Need advice for hospitalist vs specialization

[bronx43]

So some fun math that shows that you're not necessarily right! All of these first calculations are for NIGHT shifts.

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.

I guess if you’re using residency as a comparison then 500k wouldn’t be that taxing. For me personally, I would burn out doing 20 nights a month quickly...

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[tantacles]

I guess if you’re using residency as a comparison then 500k wouldn’t be that taxing. For me personally, I would burn out doing 20 nights a month quickly...

I think this is why for me, it's important to go to a schedule that isn't too easy right out of residency. If I go straight to 10 nights per month, which is my job's minimum, I'll probably never want to work 20/month again!

 

[Splenda88]

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.

Are you still making 700k/yr? How many years have you been out of residency?

 

[CCM-MD]

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.

Essentially, if you work an average of 60 hours per week you can make 500k as a hospitalist. That's a lot of cash but that's also a lot of work. But thats not so bad, considering many of the cardiologists I know work 60 hours a week for similar income. Factor in the lower amount of training and time value of money, financially you probably come ahead long term.

This is provided you can tolerate working this much as a hospitalist obviously. I would be willing to bet that most people would not be able to sustain this, but there are obviously people who can.

 

[tantacles]

Essentially, if you work an average of 60 hours per week you can make 500k as a hospitalist. That's a lot of cash but that's also a lot of work. But thats not so bad, considering many of the cardiologists I know work 60 hours a week for similar income. Factor in the lower amount of training and time value of money, financially you probably come ahead long term.

This is provided you can tolerate working this much as a hospitalist obviously. I would be willing to bet that most people would not be able to sustain this, but there are obviously people who can.

What do I know? I'm just finishing residency. But it seems like the key is to do this right out of residency so that you can scale back rather than starting small, getting used to not working so much, and ramping up.

 

[VA Hopeful Dr]

What do I know? I'm just finishing residency. But it seems like the key is to do this right out of residency so that you can scale back rather than starting small, getting used to not working so much, and ramping up.

The risk is burning out in your first 5 years out of residency

 

[tantacles]

The risk is burning out in your first 5 years out of residency

Burnout is always a risk. But am I more likely to burn out if I ramp down work a little more slowly or start working a lot less and then ramp up? Unique to each provider.

 

[VA Hopeful Dr]

Burnout is always a risk. But am I more likely to burn out if I ramp down work a little more slowly or start working a lot less and then ramp up? Unique to each provider.

Or start working the standard amount and just stay there for the majority of your career with some slowing at the end

 

[tantacles]

Or start working the standard amount and just stay there for the majority of your career with some slowing at the end

I think it depends on priorities. I'd like to be financially independent earlier rather than later, but for many people that's less of a priority.

 

[CCM-MD]

Burnout is always a risk. But am I more likely to burn out if I ramp down work a little more slowly or start working a lot less and then ramp up? Unique to each provider.

I recommend not referring to yourself as a provider.

 

[aafisahar]

I think it depends on priorities. I'd like to be financially independent earlier rather than later, but for many people that's less of a priority.

Financially independent

Live in SF

Pick one

 

[tantacles]

Financially independent

Live in SF

Pick one

No. not necessary.

 

[tantacles]

I recommend not referring to yourself as a provider.

I recommend bagels. They're delicious.

Also, large dogs.

 

[MD46]

I recommend bagels. They're delicious.

Also, large dogs.

I agree with CCM-MD.
The provider label is just not acceptable in my and views of many doctors/physicians I know.
Where ever this is brought up I correct the person to say physician or doctor (politely)
Guess it doesnt bother some people

 

[tantacles]

I agree with CCM-MD.
The provider label is just not acceptable in my and views of many doctors/physicians I know.
Where ever this is brought up I correct the person to say physician or doctor (politely)
Guess it doesnt bother some people

Yeah, I don't really care about it. To me, provider is just a broad term that means "I'm not the nurse." and isn't a word I use with patients.

