Hospitalist

[IdontTakeCall]

So i want to be an ER doc, but im worried about not being able to get into an EM reisideny or only getting into one that my family (wife and 2 under) cant move with me to. My alternative is internal medicine, with the intent of being an in-house internist or hospitalist i guess its now called. How much more/less competitive is a conventional (not yale) IM residency vs Em and whats the difference in salary between a hospitalist and EM?

---

Members don't see this ad.

 

[dragonfly99]

Internal medicine is quite a bit less competitive than ER residency.
If I were in your situation I guess I might apply to both (i.e. ER and IM residencies that you would be willing to move to/go to).
Hospitalists make probably mid 100-thousands I would say. Pretty good money if you are just starting out.
My impression is that ER docs make in the 200's, but you might want to post a thread in the ER section, buy do a search for "ER salary" or "ER pay" before you post.

Have you talked to ER faculty about whether you might be competitive vs. not as an ER applicant? At least it can give you an idea about whether they would write you good letters of recommendation, which is a big part of the application process.

 

[IdontTakeCall]

well i spoke to the chief residents at the institution that is at the top of my list. Both of them are from my school though they are D.O's and its an allopathic hospital. They said that rotating with them is very important and that i dont need to take the USMLE the COMLEX is suffiecient. But i havent taken the comlex yet and my overall avg through the first 1.5 years is about 86. I usually do well on standarized tests but im not sure how well ill do ont he boards. I guess ill just apply to a few IM programs in addition to the EM programs im going to apply to though theres only about 6-7 as im greatly limited by location. so should i just rank the 2 Im spots just after the EM residencies and plan on them if I dont make it into one of the EM ones?

 

[DrSmiles]

Perhaps I can help give you some insight. I graduated from a DO school and was deciding between EM and IM as well. I also have a family so I needed to match in one location and this limited the places I could apply to. I ended up going the IM route for several reasons. There are more IM programs and they are easier to get into. There are also more choices and different directions you can take once you are in an IM residency. You can do a fellowship if you want to specialize, do something more hands-on, or work primarily in the hospital (i.e. critical care fellowship). Or you can work as a hospitalist- I am interviewing for positions now and they are paying over $200,000 which includes the yearly bonuses.
I also felt that if I really really wanted to work in an ER when I was done I could probably do so at a small community/suburb ER as an IM doc.
You can also do Urgent care if you get tired of being a hospitalist. The hospitalist burn-out is decreasing though. A lot of groups are limiting the nights you have to work, or are hiring nocturnists. Every group is different and everything is negotiable.
The downside of going into EM is that you are stuck if you decide you want a change later in life. And I have heard this from other EM docs who wanted to change and leave the ER.
Just know for sure what you want and you will be fine.
Good luck.

 

[skypilot]

Perhaps I can help give you some insight. I graduated from a DO school and was deciding between EM and IM as well. I also have a family so I needed to match in one location and this limited the places I could apply to. I ended up going the IM route for several reasons. There are more IM programs and they are easier to get into. There are also more choices and different directions you can take once you are in an IM residency. You can do a fellowship if you want to specialize, do something more hands-on, or work primarily in the hospital (i.e. critical care fellowship). Or you can work as a hospitalist- I am interviewing for positions now and they are paying over $200,000 which includes the yearly bonuses.
I also felt that if I really really wanted to work in an ER when I was done I could probably do so at a small community/suburb ER as an IM doc.
You can also do Urgent care if you get tired of being a hospitalist. The hospitalist burn-out is decreasing though. A lot of groups are limiting the nights you have to work, or are hiring nocturnists. Every group is different and everything is negotiable.
The downside of going into EM is that you are stuck if you decide you want a change later in life. And I have heard this from other EM docs who wanted to change and leave the ER.
Just know for sure what you want and you will be fine.
Good luck.

Nice post. I think the hospitalist route has made IM much more palatable to people who are concerned about lifestyle. VA hospitals hire IM doctors to work in their ERs. And as was mentioned you can work in fast track ER, urgent care, primary care, pursue a fellowship, or even sign up for Doctors without borders and move to a third world country when you finish your IM residency.

 

[Amy B]

I was also torn between IM (hospitalist route) and EM. I spoke with a number of people including my dean which helped me make my decision to go IM. If you do not want to work in a Trauma center, you can be an ER doc with a IM residency background. If you get burned out doing ER, then you have a fall back of IM. We have a lot of our ER docs that are IMed trained. They know there stuff and are great ER docs. This is of course only if you dont want to work at the big trauma centers.
Just food for thought......

 

[iatrosB]

I was also torn between IM (hospitalist route) and EM. I spoke with a number of people including my dean which helped me make my decision to go IM. If you do not want to work in a Trauma center, you can be an ER doc with a IM residency background. If you get burned out doing ER, then you have a fall back of IM. We have a lot of our ER docs that are IMed trained. They know there stuff and are great ER docs. This is of course only if you dont want to work at the big trauma centers.
Just food for thought......

