Hospitalists Out-Earn Rheum, Endo and ID?

[rokshana]

Never mind. Figured out why you're so sour on here ALL THE TIME, perhaps its due to not becoming an attending until 47 while all of us you yell at will be by age 30-33. There's no shame in that or in going to the caribbean for medical school, but constantly attacking pre meds for the very fact that they are not in medical school makes it seem like you're very insecure. Mocking me for being an Australian college grad wanting to be with my family and practice medicine in the US and so looking at both US MD and AUS MD options would perhaps carry more weight if you didn't have to go offshore for medical school yourself.

Lol I may be a lowly premed but at least I knew not to have my SDN name be my real name and then write Dr. Rokshana in a post. Of course, I will not out your real name for respect of your privacy, but kindly you should try to get this changed.

i've never hidden any of that...probably the reason you were able to see that info if you were rooting around in my post history (though i was 46, thank you)...realize that at 33 i was a college professor teaching anatomy and physiology, so, there is that...and I'm on here fro the same reason as most others are...i got a lot of advice from here when i was going through med school, residency, and fellowship and look to be able to give back (though i wasn't uppity enough to think i knew about things before i actually experienced them).

and being an IMG that went off shore (again, been pretty open about that) , i know exactly how much of a red flag that is and how much harder you have to work to succeed in spite of that (and given that i trained both for residency and fellowship at true university programs, i would say that was able to manage it), when given the advice that you should try to get into a USMD school before going off shore, you should take some pause and not think that you are gong to be the exception to the rule...the fact that i say that, should carry MORE weight not less.

I (and many others here on sdn) don't need to be completely anonymous (and guess what? you really aren't either, sdn is able to find out who people are if they really need to, you know) its easy enough to find me....but realize that posting that here on sdn without my permission can get you (as it has others) banned from sdn...the mods don't take threats on sdn very kindly...

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[chessknt]

25 patients in 8 hours? That's a little over 15 minutes per visit including documentation not accounting for the commute home. Unless they are all healthy compliant affluent people I don't see how this could be done by a pcp in a fashion that didn't result in mass consulting for every medical problem. To be equally good at that and inpatient medicine doesnt seem likely to me.

 

[LebronManning]

i've never hidden an of that...probably the reason you were able to see that info if you were rooting around in my post history (though i was 46, thank you)...realize that at 33 i was a college professor teaching anatomy and physiology, so, there is that...and I'm on here fro the same reason as most others are...i got a lot of advice from here when i was going through med school, residency, and fellowship and look to be able to give back (though i wasn't uppity enough to think i knew about things before i actually experienced them).

and being an IMG that went off shore (again, been pretty open about that) , i know exactly how much of a red flag that is and how much harder you have to work to succeed in spite of that (and given that i trained both for residency and fellowship at true university program, i would say that was able to manage it), when given the advice that you should try to get into a USMD school before going off shore, you should take some pause and not think that you are gong to be the exception to the rule...the fact that i say that, should carry MORE weight not less.

I (and many others here on snd) don't need to be completely anonymous (and guess what? you really aren't either, snd is able to find out who people are if they really need to you know) its easy enough to find me....but realize that posting that here on snd without my permission can get you (as it has others) banned from sdn...the mods don't take threats on den very kindly...

The problem is you don't give advice, you just sit here mocking people lol. How is it "advice" to tell me to try to go to a US Medical school as if everyone in the world doesn't already know that. Obviously thats my first choice, and likely with my GPA and EC (albeit international but with some time lived in US) I have a good chance to get in depending on my MCAT score. You mock me when I say IF and ONLY IF I am unable to be admitted to a US medical school, I would attend AUS and work hard to be able to match here. Then you say "you'll only be able to practice in Australia." Thats not out of left field when UQ Ochsner has a 97% match rate of people that matriculate, whats SGU's again? (matriculants, not those who make it to 4th year). Other SDNers have pointed out your flaw in reasoning of thinking that its so ridiculous match from a good Australian school, but you fail to accept it. I don't want to be offensive as you are routinely, but the only explanation I have is some sort of perpetual insecurity from a hellish route to an MD. The fact is I'm more "uppity" because I have done extensive research on medical schools and matching, I don't plan on wasting 10 years trying to get into a US med school if I can't. I believe I could attend UQ-O or USyd and match here, or worst case (less than 3% chance given match stats) practice in AUS. Perhaps you're salty because you didn't know about the AUS option back in the day or it didn't exist (likely you wouldn't have been accepted if you weren't accepted at a US DO school after 2 masters programs). There's a reason SGU takes anybody with a pulse and a check, AUS schools aren't like that. I've tried to level with you in the past and ask you for advice in the case that I do have to try to match in the US as an IMG, but you clearly don't have the same respect for future physicians as those on SDN may have had for you when you were in the process. You also lacked the information to give advice, as evident by not knowing how much better it is to go to UQ-O vs. SGU.

You were an Anatomy & Physio Professor at a college? With a bachelors degree? Or was it with the 2 masters you spoke about that you did specifically for med school acceptance?

