How long can one be a Hospitalist?

[PCPDoc983]

How long can someone possibly survive as a Hospitalist?

Im aware that the schedule of 7 on 7 off is fairy nice, but many people talk about Hospitalist as a career that eventually involves burnout. Is this true? I have never seen a 60 year old hospitalist so I am assuming this is an accurate statement.

If so, what do hospitalists do when they burnout? Primary Care? I imagine going from inpatient to outpatient would be near impossible as the skillsets are totally different.

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[Bostonredsox]

How long can someone possibly survive as a Hospitalist?

Im aware that the schedule of 7 on 7 off is fairy nice, but many people talk about Hospitalist as a career that eventually involves burnout. Is this true? I have never seen a 60 year old hospitalist so I am assuming this is an accurate statement.

If so, what do hospitalists do when they burnout? Primary Care? I imagine going from inpatient to outpatient would be near impossible as the skillsets are totally different.

I know guys in their 60s still doing week on week off work. More commonly, after 15-20 years, people retire to an outpatient clinic, and no the skills are not different to the point that you could not do the job, just need to keep up on the preventative medcine literature along the way, or they retire into an academic scene and primarily teach. Or they bank alot of $ and just flat out retire to the beach.

 

[gutonc]

How long can someone possibly survive as a Hospitalist?

Im aware that the schedule of 7 on 7 off is fairy nice, but many people talk about Hospitalist as a career that eventually involves burnout. Is this true? I have never seen a 60 year old hospitalist so I am assuming this is an accurate statement.

If so, what do hospitalists do when they burnout? Primary Care? I imagine going from inpatient to outpatient would be near impossible as the skillsets are totally different.

Hospital medicine as a subspecialty of IM is about 10 years old at the outside so it's no surprise you've never seen a 60yo hospitalist.

What do they do when they "burnout?"

Work less.
Do UC.
Go somewhere else where the workload is different.
Do a fellowship.
Move into administration.
Retire.

Primary Care would be difficult but not impossible, but I think most people who choose hospitalist work would rather chew their own arms off than be PCPs.

 

[Bostonredsox]

Hospital medicine as a subspecialty of IM is about 10 years old at the outside so it's no surprise you've never seen a 60yo hospitalist.

What do they do when they "burnout?"

Work less.
Do UC.
Go somewhere else where the workload is different.
Do a fellowship.
Move into administration.
Retire.

Primary Care would be difficult but not impossible, but I think most people who choose hospitalist work would rather chew their own arms off than be PCPs.

This, is the epitomy of hospitalist medicine. Even the worst days, atleast we aren't in the clinic.

 

[Thinker123]

How long can someone possibly survive as a Hospitalist?

Im aware that the schedule of 7 on 7 off is fairy nice, but many people talk about Hospitalist as a career that eventually involves burnout. Is this true? I have never seen a 60 year old hospitalist so I am assuming this is an accurate statement.

If so, what do hospitalists do when they burnout? Primary Care? I imagine going from inpatient to outpatient would be near impossible as the skillsets are totally different.

There ARE 8-5 M-F hospitalist jobs out there. I don't like the idea because you lose all the free time which is the fun of being a hospitalist...but they exist. Someone could transition to one of these. There are also many hospitalist jobs that don't do week on week off. They just have random blocks of 3-5 days in a row on or off and often without nights. Many married people prefer this because they don't want to be away from their spouse for a full week then have off while their spouse still has to go to work (you might not really be off...you might get stuck with all the childcare duties!...LOL)

There are options. Hospitalists are here to stay. The night shift (nocturnist) is often the young single person's profession though.

 

[Raryn]

Hospital medicine as a subspecialty of IM is about 10 years old at the outside so it's no surprise you've never seen a 60yo hospitalist.

Depends on where you are in the country. It's at least ~15 years old in CA, given that's how long Kaisers been doing it (and I know a number of individuals who have been hospitalists that long). I think Wachter (the current chair of ABIM, who many claim is the "founder" of the hospitalist movement) pens the beginning in the mid-90s.

