Is IM primary care a better quality of life than IM hospitalist?

[psychMDhopefully]

Hospitalist seem to get paid more but the environment and work schedule seem worse, compared to something like a group primary care clinic.

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[jdh71]

Define "quality of life" for you then decide. Some folks like bankers hours without call, nights, or weekends. Some folks like a solid 7 days off in a row regularly.

Though I've always thought this was pretty much the wrong question in medicine every time it's asked. It's misses the point of the calling and the the profession.

 

[LiquidN-H]

Hospitalist seem to get paid more but the environment and work schedule seem worse, compared to something like a group primary care clinic.

Yeah, hospitalist is basically an ER doc in terms of shift hours (if you know more about ER than IM hosp), and PCP as you probably know is straight shifts; the biggest time strain outside of actual work is charts, and the work schedule is constant, whereas a hospitalist can work a few 12-hour shifts and be home for stretches, so if your ideal quality of life is being parent who is able to be home with kids, be a hospitalist, but if you prefer a steady job with set time off, pay, etc. then a PCP is better. Again, it all depends on your perspective.

 

[VA Hopeful Dr]

Yeah, hospitalist is basically an ER doc in terms of shift hours (if you know more about ER than IM hosp), and PCP as you probably know is straight shifts; the biggest time strain outside of actual work is charts, and the work schedule is constant, whereas a hospitalist can work a few 12-hour shifts and be home for stretches, so if your ideal quality of life is being parent who is able to be home with kids, be a hospitalist, but if you prefer a steady job with set time off, pay, etc. then a PCP is better. Again, it all depends on your perspective.

I would say it is the exact opposite. My wife just quit being a hospitalist because she got tired of working Christmas and Thanksgiving and every other weekend.

As soon as kids are in any kind of school, you only lose a couple hours a day with them if you work a typical outpatient job.

 

[PlutoBoy]

Yeah, hospitalist is basically an ER doc in terms of shift hours (if you know more about ER than IM hosp), and PCP as you probably know is straight shifts; the biggest time strain outside of actual work is charts, and the work schedule is constant, whereas a hospitalist can work a few 12-hour shifts and be home for stretches, so if your ideal quality of life is being parent who is able to be home with kids, be a hospitalist, but if you prefer a steady job with set time off, pay, etc. then a PCP is better. Again, it all depends on your perspective.

It's the other way around. Primary care is much more conducive to customary lifestyles.

 

[PlutoBoy]

Hospitalist seem to get paid more but the environment and work schedule seem worse, compared to something like a group primary care clinic.

Primary care is better. The 7 on/7 off schedule is a trap.

 

[jdh71]

Primary care is better. The 7 on/7 off schedule is a trap.

Some of us are into that kind of a thing, Akbar . . .

 

[PlutoBoy]

Some of us are into that kind of a thing, Akbar . . .

So you fell for it?

 

[jdh71]

So you fell for it?

7 on, 7 off??

Goodness no.

I thought you were talking about traps.

 

[PlutoBoy]

7 on, 7 off??

Goodness no.

I thought you were talking about traps.

My man.

 

[IM APD]

I work predominately as a hospital based physician and my wife is a clinic internist. The answer to the question completely depends on the nature of your job. If, as a hospitalist, you are required to be in house for your 12hr shift, take admits through your shift, don't have a cap, see patients in the ICU and are a part of the code team, then ya, 7/7 doesn't matter... that's rough and as a parent, you'll miss out on a lot of life.

If, however, you are patient capped at 15, stop admitting at 3pm and can take cross cover call out of the hospital, have no ICU or code team responsibilities, then I personally believe the hospitalist lifestyle is superior.

As a hospitalist, you are never waiting for appointments.. once you've seen everyone on your list, you are effectively done and have the rest of the day to do notes and follow up on results. As a clinic based doctor, you may have 1 patient at 0700 and not another till 0430 but you're not done until your last patient shows up. It's hard to complete notes during your day b/c an encounter can last 30 minutes. You're constantly calling in results, meds, following up on imaging, labs, pre-authorizations. My wife will work 8-5 but could work on charts until 10 if she had the ability.

