What will happen to the job market for hospitalists?

[CCM-MD]

IMO pay to liability ratio is significantly more important than the ratio of pay to amount of work. Whether it’s “worth it” is subjective.

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[tantacles]

IMO pay to liability ratio is significantly more important than the

IMO pay to liability ratio is significantly more important than the ratio of pay to amount of work. Whether it’s “worth it” is subjective.

Actually, I’d say “worth it” is more of the assessment, no? ;-)

 

[DrNotaDr]

I mean, duh? Of course the hospital doesn't want to pay for physician coverage overnight. And I'm also worried about what they're not calling about. That being said, I've gotten to know the NP's pretty well, and they tend to check in pretty frequently. The setup, at least in our community hospital 10 bed ICU, works.

Of course there are issues with this setup. But it's far better than having one physician covering the ICU and admitting and doing floor cross cover.

Does the NP take an admissions if you get slammed and respond to stats/codes? If not, what a great job, sign me up!

 

[Splenda88]

Another thing that is quite amusing to me is when physicians/NP/PA say NP/PA are hired so docs can be freed up to take care of 'complex' cases... Why should we ONLY take care of complex cases and all the liabilities that come with them?

The main hospital of my residency does that... They funnel easy admits to NP/PA while us as residents take care of the trainwrecks.

 

[tantacles]

Does the NP take an admissions if you get slammed and respond to stats/codes? If not, what a great job, sign me up!

The NP is responsible for all orders for ICU patients, new and old. If a new ICU patient comes in, I chart review, write a note, bill, discuss the plan with the NP, and check orders.

all floor admits are my responsibility and mine alone.

 

[wamcp]

Another thing that is quite amusing to me is when physicians/NP/PA say NP/PA are hired so docs can be freed up to take care of 'complex' cases... Why should we ONLY take care of complex cases and all the liabilities that come with them?

The main hospital of my residency does that... They funnel easy admits to NP/PA while us as residents take care of the trainwrecks.

for learning as a resident, it is essential to take care of trainwrecks. As an attending I am extremely glad of the high volume acuity I encountered in training- my job as a hospitalist feels easy. In residency we had private hospitalist (no midlevel) groups who would take the easy admits and residents would get everyone else

that being said, in an ideal world, np and pa shouldn’t exist. medicine should be a highly professional practice- not by playing with patient lives in a bid for ever higher profits by cutting costs with midlevels

I mean, did you know in Europe, Japan, taiwan, south korea, etc....the developed world, midlevels either do NOT exist or are nowhere near as prevalent as in america?

 

[disorder]

Are you compensated extra for covering the ICU?

I guess it depends on how you're paid and productivity.
You can bill for critical care time in the ICU more frequently.

 

[PikminOC]

Having accepted transfers and seeing midlevels practice, absolutely not.

Here's why:

Imagine for a second you run a hospital with 300 beds, and in this example all of these are medical beds staffed by midlevels. Each midlevel rounds on 15 patients, so you have 20 midlevels. The problem is they do exactly what you said - they run consult services because they have little to no clinical acumen (some superstars excluded, but the new grad NP's are awful).

So now you have 20 midlevels who each consult cardiology on half their patients (simple heart failures, resistant hypertension, new afib, old afib with new RVR - basically all the bread and butter stuff we hospitalists manage independently).

That means you need enough cardiologists to see 150 patients. Trust me, that's a lot more expensive than hiring hospitalists instead of NP's. So then as the admin you say "well fine, I'll hire 2 dozen cardiology NP's" - well now you're going to spend on your midlevel army what you would have spent on a real hospitalist group. Now wait for your outcomes to suffer and patients to stop coming because "I want to see a doctor". Because trust me, patients are starting to catch on and I get a lot of people these days who "want to see a doctor, not a nurse practitioner or PA" who end up on my service.

I understand there is a lot of doom and gloom, but the sky is not falling by any means. Yeah, my salary isn't going to go up as fast as it would have if midlevels did not exist, but I have no concerns I'm going to wake up to no job opportunities in 10 years.

It keeps everyone's rvus up so hospital and

Having accepted transfers and seeing midlevels practice, absolutely not.

