Need advice for hospitalist vs specialization

[med9999]

Hello,

I am currently an intern in a small community internal medicine program. I was hoping to get some advice as I find myself daily thinking of the future and what career path I should take. I went into residency picking internal medicine because to be frank there wasn't a field I was drawn to. I knew I didn't like procedures and didn't want to do any field requiring hands on skills. I know I am just a first year and have time to decide but as DO and being in a very small new community program I would need get research going if I pursue a fellowship.

For me the number one priority in my life is family, thats why lately Ive been finding myself thinking hospitalist would be the best route as it allows me to work half the month and without call or any work when I'm done. The only thing I worry about is burn out and not being the master of one field. I would really appreciate any advice on this. Thank you!

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[Trogghunter]

If you go the hospitalist route you can save up some money, do some research as you work (if you're at an academic center) and then go into fellowship. The less competitive fellowships will take you with little to no research. Also, you might end up enjoying being a hospitalist! There's a lot more to it than just admissions and discharges and the salary potential is impressive.

If you want to optimize spending time with family then you might not enjoy the weeks on, where you miss every other weekend and you work either Christmas or Thanksgiving. Maybe you can find a group where you only work weekdays, but it's not as family friendly as you'd think. It's perfect though if you always want an excuse not to do something, since even other doctors don't understand a hospitalist schedule.

Schedule friendly/outpatient specialties may be your ticket to a better schedule if that's what you'd like, but you're also early on into your career. Just do your best trying to learn and be a good resident.

 

[Hematologynerd]

Specialize. Specialize. Specialize. Hospitalist is not a long term career option. However, could be a good temporary job for a year or two prior to fellowship

 

[fasteddie911]

Hospitalist may not be family-friendly necessarily. Weekend shifts or lack of energy recovering from 7 days on. It's likely not a long term solution but gen med offers other opportunities too. Primary care, part-time, locums, nocturnist, home visits, etc. Where do you see yourself in 10yrs? What do you want to do? If there's an IM subspecialty you like or could see yourself doing, then that could be a option worth pursuing, even after a few years out of residency. Don't ignore opportunity costs doing fellowship, pay can also vary/change, lifestyle too, you still likely need to take call in some form. If medicine is a means to an end, then hustling as a hospitalist and saving hard may not be a bad way to go either.

 

[NITRAS]

A lot depends on what kind of Hospitalist job you get. ‘

I’ve been working my job for 4.5 years and don’t have any plans on changing. About half my group has been here for 10+ years. No nights, census is reasonable. Pay is pretty good. Location is a big hospital in a smaller town (which rocks for me).

When you consider three years of fellowship would cost me like a million bucks in compensation. . I probably would not make it up any time soon.

 

[AlteredScale]

A lot depends on what kind of Hospitalist job you get. ‘

I’ve been working my job for 4.5 years and don’t have any plans on changing. About half my group has been here for 10+ years. No nights, census is reasonable. Pay is pretty good. Location is a big hospital in a smaller town (which rocks for me).

When you consider three years of fellowship would cost me like a million bucks in compensation. . I probably would not make it up any time soon.

What sort of schedule do you work?

 

[Chemist0157]

I do not think "hospitalist vs specialist" will necessarily be THE decision to determine family friendliness or not. It will fall to the job. Hospital medicine will work if it's all days. You will still miss things occasionally on the weeks you work. Specialties vary greatly. Something like ID or rheumatology can still have call, but it will not be busy.

 

[NITRAS]

What sort of schedule do you work?

So like half the times I’m working a regularly team, but it is days only, round and go. 7 on 7 off. I don’t do admits, nor swing shift, nor nights.

The other half of the time I work directing all the admits. It is a 12 hours on type of thing, but I get 7 days on, 14 days off. They can suck, but really not as bad.

 

[AlteredScale]

So like half the times I’m working a regularly team, but it is days only, round and go. 7 on 7 off. I don’t do admits, nor swing shift, nor nights.

The other half of the time I work directing all the admits. It is a 12 hours on type of thing, but I get 7 days on, 14 days off. They can suck, but really not as bad.

Sounds great!

Are you at an academic center? like with residents/medstudents?

 

[NITRAS]

There are residents where I work, but usually don’t work they don’t work with me.

 

[aafisahar]

hospitalist = highly paid intern and treated/respected as such

 

[Hematologynerd]

hospitalist = highly paid intern and treated/respected as such

Couldnt agree more. No amount of money is enough to spend my career dealing with dispo issues and with needy patients who dont want to go home or want their morphine for their "fibromyalgia" or chronic back pain.

 

[KeikoTanaka]

hospitalist = highly paid intern and treated/respected as such

Forgive my ignorance as I'm only a 2nd year but... I never understood this sentiment. I feel like respect is something that is earned. You don't just suddenly walk into a hospital with an MD/DO name tag and get respect or vice-versa are targeted and treated like ****, regardless of your specialty..

Are there not amazing hospitalists who do great things and have amazing personalities, get along with the nurses and crack jokes with the admins, and therefore, get respect from their peers? As I'm sure there are ****ty specialists who lose respect from others due to their ****ty attitude/bad medicine...

