Point of no return?

[glorifiedresident]

For a hospitalist or internist, how long do you think you could be off work before it would be very difficult if not impossible to return to work. I know for a surgeon or procedure based physician the answer would likely be very different.

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[DrMetal]

For a hospitalist or internist, how long do you think you could be off work before it would be very difficult if not impossible to return to work.

About 3 hours. That's about how long it takes me get a fifth deep, at which point it wouldn't be safe (nor legal) to go back to work.

 

[eyeeye_captain]

About 3 hours. That's about how long it takes me get a fifth deep, at which point it wouldn't be safe (nor legal) to go back to work.

 

[DrMetal]

He was way ahead of his time.

 

[gutonc]

For a hospitalist or internist, how long do you think you could be off work before it would be very difficult if not impossible to return to work. I know for a surgeon or procedure based physician the answer would likely be very different.

While I 1000% agree with and endorse @DrMetal's response (which, let's be honest, is super rare), I suspect you're asking a very different question.

From a knowledge/skill perspective, I think you're probably good up to the 6-12 month range, and maybe longer.

From the credentialing perspective, once you get past 3 months, people are going to start asking questions and rejecting your credentials.

What's your actual question here?

 

[glorifiedresident]

While I 1000% agree with and endorse @DrMetal's response (which, let's be honest, is super rare), I suspect you're asking a very different question.

From a knowledge/skill perspective, I think you're probably good up to the 6-12 month range, and maybe longer.

From the credentialing perspective, once you get past 3 months, people are going to start asking questions and rejecting your credentials.

What's your actual question here?

Let’s say you quit medicine for 2 years, could you dive back into being a hospitalist? How about 5 years?

 

[DrMetal]

Let’s say you quit medicine for 2 years, could you dive back into being a hospitalist? How about 5 years?

What are you trying to do, is this about having kids and staying home?

If you're a graduating resident, I honestly wouldn't advise it. Straight after graduating residency, you need your initial 2-3 years as a junior attending to hone in your skills and build your own style. You also have to learn how medicine is done in the real world (everyone with joint pain get's an initial xray, Ottawa rules be damned . . .the ER admits everything, you're going to take it and like it, there's no pushing back, etc).

The unfortunate truth is we (as a community of physicians) don't have any sort of 'apprentice' or 're-training' program for physicians who haven't worked for a while. We really should, but we just don't have it. We prefer to hire mid-levels with Cracker Jack degrees.

FWIW, as an attending, you will have more time off to do whatever you want (be with family, etc). It's not complete freedom of course, but much more than that of a resident. The other option is working part time, locums style, maybe 5-7 shifts per month. That way you're still in the game, just not full time.

 

[dozitgetchahi]

Let’s say you quit medicine for 2 years, could you dive back into being a hospitalist? How about 5 years?

At more than about 3-6 months, you may get asked some questions by a credentialing committee.

At more than 1 year, many state medical boards will start asking questions and may not give you a license without taking additional classes or making you do a “reentry” program.

At 2 years, the boards will almost certainly start requiring you to do some sort of training to get a license.

At 5 years, things will start becoming much more difficult, both from the standpoint of getting a state board to give
you a license and from a lot of your knowledge and skills having faded.

It’s not so much about “knowledge decay” (which, while real, I also think is much less of an issue than generally assumed, and takes longer to become a real issue than generally thought), but what the boards and credentialing committees think.

If you want to scale back somewhat, I’d recommend reducing your hours rather than diving out altogether.

 

[Drrrrrr. Celty]

At more than about 3-6 months, you may get asked some questions by a credentialing committee.

At more than 1 year, many state medical boards will start asking questions and may not give you a license without taking additional classes or making you do a “reentry” program.

At 2 years, the boards will almost certainly start requiring you to do some sort of training to get a license.

At 5 years, things will start becoming much more difficult, both from the standpoint of getting a state board to give
you a license and from a lot of your knowledge and skills having faded.

It’s not so much about “knowledge decay” (which, while real, I also think is much less of an issue than generally assumed, and takes longer to become a real issue than generally thought), but what the boards and credentialing committees think.

If you want to scale back somewhat, I’d recommend reducing your hours rather than diving out altogether.

Ppl take 3 months off in between residency and their first jobs.

I think that 6 months you start to get rusty. But that's fine because 30-50% of docs in any field practice like rust at their best and probably need to retire anyways.

