What is the lifestyle of a IM hospitalist like?

[PS2summerdays]

I am applying to residency soon and I highly value some outside hobbies. I would like time for these hobbies and would also like some sleep, eventually. I know that IM residency is grueling. But I am curious about what the lifestyle is like?

Is it one week on, one week off? And on the week off, do you have any energy left?

What are the other models of working? It confuses me a lot because sometimes I see hospitalists at my school work for weeks and months at a time. Does it get tiring? Is being an attending mentally taxing and stressful?

I am trying my best during my MS-3 year, but the thought of doing simple "procedures" like LPs, catheters, and IV insertions makes me feel nervous. And the thought of managing a CCU almost gives me a panic attack. However, I am not sure if this is due to me knowing nothing or an actual incompetence.

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[IMGASMD]

MS3? Little early. But any schedules you can think of, you can pretty much negotiate....

 

[PS2summerdays]

MS3? Little early. But any schedules you can think of, you can pretty much negotiate....

I seriously agree. MS-3 is too early to decide what you wanna do. But I pretty much have to now. Residency applications start in just a few months. I want to get an idea of the attending lifestyle before I commit to the path!

 

[lulu09]

There are literally too many questions to address here. I was a MS-3 too once so I know how you feel, so I will indulge you with the basics. A lot of your questions can be addressed by doing a simple search in these forums with literally the keyword "hospitalist." I would encourage you to read those threads as your questions are too broad to be addressed in one thread.

I've worked in two different hospitals (my residency one and a different one now, both academic centers) and the most prevalent model is 7 on, 7 off or 14 on, 14 off. You take control of a team for the time you're on, and pass it off to the oncoming attending. On your weeks off, responsibilities differ. In an academic center, you are generally expected to assume some sort of admin or teaching role on your weeks off, so you're still kind of working, just not directly taking care of patients. Community hospitals tend to be more relaxed where when you're off, you're just off completely and you don't need to check email or come into the hospital at all.

There are also M-F 9a-5p models where you kind of function like a clinic attending - come in to round on your patients, write all the notes, and leave. You work a set number of weekends depending on how many hospitalists are in your group. In this model you get more weekends, but you don't get a lot of consecutive time off.

If there is a decent number of coworkers in your hospitalist group, switching shifts is super easy so in general it's not difficult to accommodate vacation requests...etc. I like how hospitalist medicine is similar to emergency medicine in that when you leave to go home for the day, you're just off and no one will bother you with calls (assuming there is night coverage).

You will gain competence with procedures. You should do IV insertions on anesthesia or EM rotations. Ask to do LPs on neuro. Getting good at procedures is simply a question of volume. You should be worried if you've done a paracentesis 50 times solo and still feel like you can't handle it by yourself, not 2.

If you're set on medicine, keep an open mind since medicine is one of the broadest specialities and the opportunities for fellowship, hospitalist medicine, primary care, academic general medicine...etc. abound and don't get pigeonholed into something too early. Clearly, you also have the option of doing some other specialty now, but that's for you to decide.

 

[PS2summerdays]

There are literally too many questions to address here. I was a MS-3 too once so I know how you feel, so I will indulge you with the basics. A lot of your questions can be addressed by doing a simple search in these forums with literally the keyword "hospitalist." I would encourage you to read those threads as your questions are too broad to be addressed in one thread.

I've worked in two different hospitals (my residency one and a different one now, both academic centers) and the most prevalent model is 7 on, 7 off or 14 on, 14 off. You take control of a team for the time you're on, and pass it off to the oncoming attending. On your weeks off, responsibilities differ. In an academic center, you are generally expected to assume some sort of admin or teaching role on your weeks off, so you're still kind of working, just not directly taking care of patients. Community hospitals tend to be more relaxed where when you're off, you're just off completely and you don't need to check email or come into the hospital at all.

There are also M-F 9a-5p models where you kind of function like a clinic attending - come in to round on your patients, write all the notes, and leave. You work a set number of weekends depending on how many hospitalists are in your group. In this model you get more weekends, but you don't get a lot of consecutive time off.

If there is a decent number of coworkers in your hospitalist group, switching shifts is super easy so in general it's not difficult to accommodate vacation requests...etc. I like how hospitalist medicine is similar to emergency medicine in that when you leave to go home for the day, you're just off and no one will bother you with calls (assuming there is night coverage).