 

[Laradd]

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.

Respect the math but you can't keep working residency hours forever.

 

[PikminOC]

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.

Too bad you're a physician. Some other professions change fields online while they work full time

 

[PikminOC]

Yeah, I don't really care about it. To me, provider is just a broad term that means "I'm not the nurse." and isn't a word I use with patients.

Provider includes nurse practitioners

 

[wamcp]

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.

Great to see someone else out there is just like me!
I made ~540k in 2019 from a little under 2700 hours of hospitalist shifts. Add on top of that employer contributions to 401k and HSA and my kid’s 529 (about $18000 altogether) and the great additional tax deferred benefits of 457b...life could not be better.

That being said I don’t love work so much that I would do it after being financially independent, I plan to retire in about five years or less (depending on stock returns. Congrats on Tril and Axsm. I’m currently super long on AUPH and KRTX this year).

 

[wamcp]

Essentially, if you work an average of 60 hours per week you can make 500k as a hospitalist. That's a lot of cash but that's also a lot of work. But thats not so bad, considering many of the cardiologists I know work 60 hours a week for similar income. Factor in the lower amount of training and time value of money, financially you probably come ahead long term.

This is provided you can tolerate working this much as a hospitalist obviously. I would be willing to bet that most people would not be able to sustain this, but there are obviously people who can.

Spot on. So many cardiologists are working with a far worse lifestyle than many hospitalists and making either the same or less per hour, once you crunch the numbers they may not come ahead of a hospitalist that moonlights and skips out 3 years of dirt paying fellowship. Especially if your goal is to retire early.

Same goes for critical care; I found out the other day that one of the hospital I moonlight at, they get paid less per hour than us hospitalists!
One of the horrifying things I’ve observed was a pulm crit doing a 12 hr overnight icu shift followed by bronchs at noon...5 hours after his shift ended! And telling me about how he has to drive from one clinic site to another...

Maybe GI is the only subspecialty that makes so much per hour that you can’t beat over time.

That being said, I agree not everyone can tolerate hospitalist work. If you can tolerate outpatient only work, you could be doing 4 days a week of 8 hr clinic, several weeks PTO a year, no holidays or weekends or nights and minimal call as an allergist or rheumatologist for the same pay as the average day hospitalist. Much much better lifestyle in the long run.

 

[Professional Student]

Is it possible for a hospitalist on days to round on inpatient and then see patients in clinic that same day to boost income without really boosting hours worked?

 

[Splenda88]

I am starting to think hospitalists make too much money😛 ... There is no incentive to do a fellowship anymore.

One of the PGY3 in my program got a nocturnist contract--18 shifts/month for 455k/yr with all the other benefits. Insane!

 

[bronx43]

I am starting to think hospitalists make too much money😛 ... There is no incentive to do a fellowship anymore.

One of the PGY3 in my program got a nocturnist contract--18 shifts/month for 455k/yr with all the other benefits. Insane!

But then you have to be a nocturnist...

Even then it’s 2100 per shift and 175/hour. Not bad but not great.

 

[Splenda88]

But then you have to be a nocturnist...

Even then it’s 2100 per shift and 175/hour. Not bad but not great.

Agree, but that individual wants to be a nocturnist. He just wants to admit and leave. Does not want to deal with progress note, d/c summary, and social stuff that hospitalists have to deal with etc...

 

[CCM-MD]

Spot on. So many cardiologists are working with a far worse lifestyle than many hospitalists and making either the same or less per hour, once you crunch the numbers they may not come ahead of a hospitalist that moonlights and skips out 3 years of dirt paying fellowship. Especially if your goal is to retire early.

Same goes for critical care; I found out the other day that one of the hospital I moonlight at, they get paid less per hour than us hospitalists!
One of the horrifying things I’ve observed was a pulm crit doing a 12 hr overnight icu shift followed by bronchs at noon...5 hours after his shift ended! And telling me about how he has to drive from one clinic site to another...