Do they feel confident treating the emergent child cases?

 

[carn311]

I was also torn between IM (hospitalist route) and EM. I spoke with a number of people including my dean which helped me make my decision to go IM. If you do not want to work in a Trauma center, you can be an ER doc with a IM residency background. If you get burned out doing ER, then you have a fall back of IM. We have a lot of our ER docs that are IMed trained. They know there stuff and are great ER docs. This is of course only if you dont want to work at the big trauma centers.
Just food for thought......

Be aware that fewer and fewer hospitals are hiring non-EM trained physicians for their EDs. You will certainly not be in a major urban area if you do find a job.

So, I wouldn't depend on this option as you make your choice. I would be more concerned with whether or not I was ok with having a hospitalist and/or urgent care practice.

 

[andwhat]

Be aware that fewer and fewer hospitals are hiring non-EM trained physicians for their EDs. You will certainly not be in a major urban area if you do find a job.

So, I wouldn't depend on this option as you make your choice. I would be more concerned with whether or not I was ok with having a hospitalist and/or urgent care practice.

I will say that I love sleeping, when I know that the ER doc is working hard in the ED on a night shift. I do not sleep the entire night every night, but it sure beats working in the ED, or taking call in any specialty, as a Hospitalist that is. We get paid as much as they do -- ER certified docs, as well as Primary Care docs doing ED work (we get paid more than the Primary Care docs).

 

[Amy B]

Be aware that fewer and fewer hospitals are hiring non-EM trained physicians for their EDs. You will certainly not be in a major urban area if you do find a job.

So, I wouldn't depend on this option as you make your choice. I would be more concerned with whether or not I was ok with having a hospitalist and/or urgent care practice.

We are in a more rural location where there is a shortage of docs.

 

[arrhythmia7]

I thought I would throw in a reality check and just be up front about numbers as I've now worked in a couple of different hospitalist groups:
I worked as a per diem hospitalist in LA last July-Sept and made 30k a month pre-tax. Granted, I only took two days off out of every 14, and had to pay for my own insurance, but that's 360k a year. The going rate seems to be about $100/hr day and $115/hr night unless you work for a place like Kaiser. Slightly less than EM, but a lot more down time and what I feel is a more sustainable work style.
All of the full-time hospitalists in my group were averaging about 220-240k after bonuses. That's working 28 weeks/year (with two weeks of scheduled nights added on to the standard 26)! One of my friends joined a private group in Newport Beach, CA, and is making ~230k/year. Pretty sweet deal.
I'm now a full-time academic hospitalist while working on an MBA, and I'm making just under 200k after bonus. This job is much less demanding from a clinical standpoint than private practice was...and the pay reflects that. I'm usually home by 3-4 pm unless I'm admitting late (once a week). I don't know of any hospitalists making less than 180k/year, unless they are on a part-time work schedule (like 10 days/month). The exception might be if you use a headhunter to find your job. These guys typically skim about 20 grand off your first year salary. Don't use them. Period. They target less desirable locations/positions, and the market is wide open pretty much anywhere you want to live if you do a little footwork yourself.
I don't know much about EM, but I definitely know that hospitalist work is more sustainable long-term than critical care (i.e. two physicians in my last group left critical care to do hospitalist work). Also, you are at the core of patient flow and control who gets consulted, so people are pretty nice to you. Subspecialists actually *want* to be consulted (unlike in training). Most of the undesirable aspects of medicine that residents dread (read: social issues) are handled by the much more skilled social workers, discharge planners, and hospice teams that you encounter once you're in practice. It's actually pretty relaxing, and I never really feel stressed. It's great to have the off weeks for other ventures...you can start up unique practices (cash based, medispa) or develop non-clinical opportunities. Much better than being in a small subspecialty practice where you're on call every 4th night, and getting paged by the ED at all hours. Also, as a non-proceduralist you are less likely to get sued, get hep C from a needle stick, get a brain tumor from that pesky fluoroscopy C-arm in the cath lab, etc...
One thing that struck me as I finished training this last year are how many misconceptions my fellow residents and I had about life/salary in private practice. Everyone is focused on making 350k/year in x specialty vs. 250k/year in y specialty, but in reality, the differences after tax turn out to be peanuts when you factor in your lifestyle and length of training. It all depends on how hard you work and how resourceful you are. Besides, doctors have a track record of handling the money they do make very poorly!

