Hospitalist to outpatient?

[chicandtoughness]

I’m a little med student in preclerkship so bear with me! I was wondering if it is feasible or difficult to go from a hospitalist career to solely seeing outpatient patients?

Ideally, I’d like to work purely inpatient for the first bit of my career, and then later in life transition to solely outpatient clinic work, perhaps in a more rural town.

Are generalists able to make this switch easily? Or is this more common with specialists?

If it matters, I’m interested in IM specifically and not FM.

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[sloh]

You might be singing a different tune once you actually do clinic in residency. Especially IM clinic. Complex patients and reimbursement isn’t commensurate with time/effort spent.

 

[VA Hopeful Dr]

I’m a little med student in preclerkship so bear with me! I was wondering if it is feasible or difficult to go from a hospitalist career to solely seeing outpatient patients?

Ideally, I’d like to work purely inpatient for the first bit of my career, and then later in life transition to solely outpatient clinic work, perhaps in a more rural town.

Are generalists able to make this switch easily? Or is this more common with specialists?

If it matters, I’m interested in IM specifically and not FM.

My wife did it. She did 3 years of hospital work right out of residency then went to outpatient.

Its doable but its a bit of a culture shock and will require some study to get up to date on everything.

 

[ShuperNewbie]

I’m a little med student in preclerkship so bear with me! I was wondering if it is feasible or difficult to go from a hospitalist career to solely seeing outpatient patients?

Ideally, I’d like to work purely inpatient for the first bit of my career, and then later in life transition to solely outpatient clinic work, perhaps in a more rural town.

Are generalists able to make this switch easily? Or is this more common with specialists?

If it matters, I’m interested in IM specifically and not FM.

No this isn't difficult. It's incredibly common and is one of the most common pathways for IM trained folks (esp if they spend a few years as a hospitalist and then do fellowship in a primarily outpatient specialty like rheum, endo, or heme/onc).

Finding a job as an outpatient clinician (like as a PCP) won't be difficult with IM training, especially given how in demand PCPs are. But as Sloh mentioned, outpatient carries its own challenges and requires a totally different skillset from inpatient medicine. Take that with a grain of salt. I also see migration in the opposite direction happening a lot (i.e. a lot of PCPs and FM docs transitioning to inpatient medicine for the shiftwork lifestyle benefits).

 

[Angler]

I think inpatient -> outpatient would be much easier than outpatient -> inpatient.

I did both in the pre-hospitalist days. It was challenging but mainly due to time management. After ten years of strict outpatient work, I had no idea how to manage an inpatient. I wouldn't even know how to write orders (my last inpatient order was written on NCR paper). Something like ADM Vandalism. What to give a patient with a STEMI? I taught IM residents ambulatory medicine and I made them teach me such things in return.

In outpatient medicine, you will get an old lady coming in with very vague dizziness that happens only every other Tuesday. Or an angry man with insomnia who does nothing but watch the news on CNN. But this is as much art as science...

 

[dgdg]

Yes, it's generally easy to do. As said, there will be an adjustment. Some things will easily carry over from your inpatient skills. Other things like prevention, general (non acute) symptoms, social interaction expectations will be different. One key item is how you will track important tests and referrals.

 

[Balo]

I’m a little med student in preclerkship so bear with me! I was wondering if it is feasible or difficult to go from a hospitalist career to solely seeing outpatient patients?

Ideally, I’d like to work purely inpatient for the first bit of my career, and then later in life transition to solely outpatient clinic work, perhaps in a more rural town.

Are generalists able to make this switch easily? Or is this more common with specialists?

If it matters, I’m interested in IM specifically and not FM.

This is literally what I've seen some of my attendings do once they get burned out in the hospital or they decide having an 8-5 schedule that is on track with family life is more desirable. So yes, it is common. I've also seen the reverse of transitioning from out-patient to in-patient only less frequently. As a resident you would have exposure to both clinic and in-patient so you should be able to make the switch with only a bit of difficulty, kind of like re-remembering how to ride a bike.

 

[johnwalldance]

Hospitalist now but also work in an 'acute' based clinic - clinic where I see a lot of hospital follow ups or mildly acutely ill patients (see mildly exacerbated heart failure, COPD or mild AKI, sick visits)

Agree with the above. Will say especially if it's only 3 or so years out of residency training that you switch from inpatient to outpatient probably vary feasible.

 

[Señor S]

It can be done. Anecdotally most of the hospitalists I've seen who get burnt out on it go into fellowships, rather than primary care. And the reverse (PCP-->hospitalist) does happen.

Agree that if you want to transition to outpatient after >3 years or so (arbitrary number) it might require a ramping-up period to get yourself up to date with the latest standards.

Also academic jobs are sometimes still willing to accomodate split appointments (working both inpatient and outpatient); that's probably the route I would take initially if I was wanting to do both.

 

[gutonc]

It can be done. Anecdotally most of the hospitalists I've seen who get burnt out on it go into fellowships, rather than primary care. And the reverse (PCP-->hospitalist) does happen.

Agree that if you want to transition to outpatient after >3 years or so (arbitrary number) it might require a ramping-up period to get yourself up to date with the latest standards.

Also academic jobs are sometimes still willing to accomodate split appointments (working both inpatient and outpatient); that's probably the route I would take initially if I was wanting to do both.

Rural as well.