Figure out what you like first. Then look at job advertisements in the area you're interested. It'll give a lot of the expectations. You can find gems in both areas and you can also find misery in both.

 

[itisallrelative]

Hospitalist seem to get paid more but the environment and work schedule seem worse, compared to something like a group primary care clinic.

You know, those waters can get quite murky. It really depends on where you are and who you work for or with.

 

[Siggy]

7 on, 7 off??

Goodness no.

I thought you were talking about traps.

...not that there's anything wrong with traps...

 

[jdh71]

...not that there's anything wrong with traps...

That what I was saying!!!

 

[itisallrelative]

That what I was saying!!!

You know, I just noticed that quote in your sig. I like it. Just wanted to write that.

 

[FutureInternist]

......If, however, you are patient capped at 15, stop admitting at 3pm and can take cross cover call out of the hospital, have no ICU or code team responsibilities, then I personally believe the hospitalist lifestyle is superior.........

Come to Presbyterian in Albuquerque

 

[NghtSky04]

I work predominately as a hospital based physician and my wife is a clinic internist. The answer to the question completely depends on the nature of your job. If, as a hospitalist, you are required to be in house for your 12hr shift, take admits through your shift, don't have a cap, see patients in the ICU and are a part of the code team, then ya, 7/7 doesn't matter... that's rough and as a parent, you'll miss out on a lot of life.

If, however, you are patient capped at 15, stop admitting at 3pm and can take cross cover call out of the hospital, have no ICU or code team responsibilities, then I personally believe the hospitalist lifestyle is superior.

As a hospitalist, you are never waiting for appointments.. once you've seen everyone on your list, you are effectively done and have the rest of the day to do notes and follow up on results. As a clinic based doctor, you may have 1 patient at 0700 and not another till 0430 but you're not done until your last patient shows up. It's hard to complete notes during your day b/c an encounter can last 30 minutes. You're constantly calling in results, meds, following up on imaging, labs, pre-authorizations. My wife will work 8-5 but could work on charts until 10 if she had the ability.

Figure out what you like first. Then look at job advertisements in the area you're interested. It'll give a lot of the expectations. You can find gems in both areas and you can also find misery in both.

I am curious how common are these type of jobs? I'd assume it'd be a lot easier to find outside of major cities like Chicago, New York, Los Angeles, etc etc. I wouldn't mind trading location for a better lifestyle/job.

 

[itisallrelative]

I am curious how common are these type of jobs? I'd assume it'd be a lot easier to find these type of jobs outside of major cities like Chicago, New York, Los Angeles, etc etc. I wouldn't mind trading location for a better lifestyle/job.

...and a ~100k raise to boot?

 

[BertMacklinFBI]

Depends on how much you care about weekends. There are some sweet hospitalist gigs out there like mine - 7 on 7 off, cap 12-16, with dedicated admitters during the day, and on quiet days, you can sign out mid afternoon. We do a couple weeks of swing (admitting) and 2-4 weeks of nights (admitting or cross covering) and make a respectable salary. I can't see primary care being better than that.

 

[itisallrelative]

Depends on how much you care about weekends. There are some sweet hospitalist gigs out there like mine - 7 on 7 off, cap 12-16, with dedicated admitters during the day, and on quiet days, you can sign out at 2. We do a couple weeks of swing (admitting) and 2-5 weeks of nights (admitting or cross covering) and make a respectable salary. I can't see primary care being better than that.

How many beds?

 

[BertMacklinFBI]

600 or so. It's a private group at a university hospital.

 

[itisallrelative]

600 or so. It's a private group at a university hospital.

Now that is delicious.

 

[itisallrelative]

600 or so. It's a private group at a university hospital.

Listen, I've got a kid (not mine just someone I am involved in mentoring) whose finishing up IM residency. Based on some of the discussions I've had w/ him, and out of my own curiosity (don't know that much about non-academic IM), how old's the youngest partner? You can give me a range if you're uncomfortable stating exactly, e.g. 30-35, 35-40.

 

[meerkat111]

I hate what clinics have become with mid levels trying to get away with 8 to 5 schedules, not being able to spend time w patients, more paperwork, preauth, nursing home visits, pain med seekers. Hence I put up with 12 hr shifts, i feel more fulfilled. Easy? No.

