Working as FM physician

[wise.MD]

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Do FM physicians working outpatient do rounds in the hospital for patients they admit? Or they just refer them to the hospital and the hospitalist takes over? Also, I have gone through some threads about salaries. FM hospitalists make some where between 160-180k, and as I believe hospitalist jobs are like 7-11 days per month. And then the rest of the days the same physician can probably work outpatient at some clinic and make another 150-180k? So doesnt that make an income of over 300k for someone who can do that? Isnt that a pretty sweet income, then why do most FM residents say they wont earn much?

 

[VA Hopeful Dr]

Do FM physicians working outpatient do rounds in the hospital for patients they admit? Or they just refer them to the hospital and the hospitalist takes over? Also, I have gone through some threads about salaries. FM hospitalists make some where between 160-180k, and as I believe hospitalist jobs are like 7-11 days per month. And then the rest of the days the same physician can probably work outpatient at some clinic and make another 150-180k? So doesnt that make an income of over 300k for someone who can do that? Isnt that a pretty sweet income, then why do most FM residents say they wont earn much?

First, you're not going to earn 160k working 7 days a month as a hospitalist. The baseline for that is 200k for 15 shifts/month. You can earn more if you go rural, but part time doesn't give you the same dollars/shift since the fixed costs of hiring/employing you are unchanged.

Second, not many clinics are going to want to hire you if you're gone for 1-2 weeks/month doing hospital work. That's 1-2 weeks of your partners having to pick up your slack. You could likely get some urgent care work, but this leads us to...

Third, you can earn very very good money in FM - but if takes working very hard to do it. In your example, the reason hospitalists work one week on one week off is that the week on is pretty unpleasant. You need the off week to balance that. If you then work during that off week, you will likely burn out very quickly no matter how good the money is.

 

[wise.MD]

Ok, what about my other question. If I work in a clinic and admit patients in the hosp, do I get to go see them in the hosp also? Because I would like doing that and not just be clinic based.

 

[cabinbuilder]

Ok, what about my other question. If I work in a clinic and admit patients in the hosp, do I get to go see them in the hosp also? Because I would like doing that and not just be clinic based.

Yes, you can round and admit your own patients but that gets old really quick. FM right now is so overwhelmed that there just aren't enough hours in the day to do clinic and admissions and rounding, etc. Really comes down to your contract.

 

[W19]

Is it possible to make 250k+/year in FM working less than 60hrs/week?

 

[VA Hopeful Dr]

Ok, what about my other question. If I work in a clinic and admit patients in the hosp, do I get to go see them in the hosp also? Because I would like doing that and not just be clinic based.

You can in some places. Many hospitals will require you to use their hospitalists.

That said, CB nailed it - doing both gets old very quickly

 

[VA Hopeful Dr]

Is it possible to make 250k+/year in FM working less than 60hrs/week?

Yes

 

[wise.MD]

Gotcha. Thank you1

 

[styphon]

Ok, what about my other question. If I work in a clinic and admit patients in the hosp, do I get to go see them in the hosp also? Because I would like doing that and not just be clinic based.

Depends on your job. Some clinics see their own hospitalized clinic, the majority do not. Some groups do a rotation of doctors doing inpatient (IE: 1/2 day M-F, 1 week on (hospitalist) then 3 weeks clinic, repeat. )

 

[wise.MD]

Depends on your job. Some clinics see their own hospitalized clinic, the majority do not. Some groups do a rotation of doctors doing inpatient (IE: 1/2 day M-F, 1 week on (hospitalist) then 3 weeks clinic, repeat. )

This I like

 

[primadonna22274]

^^I would sooooo love that.

 

[styphon]

This I like

If you are determined and focused, you can do the above.

During my last year of residency I was determined to find a perfect fit - I had interviewed at over 30 jobs in a geographic area that has urban, suburban, and rural populations. All of these areas had opportunities to do clinic+rotating hospitalist shifts.

 

[wise.MD]

If you are determined and focused, you can do the above.

