Hospitalist

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Cristagali

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Any opinions abot a future career as a hospitalist. I was leaning FM, but this new discipline intrigues me? :confused:
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Cristagali said:
Any opinions abot a future career as a hospitalist. I was leaning FM, but this new discipline intrigues me? :confused:
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Check out http://www.hospitalmedicine.org/. They have a lot of info on the subject. Also, you can be a Hospitalist from either IM, FM, or Ped.
 
Hi Cristagali.

I have really looked into it on the interview trail. As you know, I interviewed in FP, IM and Med/Peds.

90+% of hospitalists are IM docs and the rest are FP, med/peds and a few subspecialists like pulm/critical care. Check out www.naiponline.com

If you look at online job ads, you'll see there are tons of openings. Most schedules are very appealing, like 12 hour shifts, 7 days on/7 days off or 2/2 with every other weekend off. Many job ads ask for IM or FP applicants. ONthe trail I met many residents that were looking into becoming hospitalists and I know of one FP program with a hospitalist track.

Personally, I think a hospitalist job would be a good way to begin a career and I believe it would be very possible to settle into an out-patient practice afterwards (whereas the opposite may be harder to do).
 
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I too am interested in this emerging area of practice.

How do the hospitalists spend that 12 hour shift? Do they do rounds on the floors on their patients and then work the ICU? Do most just work in the ICU?

Thanks
 
I've heard mixed reviews, but mostly + stuff. I've only seen one IM program specifically mention Hospitalist track, but maybe more will do so for next Match. Anyway, thanks for the feedback. :cool:
 
There are two models that I have been exposed to. At the university hospital here the hospitalists are the teaching attendings and the attendings of record. All inpatients on the medicine service are taking care of by residents and their attending. The other system I have seen is where there is a hospitalist service. These are patients taken care of by attending hospitalists only. The hospitalist is essentially the resident team. Fellows I know who worked as hospitalists say they normally had a panel of 15 to 20 patients at any one time. And to an attending hospitalist a large panel is good because it means that get paid more - unlike a house officer team where lots of patients equals pain. In any case the hospitalists here are a very happy bunch of academics who enjoy teaching and enjoy the challenge of inpatient medicine. In addition some of them also have part-time outpatient practices or they attend on the resident clinics.

Residents I know who went into private practice hospitalist positions are normally paid a base salary. Once their panel increases beyond a certain number they earn a percentage of the profits that the practice gets from those additional patients. Example base of $80-100,000 qyear for a panel of 15 patients, when they increase to an average panel of say 20 their income can go up to $120,000. After being with the practice for say three or five years they then qualify for additional profit sharing from the pool, but they no longer qualify for their base salary. The numbers are approximate but it is the general idea of the jobs some people I know have.
 
Furrball said:
There are two models that I have been exposed to. At the university hospital here the hospitalists are the teaching attendings and the attendings of record. All inpatients on the medicine service are taking care of by residents and their attending. The other system I have seen is where there is a hospitalist service. These are patients taken care of by attending hospitalists only. The hospitalist is essentially the resident team. Fellows I know who worked as hospitalists say they normally had a panel of 15 to 20 patients at any one time. And to an attending hospitalist a large panel is good because it means that get paid more - unlike a house officer team where lots of patients equals pain. In any case the hospitalists here are a very happy bunch of academics who enjoy teaching and enjoy the challenge of inpatient medicine. In addition some of them also have part-time outpatient practices or they attend on the resident clinics.

Residents I know who went into private practice hospitalist positions are normally paid a base salary. Once their panel increases beyond a certain number they earn a percentage of the profits that the practice gets from those additional patients. Example base of $80-100,000 qyear for a panel of 15 patients, when they increase to an average panel of say 20 their income can go up to $120,000. After being with the practice for say three or five years they then qualify for additional profit sharing from the pool, but they no longer qualify for their base salary. The numbers are approximate but it is the general idea of the jobs some people I know have.
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Hi!

I'm still in premed outside of US but I would like to ask what is the difference between a resident and a hospitalist? Or a fellow and a hospitalist? :confused:
'cause i have an aunt, and she used to be a pulmonologist in Cali and now she says she's a hospitalist..what's the difference in years of training or programs? :luck:
 
A resident is an MD or DO who is completing their post-graduate medical education so they can become board certified in a specialty. A fellow is a physician who has completed residency training and is now subspecializing. They are roughly equivalent to PhD post doctoral fellows. A hospitalist is a physician who specializes in treating patients only on an inpatient basis. Normally they are board certified in family, internal, or pediatric medicine. In some hospitals they are the attendings for the resident teams. Or sometimes they run separate services without any residents.