Are hospitalists really treated like ****/not respected or are you all just burnt out and view things so negatively? (And I'm not accusing you of this - I'm just truly curious because the very limited contact I've had with IM doctors and hospitalists thus far have been nothing but positive - The one ED I scribed in, the ED physicians actively had their hospitalists come down to eval their patients and collaborated in real time, there never seemed to be any type of disrespect. But, of course this is one anecdotal example.

I am not trying to sound pretentious. I hope you don't think I'm attacking you or trying to come off like I know more than you as I'm not out in the field yet. I just can't imagine it's different than in any other field, where those who deserve respect get it, and those that don't... don't.

 

[InternistDO]

Forgive my ignorance as I'm only a 2nd year but... I never understood this sentiment. I feel like respect is something that is earned. You don't just suddenly walk into a hospital with an MD/DO name tag and get respect or vice-versa are targeted and treated like ****, regardless of your specialty..

Are there not amazing hospitalists who do great things and have amazing personalities, get along with the nurses and crack jokes with the admins, and therefore, get respect from their peers? As I'm sure there are ****ty specialists who lose respect from others due to their ****ty attitude/bad medicine...

Are hospitalists really treated like ****/not respected or are you all just burnt out and view things so negatively? (And I'm not accusing you of this - I'm just truly curious because the very limited contact I've had with IM doctors and hospitalists thus far have been nothing but positive - The one ED I scribed in, the ED physicians actively had their hospitalists come down to eval their patients and collaborated in real time, there never seemed to be any type of disrespect. But, of course this is one anecdotal example.

I am not trying to sound pretentious. I hope you don't think I'm attacking you or trying to come off like I know more than you as I'm not out in the field yet. I just can't imagine it's different than in any other field, where those who deserve respect get it, and those that don't... don't.

The problem is not your personal interactions with people, it's that both the hospital and a whole host of various surgeons and specialists expect you to admit their patients onto your service so that you get stuck with boring stuff (admitting a stable hip fracture patient at 2am, med recs, getting paged because their pressure is 141/80, discharge planning) so they can swoop in the next morning, do a procedure, and be off to see a new patient. In addition because your census is often high you often have to consult heavily rather than puzzle things out for yourself because of time constraints.Therefore it can feel like your job is to exist to make the lives of cardiologists and orthopedists easier rather than being a "real doctor".

Obviously not everyone feels this way because there are a zillion hospitalists running around but you have to be cool with that if you wanna be a hospitalist (though this is more specific to the community setting).

 

[gutonc]

The problem is not your personal interactions with people, it's that both the hospital and a whole host of various surgeons and specialists expect you to admit their patients onto your service so that you get stuck with boring stuff (admitting a stable hip fracture patient at 2am, med recs, getting paged because their pressure is 141/80, discharge planning) so they can swoop in the next morning, do a procedure, and be off to see a new patient. In addition because your census is often high you often have to consult heavily rather than puzzle things out for yourself because of time constraints.Therefore it can feel like your job is to exist to make the lives of cardiologists and orthopedists easier rather than being a "real doctor".

Obviously not everyone feels this way because there are a zillion hospitalists running around but you have to be cool with that if you wanna be a hospitalist (though this is more specific to the community setting).

Are you a hospitalist? Or a resident?

Because, this is what most hospitalists call a "boat payment".

To your specific example:

admitting a stable hip fracture patient at 2am

"Patient admitted from ED for hip fx. Ortho to OR in AM. No other complaints. NPO PMN. 2mg IV morphine Q3h PRN pain. Continue home meds.

med recs

This is what pharmacy students/interns are for.

getting paged because their pressure is 141/80

"Call MD for SBP >180 or <80"

discharge planning

"D/c to SNF per ortho and PT recs. SW/RN working on placement, transfer when bed available."

Look at that. I just wrote an entire weeks worth of admit, progress and discharge notes as well as orders for that patient. Add in the 15-20 minutes it will take to see that patient (total) this week and woohoo...new boat here I come.

 

[KeikoTanaka]

The problem is not your personal interactions with people, it's that both the hospital and a whole host of various surgeons and specialists expect you to admit their patients onto your service so that you get stuck with boring stuff (admitting a stable hip fracture patient at 2am, med recs, getting paged because their pressure is 141/80, discharge planning) so they can swoop in the next morning, do a procedure, and be off to see a new patient. In addition because your census is often high you often have to consult heavily rather than puzzle things out for yourself because of time constraints.Therefore it can feel like your job is to exist to make the lives of cardiologists and orthopedists easier rather than being a "real doctor".

Obviously not everyone feels this way because there are a zillion hospitalists running around but you have to be cool with that if you wanna be a hospitalist (though this is more specific to the community setting).

