Hospitalists

[gwen]

Is anyone interested in becoming a hospitalist here? I was just curious to hear what people had to say about hospitalists - ie. how is it better or worse than being an internist, how do the salaries/time compare? What type of personalities tend to stay inpatient, etc.

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[flighterdoc]

Is anyone interested in becoming a hospitalist here? I was just curious to hear what people had to say about hospitalists - ie. how is it better or worse than being an internist, how do the salaries/time compare? What type of personalities tend to stay inpatient, etc.

Good: Fixed hours, no call, don't need to worry about running a business
Bad: shift work, fixed income (can't get more $$ by seeing more pts),

Hospitalist actually appeals to me more than being an internist does.

 

[MustafaMond]

Good: Fixed hours, no call, don't need to worry about running a business
Bad: shift work, fixed income (can't get more $$ by seeing more pts),

Hospitalist actually appeals to me more than being an internist does.

WTF? That's a pretty misleading post.
1) Most hospitalists ARE internists. The two are not mutually exclusive.

2) Hospitalists ROUTINELY go on call, and admitting from the ER is the name of the game.

3) If you join a hospitalist group it is VERY MUCH a business like any other business.

4) Most hospitalist contracts have bonus clauses. You DO make more $ if you make more $ for the group

flighterdoc may have been mistaking "hospitalist" for "VA Hospitalist on teaching service"

 

[flighterdoc]

WTF? That's a pretty misleading post.
1) Most hospitalists ARE internists. The two are not mutually exclusive.

2) Hospitalists ROUTINELY go on call, and admitting from the ER is the name of the game.

3) If you join a hospitalist group it is VERY MUCH a business like any other business.

4) Most hospitalist contracts have bonus clauses. You DO make more $ if you make more $ for the group

flighterdoc may have been mistaking "hospitalist" for "VA Hospitalist on teaching service"

Not at all.

My comment about the preference of hospitalist vs. internist was perhaps poorly phrased: What I was trying to say is that I'd rather be a (internist) hospitalist than an (internist, period).

In my (admittedly limited) experience, Hospitalists are scheduled for shift work - and there are hospitalists scheduled to work around the clock - so, "call" isn't quite like for a resident.

If you join a group, you're working for somebody else. You're not working for yourself, unless you become a partner. And, you don't have to go and set up an office, hire staff, etc - the small business aspects that I don't want to do - I've already started and run a couple of small businesses, and don't want to do that any more.

And, as far as bonuses, thats up to you and your group. My point was that you're limited to the census of the hospital, you can't advertise for more patients, and you can't see more. You only see those that are available to see. So, you have little control over your income.

 

[Aloha Kid]

You gotta admit though, some hospitalists have really nice schedules. I've heard anywhere from 7 days on and 7 days off to every other day. THe need for hospitalists is booming. It's where the future of IM is at. Schedules will change and have changed to become more shift like. WIth shift work comes the ability to toss out call.

In addition, most of the hospitalists I see are pretty busy already. They don't want to be any more busy than they are already. With the baby boomer coming up, there will be no shortage of patients. Although true, you see less patients, you also code for more and bill for more as well. I think Hospitalist salaried will improve for sure. Job security is seems pretty good as well now that most PCP aren't going to hospitals anymore secondary to insurance billing issues.

Hospitalist IM, and it's subspecialties are where the next big boom is at.

 

[MustafaMond]

Hospitalist IM, and it's subspecialties are where the next big boom is at.

Yeah, its booming already, here in TN.

I like the work...interesting cases, quick turnarounds, inpatient care.
The problem is that there is a lot of dumping. The dumping in this case is ENCOURAGED by us, because we get paid more.
Surgery patients for "medical management", admitting and writing admission orders/H+P for patients that are getting bronched/scoped/fna'd/chemo'd by any other specialty.

