IM inpatient in military?

[dohopeful13]

I'm currently a med student on HPSP with an interest in doing hospitalist work down the road. From what I've researched, hospitalists are not particularly common in the military (at least as active duty). Are there any options to at least practice inpatient medicine regularly as a military internist, or is it almost entirely primary care clinic? This would affect my interest in the specialty, as I don't want to spend 4 years losing what I learned in residency and come out to the civilian world only able to do primary care.

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[HighPriest]

You can definitely practice inpatient medicine....depending upon where you end up. That's the name of the game in the military - it's all up to chance.

Maybe you'll be a brigade surgeon, and do no inpatient care at all. Maybe you'll be at a MEDCEN and to a decent amount of inpatient care. Maybe you'll be at a small MTF and do "inpatient care," which represents about 2% of your total practice. No way to tell, and only a few ways to influence that decision. It will ultimately be made above your pay grade by people you don't really know very well (or at all).

All that being said, i don't know that I ever met a real "hospitalist" military internist. They all had to do clinic of some kind. Maybe someone from IM can weigh in.

Also keep in mind that at most military facilities, being a hospitalist means taking care of 20-somethings without many real comorbidities, by and large. Before someone says I'm lying, I'm not saying you'll NEVER take care of a sick patient. I'm just saying that most of your patient's aren't that sick. Not compared to a civilian institution. The math just doesn't come out the same when you're average patient age is around 25. So it is possible that it could be hard to keep your skillset up to date. But again, I'm not an internist. I'm just extrapolating based upon the problems that basically every other specialty has in the military.

 

[DrMetal]

All that being said, i don't know that I ever met a real "hospitalist" military internist. They all had to do clinic of some kind. Maybe someone from IM can weigh in.

True, I'm internal medicine. There's no guarantee that you'll be allowed to practice solely as a hospitalist, we all do some clinic. Some of the MTFs are trying to implement 'academic hospitalist groups' where you might spend a majority of your time staffing ward treams, but again, no guarantees.

 

[CABG patch]

Army Internist here. I'll echo what everyone else said. If you want to be a hospitalist, the military makes it tough. I work at a MEDCEN and our hospitalists are civilians with military staffing the wards 1-2x per year. It's not quite as bad as what HighPriest said, the average age on my census is 60-70, but the census is low and they are not as sick as the patients down the street at the civilian hospital. We take care of active duty, retirees and their families. Those folks tend not to be homeless or addicted to hard drugs for years without treatment. Additionally, they have access to healthcare by virtue of being able to be seen at your facility so their A1C isn't 13 (usually.) You'll occasionally see someone transferred from the VA who has those issues, but your census will be filled with mostly uncomplicated HF or COPD exacerbations, PNA, a touch of the sepsis or osteomyelitis waiting on a PICC or someone to take their toe off. Before COVID you could moonlight if your command allowed it, which is where people keep their skillset active.

The reality is you'll probably get stuck in a clinic somewhere. If you're lucky you'll be at a MEDCEN with the potential to do wards 2-4 weeks a year (everyone wants these shifts.) If you deploy, unless you're with a CSH its all outpatient. Mostly MSK and psych for 20 year olds. You'll occasionally catch something interesting like renal failure from someone taking 2 grams of Advil 6 times a day, but it's not intellectually stimulating. On the plus side, if you need a test, treatment or specialist, you can get it for your patients. It's a good thing these folks are healthy, but healthy patients don't make good doctors. You need a census full of poorly controlled diabetics with coronary arteries you can map out on a dry CT and severe COPD to stay at the top of your game. Best case scenario you get an understanding command, moonlight as much as possible and get out in 4 years. You can maintain your skillset but you'll have to work at it. As far as this affecting your choice in specialty, thats MILMED in a nutshell. Whether you're a spine surgeon or an Internist, you'll need to moonlight to keep up. The upside is every nearly every hospital needs hospitalists so the opportunities to moonlight are pretty good without having to travel across the country. Admitting shifts in my area get about 1800 for a 12 hr shift, more for nights.