So then, what options exist for people interested in general-IM but want to "feel like a real doctor"? Seems like everything I read always makes me come back to then maybe wanting to just do outpatient private practice because it's the only setting I won't have anyone breathing down my neck and I can do what I want. Instead of me being the "Extender of the cardiologist" - they are the extender of me as I am sending patients to them on my terms, not the other way around. I guess I'm glad I don't care too much about salary lol

 

[rokshana]

So then, what options exist for people interested in general-IM but want to "feel like a real doctor"? Seems like everything I read always makes me come back to then maybe wanting to just do outpatient private practice because it's the only setting I won't have anyone breathing down my neck and I can do what I want. Instead of me being the "Extender of the cardiologist" - they are the extender of me as I am sending patients to them on my terms, not the other way around. I guess I'm glad I don't care too much about salary lol

In medicine today, unless you are a solo practitioner, someone will be breathing down your neck.

 

[tantacles]

So then, what options exist for people interested in general-IM but want to "feel like a real doctor"? Seems like everything I read always makes me come back to then maybe wanting to just do outpatient private practice because it's the only setting I won't have anyone breathing down my neck and I can do what I want. Instead of me being the "Extender of the cardiologist" - they are the extender of me as I am sending patients to them on my terms, not the other way around. I guess I'm glad I don't care too much about salary lol

Nocturnist. :-D

 

[aafisahar]

Are you a hospitalist? Or a resident?

Because, this is what most hospitalists call a "boat payment".

To your specific example:

"Patient admitted from ED for hip fx. Ortho to OR in AM. No other complaints. NPO PMN. 2mg IV morphine Q3h PRN pain. Continue home meds.

This is what pharmacy students/interns are for.

"Call MD for SBP >180 or <80"

"D/c to SNF per ortho and PT recs. SW/RN working on placement, transfer when bed available."

Look at that. I just wrote an entire weeks worth of admit, progress and discharge notes as well as orders for that patient. Add in the 15-20 minutes it will take to see that patient (total) this week and woohoo...new boat here I come.

RN case management calls you at 730 asking 3 people you haven't seen yet are inpatient and not obs. Hospital medicine director calls you in for being in the bottom 30% for LOS. Coder calls you to clarify "did you mean to say hypoxia, acute hypoxic respiratory failure, or dyspnea" and "please clarify if you meant acute systolic heart failure, acute on chronic systolic heart failure, or acute on chronic combined systolic and diastolic heart failure". GI scoped your patient without letting you know, cards just cathed your chest pain rule out without telling you, the ED wants to admit a 96 year old with a RDW of 18 who "just looks bad". No patient is thankful for your care, no one recognizes you as their doctor, and you are a widget to the hospital who is actively culling hospitalists for APPs.

Being a hospital is literally for the side perks, no one grows up wanting to be a hospitalist. Most IM graduates are doing it for the perceived notion that 7/7 is a good lifestyle, because they want to make money, and because they "hate clinic" only because they did clinic in a FHQC where the most functional person is the high functioning alcoholic who works as an electrician. This is why hospitalists are the second highest burnt out job in medicine after EM, because no one respects you, including specialists, administration, patients, ancillary staff. The only value you provide is decreasing a hospital's LOS so that they can do more elective hips and knees.

 

[medstudent2IM]

Couldnt agree more. No amount of money is enough to spend my career dealing with dispo issues and with needy patients who dont want to go home or want their morphine for their "fibromyalgia" or chronic back pain.

I've been working as hospitalist for last 6 months and I have to say a lot of what is being said in this thread is absolute garbage coming from people who have never actually worked as a hospitalist or probably interacted with any outside of an academic medical center. The idea that you are simply someone to hold a pager to write for a bowel regimen is ridiculous. The fact is that I have found my job to be challenging and rewarding. You see a variety of different cases and my interactions with consultants, surgeons and nurses has been positive the vast majority of the time. The physicians' lounge isn't just a place to grab coffee and leave; we all actually talk to each other about our shared, complicated patients. I also feel very fairly compensated for my work and I have a good amount of time off. As a fellow hospitalist mentioned above, the income potential is also quite high if you want to put in extra hours. There are drawbacks to any specialty that you are going to choose; its just that everyone seems to have an opinion on hospitalist work based on experience in residency.

To the heme bound individuals above...In the words of one of my friends who is now a hem/onc attending: "I didn't know when I signed up for this that I was going to become these patients' PCP."

 

[rokshana]

I've been working as hospitalist for last 6 months and I have to say a lot of what is being said in this thread is absolute garbage coming from people who have never actually worked as a hospitalist or probably interacted with any outside of an academic medical center. The idea that you are simply someone to hold a pager to write for a bowel regimen is ridiculous. The fact is that I have found my job to be challenging and rewarding. You see a variety of different cases and my interactions with consultants, surgeons and nurses has been positive the vast majority of the time. The physicians' lounge isn't just a place to grab coffee and leave; we all actually talk to each other about our shared, complicated patients. I also feel very fairly compensated for my work and I have a good amount of time off. As a fellow hospitalist mentioned above, the income potential is also quite high if you want to put in extra hours. There are drawbacks to any specialty that you are going to choose; its just that everyone seems to have an opinion on hospitalist work based on experience in residency.

To the heme bound individuals above...In the words of one of my friends who is now a hem/onc attending: "I didn't know when I signed up for this that I was going to become these patients' PCP."

