Where do hospitalists stand in the hospital pecking order?

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DrMetal

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Not well regarded since they only make 250-300k/yr. Some hospitals do not even grant them access to the physician's lounge. :(
What hospital doesn't grant them access to the physicians lounge? That's ridiculous. (I know surgeons have their own sometimes, but hospitalists usually have one, albeit they have to share it).
 
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Chemist0157

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In terms of the medical care, the docs are at the top of course. In terms of the hospital administration, it seems like hospitalists are lower priority. Just the nature of the job. It offers a lot of flexibility for the doc, but it also makes it an easier hole to fill and refill for hospital systems.
 
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aafisahar

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Hospitalists are usually well respected by other colleagues as we are mostly all in this together. Administration, OTOH, definitely plays favorites and hospitalists are often seen as a burden to be cut rather than key parts of the hospital machine.
 

end stage fibro

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The hospitalist is the main ingredient in the hospital sausage. A quick run through my day can show you:

6am - CMO blowing up my email. Why isn't my census of 25 discharged yet?
6:45am- medical director, CNO, CFO,COO, and various other C's with various combinations of the alphabet after their name fwd: me that same email
7a- STAT PAGE. FLOOR ADMIT. ED sign out is guy with chest pain that was discharged yesterday after cardiac MRI, echo, cath, and 9 trops. But the story is convincing says the ED doc. We automatically accept all admits per admin.
730a- preround. the EMR i use competes with stone tablets in terms of efficiency. most consultants here aren't bad, but I work on the CHF floor and one group consistently writes "trops per medicine, AC per medicine, milrinone per medicine, LVAD per medicine." How they respect my opinion, I marvel.
9a- discharge rounds. talk about discharging more than actually discharging.
930a to about 2p- write notes. I had a high verbal section on my MCAT so I try to make notes sound nice. Prepopulate 98% and copypasta the rest.
1130ish- have lunch with some coworkers. Gripe for 29 mins. The remaining 1 minute is a cacophony of stock tips, cars, and netflix. CMO shows up around that time and sits down but he only speaks parseltongue. STAT PAGE- admit 21yo M with appendicitis. Gen surg says too many medical problems. PMH: stubbed toe
12p: monthly hospitalist meeting -“I know we are all busy. “ “document more.” “you will be seeing more patients.” “bonuses waived this year.” All questions answered with same corporate doublespeak. Don't you know the currency of healthcare heroes is pride? Practice mindfulness at home to help with your COVID (if you were able to get tested).
1p - multiple familes want to talk to me. I speak to the patient's significant other, son, daugther, shaman, great cousin. Each conversation ends with "oh you're just the hospitalist."
2p- case management and CMO : why aren't the discharges gone? Let's place them in $BrandNewBestIdeaEver to improve efficiency.
2:01p- merely whisper: instead of paying big bucks to people leading these idea summer camps, can't we get PPE and more floor staff?
2:02- email from med director, CMO, division CMO about being a team player and to have a healthcare hero attitude.
3p- try to change order placed by ortho NP - immediately get reminded of our partnership with Big Ortho and not to touch anything they do.
4p -email from med director. new project starting; i am voluntold to lead it. Tasked to rope in the key stakeholders from last meeting with tabled agenda and circle back to maximize synergsdo*&XD. Phone blows up from too much corporate speak.

As you can see from how many "touches" I get during the day, I am pretty much an all star in terms of pecking order. All this can await you should you pursue the glamorous hospitalist life.


1593903329825.png



i actually like my job, just venting a bit.
 