The following definition is lifted from teh Society of Hospital Medicine web page: http://www.naiponline.org/presentation/apps/indlist/intro.asp?flag=6


Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching research, and leadership related to Hospital Medicine.

The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients. The term was coined by Drs. Robert Wachter and Lee Goldman in a New England Journal of Medicine article in August of 1996 (Wachter RM, Goldman L. The emerging role of "hospitalists" in the American health care system. N Engl J Med 1996;335:514-7). While some doctors have emphasized inpatient care for many years, there has been an explosive growth of such doctors since 1994.

I hope that answers your question.
 
Furrball said:
Example base of $80-100,000 qyear for a panel of 15 patients, when they increase to an average panel of say 20 their income can go up to $120,000. After being with the practice for say three or five years they then qualify for additional profit sharing from the pool, but they no longer qualify for their base salary.
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That salary seems low. I was hearing more like $175K/year when I was interviewing. No first hand knowledge tough. I can tell you the hospitalists in Houston that I know work their tails off. That was the deal. You work really hard, albeit in shifts, and you are financially compensated for your troubles. Maybe I am way off about the salary though. I heard that in Dallas and remember thinking that was way high.
 
retroviridae said:
That salary seems low. I was hearing more like $175K/year when I was interviewing. No first hand knowledge tough. I can tell you the hospitalists in Houston that I know work their tails off. That was the deal. You work really hard, albeit in shifts, and you are financially compensated for your troubles. Maybe I am way off about the salary though. I heard that in Dallas and remember thinking that was way high.
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Portland is a nice place to live so I think the hospitals low ball applicants salaries. Also I think the 80-100 K is for an academic institution so the pay is more for half-time clinician who also does research. Plus that is base pay for carrying then minimum panel of patients and with no outpatient clinic practice.
 
I also question the pay. Most job postings I've seen for hospitalist start from 130K -175K + bonus, incentives. I have no fear of working my tail off, as long as I get compensated fairly for it. I won't see my family much, but at least I can take them to Hawaii! :D
 
I hope you are right. I've got loans to pay off. I came up with that number talking to people I know applying for jobs as hospitalists. It's also probably very dependent on where in the country you are. One of the PGY3s here interviewed at the Mayo for a hospitalist position. It was 100 k qyear for 26 weeks of the year. So the full time job is effectively half time. So 175 K for 52 weeks -- with vacation -- seems reasonable.
 
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Yeah I too was once interested in being a hospitalist, what appealed to me most was the shift work(like EM), but I guess I would worry that after awhile I would start to develop "perpetual intern syndrome".... :(
just my thought

goose
 
Goose...Fraba said:
Yeah I too was once interested in being a hospitalist, what appealed to me most was the shift work(like EM), but I guess I would worry that after awhile I would start to develop "perpetual intern syndrome".... :(
just my thought

goose
Click to expand...

Yes, but the hours are SO much better than those of an intern. Several of my classmates are getting positions as hospitalists right now, and I'm quite envious of their hours. They are starting a new hospitalist service at our program's hospital, and have hired 4 of our new graduates to staff the service. It's basically a PA service, supervised by the hospitalists. But the hours are the best part -- 7 days on, 7 days off! A couple of them are trying to arrange it so that they do 14 days on 14 days off so that they can travel during their time off!

My other classmates who are getting other hospitalist positions are telling me about similarly nice schedules. I don't know what their salaries will be, though - I might try to discreetly find out.
 
100k for 26 weeks? Sweet deal! Although it is in cold Minnesota. Then I can moonlight with the snowbirds!! Thanks for that post! :cool:
 
I hear a lot about the 7 days on, 7 days off thing, but how are the hours during the 7 days? Is it like 8 hour shifts? or 12 hours, or more?
 
12s typically
 
Someone told me that they get paid roughly a thousand dollars per shift of 12 hours.if thats true then for a person working 20 days per month would be earning 20,000 per month which makes it 240,000 per year.This is not bad by any means. the guy works somewhere in NC.Any comments about this guys?
 
$240K qyear?! That sounds really high. The hospitalists here earn 150 to 170K and work hard; and are some of the higher paid hospitalists in the region (Michigan). Actually they get paid more than some of the gen IM outpatient attendings with years of experience.
 
I've taken a position as a hospitalist. There are some internish type qualities about it, but it is MUCH nicer than being an intern. I don't feel as lost as I did as an intern, and I don't have to run my plan through a resident, a fellow, or an attending! They are MY patients, and I get to call the shots. A very nice things indeed until you think about the responsibility.

