Need smart person's perspective....Hospitalists vs ER Physician

[npappasan]

Yeah but when everyone dumps their patients on your service because no one wants to write an H&P, your survival is basically guaranteed.

This. Hospitalist jobs are pretty hot right now because most practicing physicians have shifted away from admitting patients to the hospital and being called constantly through the night. Most everyone simply wants a 9-5 office schedule.

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[Gastrapathy]

This. Hospitalist jobs are pretty hot right now because most practicing physicians have shifted away from admitting patients to the hospital and being called constantly through the night. Most everyone simply wants a 9-5 office schedule.

It is a young employed field that loses money. You don't bring in patients. You make other doctors' lives better but no bean counter cares about us. There's not a lot of proof that patients benefit. ER and other contracts are so profitable now that CMGs and multi specialty groups are willing to employ loss leader hospitalists to get the contract. If you can't see the risk of disruptive change, I don't know what to tell you.

 

[npappasan]

It is a young employed field that loses money. You don't bring in patients. You make other doctors' lives better but no bean counter cares about us. There's not a lot of proof that patients benefit. ER and other contracts are so profitable now that CMGs and multi specialty groups are willing to employ loss leader hospitalists to get the contract. If you can't see the risk of disruptive change, I don't know what to tell you.

I'm not sure what disruptive change you're referring to.

You don't bring in patients, but you're there to take care of patients that need bringing in. Nobody wants to do that anymore, hence the budding hospitalist market.

 

[Gastrapathy]

I'm not sure what disruptive change you're referring to.

You don't bring in patients, but you're there to take care of patients that need bringing in. Nobody wants to do that anymore, hence the budding hospitalist market.

One example: Short stay and obs units contained within EDs and staffed by midlevels slicing off all the easy admits. Less demand for hospitalists and the remaining census sucks balls.

If other doctors or hospitals are paying you out of the money the insurers are paying them, you will forever be a target. If that seems low risk, choose hospital medicine. The saving grace is you are still an internist and can flee to other careers if **** hits the fan.

 

[TooMuchResearch]

One example: Short stay and obs units contained within EDs and staffed by midlevels slicing off all the easy admits. Less demand for hospitalists and the remaining census sucks balls.

If other doctors or hospitals are paying you out of the money the insurers are paying them, you will forever be a target. If that seems low risk, choose hospital medicine. The saving grace is you are still an internist and can flee to other careers if **** hits the fan.

I wish those loss leader hospitalists would figure out how to turn a profit. They're money losing puts ED contracts at risk to the CMGs.

 

[BeddingfieldMD]

I considered emergency medicine as a possible specialty as I neared the end of med school, so I thought quite a bit about the work and lifestyle. And like most docs, I am friends with many hospitalists (since it is a large field). Here are some of the high points of each field. Decide which seems a better fit for you:

EMERGENCY MEDICINE:
- shift work, usually rotating through days, evenings, and overnights
- extreme multitasking, seeing dozens of patients per shift for just a few minutes at a time
- usually no followup or continuity of care (except for the "frequent flyers")
- ruling out and initiating treatment of life-threatening diseases, then triaging and disposing of non-acute issues to other docs
- decent mix of small procedures, including sutures, intubations, IVs and art lines, possibly some chest tubes
- when averaged out per week, usually around a 40-hour workweek
- lots of consulting and discussing with other physicians and services
- compensation usually slightly above average for physicians, but not extravagant
- no clinic
- 3-4 years for residency, depending on the program
- residency of above-average competitiveness--but not extremely competitive
- some options to leave traditional ER work with fellowships, but not as broad as IM

HOSPITALIST:
- usually more regular hours with occasional overnights (sometimes "night float")
- often week-on, week-off schedule, so lots of stretches of time off
- multitasking, especially when cross-covering many patients on call or in evenings
- continuity of care throughout the week, but still "dump" patients once off your week
- mid-range timeframe for managing complex medical patients with acute issues, less triage
- fewer procedures than EM, but some hands-on work
- when averaged throughout the month, usually around a 40-hour workweek (often 80 hours per week x 2 weeks/month)
- lots of consulting and discussion with other physicians, just like EM
- more interaction with patient families in terms of long-term decision making, family care conferences
- compensation usually slightly above average for physicians, but not extravagant
- no clinic
- 3 years residency, not requiring fellowship (as of now)
- residency of average competitiveness
- option to do traditional internist, outpatient work if one gets tired of hospitalism
- can also do fellowships under internal medicine if desire to specialize