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Syndicate

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The hospitalist is the main ingredient in the hospital sausage. A quick run through my day can show you:

6am - CMO blowing up my email. Why isn't my census of 25 discharged yet?
6:45am- medical director, CNO, CFO,COO, and various other C's with various combinations of the alphabet after their name fwd: me that same email
7a- STAT PAGE. FLOOR ADMIT. ED sign out is guy with chest that was discharged yesterday after cardiac MRI, echo, cath, and 9 trops. But the story is convincing says the ED doc. We automatically accept all admits per admin.
730a- preround. the EMR i use competes with stone tablets in terms of efficiency. most consultants here aren't bad, but I work on the CHF floor and one group consistently writes "trops per medicine, AC per medicine, milrinone per medicine, LVAD per medicine." How they respect my opinion, I marvel.
9a- discharge rounds. talk about discharging more than actually discharging.
930a to about 2p- write notes. I had a high verbal section on my MCAT so I try to make notes sound nice. Prepopulate 98% and copypasta the rest.
1130ish- have lunch with some coworkers. Gripe for 29 mins. The remaining 1 minute is a cacophony of stock tips, cars, and netflix. CMO shows up around that time and sits down but he only speaks parseltongue. STAT PAGE- admit 21yo M with appendicitis. Gen surg says too many medical problems. PMH: stubbed toe
12p: monthly hospitalist meeting - I know we are all busy. document more. you will be seeing more patients. bonuses waived this year. All questions answered with same corporate doublespeak. Don't you the currency of healthcare heroes is pride? Practice mindfulness at home to help with your COVID (if you were able to get tested).
1p - multiple familes want to talk to me. I speak to the patient's significant other, son, daugther, shaman, great cousin. Each conversation ends with "oh you're just the hospitalist."
2p- case management and CMO : why aren't the discharges gone? Let's place them in $BrandNewBestIdeaEver to improve efficiency.
2:01p- merely whisper: instead of paying big bucks to people leading these idea summer camps, can't we get PPE and more floor staff?
2:02- email from med director, CMO, division CMO about being a team player and to have a healthcare hero attitude.
3p- try to change order placed by ortho NP - immediately get reminded of our partnership with Big Ortho and not to touch anything they do.
4p -email from med director. new project starting; i am voluntold to lead it. Tasked to rope in the key stakeholders from last tables meeting and circle back to maximize synergsdo*&XD. Phone blows up from too much corporate speak.

As you can see from how many "touches" I get during the day, I am pretty much an all star in terms of pecking order. All this can await you should you pursue the glamorous hospitalist life.


View attachment 311882



i actually like my job, just venting a bit.
If you do not mind the admin and the lack of respect and the stupid admissions, wouldn’t it be a good job then? Essentially, treat it like a secretary job but you get paid well ($250k ish for working half the year)
 
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jdh71

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Um why? Let's not pretend like the whole pecking order thing is not a daily reality\issue that we all have to deal with.

I’m not pretending anything. Where do hospitalists stand in the pecking order? It’s low. Sorry.

Are you asking why that is?
 
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end stage fibro

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If you do not mind the admin and the lack of respect and the stupid admissions, wouldn’t it be a good job then? Essentially, treat it like a secretary job but you get paid well ($250k ish for working half the year)

I think for the most part it is a good job. Stupid admissions suck as a resident but as an attending it is easy money, though I do try to minimize them because I don't want to bill some otherwise healthy person for no reason.

Lack of prestige is definite, but i think lack of respect is a different issue. At baseline, sure - hospitalists might get less respect. Admin might think you are a replaceable cog, which is probably true to an extent. However, we are not some monolithic block. If you are good to your patients and show some initiative, various members of the medical and ancillary staff will know you are worth engaging with. You better believe there are other non-hospitalist docs that are the butt of every joke and looked down upon.

you are doing yourself a disservice likening it to a secretary job. There is clerical work to be sure but this is present in every medical specialty. For complex cases, I am definitely discussing the case with specialists and making a unified treatment plan. If two specialists disagree, I make the ultimate decision. You will see your fair share of new stuff in community practice frequently and will occasionally be the one making a good diagnosis that really helps the patient. I do however feel like this is a punch in punch out job and not some higher calling. I do my best to provide quality, efficient care to patients and am internally motivated enough that i can work roughly 20+ shifts a month and not feel burned out when I get home.

tl;dr - i make like way more than 250k
 
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Splenda88

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I don't know if what I am seeing and hearing is true... It seems like that hospitalist jobs in community hospitals (200-400 beds) are on average 'better' than the ones in huge academic centers.
 

