Not so healthy Hospitalist Programs

[DoctorStrange2099]

For all looking to join University of Kentucky as Hospitalist- read this and think
Unfortunately no thread mentions or enlist places with unfair work conditions for Hospitalists, or residents looking to be hospitalist

Few points about their department of hospital medicine
- Not much support from Subspecialties despite it being a university Hospital, lot of cutting corners by procedural specialties.
- Unfair Hospital Medicine administration, who picks on physicians
- Not allowed to moonlight outside the university hospital- limiting your financial growth.
- Hospital Medicine Administration not very responsive to hospitalist complains
- Biased Patient distribution and Workload sharing
- Pulled into weekly meetings on Time Off, with no reimbursement
- Poor compensation for amount of work.
- High burnout
- Very rapid physician turnover

Lets start a thread based on Unhealthy Hospital Medicine Programs- so future residents and colleagues can stay wary of these programs.

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Members don't see this ad.

 

[gutonc]

Hmmm...new user, "DMD-PhD student" flaming a hospitalist program.

Seems legit.

 

[DrStephenStrange]

Oh no, not another DoctorStrange. If you're a troll, I'm going to have change my username.

 

[DoctorStrange2099]

MD here, removed the wrong designation, that was on my account. No trolling, sharing honest experience, Real world doesn't share a lot of maligned program information.

 

[gutonc]

You’re welcome to your opinion of course.
But nobody really appreciates a new user only here to s***post.

 

[Kaustikos]

MD here, removed the wrong designation, that was on my account. No trolling, sharing honest experience, Real world doesn't share a lot of maligned program information.

Tell you what; come to New York. Work in the urban hospital areas and tell me you find your hospital "horrible". I'm not saying all hospitals in NYC are bad, but good lord you'd be BEGGING to go back to your hospital if you experienced what some attendings/residents experience here.
Food for thought
#grass is always greener
#n of 1 /= truth/fact
#come to NYC
#experiences may vary

 

[thumbz]

I think we all appreciate a heads up on malignant groups to avoid, but can you give us some specifics? It's hard to know whether we should take these complaints seriously.

What was the pay? What's the average pay for the state? If they're paying you $150k to work 215 12's a year yeah that sucks, but who would sign that contract anyways.

Did they bait and switch you? What's the unfair patient distribution - are you RVU based so that's what you mean? Or is your list twice as long because you're the new guy?

What are these complaints that weren't responded to? That'll help us decide if they're legit - such as if you asked to have a service capped at 12 people and they said no well tough cookies. If you asked them to control the roaming gangs of hobos with shivs in the hospital hallways and they didn't want to well that's different.

 

[shouldigomd]

Tell you what; come to New York. Work in the urban hospital areas and tell me you find your hospital "horrible". I'm not saying all hospitals in NYC are bad, but good lord you'd be BEGGING to go back to your hospital if you experienced what some attendings/residents experience here.
Food for thought
#grass is always greener
#n of 1 /= truth/fact
#come to NYC
#experiences may vary

Tell you what; come to Alaska. You don't even know what horrible is.... see the logic there?

 

[Kaustikos]

Tell you what; come to Alaska. You don't even know what horrible is.... see the logic there?

That's why I said "grass is greener"
There's always someone saying their program is malignant/horrible on forums with n of 1 meaning it's fact/true and other programs are better.

 

[shouldigomd]

That's why I said "grass is greener"
There's always someone saying their program is malignant/horrible on forums with n of 1 meaning it's fact/true and other programs are better.

Yes, that is certainly true but we do not know anything about this person other than they are voicing their opinions of a certain place. That is far and away of more value than most threads on these forums where people complain / promote and fight over programs / situations they have absolutely zero experience with.

 

[blue.jay]

Most big name (academic) programs can get away with these malignant conditions. They have high turnover from fresh grads trying to network to get into fellowships.

I work at one of the famous 'CLINIC' in Midwest and they are equally bad yet we get so many applications for hospitalists jobs every year.