The hours vary with the job. I'm in a 7 on 7 off arrangement. I work from 8-5 pm most days, ending at 6pm when I'm the call person. (the ED or referring physician calls me, then I hand it over to the next doc up for an admission.) I'm contracted to work one 14hr night a month, but usually work 3-4. My census has ranged from 9 to 20, with the usual being 16. I have 4 weeks of vacation/CME time. The schedule person tries so that we have at least one week off a month without having to do any nights. I interviewed for a job with hours 9 to 5 M-F with call once a week and once a weekend/mo. Some people do moonlight, but most of my coworkers spend the extra time with family or vacation instead. I usually hang out with family.

I get a base salary and am paid for any overtime (2nd night a month, etc.) The salary isn't bad- less than in a production based model, a lot more than working at McD's. Production models base how much you are paid by how many patients you see and the level of care. (ASK your attendings about how to do billing! It isn't important to you now, but it will be when you finish residency/fellowship!) The base salaries I've seen are from the 140's to 180's. It is also affected by the area you are in. Not everywhere has been invaded by hospitalists!

The average day has me getting sign out from the night people first thing in the morning, then seeing the sickest patients first. Then the patients being discharged. Then finishing up the rest of the list. Lunch with co-workers or a meeting. I spend a lot of time on the phone with the patients' primary doctors. Sometimes, I won't finish up my list until late, especially if I take a lot of time with patients and families. Admissions get sprinkled in throughout the day- usually 2 or 3. I co-manage ICU patients, or if the service is very busy, I'll have the critical care attending take over management.
 
the salary still isnt bad even if one gets paid 150 to 180 k for 2 weeks work a month.i agree the work is hard but in the end the 7 day on and 7 day off option is appealing.i wonder whats the downside to this kind of work and why people are not intersted in doing it in the long run,considering hospitalists make more than the average primary care IM doc,any input?
 
Heya anette,

Im an intern in manhattan and have a few questions-

What area of the country are you, and are you in or near a city?

What was the general salary range when you were looking at positions?

I know there are "physician salary" websites out there, but I dont know how accurate tehy are for soemone just out of residency, only looking to take a year off before fellowship

Thanks!
 
Soul, some people don't like the inpatient environment, some want continuity of care (not counting the frequent fliers), some what more set 8-5 hours, some don't like the "intern for life" aspects of it.
 
here's a job posting from hospitalist.com. it seems pretty straight forward and well described. mind you they quote a base compensation package that includes all benefits:

ID: 4099
Location: CALIFORNIA
Hospitalist Opportunity in Los Angeles/South Bay area
Physician owned hospitalist group
Total Compensation Package starts at $230,000 (Base salary, bonus, and benefits). - Varies with level of experience.
7 days on / 7 days off schedule
Academic/Teaching activities encouraged
Internal Medicine Board Eligibility or Board Certification required
Additional positions available for Critical Care subspecialists
Outstanding opportunity to work in a large 370-bed medical center with tremendous growth opportunities.

For more information about this position, contact Alexander Shen, M.D., Medical Director of Hospitalist Services, Centinela-Freeman Hospital System, or email [email protected]. You may email your CV to the email address in the ad or by FAX, if there is a FAX number given in the ad.
When you call or email, please say that your saw this position on HospitalistJobs.com
Posted or Updated: 12/15/2006
 
Do all hospitalists have this 7 days on, 7 days off schedule? If I wanted to, could I just work a more normal schedule, like 5 days a week or something?
 
hlchess said:
Do all hospitalists have this 7 days on, 7 days off schedule? If I wanted to, could I just work a more normal schedule, like 5 days a week or something?
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No, not all schedules are the same. It all depends on the hospital. 7on/7off and 14 on /14 off seems to be the more common, but I've also seen 14 on/7 off. But I have not seen a weekday on weekdays off schedule on any of the help wanted adds. And be careful which institution you end up at. I know a few hospitals which work their h-ists hard with census lists 35+ pts. I've heard that one hospital in my home town had an average of 11 admissions an hour which would be divided up between however many h-ist services they had, and unofficially I've heard their census list never drops below 40 pts.
 