Maybe GI is the only subspecialty that makes so much per hour that you can’t beat over time.

That being said, I agree not everyone can tolerate hospitalist work. If you can tolerate outpatient only work, you could be doing 4 days a week of 8 hr clinic, several weeks PTO a year, no holidays or weekends or nights and minimal call as an allergist or rheumatologist for the same pay as the average day hospitalist. Much much better lifestyle in the long run.

CCM shifts can be brutal. Nuts that they the hospitalists are getting more per hour. I have yet to see that. CCM has some crazy locum $. But hey, good for you though. I always tell my residents who ask me about doing pulmonary or CCM or any fellowship for that matter. It’s not worth doing it for the money.

 

[rokshana]

I am starting to think hospitalists make too much money😛 ... There is no incentive to do a fellowship anymore.

One of the PGY3 in my program got a nocturnist contract--18 shifts/month for 455k/yr with all the other benefits. Insane!

That’s almost twice the number of shifts that is considered to be full time so make sense it pays a lot.

 

[VA Hopeful Dr]

Is it possible for a hospitalist on days to round on inpatient and then see patients in clinic that same day to boost income without really boosting hours worked?

That's called traditional practice and its doable but doesn't usually pay all that much more than either outpatient or inpatient alone.

 

[Splenda88]

That’s almost twice the number of shifts that is considered to be full time so make sense it pays a lot.

So you mean one can get 225k/years for 9 shifts/month as a nocturnist... That is good then.


My plan is to find a 10 shifts/month full time gig; is that even possible?

 

[rokshana]

So you mean one can get 225k/years for 9 shifts/month as a nocturnist... That is good then.


My plan is to find a 10 shifts/month full time gig; is that even possible?

I said almost twice...typical nocturnist full time is 10-13 shifts a month...but yes 225-250/yr is certainly doable.

 

[Osteoth]

That's called traditional practice and its doable but doesn't usually pay all that much more than either outpatient or inpatient alone.

Why not?


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[VA Hopeful Dr]

Why not?


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Because you don't do either as efficiently as full time hospitalist or full time outpatient.

 

[NITRAS]

Efficiency, lifestyle, and frankly medicine in general is becoming much more specialized.

 

[Osteoth]

Because you don't do either as efficiently as full time hospitalist or full time outpatient.

I guess my question in general is more toward how hospitalists are paid, and how they bill. For outpatient medicine from what I understand its patients seen x RVUs/pt = $.

For hospitalists, is it not just number of patients on your panel + procedures done?

 

[NITRAS]

I guess my question in general is more toward how hospitalists are paid, and how they bill. For outpatient medicine from what I understand its patients seen x RVUs/pt = $.

For hospitalists, is it not just number of patients on your panel + procedures done?

There is not set way that Hospitalist are paid. You have people that are private practice and rely 100% on billing, and you have those that are 100% salary and everything in between.

I work in a large healthcare system and am considered a “capacity” physician. Which means I have no control over how many patients I see, and I am like 60% base salary, 30% quality metrics, and about 10% RVU bonus. Our clinic docs can increase their panel of patients to increase their income.

 

[tantacles]

Respect the math but you can't keep working residency hours forever.

Yeeeeeeeah, I don't plan to. That's just math.

 

[xoggyux]

I am starting to think hospitalists make too much money😛 ... There is no incentive to do a fellowship anymore.

One of the PGY3 in my program got a nocturnist contract--18 shifts/month for 455k/yr with all the other benefits. Insane!

The main incentive to do a fellowship would be to do the things you enjoy for the rest of your career. When you don't look it as a purely financial analysis then it makes sense.

Yeeeeeeeah, I don't plan to. That's just math.

