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Have you transitioned from hospitalist to PCP or fellowship?

Home The Lounge Have you transitioned from hospitalist to PCP or fellowship?

  • Avatar Panscan 
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    It’s a joke how many notes either don’t have physical exam or have a physical exam that is normal even though the patient has like bilateral cellulitis and osteo with wounds. Obviously we can’t do full exams every day but I don’t understand how lazy people are with notes. I would think that would be a legal liability.

    #237018 Reply
    Liked by Duckworth
    IlliniGopher IlliniGopher 
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    Your job is very night heavy.  My group works 167 shifts a year of which – 6.5 (avg) nights, 12 evenings.  RVU productions ~4600/yr.  Salaries about $320K.  I can work this job for 30 years no problem.  My wife works as a PCP, it is HARD WORK.  I would only do a fellowship if you cannot live life without it.

    "Comparison is the thief of joy." - Teddy Roosevelt

    #237023 Reply
    IlliniGopher IlliniGopher 
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    Also, the academic model of hospitalists does not make sense at all.  At our tertiary center, specialists put in their own daily orders and discharge stuff.  Why would it make sense to have the hospitalists enter EVERYTHING.  Highly inefficient and thus specialists working in parallel makes so much more sense for through-put.  I don’t feel like “an order monkey” at all.  It’s more about driving the care forward, planning, communicating.

    "Comparison is the thief of joy." - Teddy Roosevelt

    #237024 Reply
    Liked by Duckworth
    Avatar loeffy 
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    I think your concerns about PCP work are valid, except the dumping ground thing, I don’t view it quite the same as hospitalists dumping ground.  Very well the grass may not be greener.  It sounds like you may have an opportunity lined up?  If so, why not take a shot and if it doesn’t pan out, you can always do fellowship.  Carving out the type of practice you want is do-able, and if money isn’t a huge concern then that’s a plus.  You could do 1yr critical care, or 3yrs of pulm/cc or cards.  If you have a solid background and put in some effort with extra-curriculars, I don’t think it’ll be hard to match a few years out.  I know plenty folks who have.

    Also, consider job opportunities.  If you are willing to work anywhere, it doesn’t matter, but if you have a specific place in mind, maybe take a look at the job market in a particular specialty.  I feel like this doesn’t get mentioned often but I’ve known a few people who pursued their interests, typically a subspecialty fellowship, and upon graduation realize there’s no good jobs where they want to live, back home, etc.  Whether it’s saturated market, crappy dept., terrible pay, etc.  In hindsight many of them are torn whether subspecializing was worth it or not.

     

    #237029 Reply
    Avatar CCM 
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    You could do 1yr critical care, or 3yrs of pulm/cc or cards.  If you have a solid background and put in some effort with extra-curriculars, I don’t think it’ll be hard to match a few years out.  I know plenty folks who have.

    Click to expand…

    CCM requires 2 years of fellowship after a 3 year IM residency.

    #237088 Reply
    Avatar Duckworth 
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    Interesting bunch of diverse perspectives that I appreciate. Thanks!

    Clearly the experience of a hospitalist is highly dependent on schedule and local practice patterns. The “worst” days for me are bad in that i feel like they are spent at the bottom of my license wading through a muck of crappy notes and other nonsense… I don’t care about concerned nurses, family, drug seeking patients. I want to spend more time with them not less, more time on complicated patients not less. something frankly non clinical pulling you away from that is a part of every speciality but seems baked into the fabric of pcp and hospitalist jobs. This is only one part though of my desire to switch though namely longitudinal relationships and developing an area of expertise

    The grass is greener mentality is real and I like idea of trying a job before engaging in the opportunity cost of fellowship

    #237170 Reply
    Liked by Duckworth
    Avatar loeffy 
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    You could do 1yr critical care, or 3yrs of pulm/cc or cards.  If you have a solid background and put in some effort with extra-curriculars, I don’t think it’ll be hard to match a few years out.  I know plenty folks who have.

    Click to expand…

    CCM requires 2 years of fellowship after a 3 year IM residency.