That’s great that 6 months in you have had a rewarding experience, but don’t think that the people here making comments have no experience...been doing it off and on for going on 7 years now...and as locums, generally I go into places that don’t work(why they need locums) so may be skewed to the worst examples, but the level of respect does vary ...the push from case management is there to decrease LOS , babysitting ortho patients is very real at many places, and CDI does drive you crazy with those meaningless differences of documentation....

Hopefully you feel the same way in 6 years that you do 6 months in...

 

[rokshana]

Nocturnist. :-D

Well that’s true...why I prefer doing nocturnist now over daytime rounding...but oh the stupid cross cover at 3am...smh!

 

[InternistDO]

Are you a hospitalist? Or a resident?

Because, this is what most hospitalists call a "boat payment".

Still in training, just recounting the laments of my attendings during my community medicine rotation. I'm not saying that admitting a hip fx is a great hardship, so perhaps it was a bad example. I'm just saying that as others have pointed out, hospitalist medicine has its warts, mostly relating to metrics and the feeling that you can be babysitting patients for specialists.

So then, what options exist for people interested in general-IM but want to "feel like a real doctor"? Seems like everything I read always makes me come back to then maybe wanting to just do outpatient private practice because it's the only setting I won't have anyone breathing down my neck and I can do what I want. Instead of me being the "Extender of the cardiologist" - they are the extender of me as I am sending patients to them on my terms, not the other way around. I guess I'm glad I don't care too much about salary lol

I hardly speak from a position of experience but I do know one thing, which is that you're not going to know what you enjoy until you do your clinical rotations and actually experience clinical medicine.

Plenty of people like hospitalist medicine, and a lot of this stuff is very institution dependent. Also don't forget--people come on SDN and similar sites to vent frustrations, so you are going to hear many more negative anecdotes about specialties than positive ones.

 

[Hematologynerd]

To the heme bound individuals above...In the words of one of my friends who is now a hem/onc attending: "I didn't know when I signed up for this that I was going to become these patients' PCP."

I agree, in many ways they do become like surrogate PCPs for their cancer patients.

 

[gutonc]

I agree, in many ways they do become like surrogate PCPs for their cancer patients.

I don't. Not my specialty, not my job. Just like I don't become their cardiologist or orthopedic surgeon.

 

[Chemist0157]

Forgive my ignorance as I'm only a 2nd year but... I never understood this sentiment. I feel like respect is something that is earned. You don't just suddenly walk into a hospital with an MD/DO name tag and get respect or vice-versa are targeted and treated like ****, regardless of your specialty..

Are there not amazing hospitalists who do great things and have amazing personalities, get along with the nurses and crack jokes with the admins, and therefore, get respect from their peers? As I'm sure there are ****ty specialists who lose respect from others due to their ****ty attitude/bad medicine...

Are hospitalists really treated like ****/not respected or are you all just burnt out and view things so negatively? (And I'm not accusing you of this - I'm just truly curious because the very limited contact I've had with IM doctors and hospitalists thus far have been nothing but positive - The one ED I scribed in, the ED physicians actively had their hospitalists come down to eval their patients and collaborated in real time, there never seemed to be any type of disrespect. But, of course this is one anecdotal example.

I am not trying to sound pretentious. I hope you don't think I'm attacking you or trying to come off like I know more than you as I'm not out in the field yet. I just can't imagine it's different than in any other field, where those who deserve respect get it, and those that don't... don't.

For the most part, being any physician is going to garner a lot of instant respect in the hospital. Nurses, admin staff, etc will be respectful. Now that may change as they get to know the person better. Meaning, they may remain professionally respectful but not may respect someone as a person if he is terrible to others.

Hospitalists are not treated poorly as people. Well, at least not where I work. I think the job can feel as if one is managing a dumping ground sometimes, but that's just what internal medicine is in a hospital. One will do the most he can then consult when the problem is out of one's scope. That can sometimes mean "babysitting," but just do the easy patient encounter, get paid, and move on. It probably is better for a hospitalist to comanage a patient who is there for a surgery because the surgeon is not as well trained to deal with chronic medical problems.

People get worked up here about not everything being incredibly fulfilling or incredibly intellectually stimulating all day every day, but heck, an actual attending does not want 20+ complicated, "interesting" cases to work through all day, every day. I don't want to walk into the hospital and have to manage 25+ GNs in consult, lol. I some prerenal AKI, ATN, routine ESRD patients to fill up some of the list.

 

[NITRAS]

I’m largely pretty happy with my job. Yes, as this thread clearly points out, physicians look down on you and feel that you are specialist’s scut monkey. I’m here to help patients. I have the benefit of dealing with more issues than 10 (most specialists basically deal with 10 ICD10 codes). I really don’t mind those old hip fractures. ‘

Have you actually seen ortho or neurosurgery’s management of basic medical problems? Trust me, you need someone with half a brain looking at basic stuff.

 

[medstudent2IM]

I would also say that, at least within my hospitalist system, there have been adjustments made to scheduling and workflow that keeps job satisfaction up for our group. Hospital medicine used to be thought of as solely a temporary job as bridge to fellowship and way to earn extra money. The retention within my group is insanely high and new hires come in because of expansion of hospitalist services (ie the last of the PCP's have lost hospital privileges/don't want them). Hospital systems do exist that do aim to retain hospitalist because of the cost of hiring locums, recruiting, credentialing, training new hospitalist. Churn and burn is expensive and many hospital systems understand this.