 

[andwhat]

I thought I would throw in a reality check and just be up front about numbers as I've now worked in a couple of different hospitalist groups:
I worked as a per diem hospitalist in LA last July-Sept and made 30k a month pre-tax. Granted, I only took two days off out of every 14, and had to pay for my own insurance, but that's 360k a year. The going rate seems to be about $100/hr day and $115/hr night unless you work for a place like Kaiser. Slightly less than EM, but a lot more down time and what I feel is a more sustainable work style.
All of the full-time hospitalists in my group were averaging about 220-240k after bonuses. That's working 28 weeks/year (with two weeks of scheduled nights added on to the standard 26)! One of my friends joined a private group in Newport Beach, CA, and is making ~230k/year. Pretty sweet deal.
I'm now a full-time academic hospitalist while working on an MBA, and I'm making just under 200k after bonus. This job is much less demanding from a clinical standpoint than private practice was...and the pay reflects that. I'm usually home by 3-4 pm unless I'm admitting late (once a week). I don't know of any hospitalists making less than 180k/year, unless they are on a part-time work schedule (like 10 days/month). The exception might be if you use a headhunter to find your job. These guys typically skim about 20 grand off your first year salary. Don't use them. Period. They target less desirable locations/positions, and the market is wide open pretty much anywhere you want to live if you do a little footwork yourself.
I don't know much about EM, but I definitely know that hospitalist work is more sustainable long-term than critical care (i.e. two physicians in my last group left critical care to do hospitalist work). Also, you are at the core of patient flow and control who gets consulted, so people are pretty nice to you. Subspecialists actually *want* to be consulted (unlike in training). Most of the undesirable aspects of medicine that residents dread (read: social issues) are handled by the much more skilled social workers, discharge planners, and hospice teams that you encounter once you're in practice. It's actually pretty relaxing, and I never really feel stressed. It's great to have the off weeks for other ventures...you can start up unique practices (cash based, medispa) or develop non-clinical opportunities. Much better than being in a small subspecialty practice where you're on call every 4th night, and getting paged by the ED at all hours. Also, as a non-proceduralist you are less likely to get sued, get hep C from a needle stick, get a brain tumor from that pesky fluoroscopy C-arm in the cath lab, etc...
One thing that struck me as I finished training this last year are how many misconceptions my fellow residents and I had about life/salary in private practice. Everyone is focused on making 350k/year in x specialty vs. 250k/year in y specialty, but in reality, the differences after tax turn out to be peanuts when you factor in your lifestyle and length of training. It all depends on how hard you work and how resourceful you are. Besides, doctors have a track record of handling the money they do make very poorly!

great post... my greatest dilemma in my new career choice, is what to do with all of my time off! I love this job.....

 

[droncall]

great post... my greatest dilemma in my new career choice, is what to do with all of my time off! I love this job.....

Ditto. Great post. Thanks for the insight. As someone going into IM (who pondered EM and other 'lifestyle' specialties), I'm happy to hear about the flexibility.

 

[Atlas]

I thought I would throw in a reality check and just be up front about numbers as I've now worked in a couple of different hospitalist groups:
I worked as a per diem hospitalist in LA last July-Sept and made 30k a month pre-tax. Granted, I only took two days off out of every 14, and had to pay for my own insurance, but that's 360k a year. The going rate seems to be about $100/hr day and $115/hr night unless you work for a place like Kaiser. Slightly less than EM, but a lot more down time and what I feel is a more sustainable work style.
All of the full-time hospitalists in my group were averaging about 220-240k after bonuses. That's working 28 weeks/year (with two weeks of scheduled nights added on to the standard 26)! One of my friends joined a private group in Newport Beach, CA, and is making ~230k/year. Pretty sweet deal.
I'm now a full-time academic hospitalist while working on an MBA, and I'm making just under 200k after bonus. This job is much less demanding from a clinical standpoint than private practice was...and the pay reflects that. I'm usually home by 3-4 pm unless I'm admitting late (once a week). I don't know of any hospitalists making less than 180k/year, unless they are on a part-time work schedule (like 10 days/month). The exception might be if you use a headhunter to find your job. These guys typically skim about 20 grand off your first year salary. Don't use them. Period. They target less desirable locations/positions, and the market is wide open pretty much anywhere you want to live if you do a little footwork yourself.
I don't know much about EM, but I definitely know that hospitalist work is more sustainable long-term than critical care (i.e. two physicians in my last group left critical care to do hospitalist work). Also, you are at the core of patient flow and control who gets consulted, so people are pretty nice to you. Subspecialists actually *want* to be consulted (unlike in training). Most of the undesirable aspects of medicine that residents dread (read: social issues) are handled by the much more skilled social workers, discharge planners, and hospice teams that you encounter once you're in practice. It's actually pretty relaxing, and I never really feel stressed. It's great to have the off weeks for other ventures...you can start up unique practices (cash based, medispa) or develop non-clinical opportunities. Much better than being in a small subspecialty practice where you're on call every 4th night, and getting paged by the ED at all hours. Also, as a non-proceduralist you are less likely to get sued, get hep C from a needle stick, get a brain tumor from that pesky fluoroscopy C-arm in the cath lab, etc...
One thing that struck me as I finished training this last year are how many misconceptions my fellow residents and I had about life/salary in private practice. Everyone is focused on making 350k/year in x specialty vs. 250k/year in y specialty, but in reality, the differences after tax turn out to be peanuts when you factor in your lifestyle and length of training. It all depends on how hard you work and how resourceful you are. Besides, doctors have a track record of handling the money they do make very poorly!