Splenda88

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I think for the most part it is a good job. Stupid admissions suck as a resident but as an attending it is easy money, though I do try to minimize them because I don't want to bill some otherwise healthy person for no reason.

You will see your fair share of new stuff in community practice frequently and will occasionally be the one making a good diagnosis that really helps the patient. I do however feel like this is a punch in punch out job and not some higher calling. I do my best to provide quality, efficient care to patients and am internally motivated enough that i can work roughly 20+ shifts a month and not feel burned out when I get home.

tl;dr - i make like way more than 250k
You must be killing it. The hospitalists I know who work ~20 shifts/month are making ~500k/yr...
 

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From what I've seen it depends on the capacity in which they're being dealt with. Trying to get a patient far over their max LOS out of the hospital? They'll bend over backwards and throw every else they can under the bus to make it happen. Trying to push back too hard against an ED admission? Get ready to hear an earful. Every specialty outside of the real moneymakers (surgeons and specialists that bring in big dollar procedures and service lines, people that could walk and be hard to replace) is basically treated in the same manner- if what you're doing makes money you're treated well, if you're losing them money they'll treat you like hot garbage.
 
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end stage fibro

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We are all getting screwed by the bean counter...
You must be killing it. The hospitalists I know who work ~20 shifts/month are making ~500k/yr...

dang...not quite up there. i am in top 10 population westernish, desirable city. multi quoting to show that the bean counters really are screwing us over and employment has significant disadvantages. Your hospital system will define what your hospitalist wRVU is worth by blending several estimates (Sullivan & Cotter, MGMA, Merrit Hawkins, etc). Avg hospitalist RVU around the country is worth 55-65 bucks or so. I made ~8000 RVU last year, at $55 a pop. Am I seeing 450k? Unfortunately not. My benefits are not enough to make up the difference. Pays to be in a physician owned group or a transparent employed position to see whose coffers you are filling. I know for sure I'm subsidizing some PHBs around here.
 
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Trogghunter

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dang...not quite up there. i am in top 10 population westernish, desirable city. multi quoting to show that the bean counters really are screwing us over and employment has significant disadvantages. Your hospital system will define what your hospitalist wRVU is worth by blending several estimates (Sullivan & Cotter, MGMA, Merrit Hawkins, etc). Avg hospitalist RVU around the country is worth 55-65 bucks or so. I made ~8000 RVU last year, at $55 a pop. Am I seeing 450k? Unfortunately not. My benefits are not enough to make up the difference. Pays to be in a physician owned group or a transparent employed position to see whose coffers you are filling. I know for sure I'm subsidizing some PHBs around here.

Wow, 8000 RVUs. That is unbelievable for a hospitalist. That's like busy urologist RVUs.
 

VA Hopeful Dr

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Wow, 8000 RVUs. That is unbelievable for a hospitalist. That's like busy urologist RVUs.
He responded to a post about working 20 shifts/month which would suggest he/she works about that many. That's 240 shifts/year. 8000 rvus/year gives us 33 rvus/shift.

Let's say you have a census of 16 with 4 admissions. And let's assume these are all mid-level complexity. 10.44 + 22.24 = 32.68wrvu/shift.
 

Osteoth

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dang...not quite up there. i am in top 10 population westernish, desirable city. multi quoting to show that the bean counters really are screwing us over and employment has significant disadvantages. Your hospital system will define what your hospitalist wRVU is worth by blending several estimates (Sullivan & Cotter, MGMA, Merrit Hawkins, etc). Avg hospitalist RVU around the country is worth 55-65 bucks or so. I made ~8000 RVU last year, at $55 a pop. Am I seeing 450k? Unfortunately not. My benefits are not enough to make up the difference. Pays to be in a physician owned group or a transparent employed position to see whose coffers you are filling. I know for sure I'm subsidizing some PHBs around here.

