Hospitalist vs ID Fellowship

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Dr9211

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I am working as a independent contractor Hospitalist in southwest area. 3 weeks on, one week off. We do take night calls for admissions and answer our own pagers.
I have been making 500K by working like this for 3 years but now i have burn out symptoms. Like fighting with nurses, always tired, sleepy etc.
I liked ID as subspecialty and wanted to do it but then family responsibilities lead me to work as hospitalist.
MY question is, should i go for ID fellowship. I heard some people who did ID, now working as hospitalist. I also dont want to repent by leaving this lucrative job.
What should i do, i am really confuse. Any advise would be really helpful
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Hello,
This is what I have to say that you probably didn't want to hear 😉 but the reality is only you, and you alone can evaluate your position and come with a good answer. Why is that? well because this decision has only 1 meaningful variable, how much would you ENJOY/LOVE being an ID vs IM and this information is not something that you can convey to us as to help you with your decision.
This is not a financial question. ID specialty salary is comparable with IM/hospitalist on average, you are already making 90+ percentile of your specialty and it would take you as an ID a great deal of work and acrobatics to get to the point that you are now financially, let alone the 2 years of training that you are taking a 90% pay cut. The reality is that financially, almost no specialty makes sense, it is always up to you to see if you'd enjoy 30 years of manging heart failure vs 30 years of doing colonoscopies vs 30 years of prescribing ceftaroline.
Maybe you like ID more, but not enough to do the jump, perhaps your first step would be to cut some hours or switch jobs entirely, you already worked your "3 years as a resident" perhaps this is time for you to get a cushier job at the expense of a pay cut. I am sure you can cut almost half your responsibilities and double your free time by taking a 200k pay cut and bring your income to ~300k. You would still be above ID salary at that point and would have far more time.
Now if burnout is not the real reason, and the reason is that you really, REALLY love doing ID work, then go ahead and do that, the income loss or the 2 years fellowship would pay for itself in terms of mental "sanity" during the next 30years of you working.

Hope this helps. Have a good one.
 
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Thank very much for reply. I truly appreciate that.
You guys are right. I am trying to cut down my work and see if that will help.
If still not good, i will go for fellowship.
I do like ID as a subspeciality but not to a extent that i will go to that field no matter what financial consequences will be.
More suggestions will be appreciated. Thank you
 
I have met a few ID physicians who are working as hospitalists. I was in interested in doing an ID fellowship and one them told me since ID is not competitive he would advise me to work as a hospitalist first and if I absolutely hate it, then I can do a fellowship.
 
Yes thats where my confusion lies. I dont want to spend two years in fellowship and then end up doing same Hospitalist job after that.
Any idea how is the job market for infectious disease especially around South ?
Thank you
 
Salaries for ID with some inpatient work, range in 300-400 range with weekends off except on call, ability to work 8 to 5 most days. You can pick up some hospitalist locums shifts on the weekends. Hospitalists will be almost fully replaced by NPs in 5 to 10 years. its not viable long term in your current work situation.
 
Suprep said:
Salaries for ID with some inpatient work, range in 300-400 range with weekends off except on call, ability to work 8 to 5 most days. You can pick up some hospitalist locums shifts on the weekends. Hospitalists will be almost fully replaced by NPs in 5 to 10 years. its not viable long term in your current work situation.
Click to expand...

How can they be fully replaced if they can’t practice without a doc co signing?


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wjs010 said:
How can they be fully replaced if they can’t practice without a doc co signing?


Sent from my iPhone using SDN
Click to expand...
you should really be dreaming. there are several states where NP don't need physician supervision. FL is getting a bill that will allow NP and PA to open their own practice. Its the reality. Hospital systems are actively replacing physicians with midlevels
 
Suprep said:
you should really be dreaming. there are several states where NP don't need physician supervision. FL is getting a bill that will allow NP and PA to open their own practice. Its the reality. Hospital systems are actively replacing physicians with midlevels
Click to expand...

Well although i do agree that NPs and PAs are replacing physicians. But that is happening across the board. You see one ER doc along with 3-4 midlevels. One ID physician with midlevels doing rounds in multiple places. Midlevel following HD pts and ordering HD orders etc. Just to name few.
I think, again i think that Hospitalist jobs are least affected by Midlevels.
 