I couldnt agree with this more. Nice post.

 

[retcod]

I read Arrythmia7's post with interest. It's always interesting to compare another physician's work experience with your own.

I work as a hospitalist in a nice, large hospital the DC metro area. It's also a teaching hospital for several residency programs. So my job is a hybrid of academic and community practice.

For the right kind of person, hospitalist medicine is very enjoyable and satisfying. It has a high level of acute care and faster pace than office based medicine. You do get bogged down by social issues occasionally, but there's alot of ancillary support.

I see between 12-15 pts a day. I work a week of nights every two months, but generally my work hrs of 8-5 M-F. I round on the weekend once a month.

Compensation is good, $150K base +20% bonus (if I meet the 3400 RVU/yr goal). Malpractice insurance, 401K, and $3000 CME fund is provided by the hopsital. I'd say I'm upper middle class for the area. Not ridiculously wealthy, but not hurting either. When I compare my salary to my friend in Cleveland( endocrine $220,000/yr) I think it's pretty fair.

I think this model is much more sustainable than the 7d on, 7d off model. When I talk to my friends in the ER, I think I much happier. Those guys are burned out after 3 years and all of them talk about their exit plan from ER medicine. They may make $40K more, but I don't think the increased stress and lack of professional fullfillment is worth it.

If you look at the survey done by the Society of Hospital Medicine (SHM), salaries are generally in $200k range across the country. Incredibly, practices lost about $100K/year per hospitalist after accounting for payroll taxes, admin support, etc. The billing for a hopsitalist is not as lucurative as you would imagine. But hospitals figure that hospitalsit provide costs savings in terms of length of stay, utilization resources etc that make up for the $100K. Plus hospitalists provide leadership and teaching that hospitals can't get out of the private attendings.

It'll be interesting to see how hospitalists as a specialty grows in the next 10 years. More and more hospitalist practices are taking on ortho and neurosurgery patients. In some hospitals, all post-op patients are handled by the hospitalists. So current IM training is probably not providing the breadth and diversity of patients that a hospitalist will encounter.

I hope this post helps the medical students and residents get a flavor of life "on the other side." Choose your training and job well. Base it on your life goals and morals. Base it on the reasons that brought you into medicine first. But don't base it just on money and hours. Jeez, if that's all you were concerned about, you probably just should have gone to Business School.

 

[Amy B]

Jeez, if that's all you were concerned about, you probably just should have gone to Business School.

 

[mig26x]

what type of work can a hospitalist do with those 7 days off? I ask because i would like to have a part time during those 7 days off, preferably 3 days out of those 7 days so i can rest the other days. I decided to work my ass off while Im young and then relax as I become older.

possibly work at Nursing home part time? clinic at jail? primary care as part time? do this option look reasonable or Im dreaming?

 

[dragonfly99]

what type of work can a hospitalist do with those 7 days off? I ask because i would like to have a part time during those 7 days off, preferably 3 days out of those 7 days so i can rest the other days. I decided to work my ass off while Im young and then relax as I become older.

possibly work at Nursing home part time? clinic at jail? primary care as part time? do this option look reasonable or Im dreaming?

Your hospitalist contract might limit or prohibit you from other work but I bet it depends on where you work/who you sign with. Doubtless you can find moonlighting and/or urgent care work to supplement your hours/income if that is what you would like, but you might enjoy your time off more than you think.

 

[LilJon]

im planning on going the hospitalist path myself. Im still pretty young, no family and dont think i need 7 days off. I would much rather be working. For you guys and gals who are practicing hospitalists...how reasonable do you think it is to hold a second job as a hospitalist if your contract doesnt have a clause prohibiting this? Do people do this commonly? Do you find that say your own group will allow you to pick up 4-5 extra shifts during your "off week"?

 

[Mac lover]

I read Arrythmia7's post with interest. It's always interesting to compare another physician's work experience with your own.

I work as a hospitalist in a nice, large hospital the DC metro area. It's also a teaching hospital for several residency programs. So my job is a hybrid of academic and community practice.

For the right kind of person, hospitalist medicine is very enjoyable and satisfying. It has a high level of acute care and faster pace than office based medicine. You do get bogged down by social issues occasionally, but there's alot of ancillary support.

I see between 12-15 pts a day. I work a week of nights every two months, but generally my work hrs of 8-5 M-F. I round on the weekend once a month.