During my last year of residency I was determined to find a perfect fit - I had interviewed at over 30 jobs in a geographic area that has urban, suburban, and rural populations. All of these areas had opportunities to do clinic+rotating hospitalist shifts.

Thank you for sharing your experience 🙂

 

[NurWollen]

Sounds like the demand for family doctors is such that you can shop around for a job that fits your needs and interests.

 

[KnuxNole]

I've been trying to find jobs that have both clinic and hospital work, but it seems EXTREMELY rare....I've heard from several people that it's dying and FM docs are mainly gonna be outpatient only. I know it's getting very difficult to find jobs, and this is making me worry a bit more. D:

 

[midweststudent1]

I've been trying to find jobs that have both clinic and hospital work, but it seems EXTREMELY rare....I've heard from several people that it's dying and FM docs are mainly gonna be outpatient only. I know it's getting very difficult to find jobs, and this is making me worry a bit more. D:

Difficult to find jobs? Or difficult to find jobs for inpatient work?

 

[KnuxNole]

the second one

 

[VA Hopeful Dr]

I've been trying to find jobs that have both clinic and hospital work, but it seems EXTREMELY rare....I've heard from several people that it's dying and FM docs are mainly gonna be outpatient only. I know it's getting very difficult to find jobs, and this is making me worry a bit more. D:

If you can handle a small city (50k) in the south east, PM me - I know of an FM practice that does both and is actively looking for docs.

 

[primadonna22274]

If you can handle a small city (50k) in the south east, PM me - I know of an FM practice that does both and is actively looking for docs.

Ahem. Hook a girl up buddy. [emoji6]

 

[Roguelyn]

If you are willing to move you can find just about any type of job you want. I'm in a town of 300,000 and we mainly have hospitalists jobs. We are notoriously low paying around here, too. However, drive a bit and there's some options.

I recently interviewed for a position with an office (20 min away) that still rounds on 3 hospitals and wanted any new docs to do so, too. I would have been the 3rd doc and rather than each of us each having a hospital, their plan was to rotate rounding. So every 3rd week I'd have to go to the hospitals in the morning to see our patients and then go to clinic all day and then go back to the hospitals for discharges/admits/etc if needed. It would take over an hour just to drive to all 3 hospital parking lots without even getting out of the car and then another 25min to the office. And their census is low, which makes it worse. Imagine all this driving to see 2 or 3 patients?? UGH! There are a couple of other similar offices doing this and none of them want to pay their providers - 130s. They've been looking for someone for years. I told them no, and tried to give them a heads up as to why they can't find anyone. Oh well.

An hour away from me there is a county hospital (county pop. 42000) looking for FM w/OB and doesn't really care how adequate the OB training is, they just need someone. They claim they'll train enough to get you comfortable and that OB is on-call for sections. A little further out (pop. 7000) is a practice looking for someone to work outpatient FM w/o OB. A couple of hours away (pop. 45000) is a practice looking for someone to do FM and hosp rounds. There's only one hospital in that town so that's a plus.

Anyway, I guess I didn't really have a point. I just find it interesting the varied sorts of jobs and pay out there.

 

[Bacchus]

Do FM physicians working outpatient do rounds in the hospital for patients they admit? Or they just refer them to the hospital and the hospitalist takes over? Also, I have gone through some threads about salaries. FM hospitalists make some where between 160-180k, and as I believe hospitalist jobs are like 7-11 days per month. And then the rest of the days the same physician can probably work outpatient at some clinic and make another 150-180k? So doesnt that make an income of over 300k for someone who can do that? Isnt that a pretty sweet income, then why do most FM residents say they wont earn much?

I should defer you to my inbox. The combination of work environments is unlimited. The emails are numerous and opportunities are abound (except I don't want to move).

 

[SuckySurgeon7]

An hour away from me there is a county hospital (county pop. 42000) looking for FM w/OB and doesn't really care how adequate the OB training is, they just need someone. They claim they'll train enough to get you comfortable and that OB is on-call for sections.

