Hospitalist vs. Clinical Practice

[UFMed]

Hi,
I don't know much about the life of a hospitalist. I know there are physicians and surgeons who work for a hospital and do not run a private practice after residency. EM docs, anesthesiology, radiology and trauma surgeons come to mind, but are their other specialities represented (gen/ped surgery, neurosurg, IM specialities etc)? Do these doctors receive some form of incentive? I've heard that in some under served areas, or growing cities facing doctor shortages, hospitals will pay off a doc's loans as an incentive to sign. Hospitalist may also have the benefit of working more flexible hours/schedule. Do they have their malpractice insurance paid by the hospital as well?
Clinical practice is obviously the norm of what people consider to be a "doctor." I would assume they receive more compensation and more independence in how they practice medicine (less standardized). But I don't know if I would be the type of person to hang my sign outside and run a business. From hiring employees, paying 401ks, taxes, electric bills, overhead, waiting for reimbursements, etc. It just seems like a mountain of stress and frustration.
Can anyone add to the differences in lifestyle between a hospitalist & clinical practitioner?

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[AmoryBlaine]

I've worked with hospitalists in IM/Peds. The term really applies to someone in one of those fields who only manages inpaties i.e. it is not correct to call an anesthesiolgist a "hospitalist." Similarly I don't think IM subspecialists really work as hospitalists although Pulm/CC guys might be hospital based intensivists.

The attendings I worked with usually had a schedule that I liked to think of as "shift work for internal medicine." The "shifts" were usually 1-2 weeks in length and pretty brutal as the doc would often be in house up to 10 hours a day and then on call every night. The upside was that the shifts would be followed by entire weeks off. I'm pretty sure one dude did 2 weeks on 4 weeks off.

IM hospitalists can make some pretty decent money as well (~200). Personally I think it'd be a pretty sweet gig although very tough when you were "on."

 

[Blesbok]

Hi,
I don't know much about the life of a hospitalist. I know there are physicians and surgeons who work for a hospital and do not run a private practice after residency. EM docs, anesthesiology, radiology and trauma surgeons come to mind, but are their other specialities represented (gen/ped surgery, neurosurg, IM specialities etc)? Do these doctors receive some form of incentive? I've heard that in some under served areas, or growing cities facing doctor shortages, hospitals will pay off a doc's loans as an incentive to sign. Hospitalist may also have the benefit of working more flexible hours/schedule. Do they have their malpractice insurance paid by the hospital as well?
Clinical practice is obviously the norm of what people consider to be a "doctor." I would assume they receive more compensation and more independence in how they practice medicine (less standardized). But I don't know if I would be the type of person to hang my sign outside and run a business. From hiring employees, paying 401ks, taxes, electric bills, overhead, waiting for reimbursements, etc. It just seems like a mountain of stress and frustration.
Can anyone add to the differences in lifestyle between a hospitalist & clinical practitioner?

Just remember that a lot of clinical practices these days are not "mom and pop shops" like they used to be. There are tons of practices with a dozen or more doctors that have much less to do with the business side of things than if it were a 1-2 doctor practice. That is one of the big positive sides to joining a larger practice.

 

[BigRedBeta]

I think there are some other benefits as well, beyond what Amory said:

You don't have to worry about managing DM or HTN or COPD over long periods of time. Your goal is to get the patient out of the hospital. Some chronic conditions are pretty easily managed when a patient is on the ward, others can be ignored if they're not really contributing - just stick them on their home meds and be done.

I think a lot of times the big draw is that you're only dealing with patients who are really sick.

Also, while there may be the occasional frequent flyer or bounce-back, if you're not big on "developing relationships" you can avoid them as a hospitalist. I have at least one friend who was sure he was going to do Emergency, because he liked the idea of treating the patient then not having to deal with the attachment. Comes to find out he can't stand dealing with drug-seeking behavior, discovers hospitalist positions exist and is really gung-ho about heading in that direction.

In a similar vein being an intensivist/Critical Care Med has a similar (though not identical) slate of offerings.

 

[brianoflee]

Just remember that a lot of clinical practices these days are not "mom and pop shops" like they used to be. There are tons of practices with a dozen or more doctors that have much less to do with the business side of things than if it were a 1-2 doctor practice. That is one of the big positive sides to joining a larger practice.