Compensation is good, $150K base +20% bonus (if I meet the 3400 RVU/yr goal). Malpractice insurance, 401K, and $3000 CME fund is provided by the hopsital. I'd say I'm upper middle class for the area. Not ridiculously wealthy, but not hurting either. When I compare my salary to my friend in Cleveland( endocrine $220,000/yr) I think it's pretty fair.

I think this model is much more sustainable than the 7d on, 7d off model. When I talk to my friends in the ER, I think I much happier. Those guys are burned out after 3 years and all of them talk about their exit plan from ER medicine. They may make $40K more, but I don't think the increased stress and lack of professional fullfillment is worth it.

If you look at the survey done by the Society of Hospital Medicine (SHM), salaries are generally in $200k range across the country. Incredibly, practices lost about $100K/year per hospitalist after accounting for payroll taxes, admin support, etc. The billing for a hopsitalist is not as lucurative as you would imagine. But hospitals figure that hospitalsit provide costs savings in terms of length of stay, utilization resources etc that make up for the $100K. Plus hospitalists provide leadership and teaching that hospitals can't get out of the private attendings.

It'll be interesting to see how hospitalists as a specialty grows in the next 10 years. More and more hospitalist practices are taking on ortho and neurosurgery patients. In some hospitals, all post-op patients are handled by the hospitalists. So current IM training is probably not providing the breadth and diversity of patients that a hospitalist will encounter.

I hope this post helps the medical students and residents get a flavor of life "on the other side." Choose your training and job well. Base it on your life goals and morals. Base it on the reasons that brought you into medicine first. But don't base it just on money and hours. Jeez, if that's all you were concerned about, you probably just should have gone to Business School.

Retcod, is your hospitalist group subsidized by the hospital? I am on a 7d on and 7d off schedule but am seriously considering the M-F thing. Have you done the 7d on 7d off before?

 

[bof]

im planning on going the hospitalist path myself. Im still pretty young, no family and dont think i need 7 days off. I would much rather be working. For you guys and gals who are practicing hospitalists...how reasonable do you think it is to hold a second job as a hospitalist if your contract doesnt have a clause prohibiting this? Do people do this commonly? Do you find that say your own group will allow you to pick up 4-5 extra shifts during your "off week"?

You either a masochist or just naive. IMO, it is entirely not reasonable to hold a second job as a hospitalist. I can't imagine working for a group with a contract that would not prohibit this. Obviously people do not do this commonly.

That being said, yes you can pick up extra shifts when you are not on duty. Do note that often times you'll still have responsibilities when you are not on duty, such as being back up and such. I have found that there usually are plenty of people (usually the ones that have been working a while) that are more than willing to give up shifts. Just be careful of what you wish for.

 

[Old_Mil]

... Incredibly, practices lost about $100K/year per hospitalist after accounting for payroll taxes, admin support, etc. The billing for a hopsitalist is not as lucurative as you would imagine. But hospitals figure that hospitalsit provide costs savings in terms of length of stay, utilization resources etc that make up for the $100K. Plus hospitalists provide leadership and teaching that hospitals can't get out of the private attendings.

It'll be interesting to see how hospitalists as a specialty grows in the next 10 years.

Given those numbers, a group of ten hospitalists is losing a hospital a million dollars a year...In these economic times, with the focus on the short term bottom line that exists in management, numbers like that could put a brake on the growth of the specialty...

 

[LilJon]

You either a masochist or just naive. IMO, it is entirely not reasonable to hold a second job as a hospitalist. I can't imagine working for a group with a contract that would not prohibit this. Obviously people do not do this commonly.

That being said, yes you can pick up extra shifts when you are not on duty. Do note that often times you'll still have responsibilities when you are not on duty, such as being back up and such. I have found that there usually are plenty of people (usually the ones that have been working a while) that are more than willing to give up shifts. Just be careful of what you wish for.

oh sorry for asking a question that was so "obvious".

Does anyone else have some useful input?

 

[elwademd]

hospitalist work can be hard work. some days can be easy and straightforward. it really depends on a number of factors, running from thing the hospitals have in place (or don't), to things your group provides (or doesn't).

with that said, for the most part, im residency is exposure to hospitalist work. so, in a sense you're used to it. at least i think you should be.

i do 7 on, 7 off. i also had enough time in the hospital during residency to know that i don't want to be there more than i have to. the money's good, but it's not that important. i certainly have the opportunity to pick up extra shifts, or go work in urgent care or a post discharge clinic (a bridge between the hospital and primary care docs who can't see appointments right away).

but i don't sign up for them. again, i spent enough time in residency neglecting lots of things, that i refuse to continue to do that.

so, there are plenty of opportunities out there, you just need to see what's right for you.

it could be 7 on, 7 off. other groups want 14-16 shifts covered a month in anyway that you see fit. other groups want m-f. some groups want pure hospitalist work, others want you to be a hospitalist... but still see some clinic patients.