The one piece of advice I would give to anybody looking for a hospitalist job is to ask about retention rate. Its the one thing that takes into account all facets of the job (salary, hours, respect within system...ultimately job satisfaction).

 

[xoggyux]

In medicine today, unless you are a solo practitioner, someone will be breathing down your neck.

Well, even then you always have someone. Creditors/banks if you don't fully own it, your practice manager if you hire one and he/she is any good or your "business" self. If none of those are breathing behind your neck, chances are you are going to end up bankrupt or in court xD.

The best way to deal with burnout is to set up realistic expectations and to manage them. I have a family member that used to have a nice 80k/year job but he would freak out for every tiny little thing. Guess what, he quit "because he could get something better" now he is far more stressed out, working far more hours as Uber, making half the money.

 

[tantacles]

Well that’s true...why I prefer doing nocturnist now over daytime rounding...but oh the stupid cross cover at 3am...smh!

"Your patient is constipated at 3 am? I'll put in an enema right away!"

"But . . . I don't think they need an enema!"

"No, I absolutely appreciate your call. You called me at 3 am because it's urgent that we get this patient unconstipated. I'm putting in the enema order now. Would you mind administering it?"

The important thing: No sarcasm in your voice at all. This approach teaches important lessons. When the nurse calls back in 30 minutes saying the patient refused the suppository, I usually respond with something to the effect of, "ok!"

 

[rokshana]

"Your patient is constipated at 3 am? I'll put in an enema right away!"

"But . . . I don't think they need an enema!"

"No, I absolutely appreciate your call. You called me at 3 am because it's urgent that we get this patient unconstipated. I'm putting in the enema order now. Would you mind administering it?"

The important thing: No sarcasm in your voice at all. This approach teaches important lessons. When the nurse calls back in 30 minutes saying the patient refused the suppository, I usually respond with something to the effect of, "ok!"

That has most definitely crossed my mind and have actually said it as an option...in my most serious concerned tone of voice...does make them think a bit...

 

[tantacles]

That has most definitely crossed my mind and have actually said it as an option...in my most serious concerned tone of voice...does make them think a bit...

I admit that I'm being glib, and that while tempted to do things like this, I haven't tried it yet. I'd feel guilty asking a nurse to wake a patient up at 3 am to give an enema. But I have no problem saying, "Thank you so much. I'll pass that on to the day team," with little guilt.

 

[rokshana]

I admit that I'm being glib, and that while tempted to do things like this, I haven't tried it yet. I'd feel guilty asking a nurse to wake a patient up at 3 am to give an enema. But I have no problem saying, "Thank you so much. I'll pass that on to the day team," with little guilt.

It’s not the first thing I say...I ask is there anything for constipation prn and if there is have they been tried? If not, then I say Let’s try that! If tried, I’ll ask if pt is complaining and do they feel like they need an enema? BTW, if a pt is asking for an enema...it it to them... often enough this elicits some sort of response that the nurse was reviewing the chart and saw this not that the pt was complaining...usually then some sort of response that they will try one of the prn things or wait to see if pt is having an issue...

 

[xoggyux]

"Your patient is constipated at 3 am? I'll put in an enema right away!"

"But . . . I don't think they need an enema!"

"No, I absolutely appreciate your call. You called me at 3 am because it's urgent that we get this patient unconstipated. I'm putting in the enema order now. Would you mind administering it?"

The important thing: No sarcasm in your voice at all. This approach teaches important lessons. When the nurse calls back in 30 minutes saying the patient refused the suppository, I usually respond with something to the effect of, "ok!"

I did a lot of that during my internship but then I started to learn that taking it on the patient to spite a nurse was a bit cruel on my part.
Nowadays what I do is.
Nurse: Good evening doctor, patient in 102 is constipated and there is no recorded BM since the 12th, just wanted to let you know.
Me: How is the patient, is the patient awake? is the patient complaining that he/she is unconfortable.
Nurse: I have not seen the patient in 3 hours
Me: Why don't you take a peek and let me know, if patient awake don't wake up. Give me a call.
10 mins later.
Nurse: Patient sleeping, do you want me to give him some colace or dulcolax or something?
Me: No, patient sleeping, do not wake up. If he/she wakes up and complains that the constipation is bothering her/him, call me and we will do something about it. Otherwise, let him/her sleep the night and sign out to the night nurse that this has to be addressed in the morning.

I know it does not have the same satisfaction as too passive-aggressive tell her/him to do an enema at 3 in the morning. But you have to also think that someone is going to be awoken in the middle of the night (early morning) to stick some liquid up their rectum to spend the whole night pooping rather than sleeping.