Here is the thing. It is not uncommon for highly achieving people like doctors to end up working 80/week regardless. I don't mean work in the hospital 80/week, just work. I know plenty that over the years have bought properties and managing that business has become a 20-30h/week deal for them and that's on top of their regular 40-60h in the hospital/clinic. Or when they go home they do most of their house chores and that is work. I am of the mind that if I don't enjoy being a real state or landscaping my own garden I rather work 10extra hours in the job I do enjoy than 10hours on something else.

 

[tantacles]

So you mean one can get 225k/years for 9 shifts/month as a nocturnist... That is good then.


My plan is to find a 10 shifts/month full time gig; is that even possible?

That's my gig I start next year. Pays $240,000.

 

[Splenda88]

That's my gig I start next year. Pays $240,000.

Where in the world did you find something like that?

Are these shifts 14-16 hrs?

 

[Splenda88]

The main incentive to do a fellowship would be to do the things you enjoy for the rest of your career. When you don't look it as a purely financial analysis then it makes sense.

That is great. But I wonder why ~50% of docs are not happy with their career. The # is high across all fields except for a few.

Maybe career 'satisfaction' is overrated.

 

[rokshana]

Where in the world did you find something like that?

Are these shifts 14-16 hrs?

Not unusual and typically 12 hour shifts.

Where have you been looking?

 

[tantacles]

Where in the world did you find something like that?

Are these shifts 14-16 hrs?

11-13, and it's a community hospital.

 

[Splenda88]

Not unusual and typically 12 hour shifts.

Where have you been looking?

I have not been looking. I am a PGY2 and will start looking as a PGY3. I would like to stay in the south (city or suburb)

 

[xoggyux]

That is great. But I wonder why ~50% of docs are not happy with their career. The # is high across all fields except for a few.

Maybe career 'satisfaction' is overrated.

I am not sure where you got that statistic from but there is a bunch of noise and non-sense with these sort of statistics that we hear. A lot of it is self-reported and this varies much by expectations and perception. This is not limited to doctors either. There have been plenty of surveys that shows that about half of people would choose another career if they had the chance.
I don't know what your experience have been, and admittedly my experience is anecdotally but what I have seen is that most people I interact on a daily bases seem aggraviated and generally discontent with their job. Go to the supermarket and the cashiers are slow and uninterested on what they are doing, the UPS man throws the packages on the door and beat the door really hard that if I happen to be in the living room next to the door it scares the crap out of me (yet by the time I get out, just 10secs the guy disappeared, I don't know how they do it, its magic), the nurses seem annoyed all-day long, always complaining to the doctors of how annoying the patient or the patient's family are and then they complain to the other nurses of the doctors, the specialists seem rude when they get a call. The list goes on. I don't think this automatically means they are objectively unhappy. We perform at our best when we have a bit of stress (too little is bad, too much is bad). as a general rule we have created a world that is full of stress. We can perceive this stress as something that makes us unhappy or not.

Stress comes in many forms. For the hospitalist, stress can come in the form of perception that their careers are not very valuable because some dingus attendings made it seem that way when they were in training or shortly after. The traditional "You will only be a glorified intern" attitude. I had a couple of specialist attendings tell me that when I rotated through the services and I could not believe they were telling me that when 90% of their list was the same easy patients and they themselves were also doing intern work under that mind frame. Stress can come from the idea that a hospitalist makes less $$, but we can run the numbers if you want, when you factor in the time and the opportunity cost of fellowship, hospitalist comes ahead of any specialty except perhaps GI/Card. Stress comes from the hospital or group pushing you to get some metrics... guess what, sometimes is ok to not meet the metrics and not get that extra $20k (I don't know how someone could justify paying a 80K differential on a luxury vs "normal" car but then they would work rather risky arrangements in order to get a metric for a fraction of that.

I think when people think about what is valuable for them, rather than just following other people's dreams and goals, they are more likely to enjoy their work and life. It was not always like this for me, but at one point during medical school, I had an epiphany and something ding and since then I have been a very happy medical student, a very happy intern, a very happy resident and expect to be a very happy attending for a long time because I enjoy what I do.