Hospitalist vs primary care

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Firsttimemom

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Hi everyone I need your advice..
I was wondering whether to continue working as a hospitalist or switch to primary care..I have been working as a hospitalist for past 8months and dont feel passionate towards my work..I dont like the long hours and stress..
Can anyone tell me the pros and cons of primary care IM? If I go In to primary care will it be difficult for me to go.back to being a hospitalist after few years?

TIA
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I almost took a job as a PCP but then decided to be a hospitalist instead. There are many members of my group (5 to be exact) who were previously a PCP and decided they didn't like the stress and moved to hospital medicine. Yes, the seven days on can be rough but for me the 7 days off make up for it.

In my mind both jobs are stressful. The main difference is that hospital medicine means you are dealing with higher acuity illness and need to be comfortable dealing with that. Sometimes bad things happen to sick patients no matter how much vanco and zosyn we give (sarcasm). I think the main reason for moving from one job to the other (hospitalist vs PCP) is what acuity of illness you want to be seeing. For some people doing physicals and seeing URI's intermixed with signing handicap parking passes paperwork is not fulfilling enough. Other friends of mine don't like the stress of sick patients potentially crashing on them and love showing up to work and dealing with non critical illness.

I think once you determine what kind of patient population you want to see, then the decision will be clearer. You can easily change jobs from PCP to hospitalist. I don't think that should be an issue. Good luck!
 
InvestingDoc said:
I think once you determine what kind of patient population you want to see, then the decision will be clearer. You can easily change jobs from PCP to hospitalist. I don't think that should be an issue. Good luck!
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this is the key..once you decide on the type of pt you want to see, then you can find a job that fits the schedule you want.

Not all hospitalist jobs are 7 on/7 off...if that's the issue and you want a M-F kinda job, you can do that as a hospitalist as well.

But being a PCP will have its long hours and stress as well.
 
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I am thinking about primary care because of comfortable life style 8 to 5pm job and off on weekends..and sometimes I get very scared to deal with very sick patients..most of the hospitalist jobs I.came across are 7 on 7off..very rarely did I come across M-F job as hospitalist..
I like inpt med but sometimes I hate working till 7pm and feel like I should just rush seeing patients so that I can go home by 5 pm or 6pm and relax..and I m not liking the way im feeling and rushing through work..because of this mentality I had to change 3 hospitalist jobs in 1.5 yrs..one of them was a full time others are locums..
Currently doing locums but It came to a point where I need to stop job hopping as its affecting my Resume and settle down by relocating to another state and moving to primary care..its a big decision..I am just wondering what if I switch to primary care and hate the job..then I would have to find a hospitalist job again which will look very bad in my CV..
 
Firsttimemom said:
Thank you

I am thinking about primary care because of comfortable life style 8 to 5pm job and off on weekends..and sometimes I get very scared to deal with very sick patients..most of the hospitalist jobs I.came across are 7 on 7off..very rarely did I come across M-F job as hospitalist..
I like inpt med but sometimes I hate working till 7pm and feel like I should just rush seeing patients so that I can go home by 5 pm or 6pm and relax..and I m not liking the way im feeling and rushing through work..because of this mentality I had to change 3 hospitalist jobs in 1.5 yrs..one of them was a full time others are locums..
Currently doing locums but It came to a point where I need to stop job hopping as its affecting my Resume and settle down by relocating to another state and moving to primary care..its a big decision..I am just wondering what if I switch to primary care and hate the job..then I would have to find a hospitalist job again which will look very bad in my CV..
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Sounds like lifestyle is important to you. I agree with others that 7 on/7 off is easy for scheduling and travel but I got burned out with it. No flexibility so I switched to a position with flexible scheduling. We work in blocks of 4-6 days in a row (but can be more if you request) and have off usually 4-6 days off (but can be more if you want). You get to request 4 days off a month that you guaranteed get off. Of course, you still work 50% of every weekend but this helped me out as it allowed me more control over my schedule so I encourage you to try to find a position that allows similar scheduling. I don't know of any hospitalist jobs that are mon-fri only and the best job in terms of weekend shifts was a community hospital where you had to work 3 weekend day shifts out of 8 weekend days (so 1 less weekend day every 4 weeks).

