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Hospitalist vs Anes

Discussion in 'Anesthesiology' started by anbuitachi, Feb 22, 2018.

  1. anbuitachi

    anbuitachi ASA Member
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    Just curious and since I m bored. Over the last decade hospitalist jobs have been popping up a lot for fields like IM and neurology . They work 7 on 7 off 12 hrs day. And get next week off and somehow command 300k+ salaries for doing so. Anyone know how that works? Work less in hours but get paid more? How are hospitals affording this? And I thought hospitals make more money from ORs but anesthesiology work almost 12 hr a day 5 per week every week without weeks off and command about the same salary. How are hospitals affording this hospitalist model and why would they do so?
     
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  3. dr doze

    dr doze To be able to forget means to sanity
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    It is basically a 40 hour work week. 84 hours over 14 days or 42 hours per week. But it is not M-F 7-3 which is the catch. So half the hours are nights with a good amount of weekend time and working half the holidays. Lots of time off, but your weeks on just s#ck. Throw in some commute time and you basically won't see much of your family half the time.
     
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  4. Lonestar

    Lonestar Senior Member
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    They are paying our hospitalists 220k for these 7 on 7 off gigs at our hospital. I understand that we are paying lower wages but I dont think it is anywhere near 300k for most places.
     
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  5. spacegun

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    I saw these on the neurology forum:

    Neurology compensation

    Job Market for Neurophysiology and Fellowship help!!!!
     
  6. anbuitachi

    anbuitachi ASA Member
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    They are in that range in the major cities like NYC but that's expected since it's true for all specialties in those cities.

    And while they are technically working full time x2 hours if they worked a regular inpatient internists job I doubt they'd only work 40 hrs a week. I'm sure it'd be more than that. I'm just surprised hospitals are doing this since to me it seems like hospitals are getting a worse deal and usually hospitals are out to screw docs over
     
  7. IlDestriero

    IlDestriero Ether Man
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    If I worked 12 hour days, I’d expect $600+


    --
    Il Destriero
     
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  8. GravelRider

    GravelRider SDN Lifetime Donor
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    Hospitalists help with bed turnover and maintaining throughput. The alternative is the primary care doc who wanders in late morning or even afternoon to round and discharge a patient that could have been discharged 12 hours prior. Some hospitalist groups automatically cover ortho patients with any comorbidity (think ASA 2 and up), which keeps the orthopods in the OR. A lot of hospitalists really geek out about quality measures and help the hospital improve those things for reimbursement. It's not necessarily an expense for the hospital if the hospitalist group helps improve efficiency.

    The high salaries are to attract people to a job that is known for burnout and high turnover. I've been offered $2,000 for per diem 8 hour shifts, so there is definitely decent money in it. It is true that the 7on/7off structure does average out to a 40 hour work week over the month (actually more when you take signout into consideration). The "week on" can be really terrible and you spend 2-3 days just recovering on your "week off." I have a couple friends who found hospitalist jobs where they can be at home during their shift once they are done rounding/admitting. That's ideal, but not common. Most hospitalists I know plan to cut back clinical time and do something else. That's the advantage of those types of jobs.

    If I were to advise internal medicine residents who did not want to pursue a fellowship, I would tell them to look more closely at primary care over the hospitalist route. Primary care is more sustainable as a career and you can find similar income in the 275-300k range. I know a primary care doc making over 500k and he doesn't work particularly hard.
     
  9. spacegun

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    I know a PCP making ~$350k and not working all that hard either (about 4 days/week) and living in a very nice area on the West coast. He's new too, maybe he can make more in a couple of years.

    But outpatient medicine is very boring to me. Anesthesia, crit care are much more exciting!
     
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  10. AdmiralChz

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    Yeah... remember all that terrible stuff you had to do as an intern in medicine or surgery, namely dispo meeting with SW/CM for difficult-to-discharge cantankerous patients? Pre-rounding and making sure pt/ot orders and recs are in? Answering pages about diet orders and electrolyte replacement at all times of night?

    Ugh, so not for me even with huge incentives I’d burn out quite fast. Kudos to those who can do the work, but I’ll stick to my day job.
     
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  11. caligas

    caligas ASA Member
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    There are jobs In anesthesia that are full time pay for one week on and one week off. I’ve seen them in Columbia SC and one in a small NC town.
     
  12. Beach bum

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    One thing for sure when you look at what your colleagues in other specialties are making pay for anesthesia definitely sucks these days!!
     
  13. ERRES2288

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    I wouldn’t be a hospitalist even if anesthesiology paid the exact same. My guess is despite the numbers thrown around here, the median hospitalist makes in the low 200s which is rather far off from typical anesthesiology pay.
     
  14. spacegun

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    Both MGMA 2016 and AMGA 2016 have median anesthesiology at $416k and median hospitalist at $275k.
     
  15. Mman

    Mman Senior Member
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    we still do just fine by almost any measure out there.
     