 

[xoggyux]

Specialize. Specialize. Specialize. Hospitalist is not a long term career option. However, could be a good temporary job for a year or two prior to fellowship

I think this couldnt be farther from the truth. I do understand this is a general sentiment amongst many but I disagree. For one, the generalist is important, so the position itself isen't going anywhere.
Also, compensation is not a real reason either. We can run the numbers if you want, or you can go to one of the many forums of physician/investors out there and you'd see that from a monetary perspective, specializing almost always loses you money due to opportunity cost, or at least this is true for the first decade or two of practice in most situations.
Another reason that I see given as why hospitalists sucks is "7/7 schedule sucks". The fact of the matter is that it does not. There is a reason why it is the most popular. There are groups that do 5/5 off, there are some that do 10on/5off, there are schedules that people that get their 8-5 schedule. Basically, there are many options and combinations out there. 7/7 has become popular for a reason.
Finally, there is nothing preventing you to work that until you simply get bored and then go work in a clinic outpatient. Flexibility is your friend.

hospitalist = highly paid intern and treated/respected as such

Don't confuse obedience with respect. Respect is something that it is earned based on the way you interact with others. Obedience is when person A has supervisory leverage over person B.
You can easily be the most respected doctor in your hospital regardless of your specialty if you conduct yourself in the right way. There are plenty of "quacks" specialists that in reality get far less respect than even interns.

 

[tantacles]

I did a lot of that during my internship but then I started to learn that taking it on the patient to spite a nurse was a bit cruel on my part.
Nowadays what I do is.
Nurse: Good evening doctor, patient in 102 is constipated and there is no recorded BM since the 12th, just wanted to let you know.
Me: How is the patient, is the patient awake? is the patient complaining that he/she is unconfortable.
Nurse: I have not seen the patient in 3 hours
Me: Why don't you take a peek and let me know, if patient awake don't wake up. Give me a call.
10 mins later.
Nurse: Patient sleeping, do you want me to give him some colace or dulcolax or something?
Me: No, patient sleeping, do not wake up. If he/she wakes up and complains that the constipation is bothering her/him, call me and we will do something about it. Otherwise, let him/her sleep the night and sign out to the night nurse that this has to be addressed in the morning.

I know it does not have the same satisfaction as too passive-aggressive tell her/him to do an enema at 3 in the morning. But you have to also think that someone is going to be awoken in the middle of the night (early morning) to stick some liquid up their rectum to spend the whole night pooping rather than sleeping.

As I mentioned in a later comment, while tempting, I don't actually try to torture my patients with 3 am enemas because a nurse called me at 3 am about constipation.

 

[xoggyux]

As I mentioned in a later comment, while tempting, I don't actually try to torture my patients with 3 am enemas because a nurse called me at 3 am about constipation.

Just saw it, was posting on my iPad, must have missed. It sounds much fun to say it than to actually do it, you are completely right. I know, I actually did it a few times during my internship, with experience and maturity realized it was the wrong thing to do.

 

[TraderDoc]

hospitalist = highly paid intern and treated/respected as such

LOL... I love this. Been a hospitalist for almost 3 years now, I love my job more and more everyday. My amazing social workers do almost all the disposition work. I have no clinic, no follow up appointments, no inbox messages from patients. I get to work at 8am and leave at 5pm most days aside from my few blocks of evenings each year (no overnights as we have nocturnist service), and never EVER chart at home. Get to see the broad scope of medicine, often are first to diagnose the clinical condition. Intellectually challenged everyday without having to do complex and stressful procedures. I've never felt disrespected once.

In terms of finances, I'm on pace to pay off all my $250K in loans within 5 years after residency, maxing out my backdoor ROTH/403B/457B every year, bought an amazing condo at 32 years old, have enough time to travel the world/ develop new hobbies, read whatever the hell I want, and learn about stocks, passive and active investments (have turned $20K into $150K over last 18 months, thanks to $TRIL and $AXSM among many other stocks). Hospitalist has exceeded all my expectations as a career. I moonlight enough to make $500K/year without getting anywhere near burning out, and that's more than enough money to thrive honestly and I'll be cutting back soon once Im comfortable generating consistent disposable income from stock portfolio over the next 2-3 years.

So yes, this hospitalist is definitely one HIGHLY paid intern. In terms of disrespect, I've never felt disrespected by my consultants, but i guess if they want to look down on me or whatever, they can do so as I drive out of the hospital in my Range.

 

[KeikoTanaka]

LOL... I love this. Been a hospitalist for almost 3 years now, I love my job more and more everyday. My amazing social workers do almost all the disposition work. I have no clinic, no follow up appointments, no inbox messages from patients. I get to work at 8am and leave at 5pm most days aside from my few blocks of evenings each year (no overnights as we have nocturnist service), and never EVER chart at home. Get to see the broad scope of medicine, often are first to diagnose the clinical condition. Intellectually challenged everyday without having to do complex and stressful procedures. I've never felt disrespected once.

In terms of finances, I'm on pace to pay off all my $250K in loans within 5 years after residency, maxing out my backdoor ROTH/401K/403B every year, bought an amazing condo at 32 years old, have enough time to travel the world/ develop new hobbies, read whatever the hell I want, and learn about stocks, passive and active investments (have turned $20K into $150K over last 18 months, thanks to $TRIL and $AXSM among many other stocks). Hospitalist has exceeded all my expectations as a career. I moonlight enough to make $500K/year without getting anywhere near burning out, and that's more than enough money to thrive honestly and I'll be cutting back soon once Im comfortable generating consistent disposable income from stock portfolio over the next 2-3 years.