Here's why:

Imagine for a second you run a hospital with 300 beds, and in this example all of these are medical beds staffed by midlevels. Each midlevel rounds on 15 patients, so you have 20 midlevels. The problem is they do exactly what you said - they run consult services because they have little to no clinical acumen (some superstars excluded, but the new grad NP's are awful).

So now you have 20 midlevels who each consult cardiology on half their patients (simple heart failures, resistant hypertension, new afib, old afib with new RVR - basically all the bread and butter stuff we hospitalists manage independently).

That means you need enough cardiologists to see 150 patients. Trust me, that's a lot more expensive than hiring hospitalists instead of NP's. So then as the admin you say "well fine, I'll hire 2 dozen cardiology NP's" - well now you're going to spend on your midlevel army what you would have spent on a real hospitalist group. Now wait for your outcomes to suffer and patients to stop coming because "I want to see a doctor". Because trust me, patients are starting to catch on and I get a lot of people these days who "want to see a doctor, not a nurse practitioner or PA" who end up on my service.

I understand there is a lot of doom and gloom, but the sky is not falling by any means. Yeah, my salary isn't going to go up as fast as it would have if midlevels did not exist, but I have no concerns I'm going to wake up to no job opportunities in 10 years.

Everyone's rvus go up so physicians and hospitals are happy. More billing.

 

[tantacles]

I guess it depends on how you're paid and productivity.
You can bill for critical care time in the ICU more frequently.

Ah, this is true, but my hospitalist group has pooled billing.

 

[bronx43]

Having accepted transfers and seeing midlevels practice, absolutely not.

Here's why:

Imagine for a second you run a hospital with 300 beds, and in this example all of these are medical beds staffed by midlevels. Each midlevel rounds on 15 patients, so you have 20 midlevels. The problem is they do exactly what you said - they run consult services because they have little to no clinical acumen (some superstars excluded, but the new grad NP's are awful).

So now you have 20 midlevels who each consult cardiology on half their patients (simple heart failures, resistant hypertension, new afib, old afib with new RVR - basically all the bread and butter stuff we hospitalists manage independently).

That means you need enough cardiologists to see 150 patients. Trust me, that's a lot more expensive than hiring hospitalists instead of NP's. So then as the admin you say "well fine, I'll hire 2 dozen cardiology NP's" - well now you're going to spend on your midlevel army what you would have spent on a real hospitalist group. Now wait for your outcomes to suffer and patients to stop coming because "I want to see a doctor". Because trust me, patients are starting to catch on and I get a lot of people these days who "want to see a doctor, not a nurse practitioner or PA" who end up on my service.

I understand there is a lot of doom and gloom, but the sky is not falling by any means. Yeah, my salary isn't going to go up as fast as it would have if midlevels did not exist, but I have no concerns I'm going to wake up to no job opportunities in 10 years.

Except that’s not how the economics of a hospital works, is it? Consults drive revenue and profit. A mid level that consults cardiology more will lead to increased number of expensive tests (nuc stress tests, cardiac MR, etc) and procedures (caths, ablations, etc). Just the facility fees generated is enough for them to hire a few more cardiologists let alone the actual CPT codes.

A consult happy midlevel generates significantly more profit than a consult adverse MD.

 

[CCM-MD]

Except that’s not how the economics of a hospital works, is it? Consults drive revenue and profit. A mid level that consults cardiology more will lead to increased number of expensive tests (nuc stress tests, cardiac MR, etc) and procedures (caths, ablations, etc). Just the facility fees generated is enough for them to hire a few more cardiologists let alone the actual CPT codes.

A consult happy midlevel generates significantly more profit than a consult adverse MD.

Disagree. With the amount of DRG based payments now there is much more focus on reduced LOS and minimizing utilization of resources - this is what leads to better hospital profits.

Most of a hospital’s revenue comes from elective outpatient procedures - CV surgery etc. Hospitalizations from the ER are often revenue reducing.

 

[disorder]

Ah, this is true, but my hospitalist group has pooled billing.

Then as a group, I hope you all get paid more! (but that's not the reason to go into medicine, right?) It's a better model anyway. You don't want your partners "stealing" RVU's from each other.

 

[wamcp]

Disagree. With the amount of DRG based payments now there is much more focus on reduced LOS and minimizing utilization of resources - this is what leads to better hospital profits.