Either way, Gutonc had the right general idea of it. The people who are talking about "no one does this >20 years" or "everyone burns out" are all talking out of their bums. The job hasn't been around that long.

 

[Thinker123]

The other thing is different hospitals treat their hospitalists different ways. Some hospitals treat their hospitalists like internal medicine specialists for acute hospital care and they are respected as Internists. Other hospitals treat their hospitalist like "house staff" or PAs for the subspecialist. I think when a physician gets older he/she would definitely want to be practicing at a place where the culture is the former. I would imagine it doesn't feel good to be a grey haired 50 year old and have some 33 year old specialist or surgeon or some young nurses teat you like you are a resident designed for scutwork. A young new doc might not mind...but an old more wise doc would.

 

[nope80]

From what I understand, its not always strictly 7 on and 7 off. I heard you can basically work as much as you want or as little as you want? Is that true? How much does your salary go up if you work more?

I can't imagine it being too tough of a field. Its essentially like being on service as a resident....or so it seems..

 

[rokshana]

I can't imagine it being too tough of a field. Its essentially like being on service as a resident....or so it seems..

intern...its more like being an intern (with better pay ).

and can you imagine working like an intern for the next 10-20 yrs?

 

[rokshana]

From what I understand, its not always strictly 7 on and 7 off. I heard you can basically work as much as you want or as little as you want? Is that true? How much does your salary go up if you work more?

usually full time is 15 shifts a month. If you are employed as a full time hospitalist, then you will need to do at least 15 shifts...many places are moving away from RVUs as a means of increasing compensation and instead you just work extra shifts.

 

[Thinker123]

intern...its more like being an intern (with better pay ).

and can you imagine working like an intern for the next 10-20 yrs?

It's nothing like being an intern. It can be enjoyable depending on the atmosphere. If they treat you with respect, it can be fun. If you like internal medicine but hate the boring "psysical well beings" "cold" "sore back" preventative medicine and other little complaints, then you may enjoy it.

It can feel like being a resident a little sometimes but the difference is the pay, autonomy, not having to go to attending rounds and all the conferences (which really saves time) and knowing that if you mess up, you patient can suffer (more importance in decisions). The schedule is much lighter than a resident and the off time recharges you to be able to dig in hard. residents never have that If hospitalist never had off time then it would be moving more like being a resident.

It makes a big difference making your own decisions, being important and not being bossed around. Some hospitals give their case managers too much power and they can disrespect you and talk to you like you are a resident whereas in other places they just kindly check in with you to see when the person is ready. The best is when you work as a team. They do preparations and notice things to help but never pressure you and let you make the final call while at the same time treating you with respect.

Every hospital is truly different. You should check with the hospitalists working there to see if they are happy and if they are treated with respect.

 

[Thinker123]

LOL on the intern/resident thing. Sometimes I would wonder why 15 patients was so much harder during residency. Did we really get better? Then I remember, residents have prerounding, intern or resident report, attending rounds, noon conference, sometimes journal club, sometimes continuity clinic, sometimes people want to sign out to you. Then you are doing admissions, being called by your team, doing procedures. following orders etc. Being on your own is much different. LOL

 

[rokshana]

It's nothing like being an intern. It can be enjoyable depending on the atmosphere. If they treat you with respect, it can be fun. If you like internal medicine but hate the boring "psysical well beings" "cold" "sore back" preventative medicine and other little complaints, then you may enjoy it.

It can feel like being a resident a little sometimes but the difference is the pay, autonomy, not having to go to attending rounds and all the conferences (which really saves time) and knowing that if you mess up, you patient can suffer (more importance in decisions). The schedule is much lighter than a resident and the off time recharges you to be able to dig in hard. residents never have that If hospitalist never had off time then it would be moving more like being a resident.

It makes a big difference making your own decisions, being important and not being bossed around. Some hospitals give their case managers too much power and they can disrespect you and talk to you like you are a resident whereas in other places they just kindly check in with you to see when the person is ready. The best is when you work as a team. They do preparations and notice things to help but never pressure you and let you make the final call while at the same time treating you with respect.

