Will hospitalist medicine make IM more competitive?

[Red Beard]

EM has become very competitive at least partly due to its shift work nature, with no call, good pay, and relatively large amounts of time off. It wasn't always a competitive field, and historically EDs were staffed by internists and family physicians--not people who specifically trained in EM.

It seems to me that the hospitalist movement is in a similar position that EM was in a few decades ago. It is a fairly new 'alternative' style of practice that is relatively open to people of various training backgrounds. No call, lots of time off. Research is beginning to show that dedicated hospitalists provide measurably better care in both clinical outcomes and cost savings.

The need for specialty level knowledge in this particular kind of practice is being recognized. Academic programs are starting to offer hospitalist tracks, and hospitalist fellowships are popping up all over.

And yet, somehow when I talk to people about my interest in internal medicine, they still assume I am talking about old fashioned rounds-->clinic-->rounds--->call--->repeat. Its totally off the radar somehow.

I am wondering, when are people going to catch on to this extremely attractive career direction and start applying to IM programs by the droves?

Or will that never happen?

Speculation?

P.S. I think there should be a hospitalist medicine sub-forum here

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[halifax]

Here's why....

- Hospitalists are for the most part seen as a MD to clerk in patients and get a problem oriented consult from specialists and make appropriate needs for a safe discharge of patient per their disposition. From what I've seen in 5 hospitals of vastly different quality and levels of care hospitalists are not required to do any heroics and they are expected by the powers that be and the patient and their families to get the specialists involved except maybe for things like a complicated UTI and pneumonia but even in these situations they get ID involved depending on hospitals. Having spoken to hospitalists I got the feeling they don't really feel like they are contributing substantially to the patient care directly (not all of them) and most of them don't enjoy the job (having said that the one week on/off schedule appears to keep most of them going coupled with good salaries).

But again if you are looking to earn above average of a hospitalist salary you are looking at working your back off - like carrying around 20 +/- 5 patients daily and co ordinating thier care and keeping track of multiple consults. can be really nerve racking and frustrating as you are completely at the mercy of specialists.....guess I'm just too cynical.....

 

[radslooking]

Here's why....

- Hospitalists are for the most part seen as a MD to clerk in patients and get a problem oriented consult from specialists and make appropriate needs for a safe discharge of patient per their disposition. From what I've seen in 5 hospitals of vastly different quality and levels of care hospitalists are not required to do any heroics and they are expected by the powers that be and the patient and their families to get the specialists involved except maybe for things like a complicated UTI and pneumonia but even in these situations they get ID involved depending on hospitals. Having spoken to hospitalists I got the feeling they don't really feel like they are contributing substantially to the patient care directly (not all of them) and most of them don't enjoy the job (having said that the one week on/off schedule appears to keep most of them going coupled with good salaries).

But again if you are looking to earn above average of a hospitalist salary you are looking at working your back off - like carrying around 20 +/- 5 patients daily and co ordinating thier care and keeping track of multiple consults. can be really nerve racking and frustrating as you are completely at the mercy of specialists.....guess I'm just too cynical.....

it is a system with too much paperwork, and coordination of care, which can be a b...ch. However, in a humane system it is tolerable. as for the specialist issue, I just don't consult them very often. they cause too many b.s. follow up issues so I try to do as much as i can myself. Nobody will tell you how to practice hospitalist medicine. If they do, find a new job.

 

[mercaptovizadeh]

it is a system with too much paperwork, and coordination of care, which can be a b...ch. However, in a humane system it is tolerable. as for the specialist issue, I just don't consult them very often. they cause too many b.s. follow up issues so I try to do as much as i can myself. Nobody will tell you how to practice hospitalist medicine. If they do, find a new job.

Are you a hospitalist?