Most of a hospital’s revenue comes from elective outpatient procedures - CV surgery etc. Hospitalizations from the ER are often revenue reducing.

Yes - I wouldn’t hear admin telling us to reduce unnecessary consults at each monthly meeting otherwise. They don’t tell us that out of genuine concern, unless it’s about a money/cost saving thing for the hospital system

 

[thumbz]

Except that’s not how the economics of a hospital works, is it? Consults drive revenue and profit. A mid level that consults cardiology more will lead to increased number of expensive tests (nuc stress tests, cardiac MR, etc) and procedures (caths, ablations, etc). Just the facility fees generated is enough for them to hire a few more cardiologists let alone the actual CPT codes.

A consult happy midlevel generates significantly more profit than a consult adverse MD.

Bundled payments are inevitable and hospitals across the board are moving towards cost savings rather than fee for service procedures. The fee for service era of medicine where more testing = more money = bigger bonuses for execs is coming to an end.

 

[bronx43]

Bundled payments are inevitable and hospitals across the board are moving towards cost savings rather than fee for service procedures. The fee for service era of medicine where more testing = more money = bigger bonuses for execs is coming to an end.

My understanding is physicians are paid separately and are not bundled. I guess if facility fees are bundled then there wouldn't be the incentive from the hospital standpoint, unless you can "find" more diagnoses and increase the risk of the admission. This also isn't including the number of outpatient follow ups that are generated from inpatient consults, which produces fee-for-service revenue.

Either way, If the system is truly headed towards "cost" savings, then I view that as a bigger threat towards physicians in general - hospitalist or otherwise. If total expenditures on health care actually get reduced, then I would be hard pressed to see how physician job markets and income wouldn't be negatively impacted. If revenue drops and it threatens admin's piece of the pie, they will find ways to cut cost. The best bang for their buck is labor cost. It may not show up as replacement by mid-levels, but instead through increased workload on a diminishing workforce.

 

[solitarius]

I'm sure the supply of hospitalist jobs will always be around, the same way the sewer plant jobs will always exist.

 

[tantacles]

Then as a group, I hope you all get paid more! (but that's not the reason to go into medicine, right?) It's a better model anyway. You don't want your partners "stealing" RVU's from each other.

right. No one steals RVU’s. It’s not a thing. This model encourages us to split work evenly, and as a nocturnist, im not hurt by being a white cloud. Which I am not too infrequently.

 

[chocomorsel]

for learning as a resident, it is essential to take care of trainwrecks. As an attending I am extremely glad of the high volume acuity I encountered in training- my job as a hospitalist feels easy. In residency we had private hospitalist (no midlevel) groups who would take the easy admits and residents would get everyone else

that being said, in an ideal world, np and pa shouldn’t exist. medicine should be a highly professional practice- not by playing with patient lives in a bid for ever higher profits by cutting costs with midlevels

I mean, did you know in Europe, Japan, taiwan, south korea, etc....the developed world, midlevels either do NOT exist or are nowhere near as prevalent as in america?

Only in America. Where everything, even human life is all about the Benjamins.
And physicians keep defending this BS.
It’s all political, it’s all corrupt, it’s all in the name of the Benjamins.

This country is going to hell in a hand basket.

 

[DrMetal]

This country is going to hell in a hand basket.

I don't think so. I still like 'Merica. You don't see thousands of people trying to immigrate to India or China. Nor do you see the U.S. gov't keeping anyone from leaving it. Ask that of a Chinese Hong Kong resident.

 

[collegestud2013]

Disagree. With the amount of DRG based payments now there is much more focus on reduced LOS and minimizing utilization of resources - this is what leads to better hospital profits.

Most of a hospital’s revenue comes from elective outpatient procedures - CV surgery etc. Hospitalizations from the ER are often revenue reducing.

Profitability from ER hospitalizations largely depends on the payer mix. If a hospital gets nearly all private insurance, Medicare, or cash paying patients (and has a mechanism to exclude admitting uninsured patients who cannot pay cash or low-reimbursing insurance like Medicaid) then ER admissions ares still very profitable. Most of a hospital's losses come from admitting disaster patients that are medically very sick and require the literally the million dollar work-up and treatment from multiple specialties/services but has no insurance so the hospital takes a huge hit on the admission.

