Infectious Disease Lifestyle

[BlueOranges8888]

The immense administrative and social burdens of being a hospitalist is really burning me out and have been thinking about fellowships. I'm really interested in Infectious Disease and was wondering if ID fellows or ID attendings could weigh in on some of my questions?

I know, ID saleries are so low. But is ts possible to obtain a salary of >300k per year as an ID doc in a medium to large sized city (I consider a population of >500,000)? How hard would you have to work to get this?

Can you get a 7 on and 7 off schedule for ID?

What are some of the social or adminstrative responsibilities that you have do in ID?

Thanks all.

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[eraxsisgatekeeper]

It all depends on your job

I had an offer for a Midwest, large metro (above your population threshold) for base ~300k, but with typical RVUs for the group they were making closer to 450k. Schedule was 2 weeks q2 "call" inpatient, 1 week at a smaller sister hospital and in the clinic (light week) and 1 week off.

My co-fellow took a 7/7 ID job also in the more rural midwest making ~350k with some teaching responsibilities in his off week.

I have seen 14/14 jobs in ID on the east coast with around ~300k base as well with lower patient load.

My current position is academic, closer to 2 week on 3 weeks off, my on weeks are very manageable and we have trainees but my pay is commensurately lower to accommodate that. I work 7-8 weekends a year.

I have seen BS postings for 100k in NYC and have heard of J1 Visa entrapment places that make you generate 500k and give you 150k.

I have no social (not sure what this could be?) or admin responsibilities- perks of being a consultant.
- One of our other faculty is the medical director for our clinic/group and gets less clinical time to compensate.
- If you mean forms and other insurance prior auth stuff our clinic does that for us- most places it should be minimal as ID.
- Once in a while I have to chat with our home infusion folks but they take care of things for us akin to an oncologist not actually scheduling each chemo infusion for their patients and just telling then do "CHOP-21" or whatever.

 

[collegestud2013]

The immense administrative and social burdens of being a hospitalist is really burning me out and have been thinking about fellowships. I'm really interested in Infectious Disease and was wondering if ID fellows or ID attendings could weigh in on some of my questions?

I know, ID saleries are so low. But is ts possible to obtain a salary of >300k per year as an ID doc in a medium to large sized city (I consider a population of >500,000)? How hard would you have to work to get this?

Can you get a 7 on and 7 off schedule for ID?

What are some of the social or adminstrative responsibilities that you have do in ID?

Thanks all.

You'll likely take a pay cut as a new ID attending if you worked the same hours as a hospitalist and wan to be in a mid-size city. To make similar as hospitalist, you'll likely have to work longer hours and see more patients. This is because ID is usually not subsidized at most hospitals, so you will have to generate enough on on your own to cover your own pay and overhead expenses. This is harder in ID that a lot of specialties since since patient population you see usually doesn't have the best payer mix (eg more medicaid or insured patients). This is of course on top of an additional 2 years of ID fellowship training.

For the ID attendings at the place where I work, the usual schedule is Mon-Fri and rotating on hospital consult coverage on the weekends with their group. During the weekdays, they have to cover both clinic and inpatient consults on the same day; I commonly see the ID attendings here start very early in the morning, yet still writing their notes at 10-11 PM at night since they have to cover so much. Not what I would consider to be good work-life balance, so I would only do it if you're interested in the subject matter.

If you can get an ID hospitalist job that is inpatient consults only (ie you can only be consult service and not be required by the hospital to admit and discharge your own patients), that is probably as close you can get to just pure medicine (and minimal logistical, administrative or social issues). However, these jobs are rare and suspect most ID jobs will require a good portion of outpatient clinic; and when you have your own outpatient panel you own the patients so the the administrative burden will likely be high, especially with a full patient panel (eg prior auths, inbox messages)

 

[Splenda88]

What are the administrative and social burdens that people talk about here?

As a hospitalist, I spend 15-20 mins daily with SW/CM. They are the ones who closely deal with difficult discharge.

We have a 45 mins to 1 hour monthly meeting in which our PD touches on metrics? I probably miss half of these meeting since half of them don't fall in my week.