So yes, this hospitalist is definitely one HIGHLY paid intern. In terms of disrespect, I've never felt disrespected by my consultants, but i guess if they if they want to look down on me or whatever, they can do so as I drive out of the hospital in my Range.

As someone who dreamt of being a hospitalist since I was young as my neighbors were hospitalists, this makes me happy to read. Its all doom and gloom on here. Thank you for the fresh insight. Mind if I ask if this was a place you actively sought or are you just lucky? Or are most people just angry at being a resident and think that it's always going to be like that?

 

[Splenda88]

LOL... I love this. Been a hospitalist for almost 3 years now, I love my job more and more everyday. My amazing social workers do almost all the disposition work. I have no clinic, no follow up appointments, no inbox messages from patients. I get to work at 8am and leave at 5pm most days aside from my few blocks of evenings each year (no overnights as we have nocturnist service), and never EVER chart at home. Get to see the broad scope of medicine, often are first to diagnose the clinical condition. Intellectually challenged everyday without having to do complex and stressful procedures. I've never felt disrespected once.

In terms of finances, I'm on pace to pay off all my $250K in loans within 5 years after residency, maxing out my backdoor ROTH/403B/457B every year, bought an amazing condo at 32 years old, have enough time to travel the world/ develop new hobbies, read whatever the hell I want, and learn about stocks, passive and active investments (have turned $20K into $150K over last 18 months, thanks to $TRIL and $AXSM among many other stocks). Hospitalist has exceeded all my expectations as a career. I moonlight enough to make $500K/year without getting anywhere near burning out, and that's more than enough money to thrive honestly and I'll be cutting back soon once Im comfortable generating consistent disposable income from stock portfolio over the next 2-3 years.

So yes, this hospitalist is definitely one HIGHLY paid intern. In terms of disrespect, I've never felt disrespected by my consultants, but i guess if they want to look down on me or whatever, they can do so as I drive out of the hospital in my Range.

That is the general sentiment I got from the hospitalists I have talked to (4 different hospitals). They are all making 300K+/yr and have plenty of time to do other things they love/like. They are not jaded about their job and seem genuinely content.

 

[fldoctorgirl]

I get to work at 8am and leave at 5pm

What's your schedule like on these hours? 7 on/7 off or something else?

 

[DennisReynolds]

LOL... I love this. Been a hospitalist for almost 3 years now, I love my job more and more everyday. My amazing social workers do almost all the disposition work. I have no clinic, no follow up appointments, no inbox messages from patients. I get to work at 8am and leave at 5pm most days aside from my few blocks of evenings each year (no overnights as we have nocturnist service), and never EVER chart at home. Get to see the broad scope of medicine, often are first to diagnose the clinical condition. Intellectually challenged everyday without having to do complex and stressful procedures. I've never felt disrespected once.

In terms of finances, I'm on pace to pay off all my $250K in loans within 5 years after residency, maxing out my backdoor ROTH/403B/457B every year, bought an amazing condo at 32 years old, have enough time to travel the world/ develop new hobbies, read whatever the hell I want, and learn about stocks, passive and active investments (have turned $20K into $150K over last 18 months, thanks to $TRIL and $AXSM among many other stocks). Hospitalist has exceeded all my expectations as a career. I moonlight enough to make $500K/year without getting anywhere near burning out, and that's more than enough money to thrive honestly and I'll be cutting back soon once Im comfortable generating consistent disposable income from stock portfolio over the next 2-3 years.

So yes, this hospitalist is definitely one HIGHLY paid intern. In terms of disrespect, I've never felt disrespected by my consultants, but i guess if they want to look down on me or whatever, they can do so as I drive out of the hospital in my Range.

Can I come join your group in 3 years after residency? PLEASE? I'll do anything! I'll send nudes! I'll wash your Range Rover on my days off. I PROMISE!

Seriously though.

THIS IS F*CKING GOALS.

<3

 

[xoggyux]

That is the general sentiment I got from the hospitalists I have talked to (4 different hospitals). They are all making 300K+/yr and have plenty of time to do other things they love/like. They are not jaded about about their job and seem genuinely content.

Well, I have seen that there are generally 2 types of people. The ones that are always complaining that their job sucks and they are miserable and then there are those that are generally content (or even happy) about what they do. I think it is mostly due to expectations and attitude than the actual job itself (yes, I do realize there are a few jobs that are **** and others that are amazing, however, most of the time they are just average.

 

[Splenda88]

I don't want to open another thread:

I was told hospitalist patient cap can be anything from 15 to 25... It just depends on the group or hospital. Where I am now it's 18. What is the sweet spot?

 

[CCM-MD]

I don't want to open another thread:

I was told hospitalist patient cap can be anything from 15 to 25... It just depends on the group or hospital. Where I am now it's 18. What is the sweet spot?

There is no cap once you are out of training.

 

[tantacles]

I don't want to open another thread:

I was told hospitalist patient cap can be anything from 15 to 25... It just depends on the group or hospital. Where I am now it's 18. What is the sweet spot?