You shouldn't be having to stay til 7pm every night but if you want a 8-5pm job, that'll be a bit of a stretch. What about admitting shifts where you have to stay until late evening?

Do you have a family? They might influence your decision. Why did you decide on hospitalist over primary care in the first place? Are those reasons still important to you? I agree with others. Yes, primary care has weekends off but most of the primary care physicians work more than 9 hrs a day and usually have to finish up notes at home fairly regularly and they trade off salary. Do you like building long term relationships with patients? Pick primary care. Sounds like you aren't in love with primary care but don't like hospitalist lifestyle, is this correct perception? ...in that case, you have to decide which you can tolerate longer, or do a fellowship.
 
I'm not sure primary care is really 8-5 considering the massive amount of paperwork that will build up throughout the day. I'm sure you could make it work by seeing fewer patients or being hyper efficient but most PCPs I know spend a lot of time at home working on notes and follow-up.

Good luck with your decision!
 
I am doing primary care mostly because of hours: I worked 8:30-4:30p.
I do not like it, (I always wanted to do hospitalist) but it works out for my 2 year old daughter. I am able to pick up from daycare on a regular time like any other parents and most of all, I don't have to do a nanny.. which in my opinion require huge amount of trust and I haven't found anyone
 
Doc_Mcstuffins said:
Sounds like lifestyle is important to you. I agree with others that 7 on/7 off is easy for scheduling and travel but I got burned out with it. No flexibility so I switched to a position with flexible scheduling. We work in blocks of 4-6 days in a row (but can be more if you request) and have off usually 4-6 days off (but can be more if you want). You get to request 4 days off a month that you guaranteed get off. Of course, you still work 50% of every weekend but this helped me out as it allowed me more control over my schedule so I encourage you to try to find a position that allows similar scheduling. I don't know of any hospitalist jobs that are mon-fri only and the best job in terms of weekend shifts was a community hospital where you had to work 3 weekend day shifts out of 8 weekend days (so 1 less weekend day every 4 weeks).

You shouldn't be having to stay til 7pm every night but if you want a 8-5pm job, that'll be a bit of a stretch. What about admitting shifts where you have to stay until late evening?

Do you have a family? They might influence your decision. Why did you decide on hospitalist over primary care in the first place? Are those reasons still important to you? I agree with others. Yes, primary care has weekends off but most of the primary care physicians work more than 9 hrs a day and usually have to finish up notes at home fairly regularly and they trade off salary. Do you like building long term relationships with patients? Pick primary care. Sounds like you aren't in love with primary care but don't like hospitalist lifestyle, is this correct perception? ...in that case, you have to decide which you can tolerate longer, or do a fellowship.
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I know of a big hospital in the northeast that is M-F 7-5 hospitalist work on the nonacademic service. They're rare, but they exist.
 
Thank you everyone

I came across a primary care job where the nurses and PA take care of most of the paperwork and average pt census is 15-16..and it's only 4.5 days work week and the salary is aroind 170k..so I am tempted by the hours and the weekend breaks..
Also thinking about financial aspects of going in to primary care as I will make leass than hospitalist amd what if I regret in future ?
 
Firsttimemom said:
Thank you

I am thinking about primary care because of comfortable life style 8 to 5pm job and off on weekends..and sometimes I get very scared to deal with very sick patients..most of the hospitalist jobs I.came across are 7 on 7off..very rarely did I come across M-F job as hospitalist..
I like inpt med but sometimes I hate working till 7pm and feel like I should just rush seeing patients so that I can go home by 5 pm or 6pm and relax..and I m not liking the way im feeling and rushing through work..because of this mentality I had to change 3 hospitalist jobs in 1.5 yrs..one of them was a full time others are locums..
Currently doing locums but It came to a point where I need to stop job hopping as its affecting my Resume and settle down by relocating to another state and moving to primary care..its a big decision..I am just wondering what if I switch to primary care and hate the job..then I would have to find a hospitalist job again which will look very bad in my CV..
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I was a hospitalist and made the switch to primary care about 10 months ago.

I have been much happier and comfortable with my choice.

I wake up at 8:00 AM. I work from 9:00 AM until 12:00 PM and then take a one hour break for lunch.