BerkeleyMD said:
here's a job posting from hospitalist.com. it seems pretty straight forward and well described. mind you they quote a base compensation package that includes all benefits:

ID: 4099
Location: CALIFORNIA
Hospitalist Opportunity in Los Angeles/South Bay area
Physician owned hospitalist group
Total Compensation Package starts at $230,000 (Base salary, bonus, and benefits). - Varies with level of experience.
7 days on / 7 days off schedule
Academic/Teaching activities encouraged
Internal Medicine Board Eligibility or Board Certification required
Additional positions available for Critical Care subspecialists
Outstanding opportunity to work in a large 370-bed medical center with tremendous growth opportunities.

For more information about this position, contact Alexander Shen, M.D., Medical Director of Hospitalist Services, Centinela-Freeman Hospital System, or email [email protected]. You may email your CV to the email address in the ad or by FAX, if there is a FAX number given in the ad.
When you call or email, please say that your saw this position on HospitalistJobs.com
Posted or Updated: 12/15/2006
Click to expand...

nice gig. here in my state, the hospitalist gig fresh out of residency is 160-170k
 
hlchess said:
Do all hospitalists have this 7 days on, 7 days off schedule? If I wanted to, could I just work a more normal schedule, like 5 days a week or something?
Click to expand...

as others have said, the schedule is variable.

i know some people fresh out of residency who have signed up for 7 on/7 off.

i know a hospitalist 3 years out of residency, who does 5 days a week, and is on call every 3rd or 4th weekend.

i've even heard of setups that were 4 days a week every week, and on call every 8th weekend.

there seem to be pros and cons to every set up, in terms of pay rate/base salary, amount of patients seen, expectations, length of shifts, etc. etc.
 
I am currently doing 7 on/7 off which seems like a common schedule for hospitalists. But as others have stated, the schedule can vary depending on the place of employment.

I would look closely at the base salary and benefits, average patient census, admissions and call, etc., in addition to schedule.
 
From first hand knowledge having spoken with hospitalist recruiters, etc., 80-100K would be ridiculously low for 15 pts. A hospitalist working half the year covering 15 pts should be earning between 170-200k. above 20 pts, you should be making 200+. It is not unheard of to make much more. There are hospitalists in this area making 400k, but they do not have time to spend it.
 
How is the 7 on 7 off schedule actually work out..Do most people feel it is very exhausting, is it like shift work...when you are on, you are on, when you are off you are off?....Another question (and I know this varies by hospital) but generally carrying 20 + pts, are the majority complex cases or is it a healthy mix of relatively simple and some complex? Thanks in advance, Im really interested in this path
 
Susan Watts said:
How is the 7 on 7 off schedule actually work out..Do most people feel it is very exhausting, is it like shift work...when you are on, you are on, when you are off you are off?....Another question (and I know this varies by hospital) but generally carrying 20 + pts, are the majority complex cases or is it a healthy mix of relatively simple and some complex? Thanks in advance, Im really interested in this path
Click to expand...

When you're on, you're on and you work your butt off. When you're off, you recover for a day or two, then enjoy the rest of the time off. It is like shift work in a way, but you work until you're done (not just working a certain number of hours). You may spend evenings at home finishing up 'paper'work, electronically in most cases. As far as patient load, this will vary by hospital, but in a busier place, you probably are gonna be carrying upwards of 18-20 daily. (I have seen folks carrying in the mid-20s when the hospital peaks. Not pretty.) If you're in a place where call is rotated, you may also be doing a few admissions during the day. Generally, you will have a mix of high and low complexity cases, with most being lower complexity in my experience, but this will vary from day to day and from one week to the next.
 
So is being a hospitalist more of an endurance challenge seeing 20 pts and doing the paperwork, or is there also an element of intellectual challenge that is sometimes draining? I guess the question I am getting at is, if someone is organized and efficient, will it not feel as bad? Also, after residency does the prospect of 20 pts not seem as daunting due to your training? How much time does one average with a patient? Sorry for all the questions, but this seems like an interesting career path and I'd like to know as much as I can. Thanks
 
I think it can be tough, especially 7on/7off. I just graduated and am working as a hospitalist and the 7 day stretch is really hard. You are literally working non-stop from 7am until you are done with your work which can be as late as 9pm if you get a late admission. It is not like residency where you can sit around and round on patients, go to morning reports and noon conferences, hoping you don't get that late admit. My schedule varies, so I try to break it up into shorter spurts like 3-5 days on and 2-3 days off. I see a lot of burn-out in the hospitalists that see 24 patients a day and work 24 shifts a month. I think that since this is a relatively new industry there are still some growing pains. In time I think we will see some changes because there is definitely a need for hospitalists. I rarely see an outpatient PCP admit and follow their own patients in the hospital. They really do rely on the hospitalist to do the job.
 
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