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Hospitalists?

Discussion in 'General Residency Issues' started by Gmw1386, Dec 22, 2005.

  1. Gmw1386

    Gmw1386 Member
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    I've been trying to find a field that would allow me to see a variety of problems without needing to be in the ER. And I also don't think that I would want to have my own practice. So really I'm looking to be a primary care physician for inpatients, and my searches led me to the area of Hospitalists. What I've come to learn is that it's an area that specializes in the treatment of inpatients, which came about as a hospital management structure to free up specialists. And it seems to be becoming rather popular.

    Can anyone give me any insight into this field in terms of need, salary, living comfortability and treatment in work environment?
     
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  3. skypilot

    skypilot 2K Member
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    Salary is about $160k. There are tons of jobs out there. I don't think many people are making a permanent career of hospitalist work, they do it for a few years after an internal medicine residency and then move on.
     
  4. Mumpu

    Mumpu Burninator, MD
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    Hugely growing field, expected to overtake cardiology as the most numerous IM specialty. Salary is around $150 but that may change as they are actively working on becoming recognized as a separate specialty from GIM. Lifestyle is great -- you work very hard but a lot of practices are adopting a 3 weeks on - 1 week off model so many full-time hospitalists are working maybe six months out of the year. Plus it's shift work. The burnout used to be very high, getting better now with changes in work schedules.

    Very necessary field that has been proven time and again in literature to produce superior results, but a lot of PCPs think it's the devil incarnate.

    Like skypilot said, many people are doing it for a few years out of residency but it is possible to make a very good career out of it.
     
  5. Gmw1386

    Gmw1386 Member
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    Thanks a lot
     
  6. GoPistons

    GoPistons Senior Member
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    let's not forget that hospitalists also have to take care of the worst patients... that's right, the uninsured... drug addicts, pain seekers, people who don't care for themselves, the thankless, etc.

    these doctors are contracted by the hospital to take care of all the crappy patients nobody wants to take care of...

    of course, many that are uninsured are great people, but unfortunately, a large majority of them make you wish you never entered medicine to begin with...

    additionally, as a hospitalist, you are really just a resident for life without any type of specific expertise besides efficient paperwork, calling consults, and baby sitting...

    most residents could be a fully functioning hospitalist 9 months into their internship... by that time you should be able to treat pneumonia, pancreatitis, heroine overdose, rule out MI, etc. fairly efficiently... anything more complex and you call a consult...
     
  7. Mumpu

    Mumpu Burninator, MD
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    GoPistons, you are grossly uneducated about what hospitalists do. Inpatient residency = hospitalist training is a total myth and out of touch with reality. There is plenty of credible research to the contrary -- most residencies barely teach neurology (30% of hospitalist patients in the real world), consultative medicine, or managing surgical patients, and even hospice/palliative care training is spotty. Which is why you have tracks appearing now. In addition to clinical work, hospitalists do a lot of QA and systems engineering, and in teaching institutions several studies found them to be better teachers to residents and medical students.

    In my experience, the ungrateful patients are equally distributed between the destitute and the well-off insured a-holes.

    So enough with specialty-bashing already.
     
  8. Gmw1386

    Gmw1386 Member
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    Would you say that a hospitalist makes a lot of the decisions for the patient, or are they just people to call the appropriate consults?
     
  9. GoPistons

    GoPistons Senior Member
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    they definitely make decisions... otherwise, you wouldn't make 160k... but honestly the hospitalists in my residency are glorified interns... nothing more... they do everything I do, and for the most part do exactly what I would do... when they are stuck... they call a consultant for that specialty... the difference between me and them is they have more patients on their census... about 3x... and obviously some more experience under their belt, which I think is of limited benefit for what they actually do...

    it's a good field... probably better than private practice internist for sure... you have a better lifestyle...

    I am just pointing out that your patient base will be much more of the people that makes medicine not fun (i.e. those that leave AMA with central lines so they can shoot up heroine)... clearly, I work in an inner-city type place... if you are a hospitalist in a better part of the country, then your experience may be different...
     
  10. Gmw1386

    Gmw1386 Member
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    Yeah, I assumed that you were working in an area that would be much different from what I would be aiming for. But I feel this is the area that would allow me the variety of problems that I'm looking for. I don't want to be seeing the same thing everyday.

    Any other areas that you could suggest that give me this, other than ER?
     