How often do hospitals offer to educate physicians on subjects like this? Would it be a part-time fellowship type of thing, or would it just be shadowing a doc for a while or taking a few workshops (sketchy)? I was under the impression that once a person is out of residency/fellowship, there aren't many opportunities to do anything you haven't documented as having already done before that point.

 

[Promethean]

How often do hospitals offer to educate physicians on subjects like this? Would it be a part-time fellowship type of thing, or would it just be shadowing a doc for a while or taking a few workshops (sketchy)? I was under the impression that once a person is out of residency/fellowship, there aren't many opportunities to do anything you haven't documented as having already done before that point.

Hmmm... I know quite a few people who had been attendings and then later went back for additional fellowships, even residency training. It isn't as if you have to get all your training done at the beginning of your career. One of my favorite FM/anesthesiologist/pediatricians was at least triple boarded in those three fields, because he just kept going back for more abuse. Love that guy.

I can't speak to whether a particular hospital will be willing to do remedial training in something one doesn't have a lot of experience with. I would expect that to be the sort of thing that is up for negotiation, if they need someone badly enough. Though, if they need someone that badly, you have to wonder why, and take the reasons into consideration. Maybe it is just something you can cope with, like a rural setting, or maybe it is something more intolerable, like a malignant administration. Gotta do your due diligence before you sign.

 

[SuckySurgeon7]

Hmmm... I know quite a few people who had been attendings and then later went back for additional fellowships, even residency training. It isn't as if you have to get all your training done at the beginning of your career.

Right, I guess I was really thinking about training options other than fellowships. For something like C-sections as a primary surgeon, that seems like a lot of training. I don't know anything about the surgery itself, but according to this study, most people got at least 50 c-sections out of an obstetrics fellowship, a number that seemed to correlate with receiving hospital privileges. I take that to mean it would be a long time training a doctor before he/she was able to take call for the hospital? And would the doc be working under the hospital's malpractice? It seems like a nontraditional way of gaining skills, but I actually like it a lot.

And I hope OP/mods will excuse me for blatantly hijacking the thread. 🙂

 

[Promethean]

And I hope OP/mods will excuse me for blatantly hijacking the thread. 🙂

Oh, please. =) As hijacks go, this is more like asking the pilot to do a little trick flying on the way to the planned destination. At least you are still discussing something related to the topic, however tangential.

 

[styphon]

Right, I guess I was really thinking about training options other than fellowships. For something like C-sections as a primary surgeon, that seems like a lot of training. I don't know anything about the surgery itself, but according to this study, most people got at least 50 c-sections out of an obstetrics fellowship, a number that seemed to correlate with receiving hospital privileges. I take that to mean it would be a long time training a doctor before he/she was able to take call for the hospital? And would the doc be working under the hospital's malpractice? It seems like a nontraditional way of gaining skills, but I actually like it a lot.

And I hope OP/mods will excuse me for blatantly hijacking the thread. 🙂

Lots of hospitals in the northeast require 200-250 c/sections, and hence our 1 year "fellowships" "guarantee" this number. If you were to do it the above way (not in a fellowship, outside of a residency) you would need someone with you who does c/s. I do not know if you could bill as an "assist" or if it would be at a financial loss.

 

[Roguelyn]

How often do hospitals offer to educate physicians on subjects like this? Would it be a part-time fellowship type of thing, or would it just be shadowing a doc for a while or taking a few workshops (sketchy)? I was under the impression that once a person is out of residency/fellowship, there aren't many opportunities to do anything you haven't documented as having already done before that point.

I would have thought not often until I started getting recruited even after stating that I was not cool with even assisting with sections. The hospital I considered only briefly said they'd have me be on call with another provider for deliveries until I felt comfortable. And I would not be expected to perform sections. Really, I'd be fine with uncomplicated vaginal deliveries, I think most would after residency. Well, the old residencies when you did OB. But man, anything goes significantly wrong and I'd be going straight from what I've read. What a legal nightmare.

You need to plan on 200+ sections and most fellowships offer that. 50 is nothing, 1 per week if the fellowship is a year, but a lot of the fellowships I looked at were 2 or 3 years. I wouldn't trust the guy who occasionally learned surgical skills.