In/outpatient career plans

[CasaElGato]

Seems like most people are interested in outpatient/msk/occ med type practices but just wondering if anyone's still inpatient interested and/or focused.

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[fozzy40]

Why is there a trend away from inpatient?

 

[CasaElGato]

Why is there a trend away from inpatient?

Some will say that inpatient rehab is dying a slow death as authorized stays are shortened and a lot of the patients on the inhab units at some hospitals are really sick and not able to do "3 hours of rehab," the amount of IM you'll need to know may be significant (or you could just endlessly consult if you are not at a freestanding hospital like at UW). I believe some even call the rehab unit at NYPH-Cornell the RICU. There's also the 70% rule which is something to familiarize yourself with if you're going to be interviewing anytime soon.

Some of it is lifestyle driven I'm sure. Seems like everyone would like to take as little call as possible, have weekends free so they can canoe on the Russian or play the banjo on their stoop. Seems like MSK related fellowships are currently very popular, even at inpatient heavy programs like Baylor/University of Texas, Houston or Univ of Wash. Inpatient rehab is very IM heavy as mentioned and it seems like a reason for many people going into PMR is because they are not enamored with inpatient/hospitalist internal medicine. Money also seems to be a driver of things, though it appears that these trends have actually caused a shortage in inpatient applicants and a desperate need for people who want to do inpatient neuro-rehab, etc.

 

[Hemisphere]

i inpatient and neuro-interested as long as I don't unduly suffer in terms of the lifestyle and pay... guess i'll just have to wait and make that decision as i go through residency... looking forwards to my rotation in the RICU.

 

[Disciple]

Why is there a trend away from inpatient?

Musculoskeletal, Sports, Interventional practice was not available before 10-15 years ago. EMG was, which is why you see some older Physiatrists with good EMG skills.

Ask yourself, what are some of the reasons an IM doc would choose GI or Interventional Cards over primary care? Same for PM&R in most respects. Note I'm not referring to SCI or TBI, these are subspecialties as well.

I don't think you'll see the current trend reverse unless they start paying general inpt Physiatrists more. I don't see this happening with the medicare cuts. More than likely, I see more midlevels handling general inpt units (not SCI or TBI, at least not yet).