Questions about FM residency to hospitalist route

[The One Who Knocks]

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Hello all,

I am currently an M3 possibly interested in FM. I was wondering if someone could outline the path to working as a general hospitalist following a FM residency. How common are FM hospitalists? Are the numbers growing? I noticed job offers online (from several different states) for hospitalists with IM or FM training. Are there any notable differences between an IM hospitalist and FM hospitalist?

Also, are you able to work as a FM hospitalist right after residency, or do you have to do some sort of fellowship (Someone mentioned there is a 'hospital medicine' fellowship for FM, but is this needed to work as a FM hospitalist, or no? If not, what is the purpose of this fellowship?)

I'm just trying to get all of this straight, as there tends to be a lot of different information online.

I really appreciate your time! All the best.

 

[IntheClouds4ever]

1. You probably won’t be the hospitalist in a large metropolis hospital.
2. Yes you can do it right out of residency.
3. There could be a noticeable difference on rarer cases and presentations but it’ll depend greatly on residency training
4. No need for special fellowship.
5. Plenty of job offers, especially if you consider more rural places. (<~100k)

 

[Tenk]

If you’re going to be a hospitalist you should really go for IM, not FM. The FM docs who have a practice and also admit are kind of a dying breed and it’s just not logical anymore unless you enjoy being called in the middle of the night to admit. What you should really be asking yourself is if you want to do inpatient or outpatient and stick to one or the other primarily. They both have their pluses and minuses. When you put them together you get all the minuses which sucks.

 

[VAthletics]

For every 1 place that won't hire a FM doc, there are 9 more that will. A good portion of my residency class graduate and become hospitalists.

 

[AMEHigh]

I’m FM. I’m mostly familiar with NYC and Philly and in general there’s no difficulties getting hired as a hospitalist in either city.

You can start right after residency.

 

[Eetnas123]

Yo say I get a interview because there is a shortage of hospitalist what is the likely hood I'll get an offer ?

 

[907914]

if you want to do inpatient or outpatient and stick to one or the other primarily

Is this true across specialties, not just FM?

 

[AnatomyGrey12]

Is this true across specialties, not just FM?

What do you mean?

 

[907914]

What do you mean?

Is it difficult to do both inpatient and outpatient or do you end up with the **** end of both sticks if you try to do both?

 

[993444]

If you’re going to be a hospitalist you should really go for IM, not FM. The FM docs who have a practice and also admit are kind of a dying breed and it’s just not logical anymore unless you enjoy being called in the middle of the night to admit. What you should really be asking yourself is if you want to do inpatient or outpatient and stick to one or the other primarily. They both have their pluses and minuses. When you put them together you get all the minuses which sucks.

Plus, IM gives you a chance to sub-specialize if you end up wanting to.

 

[VA Hopeful Dr]

Is it difficult to do both inpatient and outpatient or do you end up with the **** end of both sticks if you try to do both?

The latter

 

[AnatomyGrey12]

Is it difficult to do both inpatient and outpatient or do you end up with the **** end of both sticks if you try to do both?

Depends on the field. But more often the latter

 

[Doctor Strange]

If you want to be a hospitalist, do internal medicine. Period. IM offers the breadth and acuity that family medicine simply cannot match due to the fact that your exposure to inpatient medicine in FM is truncated by the focus on ambulatory medicine. Not to mention that some FM programs do not even have their residents rotate in an ICU setting, so you will no doubt be clueless when it comes to managing an acutely decompensating patient. Furthermore, to address the inpatient/outpatient issue, it's been my experience through interviewing for jobs that the physician that juggles both primary care and hospital medicine is a dying breed. Most ultimately have to choose one or the other.

 

[Tenk]

Is it difficult to do both inpatient and outpatient or do you end up with the **** end of both sticks if you try to do both?

Doing both always sucks more than one or the either due to the simple fact that people don’t schedule their emergencies. The problem is a lot of subspecialties basically require both.

 

[IlDestriero]

Plus, IM gives you a chance to sub-specialize if you end up wanting to.

This is the wisdom right here.
IM leaves the door open to specialization if you desire. FM closes that door. Think of FM as it’s own specialty with hospitalist as a pop off if you don’t want to do outpatient hell for the rest of your days.

 

[VA Hopeful Dr]

This is the wisdom right here.
IM leaves the door open to specialization if you desire. FM closes that door. Think of FM as it’s own specialty with hospitalist as a pop off if you don’t want to do outpatient hell for the rest of your days.