Agreed. I work at a family health team in Ontario with 9 physicians (others in the area have up to 18); from my perspective it seems like virtually everything is prepared in advance for the physicians (by receptionists, office administrators, nurses, nurse practitioners and AHPs), such that the doctors need really only spend at most 10 mins with each patient. So many of the traditional downsides associated with private practices are eliminated in this type of system.

 

[drholiday]

Agreed. I work at a family health team in Ontario with 9 physicians (others in the area have up to 18); from my perspective it seems like virtually everything is prepared in advance for the physicians (by receptionists, office administrators, nurses, nurse practitioners and AHPs), such that the doctors need really only spend at most 10 mins with each patient. So many of the traditional downsides associated with private practices are eliminated in this type of system.

Only 10 minutes at most?

 

[GreenShirt]

Only 10 minutes at most?

Yeah, it doesn't seem like much but that's how it is if you want to pay the bills. When you do the OSCE portion of your boards you will only have about 10 min per patient. I think there was a study a while back that showed that "chatty" doctors who spent more time with their patients didn't have better outcomes than doctors that stuck to the 10-15 min. Ten minutes does seem a little sad to me though.

 

[Blesbok]

Yeah, it doesn't seem like much but that's how it is if you want to pay the bills. When you do the OSCE portion of your boards you will only have about 10 min per patient. I think there was a study a while back that showed that "chatty" doctors who spent more time with their patients didn't have better outcomes than doctors that stuck to the 10-15 min. Ten minutes does seem a little sad to me though.

Ten minutes is a lot of time for a general practice appointment. You can do a lot in ten minutes if you aren't doing vitals and you already know the majority of the history because they are a return patient. Especially considering 90% of them are just there for a refill on their BP meds or for some antibiotics for their viral URI.

 

[45408]

Only 10 minutes at most?

Ten minutes, if done right, can seem like plenty of time for the patient. For a new patient or a serious complaint that needs thorough investigation? Different story, obviously. Don't you only get 14 minutes for each station in Step 2 CS?

 

[brianoflee]

Especially considering 90% of them are just there for a refill on their BP meds or for some antibiotics for their viral URI.

Even most of these can be done by the on-site nurse practitioners or pharmacist. In my experience, patients really seem to love the system - it's remarkably efficient.

Only 10 minutes at most?

Literally - patients are booked into 10-minute slots in the MD's schedule.

 

[dbhvt]

Yeah, it doesn't seem like much but that's how it is if you want to pay the bills. When you do the OSCE portion of your boards you will only have about 10 min per patient. I think there was a study a while back that showed that "chatty" doctors who spent more time with their patients didn't have better outcomes than doctors that stuck to the 10-15 min. Ten minutes does seem a little sad to me though.

According to this JAMA article, primary care doctors that spend more time with patients have fewer malpractice claims.

Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons... No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status.

PMID: 9032162

 

[45408]

According to this JAMA article, primary care doctors that spend more time with patients have fewer malpractice claims.


PMID: 9032162

But what's the outcome of those claims?

 

[Blesbok]

According to this JAMA article, primary care doctors that spend more time with patients have fewer malpractice claims.


PMID: 9032162

Which has absolutely nothing to do with the doctor's ability to perform an effective exam in those ten minutes and everything to do with whether the doctor is BFFs with the patient.

 

[CarolinaGirl]

I have just joined a hospitalist group as a NP. The doctors I will be working with do 7 on 7 off. They work a 12 hour shift 6-6. There is an on-call doc that has the pager for each 24hrs and they cover the night shift. I am just starting out so I am trying to figure out how it all works. I do know that they have like 12 docs in their practice.

 

[dbhvt]

Which has absolutely nothing to do with the doctor's ability to perform an effective exam in those ten minutes and everything to do with whether the doctor is BFFs with the patient.

I don't know if I'd say BFF, but yeah, that's the basic idea. Your relationship with your patients has an impact on your number of malpractice claims (which has an impact on your premiums) independent of, say, whether you miss a diagnosis, give the wrong treatment, fail to treat (actually commit malpractice). This relates here because you can tie 'time spent with patients' to malpractice claims (a proxy for how much patients like you), but you can't tie it to health outcomes. There is probably also a more direct relationship between time spent with patients and malpractice when you look at getting adequate informed consent (failure = malpractice), but those data are not as convincing.