I think grass is greener on the other side but I am so burnt out (not from work or patient volume) but how lowly we are treated even compared to their own residents and midlevels. I will be leaving in few months so my spot is own for the next victim.

 

[Kaustikos]

Yes, that is certainly true but we do not know anything about this person other than they are voicing their opinions of a certain place. That is far and away of more value than most threads on these forums where people complain / promote and fight over programs / situations they have absolutely zero experience with.

Alternatively....
And not to argue
People just tend to post negative reviews more readily than praise.
Ie - yet to hear of any employee in hospitals during COVID praising hospital admin

 

[blue.jay]

Alternatively....
And not to argue
People just tend to post negative reviews more readily than praise.
Ie - yet to hear of any employee in hospitals during COVID praising hospital admin

My experience is based on my time here the past 2 years. I have to say they have treated us well than other employers during this pandemic. The overall health system is very good just the hospital medicine dept is scum.

 

[DoctorStrange2099]

Not sucking up on anyone here, we are grown ups and professionals, look what everyones tryna do is dissect. Provided the gist of message after working here for a while. Tryna protect the new folks who may be tricked into the lies of the department and then suffer discrimination. Best wishes if you'd ignore the advise.

 

[Kaustikos]

Not sucking up on anyone here, we are grown ups and professionals, look what everyones tryna do is dissect. Provided the gist of message after working here for a while. Tryna protect the new folks who may be tricked into the lies of the department and then suffer discrimination. Best wishes if you'd ignore the advise.

Can you at least give examples. Or how other doctors feel? I'm not disbelieving you but you give very broad and nonspecific examples I've seen at hospitals.
Hell, I've seen hospitalists quit because they get dumped with 25+ patients without residents and quit in a year because of burnout.
Just saying that though you may feel this way, it could be worse. Or maybe needs to have change advocated by hospitalists.

 

[DoctorStrange2099]

Most big name (academic) programs can get away with these malignant conditions. They have high turnover from fresh grads trying to network to get into fellowships.

I work at one of the famous 'CLINIC' in Midwest and they are equally bad yet we get so many applications for hospitalists jobs every year.

I think grass is greener on the other side but I am so burnt out (not from work or patient volume) but how lowly we are treated even compared to their own residents and midlevels. I will be leaving in few months so my spot is own for the next victim.

SAME ENVIRONMENT!!! See the unfortunate part, we are initiating a chain of victims! We should spread an honest word and try to let the younger folks know that these places are going to harass them. That was the whole aim of initiating this post- The stones can't be turned in these programs, but their reality can be vocalized to the incoming youth!

 

[DoctorStrange2099]

Can you at least give examples. Or how other doctors feel? I'm not disbelieving you but you give very broad and nonspecific examples I've seen at hospitals.
Hell, I've seen hospitalists quit because they get dumped with 25+ patients without residents and quit in a year because of burnout.
Just saying that though you may feel this way, it could be worse. Or maybe needs to have change advocated by hospitalists.

The admin is a group of 8 senior hospitalist, who sit behind and all they do is distribute patients! They never do non-teaching services, Most others work on non-teaching teams who are flooded with patients. One particular group tends to enjoy the luxury, the other group is hammered with work. Lots and lots of politics. Pay structure for non-resident services for the hospitalist is pennies compared to the amount of work- which is mellowed down at presentation. Very high turnover of hospitalist. Most hospitalist are unhappy due to unfair distribution of work load and non-professional tactics of the so called elderly.

 

[DoctorStrange2099]

I have updated the post to say-'Not so healthy' programs. This way people don't feel offended, about some bitter truths.

 

[blue.jay]

The admin is a group of 8 senior hospitalist, who sit behind and all they do is distribute patients! They never do non-teaching services, Most others work on non-teaching teams who are flooded with patients. One particular group tends to enjoy the luxury, the other group is hammered with work. Lots and lots of politics. Pay structure for non-resident services for the hospitalist is pennies compared to the amount of work- which is mellowed down at presentation. Very high turnover of hospitalist. Most hospitalist are unhappy due to unfair distribution of work load and non-professional tactics of the so called elderly.