I do so enjoy when non-FPs talk about what my specialty is

 

[993444]

Doing both always sucks more than one or the either due to the simple fact that people don’t schedule their emergencies. The problem is a lot of subspecialties basically require both.

Do outpatient sub-specialists see their patients if they get hospitalized (e.g. would an outpatient cardiologist see his patient if the patient were to have a heart attack and get hospitalized)?

 

[Tenk]

Do outpatient sub-specialists see their patients if they get hospitalized (e.g. would an outpatient cardiologist see his patient if the patient were to have a heart attack and get hospitalized)?

Unlikely unless they happened to be on inpatient or they had a specific procedure done. Most cardiologists take turns doing inpatient care and rounding. Like a week or two on inpatient then off.

 

[907914]

Unlikely unless they happened to be on inpatient or they had a specific procedure done. Most cardiologists take turns doing inpatient care and rounding. Like a week or two on inpatient then off.

And most of that is like being the in call doc right?

 

[Splenda88]

I do so enjoy when non-FPs talk about what my specialty is

Only FM docs should talk about FM...

 

[VA Hopeful Dr]

Only FM docs should talk about FM...

Not as a hard and fast rule, but in many areas yes.

You don't see me telling students what it's like the be an endocrinologist because I didn't my have experience in being one.

 

[jdh71]

Only FM docs should talk about FM...

What you saw there was one doc at what can only be seen as the extreme end of the patient contact spectrum, anesthesia, telling us how bad it is at the other end of the patient contact spectrum. I would suspect that our anesthesia friend did find out patient clinical practice horrifying and is one of the reasons he became a good anesthesiologist (and based on my experience with his posting he is also a good guy, trying to help here, not trolling). But as he doesn’t practice there it can be a little insulting to project ones own personal impressions and biases into a broad and generalized statement similar to “out patient medicine is stupid hell”. I do both myself, though as a specialist. And outpatient medicine is it’s own unique kind of hard. In patient is a different hard. We all like different things and have tolerances for only so much bull**** in various locations. It might be true that most of us find outpatient primary care too hard while also being too underpaid for the hardness. We go from there.

 

[jdh71]

Hello all,

I am currently an M3 possibly interested in FM. I was wondering if someone could outline the path to working as a general hospitalist following a FM residency. How common are FM hospitalists? Are the numbers growing? I noticed job offers online (from several different states) for hospitalists with IM or FM training. Are there any notable differences between an IM hospitalist and FM hospitalist?

Also, are you able to work as a FM hospitalist right after residency, or do you have to do some sort of fellowship (Someone mentioned there is a 'hospital medicine' fellowship for FM, but is this needed to work as a FM hospitalist, or no? If not, what is the purpose of this fellowship?)

I'm just trying to get all of this straight, as there tends to be a lot of different information online.

I really appreciate your time! All the best.

Depending on where you train it can be harder to step from senior FM resident to Hospitalist than it will in IM simply because of where you will spend a lot of your time in training. FM will also dilute the acute adult experience necessarily with pediatrics and obstetrics. So you can go from FM to adult hospitalist BUT why would you necessarily want to train in FM if that is your goal? IM is the best step from where you are to hospitalist

 

[IlDestriero]

Only FM docs should talk about FM...

I wasn’t trolling your thread.
But was I wrong? Does FM open the door to IM specialty options down the line? If so that’s a new one to me. That was the take home point to focus on. I have a couple FM friends that scope, used to do OB, set fractures, etc. but that’s just some procedures once in a while. Before you specialize in being a generalist, make sure that you are OK closing the door on being a specialist.
The outpatient hell comment is my admittedly exaggerated opinion of my experiences with outpatient medicine. I can only imagine it’s an order of magnitude worse now 20+ years later with EMRs, etc., but some people love it. There’s a lid for every pot. It’s hard to be non compliant with anesthesia and surgery. If you show up, kind of on time, and didn’t eat breakfast, we’re usually good.
You could just as easily substitute inpatient hell for a hospitalist job with FM as an outpatient pop off valve. 😉
If you really were offended by the outpatient hell comments, you definitely wouldn’t like what they say about anesthesia and anesthesiologists, but we soldier on. Enjoy the weekend.

 

[RNthenDoc]

It’s hard to be non compliant with anesthesia and surgery.

For the duration of the procedure, and ignoring overall patient outcomes, right? 😉

I’m sure you’ve experienced patients who have not healed due to smoking, lost function due to noncompliance with physical therapy, or even gone septic from noncompliance in post-op wound care.

 

[IlDestriero]

For the duration of the procedure, and ignoring overall patient outcomes, right? 😉

I’m sure you’ve experienced patients who have not healed due to smoking, lost function due to noncompliance with physical therapy, or even gone septic from noncompliance in post-op wound care.