Suprep said:
the word is that Dallas metro big employers are considering fully replacing hospitalists with NP. Once board approves this might happen in majority of those hospitals in the next 2-3 years. This is the start. If this is successful, it might be rolling out elsewhere
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One thing is to be cautious and prepare for an uncertain future. That, I fully agree with.
A totally different thing is being alarmist and paranoic. I think this is touching into the alarmist/paranoic part.
There are dozens of things that could affect our salaries in the future. Healthcare reform, the rise of more Med schools, DO schools and increase in a number of residencies, advanced practitioners and even robots/machines in the slightly more distant future, just to name a few. However, randomly going into a fellowship for those reasons might not give you the protection you think it is. Advanced practitioners are working in specialties as well, if hospitalists are replaced there is nothing to stop them from replacing most ID doctors, most Nephrologist, most endocrinologists, etc. Int/structural cardiologists and GI might be safe for a while due to procedures but what makes you think that "they" will stop there xD.
Nobody knows what the job market will look like in a couple of decades, especially with the rise of automation and AI. If you going to be alarmist about this, the safest way to proceed would be to start making money RIGHT NOW, and save as much as possible. Rather than waste ~3 years in a fellowship that might be overrun by mid-levels in 10 years as you say. But again, I don't think this is likely to happen the way you are saying. While I have met a handful of mid-levels that are phenomenal, the majority of the ones I have come across are simply incapable of practicing independently, at least not safely.
 
ID doctors don’t make as much as hospitalists. They pretty much much make the same as outpatient IM folks.

Do you want to spend the next foreseeable future as an ID doc? Are you willing to be a fellow again? What do you want to do for the next 15 years? If all you want to do is manage HIV clinics or tell idiots to stop antibiotics then ID is a pretty reasonable choice, but money isn’t one of the reason to do more training, usually (and really not in this case).

You must be in a low intensity setting to tolerate 3 weeks on with nights (or you are just a bad ass). I think you need to change something about your practice setting. There are people in my group that cover a SNF who make an extra $100k plus.
 
Suprep said:
you should really be dreaming. there are several states where NP don't need physician supervision. FL is getting a bill that will allow NP and PA to open their own practice. Its the reality. Hospital systems are actively replacing physicians with midlevels
Click to expand...

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I've practice ID in a couple different settings with a number of friends now who have done ID or IM including a few who have swapped back and forth. I feel like I can confidently say 4 things:

1. There are a number of different ways to practice as an ID physician, some will be 8 to 5, many will not. Some will involve lots of weekends, some will not. Depending on how you want to practice you can probably find a job that suits your ID interests.

2. That said, ID is a subspecialty, there are significantly fewer ID positions than hospitalists, and if you do want a specific practice style you better be willing to move.

3. Hours and work setting aside the working quality of life is much better than in primary care because you are not also a social worker, discharge planner, insulin tweaker, etc.

4. The pay is fairly consistently less than what a hospitalist makes in most setting and certainly less than what you are making now.

If you really like the field of infectious disease as a discipline then go full steam ahead with ID. If you are lukewarm about infectious disease, however, and are just looking for an alternative to your current job I'd, like others have suggested, say find a different way to manage your current practice.
 
Jaundice101 said:
I've practice ID in a couple different settings with a number of friends now who have done ID or IM including a few who have swapped back and forth. I feel like I can confidently say 4 things:

1. There are a number of different ways to practice as an ID physician, some will be 8 to 5, many will not. Some will involve lots of weekends, some will not. Depending on how you want to practice you can probably find a job that suits your ID interests.

2. That said, ID is a subspecialty, there are significantly fewer ID positions than hospitalists, and if you do want a specific practice style you better be willing to move.

3. Hours and work setting aside the working quality of life is much better than in primary care because you are not also a social worker, discharge planner, insulin tweaker, etc.

4. The pay is fairly consistently less than what a hospitalist makes in most setting and certainly less than what you are making now.

If you really like the field of infectious disease as a discipline then go full steam ahead with ID. If you are lukewarm about infectious disease, however, and are just looking for an alternative to your current job I'd, like others have suggested, say find a different way to manage your current practice.
Click to expand...