Very similar to what I feel. The senior hospitalists in our main site have strict caps (12 pts), residents and smooth workflow. The made new grads do more nights (I am 50/50 day and night) and our nights are 15 hr. Our regional group run codes, rapids and stroke unlike the main campus hospitalist yet we don't have a pay differential. The worse part is I get paid the least (220k) for seeing more patients, running codes/rapids/stroke and doing 50% nights. It was a clear bait and switch which they have been doing consistently for new grads. None of these were discussed in interview and I was promised to be changed to 100% days 6 months after starting now they are saying that cannot be changed for at least 5 years.
Our midlevels have it very chill, they do 4 admissions in 15 hr shift, 4 hr cross coverage, and sleeps 4 hr for 100k. Some midlevels don't even tell/discuss a word about their patients. Day midlevels try to pick complicated patients and won't stuff because they are too confident. When I asked our leader he said midlevels with 5 YEARS of experience should considered as EQUAL to MD/DO hospitalists.

I said I am not fine with them rounding on medically complicated patients and would rather have them do H&Ps and see obs patient , for that administration said that will decrease the job satisfaction of midlevels as they prefer to have a list of patients they want to follow till discharge.
Midlevels have expanded a lot over the last 2 years. I suspect in about 10 years the whole institution will be run by midlevels.

They care more about midlevel satisfaction because they are 100k cheaper but they don't even do 50% of our workload.

 

[anonperson]

Very similar to what I feel. The senior hospitalists in our main site have strict caps (12 pts), residents and smooth workflow. The made new grads do more nights (I am 50/50 day and night) and our nights are 15 hr. Our regional group run codes, rapids and stroke unlike the main campus hospitalist yet we don't have a pay differential. The worse part is I get paid the least (220k) for seeing more patients, running codes/rapids/stroke and doing 50% nights. It was a clear bait and switch which they have been doing consistently for new grads. None of these were discussed in interview and I was promised to be changed to 100% days 6 months after starting now they are saying that cannot be changed for at least 5 years.
Our midlevels have it very chill, they do 4 admissions in 15 hr shift, 4 hr cross coverage, and sleeps 4 hr for 100k. Some midlevels don't even tell/discuss a word about their patients. Day midlevels try to pick complicated patients and won't stuff because they are too confident. When I asked our leader he said midlevels with 5 YEARS of experience should considered as EQUAL to MD/DO hospitalists.

I said I am not fine with them rounding on medically complicated patients and would rather have them do H&Ps and see obs patient , for that administration said that will decrease the job satisfaction of midlevels as they prefer to have a list of patients they want to follow till discharge.
Midlevels have expanded a lot over the last 2 years. I suspect in about 10 years the whole institution will be run by midlevels.

They care more about midlevel satisfaction because they are 100k cheaper but they don't even do 50% of our workload.

What a toxic environment.

Low pay.
Lack of respect.
Ton of work.

Is it the location or something that is attracting people there?

 

[DoctorStrange2099]

Very similar to what I feel. The senior hospitalists in our main site have strict caps (12 pts), residents and smooth workflow. The made new grads do more nights (I am 50/50 day and night) and our nights are 15 hr. Our regional group run codes, rapids and stroke unlike the main campus hospitalist yet we don't have a pay differential. The worse part is I get paid the least (220k) for seeing more patients, running codes/rapids/stroke and doing 50% nights. It was a clear bait and switch which they have been doing consistently for new grads. None of these were discussed in interview and I was promised to be changed to 100% days 6 months after starting now they are saying that cannot be changed for at least 5 years.
Our midlevels have it very chill, they do 4 admissions in 15 hr shift, 4 hr cross coverage, and sleeps 4 hr for 100k. Some midlevels don't even tell/discuss a word about their patients. Day midlevels try to pick complicated patients and won't stuff because they are too confident. When I asked our leader he said midlevels with 5 YEARS of experience should considered as EQUAL to MD/DO hospitalists.