You will gain competence with procedures. You should do IV insertions on anesthesia or EM rotations. Ask to do LPs on neuro. Getting good at procedures is simply a question of volume. You should be worried if you've done a paracentesis 50 times solo and still feel like you can't handle it by yourself, not 2.

If you're set on medicine, keep an open mind since medicine is one of the broadest specialities and the opportunities for fellowship, hospitalist medicine, primary care, academic general medicine...etc. abound and don't get pigeonholed into something too early. Clearly, you also have the option of doing some other specialty now, but that's for you to decide.

Thanks so much. You are very kind to answer all these questions. This gives me a much better idea of how things can go as an attending. You are right that a lot of posts did answer this question but I felt like they weren’t as comprehensive/reasoned out sometimes. From the bottom of a MS-3’s tachycardic heart, thank you.

 

[IMGASMD]

I seriously agree. MS-3 is too early to decide what you wanna do. But I pretty much have to now. Residency applications start in just a few months. I want to get an idea of the attending lifestyle before I commit to the path!

As maybe implied by lulu, you should pick a speciality first. If it’s internal medicine, go in with open mind. I don’t think you should choose IM based on hospitalist lifestyle. There are plenty you can do, and should explore within medicine. Pigeonhole yourself into a specific “sub speciality” is premature.
Otherwise, I stand by my answer. I don’t have any experience with big academic centers. At community hospital, you can negotiate it your way. I’ve worked with people do 7 on/7 off day with 8 or 12 hour shifts. There are 5on/5off. 14on/14off. Days only, nights only, two week days then follow by one week nights. No weekends. Bankers hours. Traditional Internist comes to hospital for an few “admission shifts” coverage to earn a few more bucks. So..... plenty of opportunities, but obviously depends on your local market more than anything else.
Anyways, keep an open mind with IM. Worry about your work schedule in few more years.

 

[PS2summerdays]

As maybe implied by lulu, you should pick a speciality first. If it’s internal medicine, go in with open mind. I don’t think you should choose IM based on hospitalist lifestyle. There are plenty you can do, and should explore within medicine. Pigeonhole yourself into a specific “sub speciality” is premature.
Otherwise, I stand by my answer. I don’t have any experience with big academic centers. At community hospital, you can negotiate it your way. I’ve worked with people do 7 on/7 off day with 8 or 12 hour shifts. There are 5on/5off. 14on/14off. Days only, nights only, two week days then follow by one week nights. No weekends. Bankers hours. Traditional Internist comes to hospital for an few “admission shifts” coverage to earn a few more bucks. So..... plenty of opportunities, but obviously depends on your local market more than anything else.
Anyways, keep an open mind with IM. Worry about your work schedule in few more years.

Thank you! Sorry if what I said came out the wrong way. I wasn’t trying to decide between sub specialties. More between IM and other choices that are available after 4th year (i.e. psychiatry and pediatrics).

For now I think I just want to be a hospitalist/internist.

 

[NITRAS]

Just to expand on the above, Hospitalist groups can be very different. Some require nights and days, swing shift, admits, round and go vs staying physically present. Closed vs open icu. Lots of procedures vs none at all. Residents vs no residents, number of patient can vary widely as well.

Comp packages can be just as varied.

 

[PS2summerdays]

Just to expand on the above, Hospitalist groups can be very different. Some require nights and days, swing shift, admits, round and go vs staying physically present. Closed vs open icu. Lots of procedures vs none at all. Residents vs no residents, number of patient can vary widely as well.

Comp packages can be just as varied.

Sorry if this sound stupid, but do they usually say up front what's expected of you? As in procedures vs no procedures?

 

[NITRAS]

Usually

 

[IM2GI]

I've worked in two different hospitals (my residency one and a different one now, both academic centers) and the most prevalent model is 7 on, 7 off or 14 on, 14 off. You take control of a team for the time you're on, and pass it off to the oncoming attending. On your weeks off, responsibilities differ. In an academic center, you are generally expected to assume some sort of admin or teaching role on your weeks off, so you're still kind of working, just not directly taking care of patients. Community hospitals tend to be more relaxed where when you're off, you're just off completely and you don't need to check email or come into the hospital at all.