I prefer being on a teaching service as a hospitalist. More patients, less notes, and more fun (residents/MS). I'm considering doing 1-2 years of hospitalist work, either privately or at our VA. After making some money, I'm going to fellow in Pulmonary/ICU.
Critical care medicine...the ultimate "hospitalists"

 

[Aloha Kid]

Mustafamond,

Absolutely man! Critical care medicine is where it's at. Awesome stuff. Lots of procedures with the occasional adrenaline rush. No dumping here. Not to mention, more time to deal with a set amount of patients. And billing! You always bill in the top top brackets. Oh! put in a central line, BAM $600, and that's reimbursement . How sweet it is.

 

[DrQuinn]

There are a lot of pros to being a hospitalist. A friend of mine is one now (recent grad) and makes 160k a year, works 7 on 7 off, and has no nights/call. Partner in two years, so roughly 200-250 a year then.

Cons (and this is less well-known), the average career of a hospitalist lasts TWO years, the burnout rate is so high, unless, of course, you own the hospitalist group and everyone works for you.

Q, DO

 

[KGUNNER1]

Oh! put in a central line, BAM $600, and that's reimbursement . How sweet it is.

Man I'd like to have your 3rd party payers!! Medicare only approves to pay $280 per line and they only pay up to 90% of what they approve.

KG

 

[KGUNNER1]

Cons (and this is less well-known), the average career of a hospitalist lasts TWO years, the burnout rate is so high, unless, of course, you own the hospitalist group and everyone works for you.

Q, DO

Quinn, I think if you look closely at the average career you'll find that the reason a lot of the hospitalists quit is because they accept a fellowship. They just wanted to make some cash before they went into another indentured servatude state.

I wouldn't call it "burning out" in the true sense of what we're used to seeing in the old ED stats.

KG

 

[DrQuinn]

Quinn, I think if you look closely at the average career you'll find that the reason a lot of the hospitalists quit is because they accept a fellowship. They just wanted to make some cash before they went into another indentured servatude state.

I wouldn't call it "burning out" in the true sense of what we're used to seeing in the old ED stats.

KG

I'm sure there are lots of reasons, but I do know that the 2 years is the "average" career-span of a hospitalist, whatever the cause.

Q, DO

 

[gwen]

thanks a lot guys for your input. i'm seriously considering becoming a hospitalist...but as a lot of you pointed out, the burnout rate is quite high.

doing something a bit more relaxing like rheumatology seems like a good idea at times. but then not making as much money or not having an amazingly interesting variety of patients is a turn off. on the other hand, i feel like the hospitalist career is so awesome...relatively decent money, great variety of patients, no office crap to deal with. but i also don't want to have a short-lived career. is it really that bad that people have to look for fellowships or do something else after the first few years?

please help...i need to figure this out soon...just started my PGY-II year.

 

[flighterdoc]

thanks a lot guys for your input. i'm seriously considering becoming a hospitalist...but as a lot of you pointed out, the burnout rate is quite high.

doing something a bit more relaxing like rheumatology seems like a good idea at times. but then not making as much money or not having an amazingly interesting variety of patients is a turn off. on the other hand, i feel like the hospitalist career is so awesome...relatively decent money, great variety of patients, no office crap to deal with. but i also don't want to have a short-lived career. is it really that bad that people have to look for fellowships or do something else after the first few years?

please help...i need to figure this out soon...just started my PGY-II year.

The best advice would come from a hospitalist so go ask one?

As far as the burn-out, is it possible that either the new IM grads work as a hospitalist for a few years to get some money, then go and do a fellowship?

Or, they do it for a few years and then decide the hours aren't worth it (weekends, nights if necessary, etc).

 

[MustafaMond]

"Burn out" is probably not an accurate representaion of the attrition rate of Hospitalists.

A lot of hospitalists (most of them) are young grads, trying to bank some money quick. After doing this, many of them do fellowships, or settle into more standard medicine practices.

 

[ERMudPhud]

I know a number of hospitalists who seem to be making a career of it. Quite a few have been at for >5 years with no plans to stop and I know a few who have been doing it >10 years. Most of the older group though are intensivists who combine their intensive care work with general hospitalist work. I think the burnout issue will probably turn out to be much like the EM burnout issue. If you go into because thats what you want to do and not because you don't have any other options, and if you keep your schedule reasonable you will be less likely to burnout. On the other hand if it ends up being like your worst months of residency without the resident cap on number of admissions and hours you won't last long.

