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Nestle

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ok another question for all of you... what's up with "hospitalists"? i really like inpatient medicine, so I wanted to get more information on this. Especially hospitalists in a tertiary care center setting, since that stuff is what I like. How does it work, in terms of hours, salary etc. ?? Does it basically just mean you don't have any clinic? Do hospitalists have any training other than an IM residency? Do they have extra training in critical care medicine?
Also, do specialists (GI, etc) also serve as general medicine attendings at times (cuz one of my attendings on gen med was a GI doc)? I'd like to specialize but the idea of having lots of variety in terms of body systems really appeals to me too.
 

Eidolon6

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Most hospitalists are board certified IM docs and a few may have subspecialty connections (usually Pulm/CCM). There are a few hospitalist fellowships out there but it is really a seller's market right now because of the push by many hospitals and medical groups to hire them that 3 years of IM w/ board certification is enough. Use of hospitalists is documented in trials/studies to reduce cost of inpatient care and length of stay. IM residency training essentially prepares you to be a hospitalist, more than it does to prepare you for outpatient medicine. My experiences with hospitalists has been fairly varied and rich. At our primary academic center, they serve the more traditional role of an attending physician who in essence serves as an admissions gatekeeper and guides resident/intern decision-making. At the private hospital, its a bit different as the hospitalists have less of a role in teaching and tend to dump work on the interns/resident because they too have a large number of patients. Being a hospitalist is a lot like being an eternal intern....except your efficiency and knowledge are much improved. You admit all the patients and are responsible for all the details. The social issues are the same, the referral/consult hassles are about the same (a bit lighter in private practice with some consultants hungry for more work and cash). The pay right now is fair...better than for a traditional internist...probably landing about $150K a year or so. Call is part of the equation as most hospitals of size need an internist on call 24/7. As for additional training, CCM is probably the most important as the acuity of illness demands special attentions...but some medicine programs excel in delivering this type of training.
Its not a bad gig...but you have to remember a couple of things. 1)Gen med patients can be extremely tedious 2)You can't reinvent the wheel with your admissions 3) Medicine can't refuse an admission and you are at the ED's whim(unlike surgery, psych, and every surgical subspecialty) 4) Dispo issues! 5) You still are a Jack-of-all-trades, schooled in all, but master of none. 6) lack of patient "ownership" (disad for some)
 

CambieMD

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Being a hospitalist seems to have some advantages. There is low overhead, no long term patient contact. You treat and street. Patients will either get better and go home or die. They will not continue to come back to you for a problem that just will not go away or repeatedly seek referrals from you. That being said, hospitalists do not seem to last long. The hospitalists that I know want to do something else. A couple have talked about applying for fellowships. Certain personality types seem to do well working as hospitalists.


CambieMD
 
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Eidolon6 (or anybody else) -

do you think there are some CC docs that split their time between inpatient medicine (hospitalist duties) and the MICU? I assume this would be more of the IM people that do a CC fellowship. I believe some pulm/CC docs split their time between inpatient pulm ward duty and MICU time (and perhaps some outpatient clinic time, though perhaps this is minimal).
 

Eidolon6

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I know the some of the pulm/ccm guys here have a rotation system set up where one follows inpatient consults and pulm inpatients while another doc is on ICU coverage and there is a weekly rotation. CCM docs are certainly qualified to do hospitalist duties although the ones I work with generally don't. I'm sure private practice setups may be a bit more flexible. Remember though that in private practice, hospitals contract individual physician groups for in-house coverage...so in theory one group could be contracted for hospitalist services while another runs the ICU. Smaller hospitals have open ICU's where the hospitalist dujour covers both the ward and ICU.
 

bigdreamer#1

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CambieMD,

I was interested in your reply, "certain personalities are suited to be hospitalists"

I'm wondering what, in your opinion is/are the matching personality traits?

Thanks, interested in going this route...for now.
 

AJM

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Originally posted by Eidolon6
I know the some of the pulm/ccm guys here have a rotation system set up where one follows inpatient consults and pulm inpatients while another doc is on ICU coverage and there is a weekly rotation. CCM docs are certainly qualified to do hospitalist duties although the ones I work with generally don't. I'm sure private practice setups may be a bit more flexible. Remember though that in private practice, hospitals contract individual physician groups for in-house coverage...so in theory one group could be contracted for hospitalist services while another runs the ICU. Smaller hospitals have open ICU's where the hospitalist dujour covers both the ward and ICU.

There is a big difference between hospitalist duties and seeing inpatient consults. The duties of the pulmonary physicians you're describing is not true hospitalist work, but just part of the duties of being in that specialty. Almost every specialty needs to cover inpatient consults, or admit their patients to the hospital, but that does not make them hospitalists in the current sense of the term. Hospitalist medicine is increasingly considered it's own specialty. What it generally refers to is IM-trained physicians who's primary responsibility is to take care of all medicine patients in the hospital, which is a relatively recent concept and an increasingly popular career choice.
 
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