Neurologist-hospitalists

[Phantom Spike]

Are there any practicing neurologists on these forums that exclusively see inpatients? I know this is a growing trend and a lot of hospitals are looking to hire neurologists for such positions, but I wonder if the patient load and volume is sufficient to forego an office and make hospital-only a reasonably lucrative long-term career option? Especially in view of the fact that the only inpatient procedures you will probably be doing on a regular basis would be LPs and EEGs.

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[Terpskins99]

I could be wrong, but I think you need to have completed a primary care residency to be a hospitalist.

There are other options though. Critical care neurologists can work exclusively inpatient.

 

[Phantom Spike]

I could be wrong, but I think you need to have completed a primary care residency to be a hospitalist.

There are other options though. Critical care neurologists can work exclusively inpatient.

I think you're right about needing to have completed a primary care residency to be a hospitalist, but a "neurologist-hospitalist" would be a neurologist who simply admits or, more often, consults on inpatients with primarily neurological diagnoses. In other words, they would only see neurological patients who are hospitalized, and not have a clinic. Basically, it represents a separation of the inpatient and outpatient aspects of neurology, similar to the way hospitalists only practice internal medicine on an inpatient basis. The main hurdle I see would be whether there would be enough patient volume to justify a "neurologist-hospitalist" position, but I do know that some hospitals are recruiting for those very positions. I was curious to see if anyone is actually doing it now, and what their experiences were like.

 

[neurolddoc]

I think that is certainly possible in the future that a hospital may want to hire/contract with a neurologist to do inpatient work exclusively. Many Neurology groups with active outpatient practices are withdrawing from hospital practice, leaving the hospitals without coverage. It would have to be a large hospital to support a full time neurologist and off hours coverage might be problematic.

Just seeing consultations, doing follow ups and reading EEG's could generate 30k/month in collections, maybe more. You would have to fight the physiatrist for the EMG concession. You could have limited overhead without an office, employees, etc; you would still have malpractice ins, collection fees, accounting expenses to pay out of that. Alternatively, a hospital might want to employ you and pay you a salary which would be less hassle but probably less money.

 

[reesie0726]

During my job search, I have come across a number of jobs for neurology hospitalists. Usually these are hospital employed positions. The neurology hospitalist sees all of the neurology consultations, etc. in the hospital. This helps the other neurologists that want to focus on their outpatient practice. Most of the hospitals that I saw did not require the neuro-hospitalists to do admissions although I guess this could be hospital dependent. The schedule is usually Monday through Friday 8A-5P, and sharing in overnight and weekend call with the rest of the neurologists. I think this must be a growing sub-specialty, especially for bigger hospitals because there are quite a number of open positions. Some groups will also employ a neuro-hospitalist so that they may focus on their outpatient practice. I personally did not feel as if neuro-hospitalist positions were as time friendly as traditional medicine hospitalists that will work 7 on and 7 off, etc. Although I did come across one hospital that did offer this kind of schedule. Hope this helps.

 

[RAD345]

Personally I do NOT like to become a Neuro-Hospitalist, since there is no physician-patient relationship. I would never know my patient they way I should.
Pts get shipped in and out of hospital like cars in an auto repair center. It does not give me a good feeling esp if I should see 30-40 patient in a day and give recommendations that might turn out to be a mistake later, because I did not know my patient thoroughly.

 

[Phantom Spike]

I personally did not feel as if neuro-hospitalist positions were as time friendly as traditional medicine hospitalists that will work 7 on and 7 off, etc. Although I did come across one hospital that did offer this kind of schedule. Hope this helps.

Again, this comes back to the question of volume. The "7 on-7 off" type of schedule would only be feasible if there were enough patients to be seen when you were "on" to justify paying you when you're "off". It's not as much a problem for internal medicine/family practice hospitalists since they have large volumes in general.

 

[HarveyCushing]

Again, this comes back to the question of volume. The "7 on-7 off" type of schedule would only be feasible if there were enough patients to be seen when you were "on" to justify paying you when you're "off". It's not as much a problem for internal medicine/family practice hospitalists since they have large volumes in general.

What about a place like Barrow Neurological Institute that have a very high census of neuro patients? I know neurosurgery probably takes care of most of them, but I wonder if a place like this would work well for a neurologist-hospitalist.

 

[reesie0726]

I think if you are interested in neuro-hospitalist positions, this could definitely be an option. I am still getting many emails regarding neuro-hospitalist positions. In larger centers, I don't think that you have to worry about there not being a large enough volume. I spoke to two hospitals that needed neuro-hospitalists and they had a rather large volume of neurology patients and needed multiple hospitalists. After these positions were described to me, I just did not find them that attractive. But if you really like inpatient neurology, it could be something to consider.

 

[HarveyCushing]

I think if you are interested in neuro-hospitalist positions, this could definitely be an option. I am still getting many emails regarding neuro-hospitalist positions. In larger centers, I don't think that you have to worry about there not being a large enough volume. I spoke to two hospitals that needed neuro-hospitalists and they had a rather large volume of neurology patients and needed multiple hospitalists. After these positions were described to me, I just did not find them that attractive. But if you really like inpatient neurology, it could be something to consider.

I am curious if you don't mind sharing; were these places academic centers, county hospitals, private hospitals? Any idea on average how large (bed wise) these places were? I'm curious to learn what kind of hospitals would cater to someone strictly interested in in-patient/neuro-hospitalist type of work.

 

[neuroir]

I am curious if you don't mind sharing; were these places academic centers, county hospitals, private hospitals? Any idea on average how large (bed wise) these places were? I'm curious to learn what kind of hospitals would cater to someone strictly interested in in-patient/neuro-hospitalist type of work.