In contrast, elective procedures are usually profitable across the board because you can usually ensure the patient's insurance will pay for the procedure ahead of time so they're almost always getting paid.

 

[DrNotaDr]

(and has a mechanism to exclude admitting uninsured patients who cannot pay cash or low-reimbursing insurance like Medicaid)

Literally illegal. Destroys your entire argument.

 

[CCM-MD]

Literally illegal. Destroys your entire argument.

Likelihood of it being illegal is especially high when it comes from someone who has "probationary status" listed under their name.

 

[MD46]

pardon my ignorance, but if a hospital is getting majority of medicare patients, little Medicaid and private. Is it still profitable?

 

[aafisahar]

Literally illegal. Destroys your entire argument.

Actually, it's not. If you have an ED attached, then you can't refuse medicare/medicaid/uninsured people from being seen, but if a hospital is direct admit only, then you can screen patients as you wish.

 

[DrMetal]

pardon my ignorance, but if a hospital is getting majority of medicare patients, little Medicaid and private. Is it still profitable?

The hospital has several lines of accounting (for instance, that of elective procedures, as mentioned above). Every hospital accounts for some 'loss' in the volume of uninsured it treats.

As for a hospitalist myself, I like getting paid by my group per patient or per shift, or some combination thereof. Yes, some places pay based on productivity (where you get a % of what's billed), but if the patient is uninsured, you get $0. And, you can't always guarantee the insurance company will pay what you're billing for (you can't claim everything to be sepsis), you can certainly be audited, lots of other headaches. Flat rate (per patient, per hour, per shift, whatever) I think is the best way to go.

 

[DrNotaDr]

Actually, it's not. If you have an ED attached, then you can't refuse medicare/medicaid/uninsured people from being seen, but if a hospital is direct admit only, then you can screen patients as you wish.

There are very few hospitals that don't have an emergency room. The ones that don't aren't generally thought of as a hospital at all to the general public.

 

[collegestud2013]

Literally illegal. Destroys your entire argument.

EMTALA only requires EDs to stabilize all patients, they don't have to admit them. Many private hospitals will thus transfer ED patients without insurance to the EDs of public hospitals.

Most of the profitable hospitals are built in more affluent areas so the number of Medicaid or uninsured patients isn't that many in the first place.

And besides, there have been discussions to repeal EMTALA so if that goes through, then even that won't be an issue!

 

[DrNotaDr]

EMTALA only requires EDs to stabilize all patients, they don't have to admit them. Many private hospitals will thus transfer ED patients without insurance to the EDs of public hospitals.

Most of the profitable hospitals are built in more affluent areas so the number of Medicaid or uninsured patients isn't that many in the first place.

And besides, there have been discussions to repeal EMTALA so if that goes through, then even that won't be an issue!

1: I have never seen this happen in my area. The "public" hospital would have to provide a service that the "private" hospital doesn't for an attending to accept. 82% of all hospitals are either public or non- profit, most of them non-profit. Believe me, the non-profits are trying to make money, too. These crashing uninsured million dollar patients are often never stable enough for EMTALA to allow a transfer between systems, so it's a moot point.

2: There's no way EMTALA is getting repealed.

 

[darklabel]

EMTALA only requires EDs to stabilize all patients, they don't have to admit them. Many private hospitals will thus transfer ED patients without insurance to the EDs of public hospitals.

Most of the profitable hospitals are built in more affluent areas so the number of Medicaid or uninsured patients isn't that many in the first place.

And besides, there have been discussions to repeal EMTALA so if that goes through, then even that won't be an issue!

I would only want to repeal it if it is to actually provide funding for those uninsured, which is unbelieveable that it didn't in the first place. But no one should be ok with being able to deny care based on a patient's ability to pay.

 

[Redpancreas]

I am planning on becoming a hospitalist when I graduate in 3 years. I was talking to a fellow the other day and he was very negative about the job market prospects long term, saying that the doctors are going to be replaced by NPs who will just farm out consults, one doctor will be "supervising" 8-10 NPs. And of course many states have or will have unsupervised NPs. I am planning on practicing in CA where AB 890 is being debated to give NPs unsupervised access. Do you think the job market for physician hospitalists is going to decrease due to replacement by midlevels?