That was helpful. Thank you for reply. As i mentioned before, i like ID as a subspecialty but i also have family to feed. I dont want to do ID fellowship for two years and after that end up doing Hospitalist jobs like i am doing right now because of jobs etc
 
Dr9211 said:
That was helpful. Thank you for reply. As i mentioned before, i like ID as a subspecialty but i also have family to feed. I dont want to do ID fellowship for two years and after that end up doing Hospitalist jobs like i am doing right now because of jobs etc
Click to expand...

The demand for ID is certainly there, so not finding a job shouldn’t be an issue...but hospitalist certainly will pay more...you have to decide which is more important.
 
Suprep said:
Salaries for ID with some inpatient work, range in 300-400 range with weekends off except on call, ability to work 8 to 5 most days. You can pick up some hospitalist locums shifts on the weekends. Hospitalists will be almost fully replaced by NPs in 5 to 10 years. its not viable long term in your current work situation.
Click to expand...
ID for those who do some inpatient work make 300-400K? how come most surveys say low 200s?
 
NITRAS said:
ID doctors don’t make as much as hospitalists. They pretty much much make the same as outpatient IM folks.


You must be in a low intensity setting to tolerate 3 weeks on with nights (or you are just a bad ass). I think you need to change something about your practice setting. There are people in my group that cover a SNF who make an extra $100k plus.
Click to expand...
How are they able to make that muck cover SNF? I was told there is no $$$ to be made taking care of mostly medicare and medicaid patients.
 
Suprep said:
Salaries for ID with some inpatient work, range in 300-400 range with weekends off except on call, ability to work 8 to 5 most days. You can pick up some hospitalist locums shifts on the weekends. Hospitalists will be almost fully replaced by NPs in 5 to 10 years. its not viable long term in your current work situation.
Click to expand...
Bro that's above 99th percentile for ID
 
Splenda88 said:
How are they able to make that muck cover SNF? I was told there is no $$$ to be made taking care of mostly medicare and medicaid patients.
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You make it by volume. You can round on 30 SNF patients in like an hour.
 
OP should do CCM so he/she can at least make 450k/yr working a regular schedule (7 days on/off)
 
aafisahar said:
You make it by volume. You can round on 30 SNF patients in like an hour.
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Good to know. I am about to be a new grad and I will looking at other possibilities to make an extra 50-75/yr to just go toward student loan repayment, and SNF will be among one of them.
 
CCM-MD said:
Since when did 7 on/off become a regular schedule :laugh: . And you're recommending CCM to someone who is already burnt out?!

The smartest move is GI. >500k working Mon-Fri.
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I guess it is now in the world of hospitalist/intensivist.

I actually believe I will enjoy better the one week on/off than the typical 5 days on and weekend off. I am recommending CCM since it's a shorter fellowship than GI/Card.

In any case, since OP is making 500k+, he/she can continue to grind for another 3-4 yrs and then transition to only 1 wks every month for 140-160k
 
Dr9211 said:
Thank very much for reply. I truly appreciate that.
You guys are right. I am trying to cut down my work and see if that will help.
If still not good, i will go for fellowship.
I do like ID as a subspeciality but not to a extent that i will go to that field no matter what financial consequences will be.
More suggestions will be appreciated. Thank you
Click to expand...
I feel like ID basically is a hospitalist fellowship already.
 
Splenda88 said:
I guess it is now in the world of hospitalist/intensivist.

I actually believe I will enjoy better the one week on/off than the typical 5 days on and weekend off. I am recommending CCM since it's a shorter fellowship than GI/Card.

In any case, since OP is making 500k+, he/she can continue to grind for another 3-4 yrs and then transition to only 1 wks every month for 140-160k
Click to expand...

3 years for GI. 2 years for CCM with most programs being 3 years combined with pulm. 1 year is not a huge difference in the long run. So many advantages to GI if you have the interest and can get in.
 
Splenda88 said:
I guess it is now in the world of hospitalist/intensivist.

I actually believe I will enjoy better the one week on/off than the typical 5 days on and weekend off. I am recommending CCM since it's a shorter fellowship than GI/Card.

In any case, since OP is making 500k+, he/she can continue to grind for another 3-4 yrs and then transition to only 1 wks every month for 140-160k
Click to expand...
Pulm/CC, GI, and cards are all 3 years.
 
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