Then I work from 1:00 PM to 4:30 PM.

I get half Wednesdays "off" to catch up on paperwork.

Do I get stressed out? A few times. Nothing as compared to what I endured in hospital medicine.

Just make the switch and never look back!!
 
Firsttimemom said:
Thank you everyone

I came across a primary care job where the nurses and PA take care of most of the paperwork and average pt census is 15-16..and it's only 4.5 days work week and the salary is aroind 170k..so I am tempted by the hours and the weekend breaks..
Also thinking about financial aspects of going in to primary care as I will make leass than hospitalist amd what if I regret in future ?
Click to expand...

I make less now but it doesn't matter to me. I'm happy. I can get home and watch a movie with my wife or go hang out and have a drink with my buddies.

I feel like I have a life outside of work even during my workweek and that is worth tens of thousands of dollars.

I really think that primary care is becoming a lifestyle specialty.
 
Firsttimemom said:
Thank you everyone

I came across a primary care job where the nurses and PA take care of most of the paperwork and average pt census is 15-16..and it's only 4.5 days work week and the salary is aroind 170k..so I am tempted by the hours and the weekend breaks..
Also thinking about financial aspects of going in to primary care as I will make leass than hospitalist amd what if I regret in future ?
Click to expand...
Not having to chart for 2-3 hours per night is worth 30k. Just make sure the PA is thorough with documentation.
 
Th reason I chose hospitalist job is because I am more familiar with it as my residency program focused more on inpatients ,i am scared to do outpt as I don't have much knowledge,the other reason being money and lastly not to offend anyone but personally I feel pcp is job is easy and I went through all these years of med school and hardwork not just to do physicals and treat URIs that I should be doing more..
At the same time I dont like spending lot of time talkinh to patient families as a hospitalist..

I am very confused what to do next ..I guess I have to decide it for myself..

Thank you everyone for your advise..
 
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Firsttimemom said:
Th reason I chose hospitalist job is because I am more familiar with it as my residency program focused more on inpatients ,i am scared to do outpt as I don't have much knowledge,the other reason being money and lastly not to offend anyone but personally I feel pcp is job is easy and I went through all these years of med school and hardwork not just to do physicals and treat URIs that I should be doing more..
At the same time I dont like spending lot of time talkinh to patient families as a hospitalist..

I am very confused what to do next ..I guess I have to decide it for myself..

Thank you everyone for your advise..
Click to expand...

I think that whatever you do is fine. One of my favorite attendings ever once gave me a bit of great advice. He told me that somewhere down the line, we all have to choose what we value most in life and act accordingly. You can't have it all. He was this guy who was all set to be the face of this big famous hospital in the city I trained. They flew him all around the US for TV interviews and conferences and key note speeches. Then one day, he came home and put his 5 year old daughter to bed and realized that he hadn't seen her awake in over month. He always left before she woke up and came back after she fell asleep. The next day he picked up the phone and asked one of his old co-residents if he wanted to start a private primary care practice with him. Now his office is lined with photos of his three daughters, the wife he's been married to for two decades, and the innumerable trips he's been on in his lifetime. He owns two homes and works a 4 day week. He is very happy with his life and his patients absolutely adore him. I can't tell you how many times they told me "Oh you follow him close. He's the best doctor in the city." I don't think a hospitalist job is any worse in regards to lifestyle either. Some hate it and some adore it in my experience. As long as you know what you value, you can act accordingly and you can seek your own form of joy accordingly. As long as you're honest with yourself, you should do fine.
 
Firsttimemom said:
Th reason I chose hospitalist job is because I am more familiar with it as my residency program focused more on inpatients ,i am scared to do outpt as I don't have much knowledge,the other reason being money and lastly not to offend anyone but personally I feel pcp is job is easy and I went through all these years of med school and hardwork not just to do physicals and treat URIs that I should be doing more..
At the same time I dont like spending lot of time talkinh to patient families as a hospitalist..

I am very confused what to do next ..I guess I have to decide it for myself..

Thank you everyone for your advise..
Click to expand...

You express a common concern about being a PCP: that it is both too hard, and too easy. Neither is true.