I said I am not fine with them rounding on medically complicated patients and would rather have them do H&Ps and see obs patient , for that administration said that will decrease the job satisfaction of midlevels as they prefer to have a list of patients they want to follow till discharge.
Midlevels have expanded a lot over the last 2 years. I suspect in about 10 years the whole institution will be run by midlevels.

They care more about midlevel satisfaction because they are 100k cheaper but they don't even do 50% of our workload.

Sorry to hear that. HORRIBLE!!
the chief hospitalist at the Univ is an extremely biased and unfair person, unprofessional and a liar. All he cares is himself and his friends in the groups
sustenance at the cost of the other hospitalist. He has created such a horrible work environment and makes sure he makes the work environment bad for a specific target group, whIle protecting his group of colleagues. NEVER seen such an unfair and unethical man on the position of chief. Don't know who will put a hold of this cruel being.
He has his wife involved in administration of the group~Huge conflict of interest there is an example.

Spread to protect the younger fellas from the bait

 

[DrMetal]

. . . he said midlevels with 5 YEARS of experience should considered as EQUAL to MD/DO hospitalists.

And hence the end of our profession.

 

[collegestud2013]

Remember that turnover is very expensive for organizations. There was a study by Stanford several years ago that the cost to hire an attending in their health system ranges from $100k-$1million depending on the specialty and rank of physician. This includes costs like paying recruiters, paying for interview expenses for new applicants, paying for sign-on bonuses and moving expenses, and lost clinical productivity time from faculty or medical directors to interview applicants. This probably doesn't even include the costs of decreased productivity from new physicians (who usually take some time to get up to speed). The more undesirable a workplace conditions are, the higher the turnover will be and hence these recruitment costs will be much higher. In many cases that can lead to understaffing issues in the short run and hospitals having to hire more part-time or locums people (almost always at a higher rate per hour) to get short-term coverage. This is especially true for hospitals more rural and less desirable geographic areas. These turnover costs can can often cause the hospital much more than the small amount the can save by lowballing some of their employees.

As an prospective employee you need to do your research, and try to get inside information from some employees if possible to see what the work environment will be like. There should be a website dedicated to what OP is doing, but specialty specific (including hospitalists) similar to how websites like Domixity and Scutwork have a section that is dedicated to allowing residents to write reviews about their programs.

Also, on the salary/compensation side make sure you do the math and see if your RVUs are in line with what you're being paid or if you're being lowballed. You should also demand to have more stuff written concretely in your contract to make it harder for them to bait and switch you, like hard patient caps per shift, number or percent of day vs night shifts, and whether you will have help from midlevels. In the current environment, it may be slightly harder to have all these in your contract since the hospitalist job market is a bit tighter so the employers might have the upper hand. This is especially true for IMGs on J1 visas since employers know they have the most limited employment options.

 

[DrMetal]

Remember that turnover is very expensive for organizations. There was a study by Stanford several years ago that the cost to hire an attending in their health system ranges from $100k-$1million depending on the specialty and rank of physician.

Uhhh yeah, that's why they'll hire a NP/PA instead, wherever they can.

 

[DoctorStrange2099]

Remember that turnover is very expensive for organizations. There was a study by Stanford several years ago that the cost to hire an attending in their health system ranges from $100k-$1million depending on the specialty and rank of physician. This includes costs like paying recruiters, paying for interview expenses for new applicants, paying for sign-on bonuses and moving expenses, and lost clinical productivity time from faculty or medical directors to interview applicants. This probably doesn't even include the costs of decreased productivity from new physicians (who usually take some time to get up to speed). The more undesirable a workplace conditions are, the higher the turnover will be and hence these recruitment costs will be much higher. In many cases that can lead to understaffing issues in the short run and hospitals having to hire more part-time or locums people (almost always at a higher rate per hour) to get short-term coverage. This is especially true for hospitals more rural and less desirable geographic areas. These turnover costs can can often cause the hospital much more than the small amount the can save by lowballing some of their employees.