So what do you make on 20 shifts/month?
 
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jurassicpark

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Not enough.

Its hard work.

yup. You kind of get a law of diminishing returns. You work hard, especially in this time of COVID when our hospitals are filled to the brim, long hours, etc. And you realize after all that hard work pushing your body and marriage to the limit, most of it goes to pay taxes to pay other people to stay home.
 
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end stage fibro

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Agree. MGMA mean wRVU for hospitalist is 4000 and 90th percentile is 6500. But it’s SDN. Everyone has a 260 on step 1 and every hospitalist makes 500k.

It only took 15 years but finally I am able to have a stat worth bragging about on SDN!

He responded to a post about working 20 shifts/month which would suggest he/she works about that many. That's 240 shifts/year. 8000 rvus/year gives us 33 rvus/shift.

Let's say you have a census of 16 with 4 admissions. And let's assume these are all mid-level complexity. 10.44 + 22.24 = 32.68wrvu/shift.

Plus or minus a few numbers, this is almost exactly accurate.

So what do you make on 20 shifts/month?

in the interest of transparency, high mid-300s. bear in mind my range is 19-22 per month, all days.

Not enough.

Its hard work.

agreed. i am grinding away. the absolute number is high but I see some posts on here that discuss what seem like much cushier jobs for nearly equal pay.

yup. You kind of get a law of diminishing returns. You work hard, especially in this time of COVID when our hospitals are filled to the brim, long hours, etc. And you realize after all that hard work pushing your body and marriage to the limit, most of it goes to pay taxes to pay other people to stay home.

COVID is the first time I've felt demoralized in medicine. The environment around me is now a miasma of despair, in a place that had bad morale before. The patients being extremely sick is not the chief reason but it does not help. Posting on SDN (instead of lurking) is an extra coping mechanism, I guess.

Having said that, I disagree this is pushing my body to the limit and definitely not my marriage lol. I take care to eat well and exercise in addition to BID dog walks with podcasts edifying me. I try to find creative outlets, either writing or programming. Was able to cobble together a python script that helps automate a few things at work. I would share it but it is really hacked together and has some work specific things i'd rather not disclose,

edit: forgot to comment on main part, which I have since bolded. taxes are killer so I try to find ways around that (standard retirement/HSA route, real estate professional status, various random credits, etc) and knowing I am paying for other people to eat pastries at BS meetings ( I know cus I've been), stay at home and tell me what to from afar is infuriating. I am hoping to ameliorate this soon. If i do, I will make a dedicated post about it.
 
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Splenda88

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It only took 15 years but finally I am able to have a stat worth bragging about on SDN!



Plus or minus a few numbers, this is almost exactly accurate.



in the interest of transparency, high mid-300s. bear in mind my range is 19-22 per month, all days.
The number should be higher with these hours... 450k+ should be more like it...
 
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disorder

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The number should be higher with these hours... 450k+ should be more like it...

I think @end stage fibro stated he/she works in a HCoL "westernish" city. Thus, your $/wrvu goes down significantly.
I was quoted $40-45/wrvu where I live (a HCoL "westernish" city). If @end stage fibro works ~8000 wrvu/year, the $350-380k salary seems appropriate.
 
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Splenda88

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I think @end stage fibro stated he/she works in a HCoL "westernish" city. Thus, your $/wrvu goes down significantly.
I was quoted $40-45/wrvu where I live (a HCoL "westernish" city). If @end stage fibro works ~8000 wrvu/year, the $350-380k salary seems appropriate.
I see, but boy! working ~20 shifts/month as a hospitalist is not sustainable unless your daily encounter is 10-12 patients with 1-2 admissions.
 