  16. SpartanWolverine

    SpartanWolverine Rads PGY-1
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    The IM hospitalists working 7 on 7 off at my community hospital start at $160-170. Up the road at the University hospital they make around $180. Going a state over you to a somewhat more rural area you can start in the low $200s... but I certainly haven't heard of any new grad hospitalists around here getting near $300 unless they're doing a boatload of nights.
     
  17. nycitygas

    nycitygas ASA Member
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    If you are working 5x12 hour weeks, you need to find a new job.
     
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  18. spacegun

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    Here is an example of a hospitalist job in a TX city someone posted on the IM forum just today, $250k base + productivity that could almost reach $300k:

    First hospitalist contract: Stressed over nothing?
     
  19. Mman

    Mman Senior Member
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    I guess that's nice. I can find you plenty of anesthesia jobs paying >$400K. I can find you some paying >$500K. If you know the right people you might find way more than that.
     
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  20. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay
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    At one of the hospitals I rotated through as an intern, the hospitalists were making $225K for 7 on 7 off. Some would go 14 on 7 off every other month or so to bump up another 25-50K. Although they had a full resident team, they would also cover patients on their own once the resident service capped. They had long busy weeks for sure. This was in a very desirable SoCal location.
     
  21. OutRun

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    That seems really low unless you’re in a super saturated urban metro area. One of my good friends just started a gig fresh out of IM residency in a metro PNW city for $250K base for 7 on / 7 off at 21 on weeks per year. $160K-$170K is academia starting money and any hospitalist who accepts these rates in private practice is shortchanging themselves.
     
  22. SpartanWolverine

    SpartanWolverine Rads PGY-1
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    Certainly agree! It's a very saturated, desirable area. I've heard the same numbers independently from senior IM residents looking for jobs as well as current attendings/administrators, so it's certainly a true, albeit lowball, offer.
     
  23. anbuitachi

    anbuitachi ASA Member
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    Pretty rare for new grads. at least i haven't heard of any grads here making that much . Some in the 300s, some start in 200s, but no 400k+ as far as I know. But even in areas not desirable it seems like salary for us doens't go up that much. Maybe 50-100k more if lucky, well hospitalist job salaries can go up very significantly in rural areas. Must be because we have CRNAs
     
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  24. FFP

    FFP Grunt, cog, body, pompous ass
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    It's probably because of that. While rural hospitals may have IM APPs, too, those are not really competent to treat anything beyond the usual bread and butter stuff, so they always need a doc, and there is no incentive for the hospital not to hire one.

    In anesthesia, there is a huge financial Medicare incentive for rural hospitals, to hire CRNAs (versus docs).
     
    #23 FFP, Feb 23, 2018
    Last edited: Feb 23, 2018
  25. Mman

    Mman Senior Member
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    you can get over $400K supervising CRNAs in small hospitals, even as a new grad, just won't be in a nice area
     
  26. caligas

    caligas ASA Member
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    I’ve had two attending jobs in 12 years, made >$400k first year in both. (Both 1 year partnerships with immediate financial parity)
     
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  27. anbuitachi

    anbuitachi ASA Member
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    Yea it's 12 years later :)
     
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  28. FFP

    FFP Grunt, cog, body, pompous ass
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    Which is exactly the right and fair way for a partnership track, so rare nowadays. I still have to hear about one in my neck of woods, in the last 5 years.

    @caligas, are you cardiac, pain or peds by any chance?
     
  29. caligas

    caligas ASA Member
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    No fellowship.

    Both jobs were generalist with some cardiac (20% ish).

    Both in nice places but probably 2nd (or 3rd) tier in terms of general desirability.
     
  30. FFP

    FFP Grunt, cog, body, pompous ass
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    That explains it. Cardiac, off the beaten path. Wouldn't expect anything less, even nowadays.
     
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  31. caligas

    caligas ASA Member
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    valid point about 12 years

    Current job is unchanged but original job has sold to AMC AND gone from MD only to supervision model.
     
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  32. Psai

    Psai Snitches get zero vicryl
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    PM me in a few years thanks
     
  33. anbuitachi

    anbuitachi ASA Member
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    i feel like id rather do my own cases and get paid a bit less.. it's stressful supervising CRNAs especially if they aren't good
     
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  34. Mman

    Mman Senior Member
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    nothing wrong with that feeling, just wondering how much less is "a bit".
     
  35. POW16

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    What is your neck of the woods,FFP?
     
  36. Pharmado

    Pharmado PharmaDo
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    I interviewed at more than one place where the jobs were >400k for a new grad doing own cases. They were in small towns, but that was what I wanted so it worked for me.
     
  37. Psai

    Psai Snitches get zero vicryl
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    What's your number thanks
     
  38. DoubleBogey

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    Hospitalist averages are 250k - some with 300k potential/bonus, some are “round and go” so as if 7-3p with home call (tough to beat that). anesthesia beats this by a mile in my opinion though, bigger salary potential with side gigs that can be very lucrative with pain management focus.

    First year out of residency and I’m on track for 300k, but working inpt/outpt (same days) and nursing homes to pull those RVUs in.