What a scam that is. 7 on 7 off already is not nearly as good as it sounds because of all the weekends you work. Get paid less, and still have teaching/quality improvement/publishing requirements on your "off" days? Hard pass.

 

[PS2summerdays]

What a scam that is. 7 on 7 off already is not nearly as good as it sounds because of all the weekends you work. Get paid less, and still have teaching/quality improvement/publishing requirements on your "off" days? Hard pass.

Usually you are OFF during your week off, right?

 

[IM2GI]

Usually you are OFF during your week off, right?

Typically yes. Given that 7 on/7 off is already a mediocre setup, having to work non-clinically on your "off" time is awful.

The model works fine if you are young and don't have kids, but as you get older and have a family it increasingly is broken.

The scourge of seven on/seven off

How many soccer games have you missed because of your work schedule? How often has your spouse had to eat dinner without you?.

acphospitalist.org

 

[PS2summerdays]

Typically yes. Given that 7 on/7 off is already a mediocre setup, having to work non-clinically on your "off" time is awful.

The model works fine if you are young and don't have kids, but as you get older and have a family it increasingly is broken.

The scourge of seven on/seven off

How many soccer games have you missed because of your work schedule? How often has your spouse had to eat dinner without you?.

acphospitalist.org

Do you have any insight as to why EVERYONE keeps encouraging IM people to specialize? Doing 2-3 years of residency doesn't seem appealing to me, especially if the flexible scheduling is no longer as easy a possibility.

 

[siliso]

7 on and 7 off makes a lot of people happy in theory but I wouldn’t want to. Every other weekend ON stinks. So does routine 12 hour workday. Primary care with occasional ward duties is great to me. I’ve wondered what on earth one does for childcare...no daycare is going to agree to get paid only every other week. My observation is people tend to do it for a few years and move on, either to outpatient or a fellowship.
But, if you are unattached and love traveling or volunteering or something else to do with all these weekdays off, could be a good deal. I get plenty of leave to have a week off when I want it but think it would actually be bad for my personality to have so much downtime. The less I have to do the less I want to do and every other week vegetating while my family is at work and school wouldn’t be positive.

 

[lulu09]

What a scam that is. 7 on 7 off already is not nearly as good as it sounds because of all the weekends you work. Get paid less, and still have teaching/quality improvement/publishing requirements on your "off" days? Hard pass.

Hey, I totally agree. I'm doing this short-term before fellowship but yes, I would not recommend any places that ask you to do additional non-clinical work (especially come in to meetings!) during your weeks off. I mean, this may be an anomaly since I'm in a very large urban center and maybe that's just the expectation here, reasonable or not.

Do you have any insight as to why EVERYONE keeps encouraging IM people to specialize?

Unfortunately, and I feel this way increasingly --
1. General medicine (primary care, hospitalists) you're just being dumped on by other services. Medicine can't refuse admissions, so when specialists decline to take patients onto their service, you have to take them. It's demoralizing after awhile to realize you don't really win any battles against specialists.

2. Increasingly, there's simply not enough time to address all the issues in general medicine in a sustainable manner while maintaining your sanity and also keeping up with the flow of the clinic or the hospital day. When my cynical side takes over, I see general medicine as putting a band-aid on whatever acute issue there is and then passing it on to the next generalist, hoping that this band-aid hasn't fallen off by the time they see the next provider and so that other band-aids can be placed on issues that hasn't been addressed. Again, to see this over and over again is demoralizing.

And then there's the reimbursement / salary issue for generalists relative to how much they work. I'm not equipped to talk about it so I won't.

But then again, I work in a very large metro area where the patient volume is constantly high and essentially all the hospitals functioning like county hospitals, so it might be different elsewhere. The way I see it here and now though, there's no way I would be a hospitalist or a PCP forever.

 

[PS2summerdays]

Hey, I totally agree. I'm doing this short-term before fellowship but yes, I would not recommend any places that ask you to do additional non-clinical work (especially come in to meetings!) during your weeks off. I mean, this may be an anomaly since I'm in a very large urban center and maybe that's just the expectation here, reasonable or not.