As an prospective employee you need to do your research, and try to get inside information from some employees if possible to see what the work environment will be like. There should be a website dedicated to what OP is doing, but specialty specific (including hospitalists) similar to how websites like Domixity and Scutwork have a section that is dedicated to allowing residents to write reviews about their programs.

Also, on the salary/compensation side make sure you do the math and see if your RVUs are in line with what you're being paid or if you're being lowballed. You should also demand to have more stuff written concretely in your contract to make it harder for them to bait and switch you, like hard patient caps per shift, number or percent of day vs night shifts, and whether you will have help from midlevels. In the current environment, it may be slightly harder to have all these in your contract since the hospitalist job market is a bit tighter so the employers might have the upper hand. This is especially true for IMGs on J1 visas since employers know they have the most limited employment options.

Most big places will have fixed and non -negotiable contracts. University hospitals don't budge an alphabet on their contract. Also most university hospitals pay is fixed and NEVER rvu based.

AGREE about your point of an attending job feedback platform similar to the one for residents.

 

[blue.jay]

What a toxic environment.

Low pay.
Lack of respect.
Ton of work.

Is it the location or something that is attracting people there?

Brand NAME; it's one of the top 10 USnews ranked hospital and it is a brand name known by every doctor in America.

 

[blue.jay]

Remember that turnover is very expensive for organizations. There was a study by Stanford several years ago that the cost to hire an attending in their health system ranges from $100k-$1million depending on the specialty and rank of physician. This includes costs like paying recruiters, paying for interview expenses for new applicants, paying for sign-on bonuses and moving expenses, and lost clinical productivity time from faculty or medical directors to interview applicants. This probably doesn't even include the costs of decreased productivity from new physicians (who usually take some time to get up to speed). The more undesirable a workplace conditions are, the higher the turnover will be and hence these recruitment costs will be much higher. In many cases that can lead to understaffing issues in the short run and hospitals having to hire more part-time or locums people (almost always at a higher rate per hour) to get short-term coverage. This is especially true for hospitals more rural and less desirable geographic areas. These turnover costs can can often cause the hospital much more than the small amount the can save by lowballing some of their employees.

As an prospective employee you need to do your research, and try to get inside information from some employees if possible to see what the work environment will be like. There should be a website dedicated to what OP is doing, but specialty specific (including hospitalists) similar to how websites like Domixity and Scutwork have a section that is dedicated to allowing residents to write reviews about their programs.

Also, on the salary/compensation side make sure you do the math and see if your RVUs are in line with what you're being paid or if you're being lowballed. You should also demand to have more stuff written concretely in your contract to make it harder for them to bait and switch you, like hard patient caps per shift, number or percent of day vs night shifts, and whether you will have help from midlevels. In the current environment, it may be slightly harder to have all these in your contract since the hospitalist job market is a bit tighter so the employers might have the upper hand. This is especially true for IMGs on J1 visas since employers know they have the most limited employment options.

Turnover is the norm in my group. This is huge brand name place, they have their own recruiters. They paid 100$ for a night stay in the hotel outside the hospital. No sign on bonus. 5k moving allowance. Every year they get ton of applicants some trying to do research with specialists here and move on to fellowship. Hence new grads (unless USMD from top tier program) get only nights and they do more work for less pay compared to career hospitalists who have been here for 10-15 yrs.

There is no contract with this employer, only an offer letter which says you are offered a position for 200k salary. No mention regarding day or night%, cap, midlevel supervision etc
It's take it or leave it kind of offer. One month before I started the changed my primary site to a community hospital >25 miles from metro area, when I already signed my apartment lease.
I got burnt out commuting 50 mins one way after a 15 hr night shift.