Also I'm not outing your identity, I would never dream of that kind of SDN misconduct. I'm simply saying perhaps it would be a good idea to change if a simple google search can reveal it. Not a problem though since you have nothing to hide, neither do I. But then why get upset if your identity is revealed on SDN?

 

[LebronManning]

25 patients in 8 hours? That's a little over 15 minutes per visit including documentation not accounting for the commute home. Unless they are all healthy compliant affluent people I don't see how this could be done by a pcp in a fashion that didn't result in mass consulting for every medical problem. To be equally good at that and inpatient medicine doesnt seem likely to me.

25 patients in 10 hours. Thats 2-3 patients per hour, pretty average for most PCPs I know or have been a patient for.

 

[VA Hopeful Dr]

25 patients in 8 hours? That's a little over 15 minutes per visit including documentation not accounting for the commute home. Unless they are all healthy compliant affluent people I don't see how this could be done by a pcp in a fashion that didn't result in mass consulting for every medical problem. To be equally good at that and inpatient medicine doesnt seem likely to me.

Its doable. Not every visit needs a full 15 minutes. That uncomplicated URI/UTI/poison ivy should only take about 5-10 minutes including documentation. Now you have an extra 5-10 minutes for that noncompliant diabetic or the chest pain.

 

[chessknt]

25 patients in 10 hours. Thats 2-3 patients per hour, pretty average for most PCPs I know or have been a patient for.

Home at 430 means he would start his day at 6am?

 

[LebronManning]

Home at 430 means he would start his day at 6am?

Home at 4:30 after years of establishing the practice with other providers working under him. I’m not saying u can see 25 pts and be home by 4:30

 

[LebronManning]

I’m curious. What accounts for specialists making more in outpatient than primary care? Is it the difference in reimbursement per patient or complaint or is it the fact that you are more likely to be booked through as a specialist? Are there any advantages to outpatient primary care vs outpatient specialist? Finally, this might be silly but out of curiosity, what’s to stop a specialist to pick up a few hospitalist shifts here and there for ancillary income or if business gets slow providing they keep their IM board cert

 

[chessknt]

Home at 4:30 after years of establishing the practice with other providers working under him. I’m not saying u can see 25 pts and be home by 4:30

That model is increasingly impossible to replicate in this country due to high startup costs, especially with new MICRA quality costs coming. If he bequeaths this to you and it remains viable then that is a good gig but not one an outsider could reliably replicate.

 

[Raryn]

Is there a reason you have an inability to participate on these forums without being hostile?

To answer your question, yes I’ve been near a patient, I scribed for 2 years ER and in patient. Is the scenario remotely feasible? Lol it’s directly from my father. He has a well established outpatient practice and works as a hospitalist. He sees his kids after work, hasn’t been at work after 7 PM any time in the last 10 years. During his outpatient weeks he’s home by 4:30. Lol. And you said ask him if his job his cake...that’s literally who told me so. Even with that, I wrote that I don’t believe it to be cake.

My dad does do that schedule, is happy, happily married for 28 years with 3 kids and coach of my little sisters soccer team. And makes a cool 600-700k per year depending on business. He has 3 other MDs and 1 PA employed at the outpatient practice. According to you he must be some sort of unicorn. That’s also false because I know of other family friend physicians who are doing similar. Kindly, I’d suggest not implying other people aren’t capable of doing things if you don’t believe yourself to be.

Finally, I’m here to get information and participate in discussion, not be yelled at by miss rokshana. You must have some great gig to where you can spend your days trying to demolish pre med and med students arguments and failing at it. Learn to disagree without being disrespectful.

What exactly is your point? In any specialty, you can work above average and make above average. This is not disputed anywhere. I'm glad that your dad enjoys his job and is able to make that much money. He could work fewer hours, have more leisure time, but then he'd make less money. Priorities. You could also argue about more time to give better care to your patients, but while that leads to more personal satisfaction it doesn't lead to more financial renumeration.

The only thing we're saying is that not everyone wants to work 50+ hours a week as a physician, and the great thing about our jobs is the flexibility inherent in them. @gutonc is an oncologist, and last I saw him post about his schedule is he works only something like 3.5 days a week. He could probably double his pay by increasing the number of patients he sees and working a full 5 clinic days. My own father is a psychiatrist and has a single inpatient job making a little more than the psychiatry average.... while getting home between 2 and 3pm more often than not. His former coresident also has an inpatient job on top of a private practice clinic and probably makes twice what he does. My dad doesn't care. My cofellow signed a job that has 1.5x the earning potential of the ones I applied/interviewed at. I don't care.

Look, a non-procedural specialist barely makes any more than primary care, and probably has the same overall earning potential. Maybe a little more due to being able to more quickly get through a high "complexity" visit (there's less cognitive strain if all of your complex visits are for similar problems), but it all comes down to how much you want to hustle. No one in the thread is arguing otherwise.

 

[PlutoBoy]

Is there a reason you have an inability to participate on these forums without being hostile?