Every hospital is truly different. You should check with the hospitalists working there to see if they are happy and if they are treated with respect.

where are you a hospitalist? I'd love to be a place where the pt load is that light! my patient load as a hospitalist has usually been larger than when i was a resident...

i ment more on the level of paperwork and time in the hospital...the autonomy and the responsibility of being the one responsibility is of course different (and when i started, scary!).

and you're right, different hospitals are different. I've only been in larger academic hospitals that are quite busy...a small community hospital that doesn't have a lot of sub specialty support( and pt are transferred to tertiary care hospitals instead of being admitted) may have a lower census.

and conferences and rounds are still part of being a hospitalists duties...and personally i'd rather be in attending rounds than IDT rounds!

 

[CanIMakeIt]

From what I understand, its not always strictly 7 on and 7 off. I heard you can basically work as much as you want or as little as you want? Is that true? How much does your salary go up if you work more?

I can't imagine it being too tough of a field. Its essentially like being on service as a resident....or so it seems..

Yeah the model is different for diff hospitals. Here the VA model is - 3on/3off and then 4on/4off and you can lead the resident teams ad also man ICU at night with intensivist as backup. Main hospital it is still 7on/7off and you could be a day person or nucturnist - just admitting at night and not having to deal with any phone calls.

 

[Thinker123]

where are you a hospitalist? I'd love to be a place where the pt load is that light! my patient load as a hospitalist has usually been larger than when i was a resident...

i ment more on the level of paperwork and time in the hospital...the autonomy and the responsibility of being the one responsibility is of course different (and when i started, scary!).

and you're right, different hospitals are different. I've only been in larger academic hospitals that are quite busy...a small community hospital that doesn't have a lot of sub specialty support( and pt are transferred to tertiary care hospitals instead of being admitted) may have a lower census.

and conferences and rounds are still part of being a hospitalists duties...and personally i'd rather be in attending rounds than IDT rounds!

First of all, all hospitalist programs mention "15" as part of their range since those studies showed that productivity goes down when you go too far above that...LOL So usually the second number is their real number...so if they say 15-18 it's really 18 and if they say 15-22 then it's 22.

Anyway, I'm not here to compare whose work is harder or argue with you about whether conferences are required as part of duties. ZZZZZZZ. I've been in all the different environments including academic hospitalist at some point. Sometimes (depending on program) academic hospitalist can seem like residents. It depends. When you have they system where the hospitalist leads teams, that doesn't but sometimes programs keep a hospitalist service to basically take overflow so their residents stay within numbers. Sometimes that feels like a paid resident service.

Anyway, my point is that there are diverse experiences out there. People can find what they like. My other point is it feels nothing like Intern year...paperwork or not...at least for most locations IMO.

 

[Thinker123]

where are you a hospitalist? I'd love to be a place where the pt load is that light! my patient load as a hospitalist has usually been larger than when i was a resident...

i ment more on the level of paperwork and time in the hospital...the autonomy and the responsibility of being the one responsibility is of course different (and when i started, scary!).

and you're right, different hospitals are different. I've only been in larger academic hospitals that are quite busy...a small community hospital that doesn't have a lot of sub specialty support( and pt are transferred to tertiary care hospitals instead of being admitted) may have a lower census.

and conferences and rounds are still part of being a hospitalists duties...and personally i'd rather be in attending rounds than IDT rounds!

Also my goal was not to upstage you with your "intern" comparison. I just wanted to give an alternate perspective in case there were residents who were seriously considering it as a profession. based on your answer, I wasn't sure if you were a joking resident (with the can you imagine being an intern for 20 years?) and I didn't want you to discourage someone who may be interested if you were not a hospitalist. Had you said "I am a hospitalist and at my location I feel like an intern", I would believe it. I have seen some malignant programs.