The situation for midlevels are different. They get PTO, sick day off which we don't. They get tons of midlevel applicants everyday but most of them are new grads and it takes lot of effort to train them. Hospitalists are not interested in training them and it's up to the senior midlevel to train the new ones. Hence, our midlevels know it is expensive and tedious to replace them. That's their justification to keep midlevels happy and don't care about new grad hospitalists who can be easily replaced every year. Every time there is a conflict between midlevels and doctors they side with the midlevels.

 

[blue.jay]

And hence the end of our profession.

They are not entirely wrong for the following reasons...

They allow midlevels to work to the top of their license (hate that term, don't know what that means) all the while making doctors less competent.
All the hospitalists except those in my community hospital arent even required to be ACLS certified because they dont do rapid response and codes (which are done by critical care NP).
No one here has any procedural competence. Some docs have never done an intubation even in residency.
Midlevels are getting free paid residency training over 5 years. Ultimately we all do the same work which is admit and discharge. The lazy hospitalist culture where the senior hospitalists complain when census is above 14 pts and uncomfortable handling critically ill patients led to this midlevel creep.

None of those apply to my site (or nights) where the census is high, we rune stroke call downs, rapid and codes. The senior hospitalists in main sites want to work 8-4 by seeing 12 pts so I don't know if the dept is balancing revenue generated in my site. Hate this discrimination where we get the same (or less for me) pay for more work.

Now in the eyes of our administration all they see is Provider = MD = NP/PA where MD cap is 12 and APP cap is 8 but APP pay is about 50% hospitalists pay. Hence, midlevels are cheaper. The already trained and seasoned ones are even more desirable as they have to train new ones from the beginning.

I once asked our group APPs to just do morning admissions to take burden off from us and they can even come at 10am (instead of 8) they said if that's going to be the requirement they will mass quit. Because doing HPs alone in a day is more work than rounding and copy pasting the notes (but they claim less continuity with less job satisfaction). Admins got freaked out how they will manage if APPs mass quit and kept things the way the midlevels like. So here in this prestigious hospital we work at the pleasure of midlevels.

 

[GassYous]

Holy **** what a horrible situation. It's a sad situation where our most prestigious hospitals are being overrun with midlevels even while the physicians are paid like crap with horrible hours. I also trained at a "top hospital" and I couldn't wait to get out of that ****hole. Goes to show you the value of those ridiculous lists.

 

[Gastrapathy]

I’m curious what constitutes cutting corners for procedural specialists

 

[DoctorStrange2099]

I’m curious what constitutes cutting corners for procedural specialists

REFUSING to see patients- fellows fighting with you when consultations requested to not see the consult. Cancelling procedures and recommending outpatient follow ups. TOXIC ENVIRONMENT CREATED BY PROCEDURALIST. NOT TALKING TO PRIMARY EVER!

 

[Gastrapathy]

If lots of your consults are being refused or deferred to outpatient, some introspection might be useful.

Share some examples of these rejected consults.

 

[thumbz]

There's a snowballs chance in hell I would ever sign on for a 15 hour night shift regardless of how many midlevels I have and the promises made. Doing 50/50 of those is a short path to a big ole stroke in 2 years.

 

[blue.jay]

There's a snowballs chance in hell I would ever sign on for a 15 hour night shift regardless of how many midlevels I have and the promises made. Doing 50/50 of those is a short path to a big ole stroke in 2 years.

Very true.. on paper it's 12-13 shifts per month (1 week days and 5-6 nights) but I feel far more miserable and unhealthy compared to residency schedule. After starting this job I got GERD, weight gain, and disrupted circadian rhythm and poor sleep hygiene. I know I will die soon if I continue to do this gig. There are some pros which is increased flexibility, I was able to take long time off upto 6 weeks for paternity (I front loaded day requirements in 4 months). For the same reason (shift job) where we still work on average 40 hrs a week , we don't get PTO (but midlevels do for some reason)

 

[thumbz]

Ugh @blue.jay I feel for you - that job is miserable. Any time someone has midlevels living a better life than them it's a malignant program. Most programs churn through midlevels and keep their docs happy, you're clearly seeing the opposite. Well, maybe not most programs, but any program I would be willing to work for would do that. Midlevels are a dime a dozen these days, I would be making them stay up while I slept.