To answer your question, yes I’ve been near a patient, I scribed for 2 years ER and in patient. Is the scenario remotely feasible? Lol it’s directly from my father. He has a well established outpatient practice and works as a hospitalist. He sees his kids after work, hasn’t been at work after 7 PM any time in the last 10 years. During his outpatient weeks he’s home by 4:30. Lol. And you said ask him if his job his cake...that’s literally who told me so. Even with that, I wrote that I don’t believe it to be cake.

My dad does do that schedule, is happy, happily married for 28 years with 3 kids and coach of my little sisters soccer team. And makes a cool 600-700k per year depending on business. He has 3 other MDs and 1 PA employed at the outpatient practice. According to you he must be some sort of unicorn. That’s also false because I know of other family friend physicians who are doing similar. Kindly, I’d suggest not implying other people aren’t capable of doing things if you don’t believe yourself to be.

Finally, I’m here to get information and participate in discussion, not be yelled at by miss rokshana. You must have some great gig to where you can spend your days trying to demolish pre med and med students arguments and failing at it. Learn to disagree without being disrespectful.

Either you or your dad is lying. PM me your confession.

 

[PlutoBoy]

25 patients in 10 hours. Thats 2-3 patients per hour, pretty average for most PCPs I know or have been a patient for.

That's a lousy lifestyle. I'm cool with my job that allows me to come home and take a nap on a daily basis.

By the way, what you did to the poster above was pretty crappy.

 

[LebronManning]

What exactly is your point? In any specialty, you can work above average and make above average. This is not disputed anywhere. I'm glad that your dad enjoys his job and is able to make that much money. He could work fewer hours, have more leisure time, but then he'd make less money. Priorities. You could also argue about more time to give better care to your patients, but while that leads to more personal satisfaction it doesn't lead to more financial renumeration.

The only thing we're saying is that not everyone wants to work 50+ hours a week as a physician, and the great thing about our jobs is the flexibility inherent in them. @gutonc is an oncologist, and last I saw him post about his schedule is he works only something like 3.5 days a week. He could probably double his pay by increasing the number of patients he sees and working a full 5 clinic days. My own father is a psychiatrist and has a single inpatient job making a little more than the psychiatry average.... while getting home between 2 and 3pm more often than not. His former coresident also has an inpatient job on top of a private practice clinic and probably makes twice what he does. My dad doesn't care. My cofellow signed a job that has 1.5x the earning potential of the ones I applied/interviewed at. I don't care.

Look, a non-procedural specialist barely makes any more than primary care, and probably has the same overall earning potential. Maybe a little more due to being able to more quickly get through a high "complexity" visit (there's less cognitive strain if all of your complex visits are for similar problems), but it all comes down to how much you want to hustle. No one in the thread is arguing otherwise.

Everything you said is in agreement with what I said. That’s what I was curious about: whether or not non procedural specialist have some inherent advantage in Outpatient PP.

My response that you quoted is in response to something you disagree with. My point was that even PCPs who are business savvy can do similar things as outpatient specialists, which is a direct contribution to this conversation which you seem to agree with.. Rokshana disagreed with this and instead of articulate why, she resorted to personal attacks. Your point disagrees with her yet you reply to me.

 

[LebronManning]

That's a lowsy lifestyle. I'm cool with my job that allows me to come home and take a nap on a daily basis.

By the way, what you did to the poster above was pretty crappy.

No one is lying. My dad is not the only IM physician making money like that, plenty others do it through entrepreneurial ability as well.

And good for you that you’re cool with it, understand some people are more ambitious. Not everyone needs to take a nap every day. Being a lowly premed, I’m not judging this as I’m not certain as to what type of physician I will become, but I have seen personal examples in my life that are contrary. And it’s not rare.

Lastly, I didn’t do anything to her. She bullies me around these forums simply for considering the possibility of an Australian medical school given I’ve lived here for the last 7 years. I’ve accepted numerous times US med schools would be my first priority but that may not be possible given my international status. Being a US citizen too, she thinks I’m crazy for thinking I’ll be able to match something like IM when UQ-O’s match rate is 97%. All while she’s an SGU grad. And what did I do? Lol. What I pointed out is literally the most obvious

 

[PlutoBoy]

No one is lying. My dad is not the only IM physician making money like that, plenty others do it through entrepreneurial ability as well.

And good for you that you’re cool with it, understand some people are more ambitious. Not everyone needs to take a nap every day. Being a lowly premed, I’m not judging this as I’m not certain as to what type of physician I will become, but I have seen personal examples in my life that are contrary. And it’s not rare.

Lastly, I didn’t do anything to her. She bullies me around these forums simply for considering the possibility of an Australian medical school given I’ve lived here for the last 7 years. I’ve accepted numerous times US med schools would be my first priority but that may not be possible given my international status. Being a US citizen too, she thinks I’m crazy for thinking I’ll be able to match something like IM when UQ-O’s match rate is 97%. All while she’s an SGU grad. And what did I do? Lol. What I pointed out is literally the most obvious

It is very unlikely that you are going to be able to make $600K as a general internist. It is rare. The numbers are out there. Feel free to investigate and do the math.