    Either way, if you’re focused on money - and business minded - you will do well in whatever field you go in to IF you enjoy it - otherwise, if you hate it, doesn’t matter if you’re making 500k...it still sucks
     
  39. anbuitachi

    anbuitachi ASA Member
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    Well pain management is a different story. Potential is of course much higher in pain than anesthesia but Pain is a fellowship and it's competitive. W anesthesia, majority will be employees, so potential for high salary is low.. And definitely not much opportunity for side gig. With IM, you can open a clinic, work whatever hours you want, and can easily adjust how much you make with how long you feel like working. That freedom isn't often there for anesthesia. Also some people take cash only, or can even get into concierge for IM.
     
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  40. OutRun

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    Good points! I think IM offers a great freedom potential, especially with locums gigs.
     
  41. bronx43

    bronx43 Word.
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    IM subspecialist here. I would take anesthesia over general internal medicine/hospitalist in a heartbeat. However, certain IM subspecialties such as GI, heme/onc, cardiology, maybe A/I or rheumatology (for some) are more attractive than non-pain anesthesia in my opinion.
     
    #40 bronx43, Apr 16, 2018
    Last edited: Apr 16, 2018
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  42. spacegun

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    Could I ask you why you'd take anesthesia over IM/hospitalist or some of the other IM subspecialties? Sincerely curious as I'm a med student trying to decide between specialties and IM and anesthesia are definitely on my list. If I did IM, maybe I'd like pulm/critical care, but a lot of the older attendings in critical care seem burned out and I don't think I really like pulm as much as critical care. Also going IM helps me delay big decisions as I could do general IM or one of the other subspecialties later on. But this might not be the best attitude to have (I'm a procrastinator, probably not a good thing!). But anesthesia seems to have problems with CRNA's, they don't seem as in control over their schedules but have to work more on the surgeon's schedule, they always are tied to hospitals and I guess that's what someone above meant by anesthesia not having as much freedom? Thanks.
     
  43. NITRAS

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    I work Hospitalist. At my hospital with a large group, no nights or swing shift. Cross cover at 8pm. Base is 210 with quality metrics it will run like 260ish with ample moonlighting opportunities at $1400/day or $2000 a night. No admissions. 15-16/day. Closed icu.

    Pretty good retention, with several people being here for over 8 years.

    My colleague left a position where he worked his butt off and probably made double (or more), but he earned every penny.
     
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  44. SnapperRocks

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    I’d rather “be on the surgeons schedule” and be done at the end of the day and truly off when I’m on vacation than sign up for a lifetime of dealing with a zillion floor pages and follow ups.
     
  45. Ezekiel2517

    Ezekiel2517 Anesthesiologist
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    The quality of your anesthesia job highly depends on the group you're in. If you're in a good group, the only IM specialty that beats it is GI
     
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  46. Southpaw

    Southpaw ASA Member
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    Not cards? Every specialty is person dependent, but I could only see myself doing cards if I weren’t an anesthesiologist. GI doesn’t interest me at all.
     
  47. Ezekiel2517

    Ezekiel2517 Anesthesiologist
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    I'm talking in terms of money and lifestyle. If you go interventional/EP, that's a good 4-5 years of fellowship after you finish IM residency. And not nearly as good a lifestyle as GI once you're out. Cards also seems saturated to me in major metro areas. Most of the GI guys I know make more than cards while working significantly less hours.
     
  48. AdmiralChz

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    Cards is SUPER saturated right now and it has been for a few years. Talk with some graduating fellows or recent graduates - the job market is really, really unforgiving. Many will stick around doing fellowships they don't really want to do (like imaging) so they have more time to secure a position. If one is super flexible and willing to work rural to suburban areas far away from major metro areas, the prospects are better but even still not great.

    Of course this is a gross oversimplification and, as with many specialties, there are some number of cards-based CCM openings out there. Long hours and pay isn't nearly as good as others from what I've been told.
     
  49. bronx43

    bronx43 Word.
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    Well, I mean one of the big advantages of IM is the versatility, but if you're going to pigeonhole yourself into pulm/CC, then that kind of takes away one of the benefits. Not that you have to decide wait until the end to decide, but I think a lot of people "find themselves" and change their minds through their intern or second year. I sure did. I was convinced I was going to be a cardiologist until certain things made me realize I didn't. Now, I'm 8-5 M-F in clinic and I would be happy never stepping foot in a hospital ever again. But some may find that to be sheer torture. To each his own.
    The important thing is that if I wanted to cover a hospital consult service, I absolutely can. If I wanted to go back to IM, I easily can. If I wanted to do hospitalist locums, I can (but why would anyone want that?) If I wanted to open up a cash only concierge business, I can.
     
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  50. SnapperRocks

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    You consider being triple boarded in IM, CC, and pulm pigeonholed? I’m confused.
     
  51. bronx43

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    Oh no, you're not pigeonholed. My point was that one of the benefits of doing IM is that so many different career paths are open to you in terms of subspecialties. He seems to be mostly interested in pulm/CC, so if you go into IM with one field in mind, then it kind of takes away one of the prime benefits. But it's all good, because most change their minds in residency anyway.
     
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