Unfortunately, and I feel this way increasingly --
1. General medicine (primary care, hospitalists) you're just being dumped on by other services. Medicine can't refuse admissions, so when specialists decline to take patients onto their service, you have to take them. It's demoralizing after awhile to realize you don't really win any battles against specialists.

2. Increasingly, there's simply not enough time to address all the issues in general medicine in a sustainable manner while maintaining your sanity and also keeping up with the flow of the clinic or the hospital day. When my cynical side takes over, I see general medicine as putting a band-aid on whatever acute issue there is and then passing it on to the next generalist, hoping that this band-aid hasn't fallen off by the time they see the next provider and so that other band-aids can be placed on issues that hasn't been addressed. Again, to see this over and over again is demoralizing.

And then there's the reimbursement / salary issue for generalists relative to how much they work. I'm not equipped to talk about it so I won't.

But then again, I work in a very large metro area where the patient volume is constantly high and essentially all the hospitals functioning like county hospitals, so it might be different elsewhere. The way I see it here and now though, there's no way I would be a hospitalist or a PCP forever.

That sounds utterly difficult. I'm sorry you get so constantly demoralized. That must be extremely hard. Good luck. Hoping you can transition into specialty soon.

How are the stress levels? My goal would be to work in a urban area as well if I go the medicine route. But it seems like a hectic job - the patient volume, getting dumped on, and the intellectual strain of constant diagnosis and workup. The last one is what intimidates me the most.

 

[lulu09]

That sounds utterly stressful. I'm sorry you get so constantly demoralized. That must be extremely hard. Good luck. Hoping you can transition into specialty soon.

How are the stress levels? My goal would be to work in a urban area as well if I go the medicine route. But it seems like a hectic job - the patient volume, getting dumped on, and the intellectual strain of constant diagnosis and workup. The last one is what intimidates me the most.

Haha, I say demoralized but it's not that bad really. Just feel frustrated at times when patients who clearly should be on vasc surg, ortho, neurology, or NSGY are hanging out on medicine because they don't want to take care of patients on their own. It's ok though because I just call them very frequently for "further recommendations" 😉

I have never worked in a rural setting or a more suburban setting, but many of my friends from residency have done so and it sounds much improved in terms of the sheer volume of patients that come in through the doors. The constant diagnosis and workup you get used to fast. Med school is so focused on learning about zebras, but you'll see that the vast majority in the real world are horses.

 

[deleted547631]

Med school is so focused on learning about zebras, but you'll see that the vast majority in the real world are horses.

I like how you put that!

 

[jhamaican]

A large part of the allure of IM hospitalist is the flexibility. You can find people working as little or as much as you can imagine.

 

[Splenda88]

Anyone working 3 days/wk (7am-7pm) with weekends off...

 

[wjs010]

Why can’t base pay be like 300. I think you would see a massive shift if this were the case. People would defer fellowship really quick

 

[the argus]

Why can’t base pay be like 300. I think you would see a massive shift if this were the case. People would defer fellowship really quick

Because hospitalists don't do anything that makes the hospital money. Sure, you write your note and bill a 99232 or 99233, but this is minimal revenue compared to what comes in for a surgery, IR procedures, GI endoscopies, cardiology procedures, etc. Some hospitalists are getting smart and billing for critical care time, which definitely brings in more money and adds value from a hospital billing perspective.

This is also why specialties like infectious diseases and endocrinology often make less than a hospitalist. They do nothing but bill for consults (i.e. knowledge), which doesn't bring in much money. They often end up seeing less patients in a day than a hospitalist, and therefore will make less money.

That's why the good hospitalist gigs have RVU based bonuses. Gives the hospitalist incentive to bill appropriately. It's a win for everyone (except the taxpayer obviously, who is ultimately paying more for the same amount of care), as the hospital will also make more money.

 

[aafisahar]

Anyone working 3 days/wk (7am-7pm) with weekends off...

probably but it would be sans benefits and a salary like 60k

 

[IMGASMD]

probably but it would be sans benefits and a salary like 60k

Maybe 100.
140*12*3*52= 262080
262k*0.65 (post tax)= 170K
170-50 (401k, retirement I know some should be pre-tax)-10 (insurance for family) =~110K

It’s not horrible, not great. Especially if you need to pay another $48000/yr for student loan payment. And that’s where I suppose the 60k comes from......