It is obvious that you want to fight everyone here. If you already know the answers, why bother asking?

What you should realize is that what you are dreaming about we have actually been doing for years. And please, before you claim that your dad is a doctor as if that somehow made you an expert, realize that many of us come from families of multiple doctors plus have personal experience.

I don't make $600,000. That has to do more with market value and what is humanly possible than it has to do with a "lack of ambition".

I will join the rest of attending physicians and fellows that have come to the realization that we have been duped into having this conversation with you.

 

[LebronManning]

It is very unlikely that you are going to be able to make $600K as a general internist. It is rare. The numbers are out there. Feel free to investigate and do the math.

It is obvious that you want to fight everyone here. If you already know the answers, why bother asking?

What you should realize is that what you are dreaming about we have actually been doing for years. And please, before you claim that your dad is a doctor as if that somehow made you an expert, realize that many of us come from families of multiple doctors plus have personal experience.

I don't make $600,000. That has to do more with market value and what is humanly possible than it has to do with a "lack of ambition".

I will join the rest of attending physicians and fellows that have come to the realization that we have been duped into having this conversation with you.

Seems like everything I'm saying is going over all of your heads and you're trying to figure out ways to still argue with me. When have I said 600k is likely as an internist? All I've said is that its possible with entrepreneurial ability. You seem to agree with this, so what are you even arguing?

How is it obvious that I'm trying to fight people here when I came here and posted a simple question about why a PCP cant do the same thing the outpatient specialists are doing? I wasn't challenging anyone, I was genuinely curious. Then I got attacked by she who shall not be named and you all think I'm some sort of bad guy here to argue. Then I brought a real life example in my father. I wanted to see if there were certain gaps in my understanding of what he does vs what you guys described in outpatient specialist medicine.

I've proven to be here for legitimate discussion and curiosity but it seems like thoughtful advice just can't be given from you all as soon as you see the Pre-Med label. I understand I'm a long way from applying this knowledge, but there's nothing wrong with my curiosity.

 

[PlutoBoy]

Seems like everything I'm saying is going over all of your heads and you're trying to figure out ways to still argue with me. When have I said 600k is likely as an internist? All I've said is that its possible with entrepreneurial ability. You seem to agree with this, so what are you even arguing?

How is it obvious that I'm trying to fight people here when I came here and posted a simple question about why a PCP cant do the same thing the outpatient specialists are doing? I wasn't challenging anyone, I was genuinely curious. Then I got attacked by she who shall not be named and you all think I'm some sort of bad guy here to argue. Then I brought a real life example in my father. I wanted to see if there were certain gaps in my understanding of what he does vs what you guys described in outpatient specialist medicine.

I've proven to be here for legitimate discussion and curiosity but it seems like thoughtful advice just can't be given from you all as soon as you see the Pre-Med label. I understand I'm a long way from applying this knowledge, but there's nothing wrong with my curiosity.

Your question has been answered. Non procedural sub specialties do not make much more than general IM. Some make less.

You decide to work six days a week, you make more. You decide to work four days a week, you make less. Even if you do work six days a week, you are unlikely to make $600,000.

This should be the end of the story. It's that simple.

 

[LebronManning]

Your question has been answered. Non procedural sub specialties do not make much more than general IM. Some make less.

You decide to work six days a week, you make more. You decide to work four days a week, you make less. Even if you do work six days a week, you are unlikely to make $600,000.

This should be the end of the story. It's that simple.

Thank you! That makes it very interesting then in the opportunity cost for non procedural fellowships if one plans to pursue outpatient private practice anyways. Any idea about demand? Definitely have heard from my dad that some of the specialists have month to 6 month long waiting lists, my dad's primary care practice is well booked too (not near that long of a wait) but idk whether to attribute that to how long its been established. According to the forecasts, Primary care is going to be the biggest shortage in the next 10-15 years. Is the average primary care practice or specialist practice more filled up with appointment slots?

 

[PlutoBoy]

Thank you! That makes it very interesting then in the opportunity cost for non procedural fellowships if one plans to pursue outpatient private practice anyways. Any idea about demand? Definitely have heard from my dad that some of the specialists have month to 6 month long waiting lists, my dad's primary care practice is well booked too (not near that long of a wait) but idk whether to attribute that to how long its been established. According to the forecasts, Primary care is going to be the biggest shortage in the next 10-15 years. Is the average primary care practice or specialist practice more filled up with appointment slots?

In my neck of the woods, primary care physicians are in high demand. We are all busy.

Subspecialists are also busy, particularly rheumatologists and endocrinologists (less people around).

I've never heard of a doctor with a clean record that is out of work. I suspect that you will be busy regardless of what you choose to do.

If you are thinking about time/money, consider emergency medicine. They train for three years and make a good amount of money, definitely more than IM. It's tough work, though.