  11. AJM

    AJM SDN Moderator
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    Keep in mind that a large proportion of hospitalists work for private practice groups. Being a hospitalist does not necessarily mean that you are employed by the hospital where you are treating patients. In fact, most hospitalists I know work for a large private practice organization, and their patients all have insurance, and have much fewer issues with IVDU, etc, than the typical patients you might see in residency.

    Almost all the hospitalists I know really enjoy what they do. The ones I know that are employed by the hospital tend to be fresh out of residency and just doing this for a couple of years before they start fellowship. But the hospitalists I know in private practice are all career hospitalists, and are not planning on leaving the field any time soon. Both groups are very satisfied with their work and enjoy what they do. They also are in a great position for teaching housestaff and medical students, since they're around the hospital all day -- and many of the hospitalists are very into medical education. Not only that, but they get a TON of free time -- the schedule is typically 2 weeks on, 2 weeks off, and when you're off, you're completely off -- leaves alot of room for vacations, etc.
     
  12. GoofyDoc

    GoofyDoc Senior Member
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    Is IM the only specialty that produces hospitalists? I don't recall seeing hospitalists in surgery or peds or ob/gyn.
     
  13. Gmw1386

    Gmw1386 Member
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    From what I've read most come from IM with some also coming from ped/FM. I think this is because it gives you the most comprehensive education of the body/medicine.

    Also, I plan on becoming a DO and feel that being a Hospitalist would fit my planned education even better. Thoughts?
     
  14. GoPistons

    GoPistons Senior Member
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    honestly, if you're not in medical school or DO school yet, this discussion will be of very limited help to you... what you want right now, will probably change... in fact, you have very little basis/knowledge of knowing what you want, so this discussion is really kind of pointless... you don't know how you will react to doing your first surgical procedure, or how you will react when you see your first brain MRI or how you will react when you see your first autopsy... you may then with a flick of a switch change and want to be a surgeon, radiologist, or pathologist... you never know...

    go to medical school... experience everything and see what you like...

    don't believe people on this board... nobody makes 160k working only six months out of the year... I find that hard to believe... especially in internal medicine, which has been taking drastic cuts from medicare since I was 5 years old... the only people that make that kind of dough for six months would neurosurgeons, rad/onc, radiology, orthopedics, etc.
     
  15. Gmw1386

    Gmw1386 Member
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    Yeah I realize that mostly everyone has a change of interest once they go through medical school. But do you have to be so nasty with answering my questions? Why do I expect that you replied "No" to the "If you could, would you do it all over again..." thread.
     
  16. GoPistons

    GoPistons Senior Member
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    go check what my reply on that thread was...

    there was nothing particularly nasty about my response... just the facts without any sugar coating...
     
  17. Mumpu

    Mumpu Burninator, MD
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    The salary figure came from talking in person to several hospitalists (fair enough, you start out in the 140's, depending on the geographic area and the practice). This is why some people think hospitalist medicine will decimate the already thin primary care pool.

    Neuro, rays and ortho make a 100K more than that.
     
  18. skypilot

    skypilot 2K Member
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    Hospitalist work is certainly no gravy train. The salary average is about $160k but that is for full time hard labor. But there is some flexibility to be had due to the shift work. If you work 7 12 hour shifts in a row, that is 84 hours and you potentially could take a week off and still be working full time.
     
  19. Mumpu

    Mumpu Burninator, MD
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    Precisely.
     
  20. radonc

    radonc Senior Member
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    actually most hospitalists take care of patients WITH health insurance. they contract out from PCP's who dont want to admit to a certain hospital due to time constraints/low reimbursements/knowledge gap in inpt medicine.

    also, someone made a comment about how other specialties make more money...of course, but they also involve more training and busy schedules. for people who like IM, a hospitalist is a great job.

    most hospitalist programs arent glorified interns...my friend has a PA or NP on any given day that do all the scut (calling consults, routine orders and writing notes). he admits, takes care of acute problems, and does procedures.

    for most people, a hospitalist job isnt for them (like me)...thats why im doing radiation oncology.
     