 

[aafisahar]

Maybe 100.
140*12*3*52= 262080
262k*0.65 (post tax)= 170K
170-50 (401k, retirement I know some should be pre-tax)-10 (insurance for family) =~110K

It’s not horrible, not great. Especially if you need to pay another $48000/yr for student loan payment. And that’s where I suppose the 60k comes from......

part time pays a premium to work part time. you can't just do the math to figure out what the per day rate is. the group has to hire 2 people to do the job of one.

 

[Splenda88]

part time pays a premium to work part time. you can't just do the math to figure out what the per day rate is. the group has to hire 2 people to do the job of one.

36 hrs/wk is part time...

 

[IMGASMD]

part time pays a premium to work part time. you can't just do the math to figure out what the per day rate is. the group has to hire 2 people to do the job of one.

140/hr was the rate 5 years ago on 1099 ( $140/hr is consider premium pay now?) They also don’t pay for my family heath insurance or 401k.

Obviously if I demand 12X3 on M-W-H or they can assign me any 12x3 maybe different.

Why can’t I just do math and figure what I want to make? At the end of the day, it’s shift work and find somewhere that will accept your terms and you’re happy with the pay.... all depends on the market demand, physician supply and the company you’re working for.

Edit: at worst they can say no. If they want to keep you, you can always negotiate for more. I asked for 25% increase within 3 months of my first job and I got it. Maybe they were desperate, maybe I was good... don’t matter, right?

 

[obiwan]

I am applying to residency soon and I highly value some outside hobbies.

Come back to me once you're done with residency and we can talk..... in all seriousness though, being a hospitalist is just like being a medicine ward team all by yourself carrying 15-20 patients every day. simple as that

 

[wjs010]

Come back to me once you're done with residency and we can talk..... in all seriousness though, being a hospitalist is just like being a medicine ward team all by yourself carrying 15-20 patients every day. simple as that

Except you do it by yourself at your own pace, not with 10 other people while teaching every 2 seconds.

 

[jm192]

I'm FM trained, but do a hospitalist gig with a group of predominantly internists.

We do 7 on 7 off. I'm 31 with a fiance and no kids. So far it's great. As we have kids, I suspect it will be tougher. My best friend is nearly 2 years into a hospitalist gig and has 4 kids. He's already talking about missing baseball games, dance recitals, etc. He's talking to some clinics about switching.

I've got 26 weeks off to travel, pursue hobbies, etc. Some days I sleep to 11.

We admit 25 year olds with sponatenous pneumos and do nothing besides pain meds while CT Surgery runs the show. It's frustrating. However, my experience with primary care was that it's also got the frustrating parts. I felt like I ran into a lot more insurance issues.

In outpatient medicine you have less control over what you can order. We had patients in office with obvious volume overload that we couldn't get an outpatient echo for because of insurance. In the hospital, I can order a transvaginal ultrasound on a man and I won't hear a word about the insurance.

You're going to find things you dislike everywhere.

What I think the real cons are: You're committed to 26 weekends +holidays. In outpatient medicine, you may do 9-5 5 days a week and have every single holiday and weekend.

Life comes up and it can be hard to switch on short notice.

The week you work is exhausting.

 

[jm192]

.

 

[alicealicealice]

7/7 is a lazy model that makes scheduling easy for your employer not life better for you. Unless you really like it or need that amount of continuity (you can still have long stretches without strict 7/7) id really look for a place where it’s set up differently if you plan on long term

 

[gutonc]

7/7 is a lazy model that makes scheduling easy for your employer not life better for you. Unless you really like it or need that amount of continuity (you can still have long stretches without strict 7/7) id really look for a place where it’s set up differently if you plan on long term

Of the 5 local hospital systems I'm aware of (1 University, 2 Community/Academic with IM programs, Kaiser and a community hospital that feels like a rural critical access hospital despite being smack in the middle of a 1M+ city), only one of them (the small community hospital) does 7/7 as a rule. The 3 hospitals with IM residencies do it for their teaching attendings, for resident/teach continuity, the the rest have systems more similar to how inpatient nurses are scheduled (3-5d in a row, 2-5d off, repeat, etc).

 

[Cheeni17]

What are the thoughts on living in a semi rural area and traveling to do week on then back home week off in higher payer less desirable areas. As in maybe 4 -6 hours away for let’s say 100k more?

