Inpatient career options

[ShuperNewbie]

Hey Folks,

I just wanted to ask people here who are more experienced on the career trail about whether / how they've seen inpatient-focused heme/onc jobs laid out? (especially @whoknows2012).

I'm entertaining the idea of looking for a hospital-employed gig with a 7-on 7-off shift work model. I don't really want to do BMT but I really do enjoy inducing leukemias / lymphomas / small cell lung cancers and seeing various consults in the hospital, then bidding "adieu" to patients when they're done with induction and not really having the responsibility of managing these patients in the clinic on follow-up. I'm curious how abundant / well defined these jobs are. Not 100% sold on the idea of being an onco-hospitalist either since I have to justify these three extra years of training somehow hahaha.

Thanks!

---

Members don't see this ad.

 

[whoknows2012]

Hey Folks,

I just wanted to ask people here who are more experienced on the career trail about whether / how they've seen inpatient-focused heme/onc jobs laid out? (especially @whoknows2012).

I'm entertaining the idea of looking for a hospital-employed gig with a 7-on 7-off shift work model. I don't really want to do BMT but I really do enjoy inducing leukemias / lymphomas / small cell lung cancers and seeing various consults in the hospital, then bidding "adieu" to patients when they're done with induction and not really having the responsibility of managing these patients in the clinic on follow-up. I'm curious how abundant / well defined these jobs are. Not 100% sold on the idea of being an onco-hospitalist either since I have to justify these three extra years of training somehow hahaha.

Thanks!

Inpatient work is grueling. Make sure that wherever you consider accepting an offer that you get rewarded for being busy, ie wRVU bonus. At about 250-300 wRVU per week presuming ~15 patients a day (7d/week) you could easily clear 7-8k wRVUs.

I’m biased but of course preferred a 5d a week specialty focused gig, though in fairness I had always assumed I would parlay the inpatient leukemia gig to an outpatient one, then decided that when the outpatient one became available I enjoyed my inpatient gig too much to swap.

Keep in mind, beyond the above, you don’t want to be a babysitter. It’s a recipe for dissatisfaction and frustration. It’s hard to feel out but you’d want to find a job where your colleagues will respect your involvement and not try to run the show even when you’re seeing their patient (ie be collaborative).

 

[ShuperNewbie]

Thanks for the reply homie!

 

[gutonc]

Hey Folks,

I just wanted to ask people here who are more experienced on the career trail about whether / how they've seen inpatient-focused heme/onc jobs laid out? (especially @whoknows2012).

I'm entertaining the idea of looking for a hospital-employed gig with a 7-on 7-off shift work model. I don't really want to do BMT but I really do enjoy inducing leukemias / lymphomas / small cell lung cancers and seeing various consults in the hospital, then bidding "adieu" to patients when they're done with induction and not really having the responsibility of managing these patients in the clinic on follow-up. I'm curious how abundant / well defined these jobs are. Not 100% sold on the idea of being an onco-hospitalist either since I have to justify these three extra years of training somehow hahaha.

Thanks!

I know a hospital that would love to hire you...and pay you like they do the hospitalists. So if that interests you, let me know.

 

[whoknows2012]

@whoknows2012 how does inbox management compare inpatient vs outpatient?

Thought not you specific question I will elaborate a bit and touch on inbox management. My job is a bit of a unicorn as I have excellent mid level and ancillary support;

We do about 10-15 procedures a week, LPs and BMBx’s all done by PAs

We have a leukemia specific pharmacist she helps with all chemo orders, can prep for prior auth on any outpatient meds I’m involved in prescribing. She also submits all appeals. Though any actual peer to peer I have to do and is very annoying as you might expect (though almost always results in an approval)

From clinical research and clinical trial perspective, we have some research nurses that will consent inpatients (though sometimes it’s fastest if I do it) and very little is expected of me besides clinical care for these patients so I’m not bogged down in paperwork related to filing SAEs etc. We have between 5-7 inpatients at a time on a trial.