 

[LebronManning]

In my neck of the woods, primary care physicians are in high demand. We are all busy.

Subspecialists are also busy, particularly rheumatologists and endocrinologists (less people around).

I've never heard of a doctor with a clean record that is out of work. I suspect that you will be busy regardless of what you choose to do.

If you are thinking about time/money, consider emergency medicine. They train for three years and make a good amount of money, definitely more than IM. It's tough work, though.

I scribe in an ER right now (have been for 8 months now)...I could never do that for the rest of my life. Plus I hate the types of hours (12-12 or 3-11, etc) they work even though its less hours per month

 

[LebronManning]

In my neck of the woods, primary care physicians are in high demand. We are all busy.

Subspecialists are also busy, particularly rheumatologists and endocrinologists (less people around).

I've never heard of a doctor with a clean record that is out of work. I suspect that you will be busy regardless of what you choose to do.

If you are thinking about time/money, consider emergency medicine. They train for three years and make a good amount of money, definitely more than IM. It's tough work, though.

Also I'm curious about something I think you will be able to answer well being a PCP. What fear, if any, do you have about mid level encroachment into primary care outpatient medicine. I think within the next 10-15 years NPs and PAs will be able to practice primary care in all states without MD oversight, isn't this already the case in 20 some states? With the huge primary care shortage, mid level lobbying may actually be very successful. I doubt they will ever be able to encroach hospitalist positions because the cost would be too high for the hospitals since I don't believe midlevels could handle anywhere near the census MDs do. By "I," I mean what my father has told me. I've asked my dad this and he generally laughs it off saying these fears are all unfounded. He is grateful for the midlevel he employs but she does the stuff none of the MDs at the practice want to do. He says he has no fear of this but never actually gives concrete reasons other than how they would be unsuccessful in inpatient medicine.

 

[PlutoBoy]

Also I'm curious about something I think you will be able to answer well being a PCP. What fear, if any, do you have about mid level encroachment into primary care outpatient medicine. I think within the next 10-15 years NPs and PAs will be able to practice primary care in all states without MD oversight, isn't this already the case in 20 some states? With the huge primary care shortage, mid level lobbying may actually be very successful. I doubt they will ever be able to encroach hospitalist positions because the cost would be too high for the hospitals since I don't believe midlevels could handle anywhere near the census MDs do. By "I," I mean what my father has told me. I've asked my dad this and he generally laughs it off saying these fears are all unfounded. He is grateful for the midlevel he employs but she does the stuff none of the MDs at the practice want to do. He says he has no fear of this but never actually gives concrete reasons other than how they would be unsuccessful in inpatient medicine.

Whether we like it or not, midlevels will definitely play a role in our health care system. I think it's a bad idea but this is unstoppable.

However, I'm not concerned. They simply lack the training or the knowledge base to deal with routine IM. They are ok for urgent care, although I do recognize that there are exceptional midlevels.

It's not only primary care. Sometimes I refer to pulm and I get a note from a midlevel. All of medicine is subject to midlevel encroachment.

It's a terrible idea. Patients know it. I hear it every day from new patients: "I'm here because I wanted a MD".

Don't sweat it. No one can predict the future. Do what you like best.

 

[DubbiDoctor]

Also I'm curious about something I think you will be able to answer well being a PCP. What fear, if any, do you have about mid level encroachment into primary care outpatient medicine. I think within the next 10-15 years NPs and PAs will be able to practice primary care in all states without MD oversight, isn't this already the case in 20 some states? With the huge primary care shortage, mid level lobbying may actually be very successful. I doubt they will ever be able to encroach hospitalist positions because the cost would be too high for the hospitals since I don't believe midlevels could handle anywhere near the census MDs do. By "I," I mean what my father has told me. I've asked my dad this and he generally laughs it off saying these fears are all unfounded. He is grateful for the midlevel he employs but she does the stuff none of the MDs at the practice want to do. He says he has no fear of this but never actually gives concrete reasons other than how they would be unsuccessful in inpatient medicine.

The primary care shortage isn't all its made out to be. The latest AAMC data (which I link below) shows that increased growth of NPs relative to past projections will decrease the projected need for primary care physicians. The report also claims that primary care, OB and anesthesiology are more vulnerable to midlevel encroachment than medical specialties and surgery are. Unless you have a passion for primary care, I'd advise against pursuing it; allow the low-scoring students and IMGs to take the FM residencies. IM is still a great residency to pursue, since it trains you better for hospital medicine -- which offers a high salary than primary care -- and offers numerous interesting subspecialties. The non-procedural subspecialties don't pay much better than out-patient primary care, but enable you to become an expert in a specialized branch of medicine, protecting you against mid-level encroachment as well as providing intellectual stimulation. The procedural specialties pay much better than primary care.