just make sure when you interview with groups or talk to headhunters, that you ask lots of question. its a recruiting process on both sides. they want to see if you're a good fit, but you need to see if they're a good fit for you as well. it can take a lot of money for a group to recruit, so they don't want to waste their time. and you shouldn't waste your time either.

i know hospitalists driving civics. i know others driving bently continental gt's. the sky is the limit. from what i've seen, it really just depends on how hard and how much you want to work.


fwiw, i just finished residency in june 08. i do 7 on/7 off. shift is 8am-8pm. no nights. cap at 20 pts a day (high, but has been rare to hit it) 3k cme. malpractice paid. 401k. group supplied blackberry. base is 154k. extra 5k/year for having passed the boards. quarterly bonus range of 2-5k depending on a variety of factors. reimbursed for state license costs, cost of the boards, subscriptions to journals, memberships for medical societies.

 

[mostwanted]

Would a FM residency prepare one well to be hospitalist? Also, for the physicians who are doing 7 on /7 off, do you feel it is a bit draining over time, or is it not so bad?

Thank you

 

[DaveinDallas]

Also, would any of the hospitalists out there comment on where you
see the field going in the next 10-15 years. I was discussing this
with a physician (who is board certified IM) and he commented
that there were a finite number of hospitals and the field would
probably be over capacity in the not too distant future.

Any thoughts?

 

[DrJosephKim]

Many family medicine docs end up being hospitalists. At the end of the day, it really depends on what you make out of the opportunities that are in front of you. If you want to gain lots of hospital experience, then moonlight as a "house doc" and gain those inpatient skills. Go to a non-opposed program where you're running the ICU and adjusting all the ventilator settings. The opportunities are there. You just have to go out there and find them.

If you want to do family medicine and work in the ER, then try to get some moonlighting in ERs. Get really comfortable with those skills and you'll have plenty of opportunities in community hospitals and in locum tenens.

 

[gutonc]

Also, would any of the hospitalists out there comment on where you
see the field going in the next 10-15 years. I was discussing this
with a physician (who is board certified IM) and he commented
that there were a finite number of hospitals and the field would
probably be over capacity in the not too distant future.

Any thoughts?

I've been thinking about this lately as a lot of my colleagues are noting that some of the programs in our area are starting to fill up and are no longer hiring hospitalists. One thing to keep in mind is that hospitalist programs are quite new and it's unclear exactly what the sustainable number of positions is. Another thing is that this does not (at least to me) seem like a long-term career option. I would imagine that, at least in the community setting, 5-10 years would be the most one could reasonably sustain that kind of schedule and workload. I don't think we're going to see too many career hospitalists (but I may be wrong). It strikes me more as an interim gig and that the majority of people will do it for 2-5 years and then move on to something else.

 

[dragonfly99]

I don't see the need for hospitalists drying up any time soon, though it's hard to predict the future.

I agree with guton on the burnout thing...a lot of young docs do hospitalist gigs, but since a lot of them are hospital employed and the hospitals tend to work people hard, folks tend to do it for 1-5 years, and then a lot of them move on. Hospitalist positions may evolve into something more sane (i.e. 7 or 8-5 M-F with some sort of weekend and night schedule set up either with rotating people or different people hired to do that) so that people would/will stay with it long term. Many community docs are giving up hospital practice, so I don't see the need for hospitalists ending soon. Judging by the mail I get recruiting for them, many places are still hiring...though many more job offers for primary care docs (traditional outpatient or outpatient + inpatient).

 

[nocdoc]

Most groups have their own open moonlighting spots..

 

[TPBC]

hospitalist work can be hard work. some days can be easy and straightforward. it really depends on a number of factors, running from thing the hospitals have in place (or don't), to things your group provides (or doesn't).

with that said, for the most part, im residency is exposure to hospitalist work. so, in a sense you're used to it. at least i think you should be.

i do 7 on, 7 off. i also had enough time in the hospital during residency to know that i don't want to be there more than i have to. the money's good, but it's not that important. i certainly have the opportunity to pick up extra shifts, or go work in urgent care or a post discharge clinic (a bridge between the hospital and primary care docs who can't see appointments right away).

but i don't sign up for them. again, i spent enough time in residency neglecting lots of things, that i refuse to continue to do that.

so, there are plenty of opportunities out there, you just need to see what's right for you.

it could be 7 on, 7 off. other groups want 14-16 shifts covered a month in anyway that you see fit. other groups want m-f. some groups want pure hospitalist work, others want you to be a hospitalist... but still see some clinic patients.

just make sure when you interview with groups or talk to headhunters, that you ask lots of question. its a recruiting process on both sides. they want to see if you're a good fit, but you need to see if they're a good fit for you as well. it can take a lot of money for a group to recruit, so they don't want to waste their time. and you shouldn't waste your time either.

i know hospitalists driving civics. i know others driving bently continental gt's. the sky is the limit. from what i've seen, it really just depends on how hard and how much you want to work.


fwiw, i just finished residency in june 08. i do 7 on/7 off. shift is 8am-8pm. no nights. cap at 20 pts a day (high, but has been rare to hit it) 3k cme. malpractice paid. 401k. group supplied blackberry. base is 154k. extra 5k/year for having passed the boards. quarterly bonus range of 2-5k depending on a variety of factors. reimbursed for state license costs, cost of the boards, subscriptions to journals, memberships for medical societies.