My biggest post rounds time drain is notes (20-25 on average) and roughly 2-2.5h per day (I cannot bill off PA notes who are primary on this service) followed by phone calls/emails to pts family and discussing cases with path and other consultants. There is truly very little “inbox management” as it is generally used when we talk about outpatient medicine.

 

[gutonc]

@whoknows2012 how does inbox management compare inpatient vs outpatient?

I know you didn't ask me, but about 90% of my outpatient inbox management involves me reviewing a lab and clicking "done". The rest takes an hour a week.

 

[RainerMaria]

I know you didn't ask me, but about 90% of my outpatient inbox management involves me reviewing a lab and clicking "done". The rest takes an hour a week.

What about the pt calls, wants to discuss lab results, imaging? Portal messages? Or does RN handle. I see a lot of docs spending 30m-2h a day calling back pts. I think it should probably be a quick yes or no via portal message and if more than that then I would schedule a telephone encounter. At least we can start billing like the lawyers do.

 

[bobsmith]

What about the pt calls, wants to discuss lab results, imaging? Portal messages? Or does RN handle. I see a lot of docs spending 30m-2h a day calling back pts. I think it should probably be a quick yes or no via portal message and if more than that then I would schedule a telephone encounter. At least we can start billing like the lawyers do.

In my clinic, we mostly instruct patients to get scheduled labs a few days before appts so this reduces much of that burden; same with scans - we set the expectation that they will be discussed at appts and will move appts up to discuss if needed.

If a patient calls about new symptoms, they largely get offered an appt with an NP (including telephone or video)

It's pretty rare that a patient is genuinely concerned about something but refuses an appointment and insists on having an answer over the portal instead

 

[gutonc]

What about the pt calls, wants to discuss lab results, imaging? Portal messages? Or does RN handle. I see a lot of docs spending 30m-2h a day calling back pts. I think it should probably be a quick yes or no via portal message and if more than that then I would schedule a telephone encounter. At least we can start billing like the lawyers do.

In my clinic, we mostly instruct patients to get scheduled labs a few days before appts so this reduces much of that burden; same with scans - we set the expectation that they will be discussed at appts and will move appts up to discuss if needed.

If a patient calls about new symptoms, they largely get offered an appt with an NP (including telephone or video)

It's pretty rare that a patient is genuinely concerned about something but refuses an appointment and insists on having an answer over the portal instead

Pretty much this. If it takes more than 30s of my time, it gets an appointment that I can bill for. My current department has decided not to bill for portal messages at all, and I think the hoops you have to jump through to be able to bill aren't worth the hassle anyway.

 

[RainerMaria]

The challenge has been with the new law releasing imaging and path right away to patients - there are a lot of calls freaking about what to do next even though we have an appt within the next week. Has been very disruptive and huge increase in calls.

 

[MD46]

The challenge has been with the new law releasing imaging and path right away to patients - there are a lot of calls freaking about what to do next even though we have an appt within the next week. Has been very disruptive and huge increase in calls.

Totally agree, even though you can set expectations that scans and path will be discussed next visit however when they see their path or radiology report they ask Dr Google and panic.

It also has created a large amount of message burden for at least our practice as well. We had to pull a nurse navigator from her other daily tasks to triage these.

 

[bobsmith]

The challenge has been with the new law releasing imaging and path right away to patients - there are a lot of calls freaking about what to do next even though we have an appt within the next week. Has been very disruptive and huge increase in calls.

I think the strategy that I and gutonc both employ is still applicable here

I should add that after this law went into effect, we gave our staff pretty free rein to move up appointments if a patient calls about scan results, regardless of the results. This prevents the need for providers to triage which patients need to be moved up and the ensuing patient panic about "oh no, Dr. Bobsmith reviewed my scan and wants me to have an appointment sooner, it must be bad news"

Since the alternatives are writing a long patient portal message that might be misinterpreted / overscrutinized unnecessarily or trying to carve out time in the day to return a phone call (and the ensuing phone tag!) to reassure patients about a scan, I would much rather add the patient onto my schedule and overbook if needed.

As I mentioned above, I can only think of 1-2 instances in the last year where the patient thought an issue was very important / urgent but refused an appointment.