 

[LiquidN-H]

I would say it is the exact opposite. My wife just quit being a hospitalist because she got tired of working Christmas and Thanksgiving and every other weekend.

As soon as kids are in any kind of school, you only lose a couple hours a day with them if you work a typical outpatient job.

It's the other way around. Primary care is much more conducive to customary lifestyles.

Primary care is better. The 7 on/7 off schedule is a trap.

I know at least 3 hospitalists that work 11 to 11 around 7 days a month, and they actually transitioned to this from PCP job... The reason they cited is that they didn't want those few hours every day from time with their kids - they only wanted to work a few days (seniority → preference → no working holidays) and they worked on a weekday schedule (M & Th every week) and they loved having weekends to go to events/kids events and not having to work holidays (this is a big thing about being senior/working there for a while).
If you think about it, it makes sense - only being there the day after when they get home from school and having the entire week free/ taking vacations whenever.

 

[IM APD]

I am curious how common are these type of jobs? I'd assume it'd be a lot easier to find outside of major cities like Chicago, New York, Los Angeles, etc etc. I wouldn't mind trading location for a better lifestyle/job.

This is the big secret that a lot of urban, east/west coast trained physicians have a hard time wrapping their minds around. Unless you need access to a celebrity night club, many southern and middle America cities and suburbs offer superb entertainment options, great restaurants, interesting bars and a quality of personal and career life, that can't be sniffed in large cities. Before I took my current academic position, the small hospital in my suburbian town was offering $240k 7/7, no ICU and the census for the hospitalist the day I interviewed, was 4.. Go play golf when you're done and the ER will write admit orders on anyone that comes in after you leave. They focus on surgical specialties and the CEO stated that having a hospitalist that lost them money, "was the cost of doing business" for keeping the surgeons efficient and happy. All this to say, there are countless options out there. Don't be convinced that you have to settle into a cookie cutter experience.

 

[Siggy]

This is the big secret that a lot of urban, east/west coast trained physicians have a hard time wrapping their minds around. Unless you need access to a celebrity night club, many southern and middle America cities and suburbs offer superb entertainment options, great restaurants, interesting bars and a quality of personal and career life, that can't be sniffed in large cities. Before I took my current academic position, the small hospital in my suburbian town was offering $240k 7/7, no ICU and the census for the hospitalist the day I interviewed, was 4.. Go play golf when you're done and the ER will write admit orders on anyone that comes in after you leave. They focus on surgical specialties and the CEO stated that having a hospitalist that lost them money, "was the cost of doing business" for keeping the surgeons efficient and happy. All this to say, there are countless options out there. Don't be convinced that you have to settle into a cookie cutter experience.

Naw, man... the local EMCare hospitalists can't be lying that $230k for week on/week off for seeing 30 patients/day is the NEW NORMAL. (there's a reason why when my program director asked if the program can hand out my information to the local recruiters I said "no.")

 

[rokshana]

Naw, man... the local EMCare hospitalists can't be lying that $230k for week on/week off for seeing 30 patients/day is the NEW NORMAL. (there's a reason why when my program director asked if the program can hand out my information to the local recruiters I said "no.")

EMcare...ugh had the WORST experience with them...and yes, their normal seems to be 25 pt (plus admit half a day)...never broke a contract as a locums until i worked at a hospital that the hospitalist service was staffed by EMCare...the hospital was nice and the staff were super, but EMCare admin...smh.

 

[Locumguy]

I would say it is the exact opposite. My wife just quit being a hospitalist because she got tired of working Christmas and Thanksgiving and every other weekend.

As soon as kids are in any kind of school, you only lose a couple hours a day with them if you work a typical outpatient job.

If you dislike working Thanksgiving/Chrismas and other holidays you could still remain a hospitalist but just change your strategy. E.g. you can go part time (one week on and 3 weeks off) and schedule the rest of your shifts when you want as a locum. If you don't want to travel just find local hospitals or hospitalists companies and work per-diem close to home.