Am I oblivious about what's going on with HM?

 

[chessknt]

Do you think ID patients don't have social problems? What do you think is going to happen to HIV medicine coverage when Trump kills medicaid?

 

[eraxsisgatekeeper]

Do you think ID patients don't have social problems? What do you think is going to happen to HIV medicine coverage when Trump kills medicaid?

ID definitely has its problems and its not a $ specialty, but to rebut the points above:

ID do have social problems but I dont see it as my job to fill out for food stamps, and medicaid paperwork, there are other people who know more about that than me. I see patients and write orders for ART or Antibiotics, if its not covered then there are other people who can help find out what is or how to make it covered and I can go with plan B or C.

In some ways ID can generate more RVU than hospitalist- 99233 is a 99233, except as a consultant I can see an ICU sepsis patient in 20-30 minutes and be done. 20 sick patients is less work for an ID than for IM. You can also get paid for non RVU work like stewardship or infection prevention.

 

[Splenda88]

ID definitely has its problems and its not a $ specialty, but to rebut the points above:

ID do have social problems but I dont see it as my job to fill out for food stamps, and medicaid paperwork, there are other people who know more about that than me. I see patients and write orders for ART or Antibiotics, if its not covered then there are other people who can help find out what is or how to make it covered and I can go with plan B or C.

In some ways ID can generate more RVU than hospitalist- 99233 is a 99233, except as a consultant I can see an ICU sepsis patient in 20-30 minutes and be done. 20 sick patients is less work for an ID than for IM. You can also get paid for non RVU work like stewardship or infection prevention.

What?

Where do hospitalists do that? Are we talking about outpatient primary care here?

 

[eraxsisgatekeeper]

What?

Where do hospitalists do that? Are we talking about outpatient primary care here?

"Do you think ID patients don't have social problems? What do you think is going to happen to HIV medicine coverage when Trump kills medicaid?" This was the question - ID is about 20-50% outpatient depending on the job so for this hospitalist who is thinking about making the switch both are probably applicable. I deal with less admin and insurance hassles than either hospitalist or PCPs FWIW.

 

[BlueOranges8888]

Thanks for the information. I was hoping for a pure inpatient consult ID position, without any clinic.

What are the administrative and social burdens that people talk about here?

As a hospitalist, I spend 15-20 mins daily with SW/CM. They are the ones who closely deal with difficult discharge.

We have a 45 mins to 1 hour monthly meeting in which our PD touches on metrics? I probably miss half of these meeting since half of them don't fall in my week.

Am I oblivious about what's going on with HM?

Must be nice. We have to round with nursing staff, and then do a separate SW/CM round. Can't physically discharge patients unless we speak with SW/CM. Usually 1/4 to 1/2 of my list require some phone calls to update families. There's a lot of admin requirements for hospitalists than other specialties, such as capturing comorbidities (obesity, homelessness, etc), managing problem lists (i.e. adding hypokalemia today to the problem list and then resolving it tomorrow), documenting ACP on everyone, lots of metrics such as discharge before 11am, LOS (admin really want to push people out), etc. Then there's the usual hospitalist responsibilities that specialists don't need to do, such as the initial med rec, doing discharge med rec, scheduling follow-ups on discharge, coordinating between specialists, doing specalist paperwork because they don't want to or otherwise will incrase LOS, etc.

You'll likely take a pay cut as a new ID attending if you worked the same hours as a hospitalist and wan to be in a mid-size city. To make similar as hospitalist, you'll likely have to work longer hours and see more patients. This is because ID is usually not subsidized at most hospitals, so you will have to generate enough on on your own to cover your own pay and overhead expenses. This is harder in ID that a lot of specialties since since patient population you see usually doesn't have the best payer mix (eg more medicaid or insured patients). This is of course on top of an additional 2 years of ID fellowship training.

For the ID attendings at the place where I work, the usual schedule is Mon-Fri and rotating on hospital consult coverage on the weekends with their group. During the weekdays, they have to cover both clinic and inpatient consults on the same day; I commonly see the ID attendings here start very early in the morning, yet still writing their notes at 10-11 PM at night since they have to cover so much. Not what I would consider to be good work-life balance, so I would only do it if you're interested in the subject matter.