 

[medlaw06]

Hey all,

Just wanted to ask another related question.

People have mentioned that some leave after a few years and then go back to do their fellowships.

One thing I don't understand is WHY would anyone want to do that? If a person is making $160k+, why would they want to go back for 2-4 years of $40-50k salary for the same (or more) amount of work in a fellowhip program.

Think about it: lets say that I am a hospitalist making 160 fresh from residency. I can (FINALLY) start paying off my rediculous debt, buy a home instead of living in a studio (or an overgrown walk-in closet), eat actualy food (instead of having bread and water...for 4 nights in a row), drive a car that actually HAS a working AC, and enjoy the fruits of what I have worked so hard to accomplish!

Why would I want to stop all that to start making $50. It is resumed that people will start making "real" money at around the age of 30 or so AT THE EARLIEST (22, finish college--> 26 finish med school--> 30, finish IM residency). It is also presumed that by that time, the person would have SOME semblance of a set family or atleast START thinking in that direction.

Then, by the time you have COMPLETED 2 years working as a hospitalist (and now are thinking about going BACK to do your fellowship), you are 32 years old and are making $ to enjoy the "finer" things in life (see above ).

Therefore, why would someone want to give up these things (again) just to go back for 3 more years. What about the house payment? Car payment? Debt re-payment? Etc.

Hope someone can clarify!

Have a nice day!

 

[medlaw06]

Apologize if I sound "like a child!"

I am "just" an MS III

 

[flighterdoc]

Hey all,

Just wanted to ask another related question.

People have mentioned that some leave after a few years and then go back to do their fellowships.

One thing I don't understand is WHY would anyone want to do that? If a person is making $160k+, why would they want to go back for 2-4 years of $40-50k salary for the same (or more) amount of work in a fellowhip program.

Think about it: lets say that I am a hospitalist making 160 fresh from residency. I can (FINALLY) start paying off my rediculous debt, buy a home instead of living in a studio (or an overgrown walk-in closet), eat actualy food (instead of having bread and water...for 4 nights in a row), drive a car that actually HAS a working AC, and enjoy the fruits of what I have worked so hard to accomplish!

Why would I want to stop all that to start making $50. It is resumed that people will start making "real" money at around the age of 30 or so AT THE EARLIEST (22, finish college--> 26 finish med school--> 30, finish IM residency). It is also presumed that by that time, the person would have SOME semblance of a set family or atleast START thinking in that direction.

Then, by the time you have COMPLETED 2 years working as a hospitalist (and now are thinking about going BACK to do your fellowship), you are 32 years old and are making $ to enjoy the "finer" things in life (see above ).

Therefore, why would someone want to give up these things (again) just to go back for 3 more years. What about the house payment? Car payment? Debt re-payment? Etc.

Hope someone can clarify!

Have a nice day!

Personal satisfaction? A desire to achieve more, academically?

Or, they think that having that fellowship on their CV will add to their value and marketability, resulting in more money down the road?

 

[medlaw06]

I agree with all the things you mentioned, Fighter.

I am just looking at it from a practical, day-to-day perspective. Don't get me wrong, I DO see the long term benefits of going back and doing your fellowship. To be honest, I want to do a fellowship also, and am worried about not getting a fellowship spot during/after IM residency.

I also understand the drive/motivation/pursuit of knowledge/etc. that someone may have, and therefore want to do a fellowhip. I also understand the need to "pacify" one's ego and add more lines in their CV.

However...is it worth it!?!

One may argue that there is the "family" consideration: what's the point in pursuing something if it'll wreck your family life (assuming 1) you have a family, 2) you care what your family thinks, 3) the family has NOT supported your decision, and 4) the fellowhip will, in fact, be as bad as to "wreck" your family life).

Obviously, there are alot of assumptions in the "family life" argument. However, I am not even looking at it from that perspective, since it is so speculative. I am looking at it from a practical perspective of re-paying your debts and being debt free, actually enjoying life to some degree since you have the money to do the things that you enjoy (let's face it....things cost $$$), buying a home, and the other things that I listed in the previous post.