I think the most common bad outcome I’ve seen is probably related to wound breakdown after major surgery in patients that are very ill and/or have poor nutritional status due to their complex medical situation.

 

[jdh71]

For the duration of the procedure, and ignoring overall patient outcomes, right? 😉

I’m sure you’ve experienced patients who have not healed due to smoking, lost function due to noncompliance with physical therapy, or even gone septic from noncompliance in post-op wound care.

Those aren’t really his problem though.

 

[AnatomyGrey12]

For the duration of the procedure, and ignoring overall patient outcomes, right? 😉

I’m sure you’ve experienced patients who have not healed due to smoking, lost function due to noncompliance with physical therapy, or even gone septic from noncompliance in post-op wound care.

Those aren't really anesthesia's problem tho....

 

[RNthenDoc]

Those aren’t really his problem though.

Those aren't really anesthesia's problem tho....

Right. They are the patient’s problem, which was the whole point I was trying to make.

 

[Drrrrrr. Celty]

There are very solid programs with very good hospitalist focused FM programs. But I think that you should for sure try to evaluate whether or not you're interested in the full scope of the FM world.

I chose IM over FM because while I like outpatient more than inpatient, I prefer the idea of being able to subspecialize and I exclusively wish to work with adults. If you like the idea of working some gyn, peds, and are very outpatient oriented then FM probably is a better deal. But if you do want to work inpatient then IM is a better deal.

 

[ACSurgeon]

I’m surprised no mention of IM-peds...

 

[jdh71]

I’m surprised no mention of IM-peds...

You dilute your training of adult medicine. Unless you want to be a hospitalist in both . . .

 

[907914]

You dilute your training of adult medicine. Unless you want to be a hospitalist in both . . .

If you want to be a hospitalist in both then wouldn’t FM be the better route.....?

 

[jdh71]

If you want to be a hospitalist in both then wouldn’t FM be the better route.....?

No. You still get your training necessarily diluted by obstetrics and lots of out patient clinic.

 

[907914]

No. You still get your training necessarily diluted by obstetrics and lots of out patient clinic.

So what is the best route to be an undiluted hospitals?

 

[jdh71]

So what is the best route to be an undiluted hospitals?

IM or Peds by themselves. Though if I recall correctly the pediatric board now wants a hospitalist fellowship. Which doesn’t mean you can’t find work coming straight out of residency, for now, but that may change.

Three years of IM to hospitalist will be the easiest and most straightforward means of getting there.

 

[IntheClouds4ever]

So what is the best route to be an undiluted hospitals?

Critical care fellowship after IM.. your IM is still going to have clinic days and diluted with other various experiences.. just figure out if you want to specialize or not. Seen badass IM and FM hospitalist and ****ty ones as well.. just put the effort in and you’ll be good to go. Lots of hypothetical arguments are made on SDN for extreme scenarios (But but FMs can’t be hospitalist a for the Mayo hospital research clinic with a 1000 inpatient unit type of examples).. if you don’t want to be the hospitalist for an extremely large academic research hospital that takes the Uber rare patients then it’s probably not going to matter and you’ll be fine either way.. just be realistic with your goals and geographic area you want to be in and then choose

 

[jdh71]

Critical care fellowship after IM.. your IM is still going to have clinic days and diluted with other various experiences.. just figure out if you want to specialize or not. Seen badass IM and FM hospitalist and ****ty ones as well.. just put the effort in and you’ll be good to go. Lots of hypothetical arguments are made on SDN for extreme scenarios (But but FMs can’t be hospitalist a for the Mayo hospital research clinic with a 1000 inpatient unit type of examples).. if you don’t want to be the hospitalist for an extremely large academic research hospital that takes the Uber rare patients then it’s probably not going to matter and you’ll be fine either way.. just be realistic with your goals and geographic area you want to be in and then choose

Critical care fellowship to do hospitalist medicine? No. Incorrect. All you need is IM residency.

 

[907914]

Critical care fellowship to do hospitalist medicine? No. Incorrect. All you need is IM residency.

Is critical care when you work in the ICU and see patients with predominantly poor prognosis or prolonged care?

 

[jdh71]

Is critical care when you work in the ICU and see patients with predominantly poor prognosis or prolonged care?

It’s the medicine of life support more or less. In general if that patient was not receiving the critical care they are getting they will die in minutes. Prognosis can be poor but timely critical care saves lives (the discussion about if this should be done in certain cases is a discussion for another thread). Care is often not prolonged but it can be especially in neurological disasters

 

[sunshinefl]

Is critical care when you work in the ICU and see patients with predominantly poor prognosis or prolonged care?