If you can get an ID hospitalist job that is inpatient consults only (ie you can only be consult service and not be required by the hospital to admit and discharge your own patients), that is probably as close you can get to just pure medicine (and minimal logistical, administrative or social issues). However, these jobs are rare and suspect most ID jobs will require a good portion of outpatient clinic; and when you have your own outpatient panel you own the patients so the the administrative burden will likely be high, especially with a full patient panel (eg prior auths, inbox messages)

Yeah I've seen a few ID docs submitting notes at 8pm, 9pm, etc. Is this common for most specialities with a mix of inpatient and outpatient? For example, cards, GI, pulm crit, all have a clinic component as well.

 

[eraxsisgatekeeper]

Thanks for the information. I was hoping for a pure inpatient consult ID position, without any clinic.


Must be nice. We have to round with nursing staff, and then do a separate SW/CM round. Can't physically discharge patients unless we speak with SW/CM. Usually 1/4 to 1/2 of my list require some phone calls to update families. There's a lot of admin requirements for hospitalists than other specialties, such as capturing comorbidities (obesity, homelessness, etc), managing problem lists (i.e. adding hypokalemia today to the problem list and then resolving it tomorrow), documenting ACP on everyone, lots of metrics such as discharge before 11am, LOS (admin really want to push people out), etc. Then there's the usual hospitalist responsibilities that specialists don't need to do, such as the initial med rec, doing discharge med rec, scheduling follow-ups on discharge, coordinating between specialists, doing specalist paperwork because they don't want to or otherwise will incrase LOS, etc.


Yeah I've seen a few ID docs submitting notes at 8pm, 9pm, etc. Is this common for most specialities with a mix of inpatient and outpatient? For example, cards, GI, pulm crit, all have a clinic component as well.

If you had a pure inpatient position you would likely have nearly zero admin/SW responsibilities- You may have to respond to a question about if BID ceftriaxone for meningitis can be made daily at discharge (answer is no) and then they can send to a SNF instead of home for home infusion- but I cant imagine you would have to get your hands dirty for the details.

I did ID locums with a private group for a bit and was pure inpatient, I was seeing 20-30 patients in 8-12 hours (less time spent as the week went on) and then going home and taking home "call" with 0-1 calls after hours. I was definitely bringing in more RVU than a hospitalist in less time and making more.

As with all specialties there are good and bad jobs, I dont doubt that ID writes notes at 9PM at some places.

 

[sloh]

If you had a pure inpatient position you would likely have nearly zero admin/SW responsibilities- You may have to respond to a question about if BID ceftriaxone for meningitis can be made daily at discharge (answer is no) and then they can send to a SNF instead of home for home infusion- but I cant imagine you would have to get your hands dirty for the details.

I did ID locums with a private group for a bit and was pure inpatient, I was seeing 20-30 patients in 8-12 hours (less time spent as the week went on) and then going home and taking home "call" with 0-1 calls after hours. I was definitely bringing in more RVU than a hospitalist in less time and making more.

As with all specialties there are good and bad jobs, I dont doubt that ID writes notes at 9PM at some places.

Where was this locums position and what was compensation with that volume?

 

[eraxsisgatekeeper]

Where was this locums position and what was compensation with that volume?

Big Midwest city ( this position no longer exists ) 2000$/day with APP support. I personally saw ~ 15-20 patients - many exceedingly straightforward follow ups (no sign off culture). An experienced APP saw a few as well to finish off the list and did some easy clinic visits which I supervised. Position was word of mouth so no agency middleman parasite.

I know locums hospitalist jobs in my area pay similar for a full 12 hour shift where you have to run around, cover rapid responses, place orders, and get yelled at by patients/families/nurses for not caving into their demands.

I probably should have asked for more money TBH, but it was my first time doing locums and I did not have a sense of the market rate.- I know the going wRVU conversion is closer to 65 in the area and I was probably bringing in more than they paid me at times.