable for some reason (inability to get outpatient set up due to lack of insurance, as an example) aren't overloaded?

How does signout occur? It would suck to be the efficient doc who gets a 30 patient dump from the inefficient doc who couldn't find the discharge button with 2 hands, a map, and GPS.

Well there is an unofficial cap of 19, but when its the same docs always hovering around that number its a “its you, not me” situation .

Signout is basically an interim summary, so like notes, it ranges from a neatly gift wrapped pt to one where 5 toddlers all went for the same box.

We get 12 pts on our first day of rounding so previous doc’s census affects us only in that then there are more pts to redistribute to other teams.

So if someone has 16 on their list, I will get 12 while the other 4 go to either other “first dayers” or people who are in the middle of their rounding cycle.

The nurses who distribute pts know who the bad eggs are and will actively spread their pts to different teams to avoid having 3 pts from Dr Smith go to Dr Jones which could cause Dr Jones to jump off the roof.

 

[Chux]

Hey guys...I'm finishing IM residency in June 2019. A foreign medical grad, matched to a NY programme from home country (so, have not lived anywhere else). Moved with wife and 3 kids ages 2, 4, 6.

I'm kinda lost on choosing where to settle after residency. Definitely not in NY. Visa not an issue. No close relatives in the US.

Searching for nice cities with good public schools and good hospitalist salary!

Your suggestions will be highly appreciated

 

[Chux]

DFW keep coming up in my search due to good schools and weather. But a colleague mentioned that hospitalist job is saturated in Dallas/Houston so they make way less compared to other cities in the midwest