Critical Care Medicine | ACP Online

The Discipline Critical care medicine encompasses the diagnosis and treatment of a wide variety of clinical problems representing the extreme of human disease. Critically ill patients require intensive care by a coordinated team. The critical care specialist (sometimes referred to as an...

www.acponline.org

 

[NITRAS]

Critical care fellowship after IM.. your IM is still going to have clinic days and diluted with other various experiences.. just figure out if you want to specialize or not. Seen badass IM and FM hospitalist and ****ty ones as well.. just put the effort in and you’ll be good to go. Lots of hypothetical arguments are made on SDN for extreme scenarios (But but FMs can’t be hospitalist a for the Mayo hospital research clinic with a 1000 inpatient unit type of examples).. if you don’t want to be the hospitalist for an extremely large academic research hospital that takes the Uber rare patients then it’s probably not going to matter and you’ll be fine either way.. just be realistic with your goals and geographic area you want to be in and then choose

Programs all vary, but IM will have a lot more inpatient months than FM. Inpatient exposure on FM can vary from very good, to very minimal.

If you want to be a Hospitalist, go IM. If you want to be a FM Hospitalist, go to a program that works you hard in inpatient and has a healthy exposure to critical care.

 

[longhaul3]

It’s the medicine of life support more or less. In general if that patient was not receiving the critical care they are getting they will die in minutes. Prognosis can be poor but timely critical care saves lives (the discussion about if this should be done in certain cases is a discussion for another thread). Care is often not prolonged but it can be especially in neurological disasters

I guess in medical critical care this is pretty true, but in surgical and neurological critical care there are a lot more reasons that someone would be in the ICU than being minutes from death. Most hospitals I know of require an ICU bed for q1h neuro checks or FSBGs or patients with an arterial line, EVD, etc., even if they are just there for monitoring.

 

[jdh71]

I guess in medical critical care this is pretty true, but in surgical and neurological critical care there are a lot more reasons that someone would be in the ICU than being minutes from death. Most hospitals I know of require an ICU bed for q1h neuro checks or FSBGs or patients with an arterial line, EVD, etc., even if they are just there for monitoring.

That’s a nursing issue though and isn’t really necessarily critical care.

I take care of neuro critical care and and surgical critical patients as well. Because of staffing issues there are some things that are not or may it be critical care that require an icu bed. Just being in the icu isn’t critical care.

 

[MedicineZ0Z]

What about FM hospitalists working with open ICUs? Which are more common than one would think since they tend to be in more rural areas.

 

[VA Hopeful Dr]

That’s a nursing issue though and isn’t really necessarily critical care.

I take care of neuro critical care and and surgical critical patients as well. Because of staffing issues there are some things that are not or may it be critical care that require an icu bed. Just being in the icu isn’t critical care.

Yep, in residency any continuous infusion had to be in the ICU. No exceptions. That doesn't mean it needs your level of expertise to manage.

 

[jdh71]

What about FM hospitalists working with open ICUs? Which are more common than one would think since they tend to be in more rural areas.

There aren't enough intensivists to go around. If you are a big enough hospital with a big enough census and high enough acuity you'll find a critical care trained person. Rural places will do they best they can and usually transfer when able or appropriate.

So basically my answer is . . . so what? What about those FM hospitalists working in open ICUs in rural America?

 

[MedicineZ0Z]

There aren't enough intensivists to go around. If you are a big enough hospital with a big enough census and high enough acuity you'll find a critical care trained person. Rural places will do they best they can and usually transfer when able or appropriate.

So basically my answer is . . . so what? What about those FM hospitalists working in open ICUs in rural America?

I mean the fact that they exist is proof that a FM hospitalist in a typical avg sized hospital w/ a closed icu is quite easy for most grads.

How many fm programs provide weak inpatient training?

 

[Splenda88]

I mean the fact that they exist is proof that a FM hospitalist in a typical avg sized hospital w/ a closed icu is quite easy for most grads.

How many fm programs provide weak inpatient training?

I think most should provide at least 10 months of inpatient training (ICU, IM, FM, EM, GS) related to IM which is probably sufficient for them work as hospitalist.

 

[MedicineZ0Z]

I think most should provide at least 10 months of inpatient training (ICU, IM, FM, EM, GS) related to IM which is probably sufficient for them work as hospitalist.

Quality matters too. I have up to 10 patients as an intern (usually 5-6) and most are complex which covers the quality aspect.