Your hospitalist group will set your limits, but ultimately, if patients need to be admitted to medicine, one of the hospitalists has to do it, so you may (and probably will at some point) go over cap when staffing doesn't meet demand.

 

[bronx43]

LOL... I love this. Been a hospitalist for almost 3 years now, I love my job more and more everyday. My amazing social workers do almost all the disposition work. I have no clinic, no follow up appointments, no inbox messages from patients. I get to work at 8am and leave at 5pm most days aside from my few blocks of evenings each year (no overnights as we have nocturnist service), and never EVER chart at home. Get to see the broad scope of medicine, often are first to diagnose the clinical condition. Intellectually challenged everyday without having to do complex and stressful procedures. I've never felt disrespected once.

In terms of finances, I'm on pace to pay off all my $250K in loans within 5 years after residency, maxing out my backdoor ROTH/403B/457B every year, bought an amazing condo at 32 years old, have enough time to travel the world/ develop new hobbies, read whatever the hell I want, and learn about stocks, passive and active investments (have turned $20K into $150K over last 18 months, thanks to $TRIL and $AXSM among many other stocks). Hospitalist has exceeded all my expectations as a career. I moonlight enough to make $500K/year without getting anywhere near burning out, and that's more than enough money to thrive honestly and I'll be cutting back soon once Im comfortable generating consistent disposable income from stock portfolio over the next 2-3 years.

So yes, this hospitalist is definitely one HIGHLY paid intern. In terms of disrespect, I've never felt disrespected by my consultants, but i guess if they want to look down on me or whatever, they can do so as I drive out of the hospital in my Range.

Moonlight enough to make $500k? That is like working 75-80% of the year. Locums gigs are drying up big time, unless you're moonlighting in your own hospital. But, then it's just a matter of time before they hire enough nocturnists.
Either way, I think most docs would burn out working enough to make $500k as a hospitalist.

 

[TraderDoc]

Moonlight enough to make $500k? That is like working 75-80% of the year. Locums gigs are drying up big time, unless you're moonlighting in your own hospital. But, then it's just a matter of time before they hire enough nocturnists.
Either way, I think most docs would burn out working enough to make $500k as a hospitalist.

I do zero locums. Base with production/quality metrics bonus is about $310K for 175 shifts a year. Moonlighting is internal. I try mostly doing doubles when moonlighting, average about $3200-3400 per double shift, I average 5-6 a month, round on 12-15 in AM and admit 6-8 in evening until midnight. Have roughly 15 weeks off throughout year after moonlighting. First year out of residency I did moonlighting to the max and did $700K but taught me money is worth working that much. My schedule is a hybrid model with some 7/7 off for days (rounding and doing 1-2 admits honestly is cake) and 5on/5 off when I work evening blocks.

maybe I’m still fresh out, but I feel like I’d burn out more if I didn’t work more than the minimum number of shifts. I love the job and seeing my patients, doing my work and leaving the hospital and never taking my work home with me. No teaching and ive learned to be super efficient, can count number of times I’ve had to stay past 5 pm on one hand in three years.

 

[bronx43]

I do zero locums. Base with production/quality metrics bonus is about $310K for 175 shifts a year. Moonlighting is internal. I try mostly doing doubles when moonlighting, average about $3200-3400 per double shift, I average 5-6 a month, round on 12-15 in AM and admit 6-8 in evening until midnight. Have roughly 15 weeks off throughout year after moonlighting. First year out of residency I did moonlighting to the max and did $700K but taught me money is worth working that much. My schedule is a hybrid model with some 7/7 off for days (rounding and doing 1-2 admits honestly is cake) and 5on/5 off when I work evening blocks.

maybe I’m still fresh out, but I feel like I’d burn out more if I didn’t work more than the minimum number of shifts. I love the job and seeing my patients, doing my work and leaving the hospital and never taking my work home with me. No teaching and ive learned to be super efficient, can count number of times I’ve had to stay past 5 pm on one hand in three years.

In which region of the country do you work? Those numbers are much higher than what I have seen in my neck of the woods. Also, most groups didn't allow double shifts.

 

[tantacles]

Moonlight enough to make $500k? That is like working 75-80% of the year. Locums gigs are drying up big time, unless you're moonlighting in your own hospital. But, then it's just a matter of time before they hire enough nocturnists.
Either way, I think most docs would burn out working enough to make $500k as a hospitalist.

So some fun math that shows that you're not necessarily right! All of these first calculations are for NIGHT shifts. Uhhhh no they weren't.

At my main hospital I'll be working at, we do 11 hour NIGHT shifts for about $170/hr. 20 shifts per month => $450,000/year.

At my first side gig, the pay for a day shift is 160/hr. 20 shifts/month => $384,000/year

At that same gig, night shifts pay $180/hr. 20 shifts/month => $432,000/year

At my other side gig, night shifts also pay $180/hr, but they are 14 hour shifts. 20 shifts/month => $604,000/year

Is that to say that you definitely won't be burned out working this many hours? No. But considering many months in residency I work 26 shifts/month, even on nights, I'd say I have a good chance of breaking $500,000/year without getting burnt out.