Mid Career Crisis as a Hospitalist

[dgdg]

Regarding starting an outpt private practice. It would not be financially viable unless you can join an IPA. Or you would have to consider if you were a later career physician who still wanted to work, but for significantly less income than similarly matched peers. There is a benefit to that as well.

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[The kitchen sink]

Wonder why open ICUs keep disappearing if hospitalists can do my job. Weird trend of hospitals going to 24/7 intensivist coverage when hospitalists can do it for cheaper. Wait a second... maybe thats bs.

My last job was in a large metro community hospital where there was a Sound hospitalist program that switched from 2 nocturnists to nocturnist and midlevel, and slowly transitioned to almost half the daytime rounders being midlevels. The medical director "cosigned" all of the midlevel notes. Consult driven trash care with reflex ICU consults for anyone mildly sick. Forget about ICU work, this hospitalist group barely provided adequate care to anyone remotely complicated. From what I hear many other corporate shops are similar.

Regardless, it really doesn't matter who's the "lowest" hanging fruit, we're all low. If I was a med student right now, I would avoid EM/HM/CC/Gas. If I had to pick without considering my interests, it would be: surgical subspecialty > GI > H/O > Cards > A/I = Pulm = Rheum = Endo > ID > Nephro.

Don’t forget Psych. Sleeper specialty. Rampant with midlevel but certainly can be well paid and a contigent of patients wanting a physician.

 

[The kitchen sink]

Unfortunately admins always come up with ways to save money.

For instance, our hospitalist group manage about 1/2 of the ICU patients (non vented, only one 1 pressor, DKA etc...). I hate it when I see 2-3 of these patients on my list. Instead of them hiring 2 CCM docs to cover ~30 ICU beds, They toss some of them to our hospitalist group.

I raise my concerns in every monthly meeting like me beating a dead horse. The answer I always got is a closed ICU is not gonna happen.

Will see how these specialties survive admins attack in the next 10 yrs.

Invite Leapfrog to your hospital, it may change lol

 

[dozitgetchahi]

You can't really give this advice to a large number of IM residents who for one reason or another are matched at community programs with/without exposure to in-house fellowship faculty or mentors. You understand that you're basically saying that most IM residents are royally you know what.
They can either roll the dice on the currently "cushy" Hospitalist gig or become PCPs.

A quick read on other specialties available isn't promising. Allergy is as tough, PCCM ditto. You're left with Rheum, Endo and apparently the dreaded corpse of Nephro.

What is a fool to do? Much appreciated.

You can match rheum, join a semi rural PP, see 18-20 patients a day, take zero call with zero hospital rounds and make $540k like I did last year as a partner.

Don’t believe the salary survey numbers. I’ve never been asked to fill one out.

If you look at MGMA, our 75% is something like $575k. In PP with appropriate compensation for ancillaries, that income is absolutely out there. But you won’t make that in a hospital system under the rip-off “RVU” system, which is basically just a mechanism for greedy admins to eat your productivity and take all your ancillaries for themselves.

 

[bronx43]

You can match rheum, join a semi rural PP, see 18-20 patients a day, take zero call with zero hospital rounds and make $540k like I did last year as a partner.

Don’t believe the salary survey numbers. I’ve never been asked to fill one out.

If you look at MGMA, our 75% is something like $575k. In PP with appropriate compensation for ancillaries, that income is absolutely out there. But you won’t make that in a hospital system under the rip-off “RVU” system, which is basically just a mechanism for greedy admins to eat your productivity and take all your ancillaries for themselves.

That’s just not true. I’m hospital employed and made similar income last year.

It all depends on the situation. Rural/semi rural hospitals with trouble hiring won’t screw you over. They paid me every rvu I made and I made much more per patient visit than I did when I was in a physician owned group.

Most rheum grads won’t be able to find a group that shares infusions. Some groups don’t even have other high end ancillaries. It’s simply a rare occurrence these days.

The biggest difference with rheum is city vs rural and not hospital employed vs “private.” I interviewed with one of the biggest physician owned groups in a major metro and it was absolutely dumpster fire. The numbers they quoted me for income potential including ancillaries was laughable.