I have not yet been accepted into medical school (although I have three interviews [fingers crossed]), but I think I'm either going to pursue emergency medicine or neurology. I have no interest in the surgery lifestyle or radiology. Emergency medicine allows you to out-earn the average medical specialist with only a three year residency - with no advantage to pursuing a fellowship. Emergency physicians treat a diverse range of pathology and perform life-saving procedures, while only having to work 36 hours a week for full-time pay. Neurology is in a sense is similar to the other IM subspecialties, but focuses on an organ system and pathology that I'm more interested in, coming from a neuroscience background. The pay is at or above non-procedural IM subspecialties. And if you're looking to make more money you can become a neurohospitalist, which pays better than general hospital medicine. If I pursue that route, I'd probably shift toward out-patient neurology as I aged.

https://aamc-black.global.ssl.fastl...c_projections_update_2017_final_-_june_12.pdf

 

[Siggy]

Emergency physicians treat a diverse range of pathology and perform life-saving procedures, while only having to work 36 hours a week for full-time pay.

Emergency Medicine is Hot

What are med students seeing now in EM?

Here's the other thing. The EM physician has to deal with those critical patients while also treating another 5-8 patients at the same time (assuming 2-3 patients per hour and 3 hour ED stay). 2-3 of those are in the "waiting for results, not much to do" stage, the other 4-6 patients are either starting their workup or getting dispoed... which means paperwork and calls. Basically, the ED is going to try to get those critical patients to the unit as quickly as they can.

Want to perform life-saving procedures across a diverse range of pathology? Be an intensivist and let the ED filter out the BS for you.

 

[CCM-MD]

Emergency Medicine is Hot

What are med students seeing now in EM?

Here's the other thing. The EM physician has to deal with those critical patients while also treating another 5-8 patients at the same time (assuming 2-3 patients per hour and 3 hour ED stay). 2-3 of those are in the "waiting for results, not much to do" stage, the other 4-6 patients are either starting their workup or getting dispoed... which means paperwork and calls. Basically, the ED is going to try to get those critical patients to the unit as quickly as they can.

Want to perform life-saving procedures across a diverse range of pathology? Be an intensivist and let the ED filter out the BS for you.

Well indicated procedures frequently get differed to admitting teams in non-academic ERs.

 

[LebronManning]

The primary care shortage isn't all its made out to be. The latest AAMC data (which I link below) shows that increased growth of NPs relative to past projections will decrease the projected need for primary care physicians. The report also claims that primary care, OB and anesthesiology are more vulnerable to midlevel encroachment than medical specialties and surgery are. Unless you have a passion for primary care, I'd advise against pursuing it; allow the low-scoring students and IMGs to take the FM residencies. IM is still a great residency to pursue, since it trains you better for hospital medicine -- which offers a high salary than primary care -- and offers numerous interesting subspecialties. The non-procedural subspecialties don't pay much better than out-patient primary care, but enable you to become an expert in a specialized branch of medicine, protecting you against mid-level encroachment as well as providing intellectual stimulation. The procedural specialties pay much better than primary care.

I have not yet been accepted into medical school (although I have three interviews [fingers crossed]), but I think I'm either going to pursue emergency medicine or neurology. I have no interest in the surgery lifestyle or radiology. Emergency medicine allows you to out-earn the average medical specialist with only a three year residency - with no advantage to pursuing a fellowship. Emergency physicians treat a diverse range of pathology and perform life-saving procedures, while only having to work 36 hours a week for full-time pay. Neurology is in a sense is similar to the other IM subspecialties, but focuses on an organ system and pathology that I'm more interested in, coming from a neuroscience background. The pay is at or above non-procedural IM subspecialties. And if you're looking to make more money you can become a neurohospitalist, which pays better than general hospital medicine. If I pursue that route, I'd probably shift toward out-patient neurology as I aged.

https://aamc-black.global.ssl.fastl...c_projections_update_2017_final_-_june_12.pdf

Wow, thank you for that information! Interesting...I think that will be the only way to address the shortage. However, there will always be a place for hospitalists in the hospitals, I don't think midlevels could do that job. Also some of the more complicated patients will always need a MD PCP as well. Personally, I'm thinking IM->GI, but I'm a pre-med so taking that with a grain of salt. I am applying next cycle though, and have seen a lot of medicine through scribing so gotten somewhat of a feel for it.

ER is a great field, but definitely gotta know what you're getting into! I used to totally wanna be an ER doc, but after having scribed in a major trauma center ER, that's kinda changed. Surgery runs all cool traumas for the most part minus the airway. You do get a lot of arrests though. All in all, ER is too hectic for me, but I respect the hell out of ER docs for being able to manage a whole department at all times even when ****s hitting the fan in multiple rooms. For those who can do it, I certainly consider it awesome for such good pay with such little hours.

 

[LebronManning]

Want to perform life-saving procedures across a diverse range of pathology? Be an intensivist and let the ED filter out the BS for you.

True. Even in academic ERs, sometimes the intensivist would rather intubate, central line, etc. upstairs. I'm sure this is way more common in community because Intensivist has more incentive there to bill for the procedure and would rather have it done on own turf. In academics, ER has some pull because at least at the hospital I scribe at, the hospital is KNOWN for its EM residency program.