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disorder

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I see, but boy! working ~20 shifts/month as a hospitalist is not sustainable unless your daily encounter is 10-12 patients with 1-2 admissions.
A big reason why I chose to sub-specialize instead of remain in hospital medicine (that and of course interest and variety of practice). Without a procedural component to your practice, you will end up working "more" to make the same money.
 
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NITRAS

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I see, but boy! working ~20 shifts/month as a hospitalist is not sustainable unless your daily encounter is 10-12 patients with 1-2 admissions.

That’s not entirely true. We had a nocturnist who was doing it for years. To be frank, since COVID, they cut out his FTE and cut 1/3 of the night time MD’s out, and two residents for 6 hours each. They were pretty flush on help before. Now, not so much.

And some of y’all have no idea how hard some sub specialists work. I was talking to one our former cardiology fellows, who went on job interviews where they commonly had 60 consults in a day. Sounds bat**** crazy to me.
 
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That’s not entirely true. We had a nocturnist who was doing it for years. To be frank, since COVID, they cut out his FTE and cut 1/3 of the night time MD’s out, and two residents for 6 hours each. They were pretty flush on help before. Now, not so much.

And some of y’all have no idea how hard some sub specialists work. I was talking to one our former cardiology fellows, who went on job interviews where they commonly had 60 consults in a day. Sounds bat**** crazy to me.

Our cardiologists work their asses off. Easily an average of 55-60 hours per week.
 
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Splenda88

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That’s not entirely true. We had a nocturnist who was doing it for years. To be frank, since COVID, they cut out his FTE and cut 1/3 of the night time MD’s out, and two residents for 6 hours each. They were pretty flush on help before. Now, not so much.

And some of y’all have no idea how hard some sub specialists work. I was talking to one our former cardiology fellows, who went on job interviews where they commonly had 60 consults in a day. Sounds bat**** crazy to me.
At least that nocturnist had a lot of help... But when you are admitting 10+ patients/night and have to deal with cross-cover, rapid response and code blue by yourself, it definitely won't be a sustainable job.
 

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I see, but boy! working ~20 shifts/month as a hospitalist is not sustainable unless your daily encounter is 10-12 patients with 1-2 admissions.

It's actually sustainable. The problem is mainly with COVID right now. The amount of time and effort to see one COVID patient is magnitudes compared to a regular floor patient. Not to mention the added stress level, not just of you but the entire staff are on hair triggers. So that's why I've been starting work earlier and ending later.
 

end stage fibro

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I think @end stage fibro stated he/she works in a HCoL "westernish" city. Thus, your $/wrvu goes down significantly.
I was quoted $40-45/wrvu where I live (a HCoL "westernish" city). If @end stage fibro works ~8000 wrvu/year, the $350-380k salary seems appropriate.

correct. i'm just on top of that range. well in line with rest of the area

I see, but boy! working ~20 shifts/month as a hospitalist is not sustainable unless your daily encounter is 10-12 patients with 1-2 admissions.

strong strong disagreement. Most people see 10 patients as an intern in residency with possible admissions on top. I am 900 million more times efficient now, write shorter (i would say better) notes, have less scutt, have a broader knowledge base and don't report to anyone. Seeing 10 a day right now would be a joke.

And some of y’all have no idea how hard some sub specialists work. I was talking to one our former cardiology fellows, who went on job interviews where they commonly had 60 consults in a day. Sounds bat**** crazy to me.
Our cardiologists work their asses off. Easily an average of 55-60 hours per week.

exactly. I see how hard many of our consultants work and don't think that is sustainable!! plus they are sometimes on call at night too and have clinic hassles.

It's actually sustainable. The problem is mainly with COVID right now. The amount of time and effort to see one COVID patient is magnitudes compared to a regular floor patient. Not to mention the added stress level, not just of you but the entire staff are on hair triggers. So that's why I've been starting work earlier and ending later.

agree 100%. the 15L O2 patients are the healthy ones. definitely feels like a pressure cooker as jurassic mentioned.
 
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