1) We ALL received mostly inpatient training. Coming out of residency or being a hospitalist, you know the most important thing, which is how to recognize the patient who is truly ill and needs immediate attention. The rest of the stuff that is done outpatient, like dealing with orthopedic complaints or rashes, you will learn on the job - just like every other internist who has ever started in practice. Much like happened in residency, after a year or two in practice you'll feel pretty confident handling most things that come your way.

2) It's true that a typical day is filled with lots of routine stuff like URIs, well visits, and follow-ups for stable chronic disease like HTN or DM. But the fun thing about primary care is that you're on the front lines, so you have to be ready for anything at any time. I see plenty of interesting stuff. Just today I diagnosed a new onset case of CHF, had to work up a sudden bump in a patient's creatinine, and took care of a patient having a pretty significant COPD exacerbation who almost needed to go to the hospital (I gave her some nebs in the office, put her on some meds, and will see her back tomorrow). I've caught plenty of "zebras" in my time too - celiac disease, Lyme, adrenal failure, etc. It's not an "easy" job if done well, though it's true that the majority of cases one sees in a typical day are more routine or low-acuity type of things.

Lastly, if you don't like talking to families, you might think about something other than primary care. This is not the field to avoid interaction with patients or their family members.
 
I think other than the higher acuity of illness, the thing I like about being a hospitalist is I feel less pressured to conform to a schedule of how my day is "supposed to go". If you're a PCP, all your patients get these short time slots in which you have to see them. Some may require a bit less time than their slot, some may require more, and all the while you've got people in the waiting area getting antsy. While there are certainly some time pressures on the inpatient side, I still feel like I'm moving more at my own pace. Got a patient who you know talks a lot and will delay your rounds? You can choose to see them last. Does a patient have one helpful family member and one unhelpful one? I can show up at bedside when I know the unhelpful person is at work. Something urgent comes up while at bedside? I can promise to come back and see the patient later that day. In the outpatient setting you'd have to reschedule the patient, which is pretty inconvenient for them (and you).
 
I've been working as a hospitalist for the past 5-6 years now and I can tell from your description that you're getting burned out. Switching to PCP will not help that. In fact, I think it would make it worse (you'll end up seeing even more patients per day in the outpatient setting). I've been through a similar situation as you over the last year and I'm currently working on finding a new position elsewhere. What I would recommend is that you talk to your employer and cut back on your schedule. Go to a part time status while you are searching for new work. It will help to get more time off. The temporary drop in pay is worth it.
Also, I would highly recommend you search for a job that is NOT 7a-7pm and not 7 on/7 off. Those are AWFUL hours and an AWFUL way to live your life. I know of many groups out there that do things much smarter than that. The group I'm considering joining works roughly 9-3 and after 3 its just answering pager calls until 5 or 6. You can go home at 3 or 4 if you're done. And its not 7 days in a row. It could be 4 days or 5 days or 6 days at a time, its up to you based on your monthly requests for time off. If you feel like you're seeing too many patients, try moving to a smaller hospital that's less busy. We as physicians need to DEMAND better working conditions from our employers. If we don't burn out will continue to be a constant problem.
Being a hospitalist can be great when you find a group that has a good schedule and good hours and isn't too busy (12-16 patients per day would be ideal for me). Working 14-16 days per month can be great, especially if you like to travel or have kids. But, again, its up to us to demand those kind of work conditions otherwise the hospitals will continue to try to take advantage of us.
 
DrMetal said:
In the 7 days on / 7 days off model...when you're on, what are your hours like? Can you work from home? (E-prescribing, E-ordering and documenting). Or do you literally have to come in every time a patient needs potassium supplementation?


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Ha ha, "DrMetal" I like your username🙂 I'm into metal too (I'm going to see Kreator and Obituary in NYC this April). Good questions for the OP though. I wouldn't work anywhere that doesn't have the ability to place orders from home.
 
jacksparrow82 said:
Ha ha, "DrMetal" I like your username🙂 I'm into metal too (I'm going to see Kreator and Obituary in NYC this April). Good questions for the OP though. I wouldn't work anywhere that doesn't have the ability to place orders from home.
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I'm still an aspiring shredder, medicine is only my day job!

jacksparrow82 said:
Also, I would highly recommend you search for a job that is NOT 7a-7pm and not 7 on/7 off. Those are AWFUL hours and an AWFUL way to live your life. I know of many groups out there that do things much smarter than that. The group I'm considering joining works roughly 9-3 and after 3 its just answering pager calls until 5 or 6.
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I'm intrigued. I always thought the 7 on/7 off model was a necessary evil, the only way to do it, to make sure everybody covered their fair share of weekends/nights.