Note: This "7 days on and 7 days off" schedule with 12 hour shifts adds up to more hours per year (12 X 7 X 26 = 2184) then the standard 40 hours (8 to 5) schedule (40 X 52 week = 2080 hours per year). I would rather work the tradional schedule than work like "crazy" one week followed by a week of relative boredom. It seems like I read somewhere else that EM docs usually work three 12 hour shifts follow by four days off. If this is true, that would be a great schedule and, if so, we are comparing "apples and oranges" with the internist and ER doc schedules (and salaries).

 

[dragonfly99]

average ER doc salary is definitely more than a hospitalist...there are fewer ER docs and I suppose it requires some more specialized skills. Also, I think more ER docs are part of a group and have some say in their schedules, whereas hospitalists are often an employee of the hospital and their goal is to work you as hard as they need to in order to get the patients taken care of. That's why most people don't stay as hospitalists more than a few years.

 

[Red Beard]

BUMPing because I am curious about the following:

It's fairly clear that EM physicians are able to make more per hour worked, but do they also tend to have much more demanding/tiring shifts than the average hospitalist shift? Put another way, who is more likely to have time to take a p*ss and get a bite to eat during their 12 hour shift? Something to consider in choosing between the two specialties....

 

[Red Beard]

BUMPing because I am curious about the following:

It's fairly clear that EM physicians are able to make more per hour worked, but do they also tend to have much more demanding/tiring shifts than the average hospitalist shift? Put another way, who is more likely to have time to take a p*ss and get a bite to eat during their 12 hour shift? Something to consider in choosing between the two specialties....

 

[Dr McSteamy]

if youre on a 7on 7off schedule, you can't do anything on the side?
that's messed up if that's what the contract says

you could easily supplement your income during your 7 offdays by doing cosmetics stuff

 

[dragonfly99]

A lot of hospitalists are IM docs and most of us aren't really trained to do "cosmetic stuff". I know there are more fp's that do this type of stuff...botox, etc. However, you'd pretty much need to set up your own office to do this type stuff. Adding cosmetic procedures is usually something that's done by outpatient docs with an existing practice who want to gain additional revenue, and not something hospitalists usually do. I know of a doc who set aside 1 office day/week to do this type stuff...the rest of the day he does regular doctor appointments.

 

[BGriffin]

A lot of hospitalists are IM docs and most of us aren't really trained to do "cosmetic stuff". I know there are more fp's that do this type of stuff...botox, etc. However, you'd pretty much need to set up your own office to do this type stuff. Adding cosmetic procedures is usually something that's done by outpatient docs with an existing practice who want to gain additional revenue, and not something hospitalists usually do. I know of a doc who set aside 1 office day/week to do this type stuff...the rest of the day he does regular doctor appointments.

Where would one go about learning these skills to do cosmetic stuff? It would seem that something like botox could be easily taught to anyone with enough hand eye coordination to do phlebotomy.

edit: so I forgot to google this before asking...but I found a couple courses for MD's who want to learn botox injections. One was 8 hours, the other 2 days. Does that sound about right?

 

[dragonfly99]

Yes, you can pay to take courses, etc. to learn to do stuff like Botox injections. However, remember that any time you do a procedure you are subjecting yourself to potential liability. Personally, I wouldn't be comfortable doing these types of cosmetic procedures. I'd rather leave them to the derm and plastics folks because it falls within their area of training. I guess it all depends on your risk tolerance though...it's not illegal for a doc in a specialty like IM or fp to do Botox.

 

[andwhat]

if youre on a 7on 7off schedule, you can't do anything on the side?
that's messed up if that's what the contract says

you could easily supplement your income during your 7 offdays by doing cosmetics stuff

Cosmetics stuff I would assume that you would need a practice. Urgent Care pays pretty well part time. It pays pretty well as a full time gig as well. Hospitalist job is amazing, but use youre time off constructively -- you have worked hard enough youre whole life.... live it up a bit. two weeks off per month is great!!!!
ER docs work considerably harder in our Hospital system, than Hospitalists do. Then again, I have had rough rough shifts as well. Nonetheless, if you compare objectively, ER docs do not make significantly more per hour than Hospitalists (again in our system) -- and as mentioned ER docs work significantly harder. I can sleep once I finish rounding, or do whatever, and do not have to be in the Hospital on night shifts. I can work from home, unless I have an admission or a sick patient that needs to be seen urgently. I finish up my work and go home.

