Coming from an academic program in NorCal and currently applying for hospitalist positions, I wanted to know if anyone has any experience working at Kaiser and what they think of it. Is it frustrating to be a part of an HMO? Are your decisions completely autonomous or do you have to follow certain Kaiser protocols? I'm very interested in working here but just don't seem to know much about it. If anyone could help that would be great.
Hospitalist work at NorCal Kaiser
- Thread starter goanit
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I did some work at Kaiser as a resident and moonlighted a little on their hospitalist service when I was a fellow so I know some (but not a ton) about it. You get to practice somewhat autonomously with the caveat that they focus on EBM like it's going out of style. So if you can't find a Phase III RCT to support whatever you want to do, you're not going to get to do it. Also, because they contract with pharma companies to get drugs systemwide, you may be stuck with a different ACEI/ARB or statin than you're used to...you get over it. You may also not have the full range of subspecialties available to you in-house. I know that at our Kaiser hospital, all CT surgery, transplant surgery and most neurosurgery as well as BMT and all Peds (not an issue for you) gets sent up here to the U. This might make a complex patient more difficult to deal with but in general, if a procedure they can't do is indicated, they will get transferred.
Upsides of the system are phenomenal inpatient/outpatient integration. Like at the VA, you don't have to worry about your patient having a PCP to follow them on discharge...they've got one. Also, drugs are cheap for them, even non-generics so, while they may not take them (a problem everywhere), they can get them (a problem lots of places).
I know a ton of people who have taken hospitalist jobs with Kaiser and love it. The same can not be said for some of the people I know working RVU-based private hospitalist gigs (although many of them love their jobs as well).
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I've worked for Kaiser in northern california for the last 5 years, and worked at a sutter hospital for 1.5 years prior to that immediately after coming out of residency. It's overall been a great experience. I would certainly recommend looking at kaiser for positions. The system will be the same regardless, but the details of the job/program may very quite a bit between specific hospitals so be careful with that. I find I am able to practice good medicine with quite a lot of autonomy. I really wouldn't worry about that issue at all. You may not be able to get the latest treatment/medication you read about but in general I have not had any significant issues where I felt my care was compromised. As regards to formulary medications that gutonc mentioned, honestly I found this to be much worse working at sutter. Every hospital will have their own inpatient formulary. At least at kaiser its one systemwide formulary. I found it difficult at sutter when I was discharging patients, depending on which private insurance they had, they each had different formulary medications, and I often had no idea which medication i needed to switch to at discharge.
The system overall really enhances your ability to provide great care. I love having access to all of my patients medical records, not having to worry about care being fragmented. And it is so easy to establish post discharge followup that really eases a lot of worries you may have about discharging people.
For inpatient what services you have available will very greatly between facilities as they concentrate subspecialty care at a few locations. This can present challenges sometimes.
If you have any specific questions feel free to private message me.