I think for a generalist more so than a specialist it's easier to get back into the work because you can always cop out and consult and there are plenty of doctors who very much exist to just consult for everything outside of a COPD AE, PNA, and a UTI.

 

[dozitgetchahi]

Ppl take 3 months off in between residency and their first jobs.

I think that 6 months you start to get rusty. But that's fine because 30-50% of docs in any field practice like rust at their best and probably need to retire anyways.

I think for a generalist more so than a specialist it's easier to get back into the work because you can always cop out and consult and there are plenty of doctors who very much exist to just consult for everything outside of a COPD AE, PNA, and a UTI.

I agree that nobody *should* care about 3 months off, but I have encountered credentialing documents that want explanations and documentation of employment gaps starting at 3 months.

 

[DrMetal]

I agree that nobody *should* care about 3 months off, but I have encountered credentialing documents that start wanting explanations and documentation of employment gaps starting at 3 months.

It's quite true. We'll allow an on-line educated NP to run a heart failure service, but we'll scold a physician for taking 12 months off to have/raise a kid.

If our profession isn't the dumbest, not sure which is.

 

[Drrrrrr. Celty]

It's quite true. We'll allow an on-line educated NP to run a heart failure service, but we'll scold a physician for taking 12 months off to have/raise a kid.

If our profession isn't the dumbest, not sure which is.

We built a system that is inherently inflexible and only able to fail. Between medicine progressively becoming a profit first system run by administrators with no medical training. To our own purist visions of what medicine needs to be to be considered appropriate ex. obtuse CV padding, title hoarding, and board certifications / credentialing. We are forcing ourselves further into a degrading cycle of depreciation with no gain.

This beside the fact that I think hospitalists are a chain within the medical system that is very vulnerable as increased pressure to consult, automated metrics that detect increased risk for sepsis/ etc may lead to it being degraded to being run by NPs who prescribe Mag, Kdurs, and opioids while consultants do the actual medical management or consults to critical care for quick assessments and prevention of deterioration.

 

[glorifiedresident]

Just to clarify, I’m not planning on taking a extended lead nor have I ever taken an extended leave but I thought it was something interesting to think about.

 

[DrMetal]

Just to clarify, I’m not planning on taking a extended lead nor have I ever taken an extended leave but I thought it was something interesting to think about.

Well, what are you asking for then??? I often think about joining a heavy metal band and/or the PGA tour. Can anybody here help me that?

 

[Raryn]

Ppl take 3 months off in between residency and their first jobs.

I think that 6 months you start to get rusty. But that's fine because 30-50% of docs in any field practice like rust at their best and probably need to retire anyways.

I think for a generalist more so than a specialist it's easier to get back into the work because you can always cop out and consult and there are plenty of doctors who very much exist to just consult for everything outside of a COPD AE, PNA, and a UTI.

I've had to submit written explanations to credentialing committees for 2 week gaps ("I was moving across the country" was thankfully accepted, but really?). That's less common, but 3 months will *absolutely* require a written explanation.

 

[Drrrrrr. Celty]

I've had to submit written explanations to credentialing committees for 2 week gaps ("I was moving across the country" was thankfully accepted, but really?). That's less common, but 3 months will *absolutely* require a written explanation.

Glad my job is content with letting me start 3months after I finish fellowship without any hassle lol.

Also this is peak medicine gate keeping. Will let an NP borderline cath people out of NP school and will make MD/DOs have to explain taking a vacation.

 

[anonperson]

Glad my job is content with letting me start 3months after I finish fellowship without any hassle lol.

Also this is peak medicine gate keeping. Will let an NP borderline cath people out of NP school and will make MD/DOs have to explain taking a vacation.

That's hospital and employer dependent. Those gaps come to the chair of the department and c the credentialing committee of a hospital. Any rules/limitations can be changed just like any hospital bylaw with the support of the medical staff. It just has to be voted on.

Same thing for what a mid level can and can't do in the hospital setting.

 

[Drrrrrr. Celty]

That's hospital and employer dependent. Those gaps come to the chair of the department and c the credentialing committee of a hospital. Any rules/limitations can be changed just like any hospital bylaw with the support of the medical staff. It just has to be voted on.

Same thing for what a mid level can and can't do in the hospital setting.

And it's all crap. We've engineered ourselves out of an actually livable field. Instead we live in service to ideals for pocket change. How long until computer engineers have a 4 year degree that pays them more money and without 5 social science driven projects to help with resilience?