 

[mercaptovizadeh]

Cosmetics stuff I would assume that you would need a practice. Urgent Care pays pretty well part time. It pays pretty well as a full time gig as well. Hospitalist job is amazing, but use youre time off constructively -- you have worked hard enough youre whole life.... live it up a bit. two weeks off per month is great!!!!
ER docs work considerably harder in our Hospital system, than Hospitalists do. Then again, I have had rough rough shifts as well. Nonetheless, if you compare objectively, ER docs do not make significantly more per hour than Hospitalists (again in our system) -- and as mentioned ER docs work significantly harder. I can sleep once I finish rounding, or do whatever, and do not have to be in the Hospital on night shifts. I can work from home, unless I have an admission or a sick patient that needs to be seen urgently. I finish up my work and go home.

Sounds like a great job. So you work two weeks of 12 hour days straight and then two weeks entirely off? Do you get exhausted by the 12 hours * 14 days all in a row?

I can't understand why anyone would want to do extra work on the days off. The money is enough, I'd imagine, and the free time would seem to be good for other interests, like family, hobbies, travel, or non-clinical medicine-related work like a bit of research.

Any input on what the trajectory for hospitalists will look like in a declining economy? Also, can hospitalists pick up certain lower-risk subspecialty procedures (i.e. not cardiac cath) and employ them or is it established that subspecialty procedures are only done by those trained in them through a fellowship?

 

[gutonc]

Any input on what the trajectory for hospitalists will look like in a declining economy? Also, can hospitalists pick up certain lower-risk subspecialty procedures (i.e. not cardiac cath) and employ them or is it established that subspecialty procedures are only done by those trained in them through a fellowship?

If you mean things like thora/para centeses, LPs, I+Ds, other stuff you get trained to do in an IM residency, then yes. Of course, if you're rounding on 15 patients, you won't have time to do these and most hospitalists either punt this stuff to rads or other specialists, or some groups will have a hospitalist on "procedures" (not rounding on patients that day/week) so that the group can capture that billing.

 

[andwhat]

Sounds like a great job. So you work two weeks of 12 hour days straight and then two weeks entirely off? Do you get exhausted by the 12 hours * 14 days all in a row?

I can't understand why anyone would want to do extra work on the days off. The money is enough, I'd imagine, and the free time would seem to be good for other interests, like family, hobbies, travel, or non-clinical medicine-related work like a bit of research.

Any input on what the trajectory for hospitalists will look like in a declining economy? Also, can hospitalists pick up certain lower-risk subspecialty procedures (i.e. not cardiac cath) and employ them or is it established that subspecialty procedures are only done by those trained in them through a fellowship?

Its not easy at times, but it is fun, exciting, and challenging. The time off is great, two weeks off per month. We all make more than $200 K with bonuses (RVUs), some much more who do the dreaded 36 hour shifts -- never ever for me.
Typically work like say 5 days on and 5 off at times, or 6 on and three off -- and it varies, to equate to say roughly 13-14 days off per month. It is totally flexible, but I never work more than 5 or 6 days in a row without a break in between -- approximately one or two days in between.
Nights are challenging at times (only have to work 1-4 nights per month), I have had more than 10 admits in less than ten hours, with lots of phone calls in between.
You learn on the job, time and energy management. Are you going to answer a floor call while you are seeing an admit, or worry about it? Probably not -- deal with it when you are finished, and do not get distracted.
Its tough getting adjusted in the beginning, but it gets better usually.
I never ever work more than 12 hours in a shift, no matter what.
That is the great thing about it -- no office, no shifts more than 12 hours at a time, no clinic the next day when I am drained juggling between office and hospital, and no phone calls from patients at night. My partner recently took 3.5 weeks off, to travel abroad (used part of one month, another part of the overlapping month).
I did get two full weeks off, but I had to work 13/14 days, and a couple more days. It worked out great in the end.
Typically we take 7-10 days off in the schedule consecutively, the rest interspersed and admixed. I do not know about when we hire more Hospitalists though. They might become more strict. Right now it is great though.
In the declining economy, I believe that Hospital medicine is actually surging.
Procedures, I say forget about it. You can do a biopsy in the hospital, but why bother?? You can work in Urgent Care and do tons of procedures on youre off day if you please, knock yourself out.
Me? I would much rather travel, and enjoy my time off.
There is talk, about Hospitalists doing procedures in the Hospital. Those that profit from these procedures, will work very very hard to not make this possible -- which is even more of an incentive to do it. Colonoscopies, Endoscopies, some cardiac interventions. There are not enough specialists on call in the Hospital at times, to cover all of the necessary critical situations going on. Hospitalists can become trained, and help alleviate some of this shortage, to improve the efficiency, and most importantly medical outcomes of patients who are hospitalized. I would imagine that the ER would love this situation, as they are already overburdened with critical situations, as well as patients using the ED for primary care needs.