DrDudeMD

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Hoping seasoned vets can shed some light on the work schedule of a typical hospitalist and how things work..

Most, if not all of these places I'm looking at are doing a 7 on 7 off model, 12-h shifts. Some occassionally throw in a few night shift over the course of the month. Some places tell me that they don't do the 7 on 7 off model, but their hospitalists still work 14-15 shifts/month. That pretty much the same number of shifts as above. I can imaging 7on/7off being advantageous in that you have that set block of time aside as being off, where as in the other model, shifts are more disperse over the month and thus less likely to hit the wall by working 7 consecutive shifts. With that said, which is the preferable model?

Do all hospitalists stay for their full 12 hour shifts or do they rotate between themselves and cross-cover/be on call for the other hospitalists? That way, the non-covering hospitalists can round, do all of their work, sign out and go home.

Appreciate any insight. Thx!
 

gutonc

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You've more or less answered your own question already. You've described a bunch of possible scenarios and I've seen them all. And others you haven't described.

Imagine a wards month during residency. Now imagine that you're only working half as many days as you did during that wards month. That's pretty much what being a hospitalist is like. You might work 6 or 7 straight days, get a few days (2-6) off, then work another 6 or 7. Or you might work 4 on, have 5 off, work 6, take 3 off, work 4 then have 7 off. You'll probably be the admitting/late doc for 20-50% of those days (depending on the size of your group). The rest will likely just be "rounding".

These are the kinds of questions you need to ask when you're interviewing.
 

obiwan

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Yep, what gutonc said.

Even within my group itself of 20ish hospitalists, there are people who do the 7 off/7 on model while others like myself are more random with our schedule. A pretty important detail to iron out is how late you are expected to cover on your own patients. Ours is pretty ridiculous where we only have to cover until 4:30 so we have people in the group leaving early in the day and just fielding calls at home.
 
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FutureInternist

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Everyone's "preferable" model will be different

With no kids, no long vacations to take, I don't mind the 4-5 shifts in a row, then 2 days off, then back to work. Allows me to get my necessary # of shifts earlier in the month, hence being one of the few people able to take extra shifts when people start getting tired near the end or unforeseen things happen

We do 10 hour shifts.

During the days, you start @ 8 am, see your pts, get up to 2 admits (not counting the overnight ones that someone else admitted onto your team), then home whenever you feel comfortable leaving as long as you answer your pager till 6pm.

We have a Cross-Cover list in Epic where all the "follow up the Hgb & transfuse if < 7" etc stuff goes

For night shifts, 430p-230a or 10p-8a
7 admissions.
$200 for every admission after that.
Leave when done with 7 (if you don't want to do any extra) & again answer pages till end of your shift

We do not have any "admitting" shifts during the day so everyone gets a pt to admit, then when all teams have gotten one they start doubling up - so a max of 36 pts (18 teams) during the day. I actually think it wouldn't be too bad to have 1-2 docs dedicated to admissions, but then the # of hand-offs increases & that can cause problems

SOME of the things to ask on interviews
a) # of admits per day
b) Is there a cap on the teams (ours used to have one but then some docs started hanging on to pts till their last day & then diarrhea'd them all)
c) How late do you have to be on premises
d) ICU - open or closed
e) Any procedures you are expected to do
f) Are the admits from overnight evenly distributed - This favours the more efficient docs since if you d/c 5 in a day & get your list down to a reasonable number, you will not be "punished" by getting more admits to "even out the teams"
 
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flipmd

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18 teams?!? Holy hell, how big is your hospital?!?

EDIT: Just saw that you are 4-5 on, 2 off. So I guess that's not too bad. Probably equivalent of 9 teams if 7 on / 7 off.
 

FutureInternist

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18 teams?!? Holy hell, how big is your hospital?!?

EDIT: Just saw that you are 4-5 on, 2 off. So I guess that's not too bad. Probably equivalent of 9 teams if 7 on / 7 off.
Well the census is still approx 15 -17 per team so the number of days in a row doesn't affect it

Part of it is us taking EVERY SINGLE CONSULT that we get paged for......but since an easy admit counts just as much towards your cap as a hard one, I don't care :)
 

TimesNewRoman

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Well the census is still approx 15 -17 per team so the number of days in a row doesn't affect it

Part of it is us taking EVERY SINGLE CONSULT that we get paged for......but since an easy admit counts just as much towards your cap as a hard one, I don't care :)
I've never understood why some people pushback on soft admissions. In academics, your team moves towards your cap earlier in the day and you're likely not getting a rock. When you're in private practice, you're getting paid for a softball.
 

FutureInternist

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I've never understood why some people pushback on soft admissions. In academics, your team moves towards your cap earlier in the day and you're likely not getting a rock. When you're in private practice, you're getting paid for a softball.
Specially when you don't know what kind of 90 yo, full code, 15 co-morbidities having train wreck awaits as your next admission
Better to cap early on the easy ones :), and you get paid the same for either
 

jacksparrow82

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Our group works as such:
We have "rounding days" where we are not on call and only expected to do our work and go home whenever we want. However, we have to answer our pagers from 8-8 daily
We have nocturnists, so no nights for the daytime people
We have an "Admitting of the Day" shift that is from noon-8pm where that one person takes all the admissions. Its a killer shift, so there's a back up person that comes in at 4pm and stays till 11pm.
We also have a morning call person that is on call 7am to Noon, they have to both round and be on call during that time. But, when they are done with their work and its after noon, they can leave as well, also answering pager from 8-8.
The number of days we work is completely random. I've had stretches as short as 2 days and as long as 10. We usually get 2-7 days off at a time, unless you request more. We're required to work 200 days per year per our contracts. Its a very random system and the person who makes the schedule has a hell of a time doing it.

Its nice when the census is low, but the work load can be very bad at times, so its not as rosy as it seems doing things this way.
 

jacksparrow82

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I've never understood why some people pushback on soft admissions. In academics, your team moves towards your cap earlier in the day and you're likely not getting a rock. When you're in private practice, you're getting paid for a softball.
There's no cap once you're an attending, so a soft admission doesn't help protect you from real/harder admissions later. Plus, you can't bill for a higher level of care in a soft admission (unless you want to get audited and accused of billing fraud) so they can be a waste of time and only add to the stress of seeing your sicker patients.
The important thing though is making sure you're only putting patients in the hospital when they absolutely NEED to be there.
 

FutureInternist

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There's no cap once you're an attending, so a soft admission doesn't help protect you from real/harder admissions later. Plus, you can't bill for a higher level of care in a soft admission (unless you want to get audited and accused of billing fraud) so they can be a waste of time and only add to the stress of seeing your sicker patients.
The important thing though is making sure you're only putting patients in the hospital when they absolutely NEED to be there.
Certain places/jobs (like mine) cap the # of admissions per day & others also have an unofficial cap past which they will try their best to not give you an admission
 

jacksparrow82

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Certain places/jobs (like mine) cap the # of admissions per day & others also have an unofficial cap past which they will try their best to not give you an admission
So does your ER then start diverting patients to other area hospitals? Or do you have other competing groups that take those admissions once your capped?
 

FutureInternist

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Ours is the only group

When things get too busy then they incentivize taking more pts i.e $ 200 for each extra admission

Plus we have 3 admitters that come in @ 430 & another 2 @ 10 pm who then clean up the leftovers from the day shift
 
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