  21. tiredmom

    tiredmom Senior Member
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    An important point in the hours issue is how many hospitalists are in the group... our hospital back home started with one, and he was working his tail off! Now they are up to ~5 (or were 3 years ago when I moved), and still working quite a bit (they would work 2-3 during the day and 2-3 covering nights). We only saw them occasionally in L&D, but they didn't seem to do a ton of consults, basically managed the patients as a medicine physician would. They seemed happy, but exhausted. Each one had their own nurse that worked 1:1 with them.
     
  22. billydoc

    billydoc Senior Member
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    Hospitalist is a term (generally) designated for the physicians. But I know more and more PCP groups hiring NPs (or PAs in some cases) to keep an eye on ER patients, admit, not admit, take call for the group, etc. Believe it or not some of these folks are making upwards of 160K :eek: , full-time+,of course. But still, quite amazing...and no $250K in debt :scared:
     
  23. Gmw1386

    Gmw1386 Member
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    This is what I like to hear.

    thanks
     
  24. raspberry swirl

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    so far i think IM sees the most hospitalists, but i've heard of it in peds, and im hoping that it grows because peds hospitalist is what i am interested in. i also read an article that its probably going to be an up and coming thing for OBGYN, too. for my IM rotation, my attending was a hospitalist. he rolled in around 9ish after we were all done rounding and all that, and we all saw the patients. there were two hospitalists, and they were both really busy seeing all the patients that were admitted with no PCP. but they usually had a lot of time to teach. then we'd sort of re-round on patients in the afternoon, and he'd usually leave by 4:30 in the afternoon. he had a pretty sweet lifestyle, i think. when i did my FP rotation, my attending had a hospitalist who saw all his patients that were admitted. one was solely office, the other was solely hospital. worked out really nicely for them, each doing the part of medicine that they preferred. i think its a pretty neat specialty, and has the opportunity to be quite flexible, depending on where, and whom with, you are working.
     
  25. dr_almondjoy_do

    dr_almondjoy_do So Very Happy to Be Here!
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    When I did my IM rotation, we rotated with hospitalists and they did work hard, but their schedule was their own. They had a collective pt load (about 15-25 pts per hospitalist) and made their own daytime hours, basically 7am to 3pm or 9am to 6pm during the day for 3 weeks; then worked 5 weeks of of Fri, Sat, Sun only shft, and had 2 weeks of overnight 7pm-7am for admissions. They had short call during the day shift weeks until 7pm Q4. After every cycle of 10 weeks they got 2 weeks off. I would estimate them working 60-75 hrs/week. They signed out to eachother by group email, and the overnight/on call person who did the admissions split up the patients evenly.

    They worked for the hospital and handled all the service patients (no insurance, no PCP, PCP w/o admitting priviledges in the hospital). They managed the patients then signed them out to their PCP by phone or found them a PCP upon discharge. They handled every aspect of the patients care, often touching base with the PCP to maintain continuity (the outpatient PCP would know things like family history, number of admisstions, etc, etc..). They did call consults, but that was only to have another person agree with the plan. This allowed sharing of liability, and it wasn't like they didn't know what to do once the consult was called.

    Our teams consisted of: hospitalist, senior resident, intern, and two students. We all split up the work and the day ended when we were done. We had to be there at 7am to get the new patient list and round with the resident, and met up with the hospitalist when they arrived for the day. We then rounded on everyone, split up the list, did what we had to do, break for lunch, and did rounds at the end of the day to go home. The whole day the hospitalist is seeing patients, meeting with the family, and overseeing our work. The resident/intern/student assigned to the patient did all the scut/ordering of labs/consults under the hospitalist's recommendations. We each had about 2-5 patients to manage.

    Teaching happened during the rounds when we would discuss an interesting case, and occasionally we would all present up to 10 minutes a random topic we were assigned during the day.

    The only down side I saw to it was the lack of continuity once the shift changes or if the pt is discharged. And pts with long admissions have to see their doctor change every few weeks without warning alot of the time.

    I think it is really good to have a hospitalist service in a hospital, or part of a primary care group to provide the best care for a patient. I think it's a very good job for IM, FP or Med/Peds residents fresh out of residency.

    Oh and I forgot to add that starting salary was 150K + a percentage of the revenue billed to insurace for service patients. not bad.... and your referral base is strong if you would like to set up a private practice in the area since the specialists already know you.
     
  26. Gmw1386

    Gmw1386 Member
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    loving the sound of this more and more. hope i like IM. errrr hope i get into med school.... let's just hope i pass orgo

    thanks
     

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