 

[dozitgetchahi]

That’s just not true. I’m hospital employed and made similar income last year.

It all depends on the situation. Rural/semi rural hospitals with trouble hiring won’t screw you over. They paid me every rvu I made and I made much more per patient visit than I did when I was in a physician owned group.

Most rheum grads won’t be able to find a group that shares infusions. Some groups don’t even have other high end ancillaries. It’s simply a rare occurrence these days.

The biggest difference with rheum is city vs rural and not hospital employed vs “private.” I interviewed with one of the biggest physician owned groups in a major metro and it was absolutely dumpster fire. The numbers they quoted me for income potential including ancillaries was laughable.

I’ve never encountered a hospital deal anywhere in the country that would pay me similarly - and believe me, I’ve gone looking. I’ve monitored job ads closely for the last 5 years or so, and I’ve been on a ton of interviews both PP and hospital. I’m happy that you found one, but I think finding another hospital that pays like that is much less realistic than even finding another PP that pays that well.

There is a hospital across town where I live now that “can’t find a rheumatologist” because they’re basically paying MGMA median. They cycled through two full time rheums that left and now have had a procession of locums rheums who all seem to leave after 6 months or so. I actually know the CFO of this hospital, and I’ve told him several times that if you want a rheumatologist, you’re going to have to pay for it. They won’t.

The philosophy seems to be similar at most any hospital I’ve encountered in the country. Granted, I’ve seen a lot of BAD PP deals too, so I’m not surprised you got screwed. I’ve seen a number of PP deals that were distinctly worse than any hospital deal I’ve encountered. I worked at a PP previously that was also ripping me off to enrich the “super partners” (and this institution later imploded under the weight of its own fraud and incompetence). So the downside of a **** PP deal is very clear to me, without a doubt. But if you can find the right job, the upside seems to be way better on the PP side, with much less BS.

 

[bronx43]

I’ve never encountered a hospital deal anywhere in the country that would pay me similarly - and believe me, I’ve gone looking. I’ve monitored job ads closely for the last 5 years or so, and I’ve been on a ton of interviews both PP and hospital. I’m happy that you found one, but I think finding another hospital that pays like that is much less realistic than even finding another PP that pays that well.

There is a hospital across town where I live now that “can’t find a rheumatologist” because they’re basically paying MGMA median. They cycled through two full time rheums that left and now have had a procession of locums rheums who all seem to leave after 6 months or so. I actually know the CFO of this hospital, and I’ve told him several times that if you want a rheumatologist, you’re going to have to pay for it. They won’t.

The philosophy seems to be similar at most any hospital I’ve encountered in the country. Granted, I’ve seen a lot of BAD PP deals too, so I’m not surprised you got screwed. I’ve seen a number of PP deals that were distinctly worse than any hospital deal I’ve encountered. I worked at a PP previously that was also ripping me off to enrich the “super partners” (and this institution later imploded under the weight of its own fraud and incompetence). So the downside of a **** PP deal is very clear to me, without a doubt. But if you can find the right job, the upside seems to be way better on the PP side, with much less BS.

almost every hospital that isn’t in a big city pays similarly. MGMA median isn’t bad as long as they pay productivity bonus above your target. Mine is $62 which is not even top 10% for rvu comp in the country. The rvu system is definitely much more lucrative if the PP doesn’t have shared infusions.

If you know of another PP group that shares infusions let me know.

 

[dozitgetchahi]

almost every hospital that isn’t in a big city pays similarly. MGMA median isn’t bad as long as they pay productivity bonus above your target. Mine is $62 which is not even top 10% for rvu comp in the country. The rvu system is definitely much more lucrative if the PP doesn’t have shared infusions.

If you know of another PP group that shares infusions let me know.

$62/RVU isn’t bad, I’ll agree there. My first crap hospital job was giving me like $44/RVU, and probably not even paying me all of what I had earned.

That said, I can’t say I’ve found $62/RVU quoted for any other hospital rheum job I’ve seen - rural or urban. Not saying it doesn’t exist, but it seems to be rare.

I also was treated like yesterday’s garbage at that first hospital job, so that colors my view of things. The PP experience has been way better in terms of autonomy and minimal BS, hire/fire authority for staff, etc.