No one can predict the future definitively. A couple points regarding your initial questions.
1) The fellow's clearly biased as he chose to specialize. Also, he's likely at an academic place where he sees hospitalists consulting him for stupid things leading him to develop that cynicism.
2) In regards to hospitalists (and also IM PCPs), it is definitely reasonable to speculate that your services may end up being less valuable due to mid-levels perceived by some to be equivalent. It doesn't take a doctor to place admission orders/place consults or look at the EMR and realize the patient needs their health maintenance updated. On the other hand, realize that while there's a pressure to cut costs, salary does not contribute to hospital spending as testing/procedures do and unnecessary testing/procedures generated by these NP farms would likely more than make up for the difference in salary of an NP and physician. Accurate, high value care matters and quality hospitalists have value. The issue I guess is proving that.

As a general point, choosing a career is like choosing a wife. Do what you love. People are treating specialties like stocks looking for the ones with the highest upside so they can make 50-100K more per year most of which is going to be taxed away from them, while ironically treating stocks like stocks would be the better idea.

 

[Ramo711]

As a general point, choosing a career is like choosing a wife. Do what you love. People are treating specialties like stocks looking for the ones with the highest upside so they can make 50-100K more per year, while ironically treating stocks like stocks would be the better idea.

This is the best advice I have ever heard on this website

 

[Doc mu]

Having accepted transfers and seeing midlevels practice, absolutely not.

Here's why:

Imagine for a second you run a hospital with 300 beds, and in this example all of these are medical beds staffed by midlevels. Each midlevel rounds on 15 patients, so you have 20 midlevels. The problem is they do exactly what you said - they run consult services because they have little to no clinical acumen (some superstars excluded, but the new grad NP's are awful).

So now you have 20 midlevels who each consult cardiology on half their patients (simple heart failures, resistant hypertension, new afib, old afib with new RVR - basically all the bread and butter stuff we hospitalists manage independently).

That means you need enough cardiologists to see 150 patients. Trust me, that's a lot more expensive than hiring hospitalists instead of NP's. So then as the admin you say "well fine, I'll hire 2 dozen cardiology NP's" - well now you're going to spend on your midlevel army what you would have spent on a real hospitalist group. Now wait for your outcomes to suffer and patients to stop coming because "I want to see a doctor". Because trust me, patients are starting to catch on and I get a lot of people these days who "want to see a doctor, not a nurse practitioner or PA" who end up on my service.

I understand there is a lot of doom and gloom, but the sky is not falling by any means. Yeah, my salary isn't going to go up as fast as it would have if midlevels did not exist, but I have no concerns I'm going to wake up to no job opportunities in 10 years.

But i thought midlevels doing unneeded consults and tests made the hospital more profit rather than less (according to what i read on reddit)

 

[HemeOncHopeful19]

But i thought midlevels doing unneeded consults and tests made the hospital more profit rather than less (according to what i read on reddit)

I think unneeded referrals and outpatient imaging = $$, but inpatient orders where patients are billed by DRG probably = no $$.

I could be wrong here.

 

[blue.jay]

But i thought midlevels doing unneeded consults and tests made the hospital more profit rather than less (according to what i read on reddit)

Also in some instances, over testing and over consulting (which is basically not knowing what to do) will result in some delay in increase in LOS. Hospitals make more money when LOS is less than average for the diagnosis (due to bundled payment).

 

[Doc mu]

I think unneeded referrals and outpatient imaging = $$, but inpatient orders where patients are billed by DRG probably = no $$.

I could be wrong here.

Makes sense, though i wonder why midlevels would even do unneeded tests and referrals when medicine has become so algorithmic

 

[Doc mu]

Also in some instances, over testing and over consulting (which is basically not knowing what to do) will result in some delay in increase in LOS. Hospitals make more money when LOS is less than average for the diagnosis (due to bundled payment).

Then why are hospitals racing to get midlevels again?

 

[Osteoth]

Then why are hospitals racing to get midlevels again?

Cheaper, easier to control.

 

[Doc mu]

Cheaper, easier to control.