If you work in a system where you're only 9-3 M-Fri, who covers your weeknight/weekends? Do you have dedicated night/weekend floats? Must suck for them! (unless of course they're well paid).
 
jacksparrow82 said:
I've been working as a hospitalist for the past 5-6 years now and I can tell from your description that you're getting burned out. Switching to PCP will not help that. In fact, I think it would make it worse (you'll end up seeing even more patients per day in the outpatient setting). I've been through a similar situation as you over the last year and I'm currently working on finding a new position elsewhere. What I would recommend is that you talk to your employer and cut back on your schedule. Go to a part time status while you are searching for new work. It will help to get more time off. The temporary drop in pay is worth it.
Also, I would highly recommend you search for a job that is NOT 7a-7pm and not 7 on/7 off. Those are AWFUL hours and an AWFUL way to live your life. I know of many groups out there that do things much smarter than that. The group I'm considering joining works roughly 9-3 and after 3 its just answering pager calls until 5 or 6. You can go home at 3 or 4 if you're done. And its not 7 days in a row. It could be 4 days or 5 days or 6 days at a time, its up to you based on your monthly requests for time off. If you feel like you're seeing too many patients, try moving to a smaller hospital that's less busy. We as physicians need to DEMAND better working conditions from our employers. If we don't burn out will continue to be a constant problem.
Being a hospitalist can be great when you find a group that has a good schedule and good hours and isn't too busy (12-16 patients per day would be ideal for me). Working 14-16 days per month can be great, especially if you like to travel or have kids. But, again, its up to us to demand those kind of work conditions otherwise the hospitals will continue to try to take advantage of us.
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How do you find a job that you can just round and go..do you ask the recruiters or do you ask when you go for an interview..
I dont want to leave hospital medicine just because I wasnt able to Find a good job.I like inpt medicine but I really wish the hours are flexible..like come at 7 and leave when done around 4 or 5 😛m and carry pager till 7pm..I just don't like staying in hospital for whole 12hrs 7 days in a row..
 
Firsttimemom said:
How do you find a job that you can just round and go..do you ask the recruiters or do you ask when you go for an interview..
I dont want to leave hospital medicine just because I wasnt able to Find a good job.I like inpt medicine but I really wish the hours are flexible..like come at 7 and leave when done around 4 or 5 😛m and carry pager till 7pm..I just don't like staying in hospital for whole 12hrs 7 days in a row..
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places that have separate rounders and admitters...though you on occasion will need to be an admitter...or a really big place that has enough people that they are separate jobs.

or a really small place where you are either the hospitalist or one of a few...generally the nurse handle a lot of things and you can admit from home and then see the pt the next day...because they are not really that sick...the sick ones go to the bigger hospital...in other words a job at OSH 🙂

the VA could also be an option.

talk to some of the locums/recruiters and tell them exactly what you want...they may have something.
 
Firsttimemom said:
How do you find a job that you can just round and go..do you ask the recruiters or do you ask when you go for an interview..
I dont want to leave hospital medicine just because I wasnt able to Find a good job.I like inpt medicine but I really wish the hours are flexible..like come at 7 and leave when done around 4 or 5 😛m and carry pager till 7pm..I just don't like staying in hospital for whole 12hrs 7 days in a row..
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If you don't mind relocating to South Carolina, my wife's group is hiring and that is exactly how they do it - if your admitting shift is 9-12 and you finish your work at 4pm you can leave (still on the pager, but at home).
 
Its such a personal choice and I don't think if you're in one, you are excluded from the other.
life is fluid. Change happens.
For me, my priority is my daughter (and then my loans! :S), so even though I may not be able to pay it all in a year or two...maybe 3, atleast I am content knowing I have a decent life with my daughter. When I pick her up from daycare, sometimes we go have 'fun'.. eat out, maybe do groceries.. (which in this cold cold Midwest winter, is an outing). Once shes a little older, i'll probably pursue a fellowship or a hospitalist job
 
DrMetal said:
I'm still an aspiring shredder, medicine is only my day job!


