Will I lose my inpatient skills if I practice 100% outpt?

[fleshwound]

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I'm in the process of deciding on my first job out of fellowship (EMG) and I've seen many (non-academic) outpatient positions (private practice and employed) that are 100% outpatient with no inpatient call whatsoever. I can see the appeal however I'm wary about losing my inpatient skills. I presume this may backfire if one day I switch jobs to one that does have inpatient coverage. However, the way things are going, is this going to become the default model one day? so many practices I've spoken to say that call is becoming increasingly burdensome so they are hiring neurohospitalists. One practice didn't even care to hire a hospitalist and still did away with call. Thanks.

 

[Thama]

Everyone loses skills they don't use. Neurology as a whole is subspecializing more even by separating inpatient care. So the answer is yes, and just go with it. Pick a niche and run. Nobody can do everything.

 

[Epic786]

not at all

 

[NITRAS]

Yes, you will. I cringe when the outpatient neurologist cover the inpatient service (usually weekends). They are slower and generally overly cautious.

 

[Epic786]

It depends upon the neurologist. If you are old school, then yes you would be slow, but I am seeing a lot of general neurology in our practice and managing seizures and AMS is not that hard while you are in patient.

 

[grizzlyblair]

To follow up on this- does it become harder to find positions at academic centers that do a mix of inpatient/outpatient if you've been outpatient-only for some time? I did a 1 year outpatient fellowship (was allowed to moonlight so did some teleneuro calls) and then took a position that was exclusively outpatient (now 1yr in). I am somewhat surprised at how much I am missing inpatient time and was hoping to pivot to a position that would allow for 4-8 weeks per year inpatient with remainder outpatient. My current institution is an unlikely spot for this (it LOVES the hospitalist model so all inpatient covered by those having done a neurohospitalist fellowship) but I do not have a sense how pervasive this would be across academic institutions.

 

[Thama]

I don't think a year or 2 off is going to be seen as a problem. You're still close enough to your inpatient training that you'll pick it back up easily.

A decade away from inpatient work might be more of an issue, but even then I think you'd be surprised how many centers don't care and will just throw you in there because they need bodies to take service time.

The idea that you need a fellowship to do what you've been trained to do for 4 years of residency is an abomination and should be boycotted. Centers that insist on this model are low-key impugning the quality of their residency training.