 

[VA Hopeful Dr]

I'd advise against pursuing it; allow the low-scoring students and IMGs to take the FM residencies.

I have not yet been accepted into medical school

Interesting...

 

[PlutoBoy]

Interesting...

What's interesting? Are we thinking the same thing?

 

[Siggy]

Well indicated procedures frequently get differed to admitting teams in non-academic ERs.

...that then get deferred to IR for hospitalist teams...

 

[Siggy]

True. Even in academic ERs, sometimes the intensivist would rather intubate, central line, etc. upstairs. I'm sure this is way more common in community because Intensivist has more incentive there to bill for the procedure and would rather have it done on own turf. In academics, ER has some pull because at least at the hospital I scribe at, the hospital is KNOWN for its EM residency program.

I wouldn't blame billing. For non-academic EDs (my IM program is unopposed at my hospital), non-"OMG THE PATIENT IS GOING TO DIE RIGHT NOW" procedures are normally deferred to the inpatient service just due to the time requirement while the ED physician and NPs try to see 3 patients per hour. The amount of times I've come in in the morning to find a patient on my list on levophed and no central line is well past the single digits (our intensivists are on call overnight).

The intensivist would rather do it on the floor because there's more room and a smaller patient to RN ratio. The RN in the ED that's taking care of the critical patient still has 4 other patients, including the one that's waiting for discharge, the one waiting for report to be called, and the one that just got to the room. Hence it's easier to tie up an RN to assist with a central line or RN/RTs for an intubation. It's just easier to do procedures in the unit than in the ED. Also, it's not like billing matters whether the procedure was done on a patient boarding in the ED vs physically in the unit.

 

[Siggy]

I'm sure that primary care physicians can make $600k a year. However, what's the point of making so much money when you there's no time to actually spend it?

 

[gutonc]

What's interesting? Are we thinking the same thing?

That we're getting trolled?

Definitely.

 

[CCM-MD]

True. Even in academic ERs, sometimes the intensivist would rather intubate, central line, etc. upstairs. I'm sure this is way more common in community because Intensivist has more incentive there to bill for the procedure and would rather have it done on own turf. In academics, ER has some pull because at least at the hospital I scribe at, the hospital is KNOWN for its EM residency program.

You have no idea what you are talking about.

 

[Trogghunter]

I'm sure that primary care physicians can make $600k a year. However, what's the point of making so much money when you there's no time to actually spend it?

600k? 600k?!?! We're not talking about a million. We're talking about 600k.

According to one estimate, wealthy couples in NYC need $190 million to keep their heads above water

 

[thierryhenry]

Cause Hospitalist lifestyle is horrible...try it out then let me know why all hospitalists out for a couple years are dying to go back into fellowships even the "less competitive," and "lesser paying ones," such as Endo, Rheum, ID, Nephro, etc.
Hospitalist is a thankless and burn out ridden path.

 

[bronx43]

Cause Hospitalist lifestyle is horrible...try it out then let me know why all hospitalists out for a couple years are dying to go back into fellowships even the "less competitive," and "lesser paying ones," such as Endo, Rheum, ID, Nephro, etc.
Hospitalist is a thankless and burn out ridden path.

Don't forget to mention trying to break into "administration."

In all honesty, it's possible to have a sustainable career in hospital medicine. It just takes a special kind of person and a great set up.

 

[toastee]

The problem is you don't give advice, you just sit here mocking people lol. How is it "advice" to tell me to try to go to a US Medical school as if everyone in the world doesn't already know that. Obviously thats my first choice, and likely with my GPA and EC (albeit international but with some time lived in US) I have a good chance to get in depending on my MCAT score. You mock me when I say IF and ONLY IF I am unable to be admitted to a US medical school, I would attend AUS and work hard to be able to match here. Then you say "you'll only be able to practice in Australia." Thats not out of left field when UQ Ochsner has a 97% match rate of people that matriculate, whats SGU's again? (matriculants, not those who make it to 4th year). Other SDNers have pointed out your flaw in reasoning of thinking that its so ridiculous match from a good Australian school, but you fail to accept it. I don't want to be offensive as you are routinely, but the only explanation I have is some sort of perpetual insecurity from a hellish route to an MD. The fact is I'm more "uppity" because I have done extensive research on medical schools and matching, I don't plan on wasting 10 years trying to get into a US med school if I can't. I believe I could attend UQ-O or USyd and match here, or worst case (less than 3% chance given match stats) practice in AUS. Perhaps you're salty because you didn't know about the AUS option back in the day or it didn't exist (likely you wouldn't have been accepted if you weren't accepted at a US DO school after 2 masters programs). There's a reason SGU takes anybody with a pulse and a check, AUS schools aren't like that. I've tried to level with you in the past and ask you for advice in the case that I do have to try to match in the US as an IMG, but you clearly don't have the same respect for future physicians as those on SDN may have had for you when you were in the process. You also lacked the information to give advice, as evident by not knowing how much better it is to go to UQ-O vs. SGU.