 

[IMGASMD]

What are the thoughts on living in a semi rural area and traveling to do week on then back home week off in higher payer less desirable areas. As in maybe 4 -6 hours away for let’s say 100k more?

Sure. But you can only do it for so long. A few years ago, I’ve seen jobs for Alaska that would last for only “6 months”. Maybe up to 400+.
They mean you stay there for 6 months and “on” the most if not all the time.

You also have to consider, you’d need two places to stay. If you’re single and no family it might be fine for a few years. But I don’t think it’s a real ideal for long term. Also, then I would also consider locum.

 

[NITRAS]

What are the thoughts on living in a semi rural area and traveling to do week on then back home week off in higher payer less desirable areas. As in maybe 4 -6 hours away for let’s say 100k more?

I feel the most sustainable Hospitalist positions are the ones that let you see your family most every day. You also have to add a day of travel to your week.

I have currently 8 weeks a year where I don’t, and they suck. The rest is pretty reasonable. I also like living in a smallish town. I do have the benefit of a large hospital in a smaller town.

 

[Cheeni17]

Thanks guys just been reading offers our upper residents have gotten/ on facility job boards offers I’ve seen. Still not sure if going on to fellowship or not. I love small towns but as most people not sure if I want to live super far from a decent sized city. Appreciate the points to ponder thus far

 

[IMGASMD]

Thanks guys just been reading offers our upper residents have gotten/ on facility job boards offers I’ve seen. Still not sure if going on to fellowship or not. I love small towns but as most people not sure if I want to live super far from a decent sized city. Appreciate the points to ponder thus far

It’s good to ponder now, but you won’t know until you are there.
If you’re a small town person, maybe do a traditionalist approach. You can have your own patients and work for a hospital on other days. It will have a little more balance and also you can be more rooted to the community.
Here comes the BUT. It can be a little weird for the political side of things. Will you admit for some other doctor, who in essence is your competitor? Will you keep the patients? Will hospital let you piss off other doctors?

There are plenty of options/arrangements, you just have to explore it. It’s very difficult to “see” unless you have an open mind and also hear about all these “business plans”.

Know a new grad who was hired to be a small town hospitalist for a hospital serving a town of less than 3000. Did a year or two, picked up a few nursing home around. Quit. Now just does nursing homes.

A locum, who has been doing locum gig for the last 5 years, just travel from hospital to hospital around the region. Lodging and travel paid for whenever he’s on a job. It sounds great when I was younger, but after a while you just want to settle down.

Someone looked into a Alaska job where you can be paid up to 500k, yes 1/2 Mil. She actually explored it pretty throughly. Turns out they don’t really have any specialist in house, so you’d have a learn a little of everything. Starting dialysis, antibiotics, vent management. If get into a bind, call someone hundreds of miles away. Does that sound exciting? Sure, when I am in my early 30s or right after my training, can I do it for a long time before completely burn out? Probably not.

Last one, a few years ago now, you can be a hospitalist internationally for American hospitals abroad. They provide interpreter, housing, chauffeur and IRS looked away when you have high foreign income. They provide two round trip tickets yearly, so you can go home.

So..... here are all the arrangements I know of..... good luck!

 

[DrSnips]

Someone looked into a Alaska job where you can be paid up to 500k, yes 1/2 Mil. She actually explored it pretty throughly. Turns out they don’t really have any specialist in house, so you’d have a learn a little of everything. Starting dialysis, antibiotics, vent management. If get into a bind, call someone hundreds of miles away. Does that sound exciting? Sure, when I am in my early 30s or right after my training, can I do it for a long time before completely burn out? Probably not.

Starting HD as a hospitalist? I hope that 500k comes with a substantial malpractice insurance policy.

 

[IMGASMD]

Starting HD as a hospitalist? I hope that 500k comes with a substantial malpractice insurance policy.

What’s YOUR price? If they cover you, will YOU do it? Malpractice premium isn’t as bad as you think it is. You’re licensed, as a physician, as long as the hospital credentials you to do the procedure, you say you can do the procedure...... it’s not as hard as you may think. If a NP with substantial less training than you can be a hosptialist, YOU, a physician, can do A LOT more, as long as you will take the responsibility for it.