Are you going to leave, or are you tied to that location? If you're just working off a letter of intent I'd give minimal notice and bail hard.

 

[blue.jay]

Ugh @blue.jay I feel for you - that job is miserable. Any time someone has midlevels living a better life than them it's a malignant program. Most programs churn through midlevels and keep their docs happy, you're clearly seeing the opposite. Well, maybe not most programs, but any program I would be willing to work for would do that. Midlevels are a dime a dozen these days, I would be making them stay up while I slept.

Are you going to leave, or are you tied to that location? If you're just working off a letter of intent I'd give minimal notice and bail hard.

Midlevels might be dime a dozen but if you've the midlevels working for you for more than 5 years doing almost the same job as the hospitalists for half the pay, the employer will try to hold on to them.
I am ashamed to say that I feel like the intern covering the pager 15 hr, running rapid responses and taking admission in turns with midlevels (who split the night to sleep 4 hr each after midnight). Sometimes I get quick tiger nap 10-20 min on the chair the whole 15 hr.
I wish it was the other way around.

Yes I am leaving this toxic place soon, have accepted another offer. Hopefully that one is as good as it sounds and it reinvigorates my passion to practice medicine. For how well this health system is know around the world the hospitalist dept is sham. This health system actually cares more about specialist care than primary care so I am not surprised.

 

[DrMetal]

Midlevels might be dime a dozen but if you've the midlevels working for you for more than 5 years doing almost the same job as the hospitalists for half the pay, the employer will try to hold on to them.

Of course they would. And we can't make an argument against that. That's the problem. We're done guys. If you're a general internist (I am) hoping to do either outpatient primary care or inpatient general care (hospitalist), our days are numbered. If a mid-level works just as hard (or even harder, b/c they always have something to prove) and can be paid less, resulting in more money for the hospital, the economic machine will always vie for that option.

Of course we can still find work, but you may have to flex your geography and your pay. Maybe our subspecialist colleagues will fare better. But I recently talked to a cardiologist (general) who can't find work in his hometown. He's bummed he didn't do EP or IC! That's great. If you're a doctor with less than 8 years of PGY, you're not employable?!

 

[blue.jay]

We're done guys. If you're a general internist (I am) hoping to do either outpatient primary care or inpatient general care (hospitalist), our days are numbered. .

That's how I feel, but it is the same for FM, Peds, Anesthesia, Psych. Places which were run by 5 cardiologists/pulmonologist/invensivists are now staffed by 2 specialist and 5 midlevels.
Not every medical student can match into procedural and surgical specialities.
Midlevel growth is the outcome of capitalistic greed in this country.
I don't want to sacrifice more years as a under paid trainee to be replaced by a midlevel or AI a decade later.

 

[DrMetal]

That's how I feel, but it is the same for FM, Peds, Anesthesia, Psych. Places which were run by 5 cardiologists/pulmonologist/invensivists are now staffed by 2 specialist and 5 midlevels.
Not every medical student can match into procedural and surgical specialities.
Midlevel growth is the outcome of capitalistic greed in this country.
I don't want to sacrifice more years as a under paid trainee to be replaced by a midlevel or AI a decade later.

So what are you going to do?

The problem for most of us is that we've been so dedicated to this cause for so long, that we can't exactly just leave. For instance, I have a PhD in chemistry, I could try to go back into research, but would have to relearn a lot of things, and the pay sucks. I'm fortunate that I'm in the military and will have a pension, and that'll help me in making a career change (if I end up doing something that doesn't pay as well).