You were an Anatomy & Physio Professor at a college? With a bachelors degree? Or was it with the 2 masters you spoke about that you did specifically for med school acceptance?

Also I'm not outing your identity, I would never dream of that kind of SDN misconduct. I'm simply saying perhaps it would be a good idea to change if a simple google search can reveal it. Not a problem though since you have nothing to hide, neither do I. But then why get upset if your identity is revealed on SDN?

Glad someone called her out. Even gutonc, as dislikeable as he is at times, gives out good non-filtered advice. But this one right here is always spiteful and when faced with disagreement is so quick to pull the "you're not an attending so you can't have an opinion on anything, no matter what it is" card, regardless of the topic.

Interesting discussion though

 

[VA Hopeful Dr]

Glad someone called her out. Even gutonc, as dislikeable as he is at times, gives out good non-filtered advice. But this one right here is always spiteful and when faced with disagreement is so quick to pull the "you're not an attending so you can't have an opinion on anything, no matter what it is" card, regardless of the topic.

Interesting discussion though

I find it interesting that so far only pre-meds and med students think that. I've not noticed any residents, fellows, or attendings have a problem with said poster.

But I'm sure that's just my attending bias. What do I know?

 

[toastee]

I find it interesting that so far only pre-meds and med students think that. I've not noticed any residents, fellows, or attendings have a problem with said poster.

But I'm sure that's just my attending bias. What do I know?

Such is life on SDN.

Sent from my SM-G955U using SDN mobile

 

[gutonc]

Such is life on SDN.

Sent from my SM-G955U using SDN mobile

You mean when the people who know the least and have the least amount of relevant experience, have the strongest opinions?

I suppose so.

 

[LebronManning]

We don't have the strongest opinions, they're just opinions. Personally, I've only shared anecdotes or opinions that I've made clear are from an inexperienced POV. Doesn't prevent me getting attacked. Said poster doesn't pick fights with fellow MDs which is why you all don't have problems with said poster, but said poster shows a clear lack of respect for Pre-MD opinions, which is why we conversely do not respect said poster.

 

[VA Hopeful Dr]

We don't have the strongest opinions, they're just opinions. Personally, I've only shared anecdotes or opinions that I've made clear are from an inexperienced POV. Doesn't prevent me getting attacked. Said poster doesn't pick fights with fellow MDs which is why you all don't have problems with said poster, but said poster shows a clear lack of respect for Pre-MD opinions, which is why we conversely do not respect said poster.

Why should they respect your opinions on things which you have no experience and little knowledge? It would be like if I went to a meeting of the ABA and told them they were wrong because I have an uncle who is a lawyer.

 

[DubbiDoctor]

We don't have the strongest opinions, they're just opinions. Personally, I've only shared anecdotes or opinions that I've made clear are from an inexperienced POV. Doesn't prevent me getting attacked. Said poster doesn't pick fights with fellow MDs which is why you all don't have problems with said poster, but said poster shows a clear lack of respect for Pre-MD opinions, which is why we conversely do not respect said poster.

If you browse, she has an attitude with everyone who displays ignorance, acts provocatively or doesn't listen to what other informed posters are telling them. I like her style honestly. There are a lot of jerks in medicine, and you need to be tough. When my mother was a psychiatry chief resident, she didn't want to admit a patient from neuro to psych unless they performed an MRI ruling out a tumor as a cause of the behavioral problem. She didn't think the guy had a tumor, but she had reason to not want to admit anymore patients if they could be someone else's problem. The neurologist cursed her out and screamed at her, but relented and did the MRI. He said that if there was a tumor, he would eat the scan. The neurologist never reported back, but the scan did show a tumor. My mother hunted down the neurologist, threw the scan at him, and said "here's your dinner!".

 

[Psai]

God i hate premeds

 

[PlutoBoy]

If you browse, she has an attitude with everyone who displays ignorance, acts provocatively or doesn't listen to what other informed posters are telling them. I like her style honestly. There are a lot of jerks in medicine, and you need to be tough. When my mother was a psychiatry chief resident, she didn't want to admit a patient from neuro to psych unless they performed an MRI ruling out a tumor as a cause of the behavioral problem. She didn't think the guy had a tumor, but she had reason to not want to admit anymore patients if they could be someone else's problem. The neurologist cursed her out and screamed at her, but relented and did the MRI. He said that if there was a tumor, he would eat the scan. The neurologist never reported back, but the scan did show a tumor. My mother hunted down the neurologist, threw the scan at him, and said "here's your dinner!".

Cool

 

[LebronManning]

God i hate premeds

I feel ya man. Good think you all were born with the MD behind your name!

 

[chessknt]

I feel ya man. Good think you all were born with the MD behind your name!

This is a forum for residents and beyond. If we wanted to answer premed questions we'd be on the pre allo board.

 

[Psai]

I feel ya man. Good think you all were born with the MD behind your name!

This is exactly the kind of nonsense that makes you so annoying

 

[gutonc]

I think this thread has more than outlived it's usefulness...assuming it had any to begin with.

Closing.