So it still makes more sense money-wise to have NPs rather than physicians, FIRE FTW the future is looking bleak boys

 

[blue.jay]

Then why are hospitals racing to get midlevels again?

In some places (like the community site of big academic name) the administration is hoping to slowly replace physicians with midlevels and ramp up the workload for those seasoned midlevels. But these midlevels are smart once the see these changes coming they quit. Administration sees these midlevels as big assets (because they trained on the job in their hospital) midlevels benefit from leaving but hiring new midlevel grad and training them is hard (unlike MD/DO who are hired board certified and competent to practice from day 1).

Like you said the main reason I suspect is control. Once doctors have the fear that they can be replaced by cheap workers any day, administration gets to tame you.

 

[Doc mu]

In some places (like the community site of big academic name) the administration is hoping to slowly replace physicians with midlevels and ramp up the workload for those seasoned midlevels. But these midlevels are smart once the see these changes coming they quit. Administration sees these midlevels as big assets (because they trained on the job in their hospital) midlevels benefit from leaving but hiring new midlevel grad and training them is hard (unlike MD/DO who are hired board certified and competent to practice from day 1).

Like you said the main reason I suspect is control. Once doctors have the fear that they can be replaced by cheap workers any day, administration gets to tame you.

I highly doubt midlevels would leave after a higher work-load especially if admins wave a few more benjamins in their face and if doctors remain fearful of being replaced by midlevels they open themselves up to abuse (less pay, more work, less negotiating power...etc), one of the few ways we can win is if a nation wide healthcare reform makes midlevels less financially profitable than physicians

 

[Osteoth]

I highly doubt midlevels would leave after a higher work-load especially if admins wave a few more benjamins in their face and if doctors remain fearful of being replaced by midlevels they open themselves up to abuse (less pay, more work, less negotiating power...etc), one of the few ways we can win is if a nation wide healthcare reform makes midlevels less financially profitable than physicians

The culture of nursing and mid level work in general doesn’t encourage the level of hard work it takes to get through medical training as a doctor.

The corollary to this is that they are both less controllable and harder to manage because they don’t in many cases know what truly excellent care so they don’t even know when they’re not delivering it.

Doctors just need to nut up and say no. Problem is these days too many people in medicine just want an easy job and a salary.

Owning your life is neither cheap Nor easy. Running a practice is not easy. But what is the price for freedom?

 

[Doc mu]

The culture of nursing and mid level work in general doesn’t encourage the level of hard work it takes to get through medical training as a doctor.

The corollary to this is that they are both less controllable and harder to manage because they don’t in many cases know what truly excellent care so they don’t even know when they’re not delivering it.

Doctors just need to nut up and say no. Problem is these days too many people in medicine just want an easy job and a salary.

Owning your life is neither cheap Nor easy. Running a practice is not easy. But what is the price for freedom?

The process somehow changes people, the most passive people i have ever seen are in medicine they always just keep their head down and avoid friction so if my anecdotal experience is anything to go by they will never stick it to the man

 

[Osteoth]

The process somehow changes people, the most passive people i have ever seen are in medicine they always just keep their head down and avoid friction so if my anecdotal experience is anything to go by they will never stick it to the man

Yes I have seen this in myself.

It is like the old game show, I forget which one, “the points are made up and the prizes don’t matter”. When you’re indoctrinated in a system from the time you’re 18 to the time you’re 30 where your boss has ultimate power over you, it’s hard to realize when you become an attending that the leverage has changed.

Especially when the “best” students are all killing themselves to join some Ivy League circle jerk…

 

[blue.jay]

Atleast the burnout for hospitalist is less.

Burnout by specialty​

The study also revealed patterns in burnout levels by specialty. The specialties with the highest levels of burnout were:

• Family medicine
• Hematology/oncology
• Internal medicine
• Pulmonology
• Neurology
• Cardiology

Those with the lowest levels of burnout included:

• Psychiatry
• Anesthesiology
• Orthopedics
• Hospital medicine
• Gastroenterology

The Surprising Way to Actually Address Physician Burnout | Physician Sense

A new study sheds some light on how this unpopular aspect of the physician career is contributing to burnout.

www.mdlinx.com

 

[Splenda88]

Atleast the burnout for hospitalist is less.