 

[DrSnips]

What’s YOUR price? If they cover you, will YOU do it? Malpractice premium isn’t as bad as you think it is. You’re licensed, as a physician, as long as the hospital credentials you to do the procedure, you say you can do the procedure...... it’s not as hard as you may think. If a NP with substantial less training than you can be a hosptialist, YOU, a physician, can do A LOT more, as long as you will take the responsibility for it.

There is no price you can pay me to get me to do something outside my scope of training. Even if you would cover malpractice, it's a disservice to the patients to have an inexperienced provider with no in house backup working on them.

 

[IMGASMD]

There is no price you can pay me to get me to do something outside my scope of training. Even if you would cover malpractice, it's a disservice to the patients to have an inexperienced provider with no in house backup working on them.

If that jobs goes to NPs how’s that a service to the patient? But that’s certainly a different discussion. All I can say is the colleague end up didn’t taking the cool 1/2 mil. Like I said if I was young just finished, and think I am some hotshot and ready to take on the world, why not?

 

[rokshana]

If that jobs goes to NPs how’s that a service to the patient? But that’s certainly a different discussion. All I can say is the colleague end up didn’t taking the cool 1/2 mil. Like I said if I was young just finished, and think I am some hotshot and ready to take on the world, why not?

No NP should be writing HD orders...

 

[IMGASMD]

No NP should be writing HD orders...

....

Should and could are two very different words. I am not saying I’ve seen it, but I don’t think I will be surprised if someone out there had done it.

 

[rokshana]

....

Should and could are two very different words. I am not saying I’ve seen it, but I don’t think I will be surprised if someone out there had done it.

I doubt it..there are certain things that tend to be things people are afraid to do...have a friend who is hem/onc and he said that mid level encroachment is not a huge worry for most hem/ones...why? Because no one is willing to take the risks that come from ordering chemo...I would imagine the same could be said for dialysis...

 

[DrSnips]

I doubt it..there are certain things that tend to be things people are afraid to do...have a friend who is hem/onc and he said that mid level encroachment is not a huge worry for most hem/ones...why? Because no one is willing to take the risks that come from ordering chemo...I would imagine the same could be said for dialysis...

Agreed. I doubt we will see NPs writing HD or chemo orders. I certainly know that hospitalists like me should not be doing those things. I find it ridiculous there is some hospital in Alaska that thinks they can get around that by just paying us more to do it.

 

[IMGASMD]

Agreed. I doubt we will see NPs writing HD or chemo orders. I certainly know that hospitalists like me should not be doing those things. I find it ridiculous there is some hospital in Alaska that thinks they can get around that by just paying us more to do it.

Part of my icu rotation went to a hospital with CC fellows and NPs. I will let the NP write my dialysis orders any day. It’s not totally “hard” to acquire that knowledge if she has been paying attention (which I am sure she had) with all the dialysis and cvvh orders that’s being initiated on a daily basis without any real renal involvement. But I am sure this is more unique (since the icu is essentially closed and ran by fellows and NP) than what other programs are used to.

I wouldn’t do any chemo orders, since I never done more than more 4 weeks of heme-onc. But to initiate a “life saving” procedure/protocol “may not” be as hard as you think it might be.
I still remember my first few central lines without US (our hospital couldn’t afford one, this was 10 years ago). At some point, you just kept going, with the belief that it may eventually mean life vs death. Wouldn’t be too bad now that decision is also associated with a good size paycheck?

 

[aafisahar]

No NP should be writing HD orders...

I was on renal for a month and you can very easily figure out how to write dialysis orders. It's all formulaic. There's no magic going into them. Nephrology seemed happy they didn't have to spend several hours writing dialysis orders instead of seeing consults that required much more thought.

 

[IMGASMD]

I was on renal for a month and you can very easily figure out how to write dialysis orders. It's all formulaic. There's no magic going into them. Nephrology seemed happy they didn't have to spend several hours writing dialysis orders instead of seeing consults that required much more thought.

Yep. Especially to initiate. Time is short, because you don’t want to do a lot right off the bat. Then you just adjust based on electrolytes.....

I am not saying anyone should do anything they aren’t comfortable. But maybe at some point with enough education, it’s also a skill someone who wants to learn can learn.