You can't knock capitalism. I think it's truly the best form of gov't (and history has clearly demonstrated its superiority to other forms). I love the free market-competitive environment. It's what allows me to get a cheap but good car, a nice guitar, etc etc. But I shouldn't be surprised that it's taken over my own profession, the health industry. The problem is, we never saw the train coming. A douchey Kaiser commercial comes to mind, "We believe healthcare is a cause, not an industry." Bullsht, of course it's an industry,it is in every sense of the word.

 

[tantacles]

So what are you going to do?

The problem for most of us is that we've been so dedicated to this cause for so long, that we can't exactly just leave. For instance, I have a PhD in chemistry, I could try to go back into research, but would have to relearn a lot of things, and the pay sucks. I'm fortunate that I'm in the military and will have a pension, and that'll help me in making a career change (if I end up doing something that doesn't pay as well).

You can't knock capitalism. I think it's truly the best form of gov't (and history has clearly demonstrated its superiority to other forms). I love the free market-competitive environment. It's what allows me to get a cheap but good car, a nice guitar, etc etc. But I shouldn't be surprised that it's taken over my own profession, the health industry. The problem is, we never saw the train coming. A douchey Kaiser commercial comes to mind, "We believe healthcare is a cause, not an industry." Bullsht, of course it's an industry,it is in every sense of the word.

And yet at least in my state, Kaiser has no NP's working as hospitalists. It's all doctors.

 

[InternistDO]

And yet at least in my state, Kaiser has no NP's working as hospitalists. It's all doctors.

Probably because the Kaiser system rewards efficient care as opposed to pan consulting and ordering a zillion tests like traditional fee for service. Not that it’s perfect either, but at least it has that going for it.

 

[chessknt]

Probably because the Kaiser system rewards efficient care as opposed to pan consulting and ordering a zillion tests like traditional fee for service. Not that it’s perfect either, but at least it has that going for it.

Definitely not perfect. My mom is a kaiser pt ex smoker who met lung cancer screening criteria. Her pcp never brought it up and when she did (at my behest) they ordered a cxr. When the CT she got (again at my behest) showed some interstitial ground glass change in a single lobe associated with URI symptoms he ordered an IR-guided biopsy which I told her to not get. Repeat CT in 6 months showed it was all gone.

He also ordered a punch biopsy to diagnose suspected melanoma (it wasn't thankfully). That guy needs to consult someone.

 

[tantacles]

Probably because the Kaiser system rewards efficient care as opposed to pan consulting and ordering a zillion tests like traditional fee for service. Not that it’s perfect either, but at least it has that going for it.

I’m not sure why, but I do agree overall that the inpatient care is more efficient most of the time. That being said, my experience is that many of the kaiser docs (not all, and not every site) are kind of soft; the system is so cushy that they forget what it means to do that intense day of work. One of my sites quite strictly aims for 10-11 patients for a daytime hospitalist daily. Super nice, but I would be so bored if that were my job.

Edit: Oh I should also mention that you can not do anything else if you work for kaiser if it has anything to do with medicine based on your contract. Wanna start a medical app? Nope, kaiser owns that if you start it. Wanna do extra moonlighting on the side? Nope, can’t do that while you work for kaiser. If you work for kaiser, it’s only kaiser until you quit.

 

[sloh]

I’m not sure why, but I do agree overall that the inpatient care is more efficient most of the time. That being said, my experience is that many of the kaiser docs (not all, and not every site) are kind of soft; the system is so cushy that they forget what it means to do that intense day of work. One of my sites quite strictly aims for 10-11 patients for a daytime hospitalist daily. Super nice, but I would be so bored if that were my job.

I used to work for kaiser (PM&R). Their hospitalist gig is one of the best gigs out there. Some work 9-5 with minimal nights (that can even be traded). Outpatient specialties (especially FM) don’t fare as well largely due to inbox messages and patient phone call responsibilities (and patient satisfaction scores are tied to that—your employment is dependent on hitting patient satisfaction score benchmarks).