Burnout by specialty​

The study also revealed patterns in burnout levels by specialty. The specialties with the highest levels of burnout were:

• Family medicine
• Hematology/oncology
• Internal medicine
• Pulmonology
• Neurology
• Cardiology

Those with the lowest levels of burnout included:

• Psychiatry
• Anesthesiology
• Orthopedics
• Hospital medicine
• Gastroenterology

The Surprising Way to Actually Address Physician Burnout | Physician Sense

A new study sheds some light on how this unpopular aspect of the physician career is contributing to burnout.

www.mdlinx.com

Yeah... a 5-day 9-5pm job M-F dealing with patients is not what comes to mind when I think about lifestyle. The 7 days on/off in the right setting is better IMO. I am bias since I am going be a hospitalist in a few months. The perfect hospitalist job would be a T-Thur schedule 10 hrs-shift (30 hrs/wk) for ~300k/yr . I could not find a setting like that. One can always dream, however.

 

[deleted6669]

Yeah... a 5-day 9-5pm job M-F dealing with patients is not what comes to mind when I think about lifestyle. The 7 days on/off in the right setting is better IMO. I am bias since I am going be a hospitalist in a few months. The perfect hospitalist job would be a T-Thur schedule 10 hrs-shift (30 hrs/wk) for ~300k/yr . I could not find a setting like that. One can always dream, however.

The 2 hospitalists at my rural critical access job do 7 on/7 off. avg daily census maybe 8. they round 8-noon every day then take call from home.

 

[Splenda88]

The 2 hospitalists at my rural critical access job do 7 on/7 off. avg daily census maybe 8. they round 8-noon every day then take call from home.

These 2 hospitalists have the perfect job. Do they live in that rural place? How far is that place from a major city/airport? I learned that some hospitalists/intensivists travel to work a nice gig in these rural places and fly back to the city where they want to live. I wonder how common is that

 

[deleted6669]

These 2 hospitalists have the perfect job. Do they live in that rural place? How far is that place from a major city/airport?

They both live within 10 min of the facility. The area is considered a vacation destination and is actually quite livable. It is 1.25 hr from a major metro area.

 

[NITRAS]

The 2 hospitalists at my rural critical access job do 7 on/7 off. avg daily census maybe 8. they round 8-noon every day then take call from home.

Wonder what happens when they get stuck with patient’s whole they are out of the league when the big hospitals can’t take transfers. . . .like you know. COVID.

 

[Mad Jack]

Yeah, that too. The stuff I mentioned I think has had something to do with it. If Dr. Metal were in charge: I would
- make med school 3 years instead of 4 (we all know the 4th year of school was a F-off year, I'm sure you'd rather save the $100K),
- maybe knock off a year of bachelors programs as well (that's doable now....so the combined BS+MD = 6 years, instead of 8, I think some programs like that exist),
- create more residency spots by utilizing more community hospitals (consolidate admin and academics: one office could support 5 county hospitals, etc)
- pay residents more (a pgy4 GS resident should be making $80k/year. A fellow $90K: yeah that doesn't make you rich, but at least you can live decently).
- more student loan payoff options: no one should have a debt >$200K for going into this ofthentimes thankless profession.
- get rid of MOC. BC should be a one time deal. After you obtain it, you're judged by the merits of your own practice.

I think the premed curriculum should be two years that are standardized, culminate in the MCAT, and can be used to fulfill science requirements in other majors. That way everyone can just use the first two years to try and get themselves into a medical school, know if they're going to fail early, and switch gears having saved themselves a large amount of time. Medical school itself should remain four years. You could compress it to 36 months of you forego vacations, but that creates three hellish years and also gives students less time to explore their interests. Having medical school be shorter than 36 months would cost us global recognition at the WHO level and look quite bad for American doctors. Furthermore going from nothing to MD in 5 years would be the shortest pathway to a MD in the world, and really put high pressure on students to learn an ever larger amount of data in a shorter amount of time.

Now, with regard to training, I think GP pathways should exist that allow practice after 2 years that would be reimbursed by insurance providers. It's absurd that a NP can practice independently and be reimbursed by insurance after 500 hours of self-arranged clinical rotations while a physician gets nothing unless they're board eligible, despite carrying a full license and far more training than a NP