Alternatively you can switch to full time locum tenens or per-diem which is paid better so that you can make full timers income by just doing 10-11 shifts a month so effectively your schedule will be 10 days on/20 off (or 7on/14 off), this way you will have even more time to spend with kids.

 

[VA Hopeful Dr]

If you dislike working Thanksgiving/Chrismas and other holidays you could still remain a hospitalist but just change your strategy. E.g. you can go part time (one week on and 3 weeks off) and schedule the rest of your shifts when you want as a locum. If you don't want to travel just find local hospitals or hospitalists companies and work per-diem close to home.

Alternatively you can switch to full time locum tenens or per-diem which is paid better so that you can make full timers income by just doing 10-11 shifts a month so effectively your schedule will be 10 days on/20 off (or 7on/14 off), this way you will have even more time to spend with kids.

Most places we've found will only let you do part time if there is someone else who also wants to do part time (so that between the 2 of you its a full time equivalent).

Per diem is all well and good, but you never really know how much you'll be working. Could be 8 shifts a month, could be 2. That income uncertainty is not ideal.

If you want to spend more time with kids, why on earth do you think locums is a good idea? I mean sure, you'll have more days off. But the days on you won't see your family at all.

 

[Locumguy]

Most places we've found will only let you do part time if there is someone else who also wants to do part time (so that between the 2 of you its a full time equivalent).

Per diem is all well and good, but you never really know how much you'll be working. Could be 8 shifts a month, could be 2. That income uncertainty is not ideal.

If you want to spend more time with kids, why on earth do you think locums is a good idea? I mean sure, you'll have more days off. But the days on you won't see your family at all.

I agree with you, there's always a degree of uncertainty when you work locum tenens or per-diem. But you can minimize it if you sign a per-diem contract with multiple hospitals which means you have to work directly with the hospital or hospitalists company as opposed to the locum agencies (that's the key). I live in the large size metro and I'm credentialed at 5 hospitals in the area (30-55 minutes away from where I live) and 2 that are beyond the commutable distance but still under 2 hours from my home (my back up facilities). There's been only once when there were less than 10/months shifts available. As to the family time I get home around 6 pm and never need to spend nights at the hotels.

Let's look at the full-time primary care employment - usually you have to do 4.5 to 5 day a week clinic to be a full timer and that is not even considering your weekend call responsbility that some practices have. So we are looking at anywhere between 18 and 22 working days a month. To make the same or higher annual salary while being per-diem/locum hospitalist you need to do 10-11 days a months only! $160 and hour (which is at the low end)*12 hour shifts=$1920 per shift. Now 11 shifts a month will total 19.2K per month will give you ~250K salary per year.

IMHO this approach has much better return both financially and timewise. Plus you have much more control over your time since YOU decide if you want to be on or off during major Holidays (if you're willing to work on those days you usually get premium pay when you are locum/per-diem).

 

[VA Hopeful Dr]

I agree with you, there's always a degree of uncertainty when you work locum tenens or per-diem. But you can minimize it if you sign a per-diem contract with multiple hospitals which means you have to work directly with the hospital or hospitalists company as opposed to the locum agencies (that's the key). I live in the large size metro and I'm credentialed at 5 hospitals in the area (30-55 minutes away from where I live) and 2 that are beyond the commutable distance but still under 2 hours from my home (my back up facilities). There's been only once when there were less than 10/months shifts available. As to the family time I get home around 6 pm and never need to spend nights at the hotels.

Let's look at the full-time primary care employment - usually you have to do 4.5 to 5 day a week clinic to be a full timer and that is not even considering your weekend call responsbility that some practices have. So we are looking at anywhere between 18 and 22 working days a month. To make the same or higher annual salary while being per-diem/locum hospitalist you need to do 10-11 days a months only! $160 and hour (which is at the low end)*12 hour shifts=$1920 per shift. Now 11 shifts a month will total 19.2K per month will give you ~250K salary per year.

IMHO this approach has much better return both financially and timewise. Plus you have much more control over your time since YOU decide if you want to be on or off during major Holidays (if you're willing to work on those days you usually get premium pay when you are locum/per-diem).

If you're working a full time outpatient schedule, you should be making more than 250k.