One of such places currently recruiting neurohospitalists is "Marshfield Clinic" in Wisconsin (just got an email from them). You can google their website and read about the hospital specs.

 

[reesie0726]

I only spoke to two hospitals and after that I quickly lost interest in neuro-hospitalist positions. One hospital was 400+ beds and the other was 1000+ beds. They weren't county hospitals. One was an academic hospital but did not have a neuro residency program at that site. I think most academic hospitals would not need neuro-hospitalists because they would have neurology residents. You can just do a neurology job search and you will find some neuro-hospitalist positions. I was looking for jobs in Texas only.

 

[Phantom Spike]

After these positions were described to me, I just did not find them that attractive. But if you really like inpatient neurology, it could be something to consider.

Just out of curiosity, if you don't mind my asking, what was it about these positions that you found unattractive?

 

[reesie0726]

Well, I was interested in these positions only if they gave me the flexibility to spend more time with my family. But if I had to do all inpatient work Monday through Friday and still take night and weekend call, I did not see how this would allow me that flexibility. Honestly, I felt like it would be like being a resident forever. However, if you really like inpatient work, it's definitely an option. Some communities are finding the problem of having neurologists that only want to see patients in their outpatient practice. Sometimes the volume is too much for an outpatient neurologist to manage the inpatients as well. I think this will probably be a growing field.

 

[neurolddoc]

One issue I would clarify when discussing neurohospitalist positions with the employer is the issue of stroke/TPA coverage. A hospital large enough to need a dedicated inpatient neurologist will likely have a stroke program. Will you be expected to haul yourself in at all hours to evaluate these patients? Is there a PA to cover nights? It would seem to me that a hospital would need several employed neurologists to provide night and weekend coverage.

 

[reesie0726]

Neuro-hospitalists aren't expected to be on call 24 hours a day. Typically, you would take call according to the group's or hospital's call schedule. You would be on call say one out of seven nights. On that night, you would have to take all the ed calls and tpa calls, etc. On the other days, you work your daytime shift and then you're off.

 

[Wheezy]

What about a place like Barrow Neurological Institute that have a very high census of neuro patients? I know neurosurgery probably takes care of most of them, but I wonder if a place like this would work well for a neurologist-hospitalist.

Interesting thread.

Here's some clarification about Barrow. There is a high census on both neurology & neurosurgery. Also most patients are not seen by both services i.e. most of the neurology services consists of patients where neurology are the primary team without any neurosurgery input, the same is true for neurosurgery.

There are patients where neurosurgery are consults & vice versa e.g. MCA stroke +Craniectomy, cerebellar stroke +EVD/craniectomy, GBM +Seizure, SAH/ACOM aneursym in status epilepticus,

To sum up: currently for a given neurology team ~2/3 are primary patients, ~1/3 are consults. Consults come from medicine (delirium, seizure, vertigo, brain death/prognosis, Transient symptoms) & Neurosurgery (postop status epilepticus, seizure, coma) almost equally & the odd OB/GYN/other service case

We currently have 1 attending that does exclusively inpatient general neurology. The stroke attendings do inpatient & outpatient. The other attendings do inpatient & outpatient for general/subspecialities. Everyone does attending call. But as with every department things may change & there may be plans for hiring more neurohospitalists.

I guess neurohospitalist are not a homogenous group. Some points to consider may be:
academic hospital (that have residents) vs. community.
salaried vs. paid based on number of patients seen
General neurology vs. stroke +general neurology
How many other neurologist to split the overnight call schedule
How many other neurologist to split the weeks covered each month
Covering 1 hospital vs. multiple hospitals

 

[danielmd06]

Something I recently noted (from an AAN news mailer) was that there are currently 3 formal fellowships for neurohospitalist work at UCSF, Mayo Florida, and the University of Washington. There is even an AAN subsection forum dedicated to this that I wasn't previously aware of.

Furthermore, it seems like there are many classified postings in the green journal (and online) for this type of position as well. Interesting that more of the older neurologists and bigger groups are heavily favoring their outpatient practices and want to hire someone to exclusively do the inpatient case load, though.

 

[Phantom Spike]

Something I recently noted (from an AAN news mailer) was that there are currently 3 formal fellowships for neurohospitalist work at UCSF, Mayo Florida, and the University of Washington. There is even an AAN subsection forum dedicated to this that I wasn't previously aware of.

.

Interesting; since most neurology residencies have a significant inpatient service/consultation component already, do graduates of these fellowships feel better prepared for a neurohospitalist career? Would such fellowships be worth the extra year of lower income? I don't personally know anyone who's done such a fellowship, but would be interested to hear their experiences.

 

[danielmd06]

Interesting; since most neurology residencies have a significant inpatient service/consultation component already, do graduates of these fellowships feel better prepared for a neurohospitalist career? Would such fellowships be worth the extra year of lower income? I don't personally know anyone who's done such a fellowship, but would be interested to hear their experiences.

I don't know anyone who's completed one of these, either.

My personal residency was very, very heavy on inpatient work and quite scant on outpatient (true general neurology) stuff. More's the pity as I believe this is becoming the norm rather than the exception from anecdotal, friendly fellow and resident commentary at the AAN. It seems many are garnering that priceless (and necessary) outpatient expericence in the fellowship year.

I would have felt comfortable transitioning directly into a neurohospitalist role despite lack of "fellowship" training in this and would not have sacrificed the year's potential income for this. Depending upon your own residency experience, you might feel differently. I too would be interested to hear from those who have completed a fellowship in this work...