I realize that there may be no correct answers to what I am asking, and that it is completely arbitrary and personal to each.

Once again, I apologize if some of the things I am talking about seem "novice." Just a third year trying to get atleast a vague grasp on what the future holds.

 

[flighterdoc]

I agree with all the things you mentioned, Fighter.

I am just looking at it from a practical, day-to-day perspective. Don't get me wrong, I DO see the long term benefits of going back and doing your fellowship. To be honest, I want to do a fellowship also, and am worried about not getting a fellowship spot during/after IM residency.

I also understand the drive/motivation/pursuit of knowledge/etc. that someone may have, and therefore want to do a fellowhip. I also understand the need to "pacify" one's ego and add more lines in their CV.

However...is it worth it!?!

One may argue that there is the "family" consideration: what's the point in pursuing something if it'll wreck your family life (assuming 1) you have a family, 2) you care what your family thinks, 3) the family has NOT supported your decision, and 4) the fellowhip will, in fact, be as bad as to "wreck" your family life).

Obviously, there are alot of assumptions in the "family life" argument. However, I am not even looking at it from that perspective, since it is so speculative. I am looking at it from a practical perspective of re-paying your debts and being debt free, actually enjoying life to some degree since you have the money to do the things that you enjoy (let's face it....things cost $$$), buying a home, and the other things that I listed in the previous post.

I realize that there may be no correct answers to what I am asking, and that it is completely arbitrary and personal to each.

Once again, I apologize if some of the things I am talking about seem "novice." Just a third year trying to get atleast a vague grasp on what the future holds.

You're right, there is no correct answer. I don't know what motivates others, but I agree the penalty of doing a fellowship (unless you have ambitions of academic medicine, perhaps) outweigh the cost. Assuming as a PGY-4 or 5 you get around $45K per year, and an income of $160K per year for a working hospitalist, the cost of a 2-year fellowship is in excess of $230K (plus cost of money, opportunity costs, etc). It would be tough to pay school loans back, much less have a family or life, and the payoff on the back end wouldn't seem to offer an opportunity to ever make up the difference in income.

So, I'd guess that people don't do it for financial reasons which leaves ego (CV pumping) or the hope that a fellowship will lead to an academic position somewhere.

 

[MustafaMond]

,,,,,

 

[KGUNNER1]

Hey all,

Just wanted to ask another related question.

......................

Therefore, why would someone want to give up these things (again) just to go back for 3 more years. What about the house payment? Car payment? Debt re-payment? Etc.

Hope someone can clarify!

Have a nice day!

Many of my friends from residency couldn't decide what fellowship to do until after their 2nd year. That usually left them out for 1 yr (apply in your 3rd year, start 2 years later). They then just worked in the hospital for a year or two (depending when their fellowship started).

After an IM residency, the hospital is second nature, you know the system and your "home" usually will offer you a spot since they trained you anyway. Jobs are usually easy to come by if you are shopping around.

Most people I know just want to get a head start on paying off loans etc... The hospitalist job is a nice "breather" and a taste of life after residency. Usually most have ultimate plans, they just put them on hold for a year or so.

You couldn't do that with private practice, so that's why you didn't really hear about this 10 yrs ago. Back in the "old days" you really only had 2 choices after graduation, going out an joining a general IM practice, or off to fellowship. Now you can stick around, doing what you've always done except now calling the shots, and get paid 4 times what you were making as a resident.

KG

 

[Aloha Kid]

Well said KGUNNER!

 

[Krafty]

I'm actually going into anesthesiology, but I thought I would share something I came across during my (current) IM-Prelim internship. I was on call with one of the R3 residents, who just clocked a new job. Here's what he's excited about:

Hospitalist Group Practice (Scottsdale, AZ)
- Base of like $160k-$175
- He bills extra admits on top of his base
- No call (all shift)
- Two modes, 20on/10off per month, or 14NF/14of per month
- of course procedures are extra$

Not a bad deal, no overhead, partnership prospects (don't know details here), but that is really a decent model of practicing IM. Things do seem to be improving, hell if I was more into long term f/u of chronic conditions, I would maybe consider it. Cheers.