If we assume 46 working weeks at 4.5 days per week, that's only 21 patients per day using standard wRVU numbers.

 

[DaTruMD]

I agree with you, there's always a degree of uncertainty when you work locum tenens or per-diem. But you can minimize it if you sign a per-diem contract with multiple hospitals which means you have to work directly with the hospital or hospitalists company as opposed to the locum agencies (that's the key). I live in the large size metro and I'm credentialed at 5 hospitals in the area (30-55 minutes away from where I live) and 2 that are beyond the commutable distance but still under 2 hours from my home (my back up facilities). There's been only once when there were less than 10/months shifts available. As to the family time I get home around 6 pm and never need to spend nights at the hotels.

Let's look at the full-time primary care employment - usually you have to do 4.5 to 5 day a week clinic to be a full timer and that is not even considering your weekend call responsbility that some practices have. So we are looking at anywhere between 18 and 22 working days a month. To make the same or higher annual salary while being per-diem/locum hospitalist you need to do 10-11 days a months only! $160 and hour (which is at the low end)*12 hour shifts=$1920 per shift. Now 11 shifts a month will total 19.2K per month will give you ~250K salary per year.

IMHO this approach has much better return both financially and timewise. Plus you have much more control over your time since YOU decide if you want to be on or off during major Holidays (if you're willing to work on those days you usually get premium pay when you are locum/per-diem).

This is a great post. Thanks for the info.

 

[sluggs]

Define "quality of life" for you then decide. Some folks like bankers hours without call, nights, or weekends. Some folks like a solid 7 days off in a row regularly.

Though I've always thought this was pretty much the wrong question in medicine every time it's asked. It's misses the point of the calling and the the profession.

Finally JDH says something I agree with... this is a profession and a calling. We need to treat it as such!!

 

[VA Hopeful Dr]

Finally JDH says something I agree with... this is a profession and a calling. We need to treat it as such!!

So we should all work 100 hours a week and be thankful for the privilege? Don't be silly. Most people need good work/life balance, otherwise burnout would be worse than it already is.

 

[Gastrapathy]

I hate hate hate the phrase work/life balance. It suggests you've given up on finding fulfillment at work and your life stops when you step inside the walls. You spend so much time at work, you need to keep looking until you don't think that phrase applies. But, don't get me wrong, part of finding work fulfilling is not being there more than you should for your own happiness.

I can't fathom hospitalist life personally. It looks like a perpetual R2 year to me. If you want shift work, be an anesthesiologist, EM, etc.

 

[VA Hopeful Dr]

I hate hate hate the phrase work/life balance. It suggests you've given up on finding fulfillment at work and your life stops when you step inside the walls. You spend so much time at work, you need to keep looking until you don't think that phrase applies. But, don't get me wrong, part of finding work fulfilling is not being there more than you should for your own happiness.

I can't fathom hospitalist life personally. It looks like a perpetual R2 year to me. If you want shift work, be an anesthesiologist, EM, etc.

Fair enough, but I'm not sure what else to call it.

 

[Gastrapathy]

Fair enough, but I'm not sure what else to call it.

Me either. I just hate the underlying assumption.

 

[GastriqueGraffin]

When I started medical school and asked docs what I should be I was told look at the personalities of specialty and you will find your fit. Surgeons are different than internists who are different than anesthesiologists, and dermatologists, etc. This is also very true for the answer to the question of hospitalist vs PCP. You know what environment makes you happy. For a hospitalist-minded person outpatient is slow and painfully boring. For a primary care person the hospital work and pagers would make you want to jump out the window.

 

[IM2GI]

Primary care is better. The 7 on/7 off schedule is a trap.

It's a young person's game. As soon as you have a family and less flexible lifestyle the weekends and holidays get old fast. Hard on your partner too.

I did a year of night hospitalist 6 on 8 off, which was fine, but no way that lifestyle is sustainable.

 

[Trogghunter]

Seek and you shall find, I suppose, but there's no way I could be doing PCP right now. My favorite aspect is that when I am off, I have significantly less clinical responsibility that goes with being a PCP. I love those admit and night shifts--pure medicine, no mumbo-jumbo.