Hospitalist = More $$$$ than an outpatient internist, but like anything in medicine it comes at a cost. Whatever the system you're going to work about 15 shifts a month. You'll see about 15-25 patients a day. You'll work about 10-12 shifts. Unlike ER or Pulm -- other shift work stuff -- you'll run around the hospital. Unlike ER -- you'll have to deal with SW, Discharge summaries, calling consults and can at points be very peripheral in making decision on your patients or risk getting into arguments with the consultants.
The best aspect of a hospitalist's day is taking to patients, explaining to them their disease, keeping them out of the hospital, and perhaps cleaning up some inappropriate meds, and doing some preventive counseling. However, the pressures of your day limits time spent with patients. The documentation needs are endless. HNPs have to be crazy comprehensive and, at least my employer rewards excess -- i.e. -- a patient who has not been eating due to a gastroenteritis has: ARF, Dehydration, Hypotension. You give IVFluids for each and monitor, but WOW! I'm billing for three diagnoses. The private business that contracts out to my hospital and employs me will get even more of a reimbursement! They'll like me as an employee!
In a hospital, very small incentive exists to not pan-consult. The specialists have someone in their practice on call -- i.e. not scheduled to be making money in the office anyways -- and they'll be glad to add some steroids for that COPD exacerbation. You did all the work and sit and ask the standard HNP questions. They get to read yours, add steroids, and bill! While you might have hated consults while on a specialists service in residency, you love them here.
The nice aspects are -- no concern about overhead, patient scheduling, malpractice, etc. You show up to the hospital and get to concentrate on patient care -- but please reference the above as to when that happens.
I joke that I'm a glorified resident. Perhaps I am. Perhaps you are in any field. But, rarely do you FEEL like it as in hospital "medicine". I've never felt more like a cog in the wheel that at this point.
I guess another plus is the dough. Hospitalists make about $200,000 for those 15 shifts. Not bad after 3.0 years of training. Family practicioners can do it too! Endcrine/Neph/ID docs in my region make less.
Another strange aspect is the weird hours. You might have to 4-5 night shifts a month. You won't get paid vacation. You work 1/2 of weekends a month. Yes you're "off" 15 days a month, but some of that is recovery if you work in a busy hospital.
The toughest aspect for me is that after being a senior resident recently, it's harder to know my patients are getting quality care. It's not because of medical knowledge deficits, it's because the nitty-gitty and constant documentation that's an intern's work can bog you and make you loose the big picture.
At last, another annoying thing, is "waiting for the consultants to get on board for discharge"......seems like I'm always waiting for Pulms or GIs or Cards blessing to send a pt. home. As the attending of record, it can be hard to take.
Ok, perhaps more than you wanted to know, but in internal medicine....the money's about the best you'll do. It's not GI/Cards/Pulm type $$$$ but it's not bad....plus you actually can get to have some choice where to live. Ask a mediocre Cards program guy if he's going to be able to set up shop at $450,000 in a big city -- I'm taking a place with at least 2-3 pro sports teams. It's not happening. As a hospitalist, you can actually live in such a place and make something near the $275,000 that mediocre cards program guy makes and not fret so much about fellowship when you see each other in a nice section at a NBA game.