I'm intrigued. I always thought the 7 on/7 off model was a necessary evil, the only way to do it, to make sure everybody covered their fair share of weekends/nights.

If you work in a system where you're only 9-3 M-Fri, who covers your weeknight/weekends? Do you have dedicated night/weekend floats? Must suck for them! (unless of course they're well paid).
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We work weekends too. I should have made that clearer. There's no such thing as a hospitalist who doesn't work weekends😉
These hours work though because of the swing shift. We do 2 or 3 swing shifts a month and those are from 3pm - 10pm. That covers the cross coverage after 6pm and does the admitting with the admitting doc of the day (12-8). Then our nocturnists work 9pm to 7am.
 
Firsttimemom said:
How do you find a job that you can just round and go..do you ask the recruiters or do you ask when you go for an interview..
I dont want to leave hospital medicine just because I wasnt able to Find a good job.I like inpt medicine but I really wish the hours are flexible..like come at 7 and leave when done around 4 or 5 😛m and carry pager till 7pm..I just don't like staying in hospital for whole 12hrs 7 days in a row..
Click to expand...

That is definitely one of the first things you should ask about when you're applying/interviewing. If you like inpatient medicine then you really owe it to yourself to spend some time shopping around for different positions. I'm certain you'll be able to find something better than 7-7 and 7on/7off.
 
jacksparrow82 said:
That is definitely one of the first things you should ask about when you're applying/interviewing. If you like inpatient medicine then you really owe it to yourself to spend some time shopping around for different positions. I'm certain you'll be able to find something better than 7-7 and 7on/7off.
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I really like that we're starting to see some decent actual research coming out saying that you get happier doctors who stick around longer if you have flexible scheduling. Since we already have research that says happier doctors = better care and happier patients, hopefully that will become a trend.
 
FWIW, there is only 1 group out of the 7 that I know of in my town, that does 7/7 scheduling. All the rest have much more flexible schedules with admitting/rounding shifts, swing shifts, Nocturnists and night bonuses.

The 7/7 model is easy to schedule...and there's almost no other upside to it.
 
it is slightly off topic here but earlier this morning one of the third year residents was talking about how he signed a hospitalist contract with 40k sign on bonus in a 30 plus hospitalists group. He said he has been told people can potentially make 350K to 450k picking extra shifts. He signed in a midwestern small town but I was still skeptical about the pay? Is it feasible to make this much in hospital medicine?
Oh and he said no procedures/Icu coverage and he has nothing to do with codes !
 
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Successor12 said:
it is slightly off topic here but earlier this morning one the third year residents was talking about how he signed hospitalist contract with 40k sign on bonus in a 30 plus hospitalist a group. He said he has been told people can potentially make 350K to 450k picking extra shifts. He signed in a midwestern small town but I was still skeptical about the pay? Is it feasible to make this much in hospital medicine?
Oh and he said no procedures/Icu coverage and he has nothing to do with codes !
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450k may be pushing it, but the 350 is doable...probably have to pick up an extra 5-7 shifts a month, but doable.
 
Successor12 said:
it is slightly off topic here but earlier this morning one of the third year residents was talking about how he signed a hospitalist contract with 40k sign on bonus in a 30 plus hospitalists group. He said he has been told people can potentially make 350K to 450k picking extra shifts. He signed in a midwestern small town but I was still skeptical about the pay? Is it feasible to make this much in hospital medicine?
Oh and he said no procedures/Icu coverage and he has nothing to do with codes !
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You can make 250+ working 12-14 days a month in the Midwest easy. Work like a resident and you'll hit >400, but you'll also want to shoot yourself after a few months.
 
Raryn said:
You can make 250+ working 12-14 days a month in the Midwest easy. Work like a resident and you'll hit >400, but you'll also want to shoot yourself after a few months.
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Yeah one of the local groups pulls in numbers like that. 30-ish patients/day, 7-on 7-off, one 24 hour shift in your week one. When my wife interviewed there, the quote was "Yeah we make a ****load of money but the workload is a real piledriver".
 
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