 

[Bostonredsox]

My contract is 7 on 7 off for around 220k, right out of residency. supposedly there will be another 20k raise before I start too which is nice. Anyway, its avg load from 15-23 pts per day depending on overall census. ICU is its own team of 12-18. One hospitalist, me is the plan, has that team, alternating weeks with our one intensivist. 5 other hospitalists split the floor patients into 5 teams of the aforementioned 15-23. Each floor team as a 3 hour admit block which is usually 2-4 admits a day. times rotate. If you are one one of the 3 medicine teaching teams, you get more pts, more ICU sendouts and direct admits from the clinics, but residents also do all of your work. the 2 non teaching teams run like butter. If you are one of them and draw the 10a-1p admit time, that attending is usually gone by 2pm, not a bad day. all in all its a pretty solid gig and the attendings have much easier days than the residents. I totally disagree that it is intern work. You see your pts, right your notes, round once if your teaching team, usually at 10am, then follow up on your consults and discharges. I have done a few 1 on 1 months with an attending on a non teaching team as a senior. took 22 pts, split the list in half and we rounded quick at the end. Made for a 7-2 day for him, 7-4 for me.

This may be very different than an academic hospitalist but at a community shop, its not at all intern like.

 

[rokshana]

Also my goal was not to upstage you with your "intern" comparison. I just wanted to give an alternate perspective in case there were residents who were seriously considering it as a profession. based on your answer, I wasn't sure if you were a joking resident (with the can you imagine being an intern for 20 years?) and I didn't want you to discourage someone who may be interested if you were not a hospitalist. Had you said "I am a hospitalist and at my location I feel like an intern", I would believe it. I have seen some malignant programs.

i was half joking...half not...there are time when, yes, i did feel very much like the intern...and i'm sorry, i guess i felt your response to me was a bit condescending...guess i'm losing my thick skin...

if the pace of the places I have been is the norm, i see how being a hospitialist for 20+ years could be a bit exhausting and that it is more for those coming out of residency than a long term plan (or maybe for me it has been a stop gap between residency and fellowship, i don't see it being something one could do for a long time).

i guess my point was to dispel the notion that being a hospitalist is an easy gig...some places it maybe one, but i think hospitalists in general work pretty hard (but at least the pay helps to make up for it!).

 

[Thinker123]

i was half joking...half not...there are time when, yes, i did feel very much like the intern...and i'm sorry, i guess i felt your response to me was a bit condescending...guess i'm losing my thick skin...

if the pace of the places I have been is the norm, i see how being a hospitialist for 20+ years could be a bit exhausting and that it is more for those coming out of residency than a long term plan (or maybe for me it has been a stop gap between residency and fellowship, i don't see it being something one could do for a long time).

i guess my point was to dispel the notion that being a hospitalist is an easy gig...some places it maybe one, but i think hospitalists in general work pretty hard (but at least the pay helps to make up for it!).

OK...it was not meant to be condescending. Your remark just came off to me as a non hospitalist taking a cheap shot...and it somewhat could be since you are planning to go into fellowship (and not stay). Anyway, you are entitled to your opinion.

I do feel it can be hard being a hospitalist...exhausting at times...but most physician jobs are hard. The outpatient clinic can even be hard if they push too many patients at you. What I like about hospitalist is that it is a work hard/play hard kind of job. Yes...you work hard during your time but then you get to enjoy a great amount of free time (when you are home and during your off periods) that many physicians don't enjoy. No being at a restaurant or movies and needing to answer a page. No answering questions at home and needing to drive back in. You can take nice mini trips (if you do the 7 on 7 off).

Again...it's also not that I am disagreeing with you completely. If you took away the high compensation and the time off and just made a person do the same thing day after day, it could be grueling. In addition, you always have to have your eyes out for programs looking to take advantage of you. For some programs the day shift is malignant and the night shift is nice. If that's the case, you can mix up your shifts so you don't burn out (night doesn't care what the census is...just the number of nightly admissions). Other programs, the day shift is nice and the night shift is malignant (day people unofficially stop taking admits after 4:30 and they pile up for the night person to see at 6...the night person gets slammed with 4 waiting then many through the night). It all depends. Each program must be investigated individually.

Some programs have a separate hospitalist during the day just doing admissions and all you need to do is see your patients. There are all kinds of models.

I wish you the best and I have no intention of trying to be condescending. I was just defending the hospitalist profession a bit that there is variety.