    Click to expand…

    Whoops, thanks for the correction. It seems the 1yr is for only certain specialties, but not hospitalists.

    #237240 Reply
    q-school q-school 
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    something frankly non clinical pulling you away from that is a part of every speciality but seems baked into the fabric of pcp and hospitalist jobs

    Click to expand…

    true of every clinical job, at least that i can see.  i’m not sure we can know if it is more baked into pcp/hospitalist than any other job.

     

    #237250 Reply
    Liked by Duckworth
    Avatar Crockett’sRiver 
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    I did a year as a peds hospitalist right out of training, then switched to primary care (outpatient only) and am happy as a clam.  Here’s my experience, so you can see if it resonates with you:

    I became a hospitalist because I enjoyed the higher acuity stuff in residency, found resident clinic equally satisfying and stressful (the usual reasons: never enough time to follow up and give good care, super high-risk population etc).  And, in my experience, academic medicine takes a rather snobbish view of primary care.  In med school and residency I heard over and over that smart people go into specialties, primary care is a dead end etc etc.  I considered fellowship but ruled it out for family reasons.

    My year as a hospitalist was OK but I knew it wasn’t right long-term.  The truly sick kids were stressful, I missed the continuity, found that I was doing the same thing over and over and really didn’t have strong collegial relationships because I only saw the other hospitalists for hand-offs.

    My first primary care job covered inpatient (deliveries, admissions, ED) as well, and that was incredibly stressful.  I couldn’t do both, well.  So now I am 100% outpatient.

    I love being a primary care physician.  I love seeing families grow, love having patients who trust me, love seeing my colleagues every day.  I don’t feel dumped on by specialists – they do their job, I do mine – and I get to do mine during business hours and sleep in my own bed at night :).

    I can’t say the same would be true for IM vs peds, or for you, but I’m so glad I made the switch.  I would say that if you are unhappy after just one year, then hospital medicine is not for you.  Best of luck.

    Career and finance for PCPs at ADoctorsWorth.com

    #237261 Reply
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    Avatar mjohnson 
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    I went from a hospitalist to a fellowship. First, I was working at different hospitals and there are large differences between them..

    The private practice/community hospital setting was the best as the nurses respected you. Also the specialists/surgeons would call personally as they wanted a good relationship (and referrals to their practice).

    Academic hospitalist work was a huge drag compared as not as respected by nurses and the surgical teams.

    Hospitalists are the whipping boys/girls of hospitals, but at least in the private practice setting it felt more like a team along with more respect.

    Now, going to fellowship from attending/hospitalist. To be honest it was very painful especially the first year. Especially all the journal clubs giving presentations, sitting around waiting for attendings, having to deal with different personalities in attendings, etc.

    That being said, it was the best decision I have ever made, and now have a job that I could see myself doing until I retire.

    #237281 Reply
    Liked by Duckworth
    Avatar Duckworth 
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    something frankly non clinical pulling you away from that is a part of every speciality but seems baked into the fabric of pcp and hospitalist jobs

    Click to expand…

    true of every clinical job, at least that i can see.  i’m not sure we can know if it is more baked into pcp/hospitalist than any other job.

     

    Click to expand…

    I think its present, but I thought it wasn’t controversial that higher paperwork and PA burden, along with constant flood of notes from PTs, VNA etc into the inbox is one of the main, well known reasons PCPs burn out.  Maybe I am wrong, but I see PCPs complain they do not have enough time to address what they need to address in a office visit much more than outpatient specialties.

    Similarly, case management rounds and pressure to dispo, inheriting patients with weeks long length of stay with heavy psychosocial burden, middle of the night pages about mag repletion and nystatin, are “stereotypical” problems of hospitalist work that also drive people away.  I personally think that these are overblown, highly location dependent, and other specialties have their equivalents, and just part of the job; but I dont think it is unfair to say the burden of this is higher in hospital medicine.

     

    I did a year as a peds hospitalist right out of training, then switched to primary care (outpatient only) and am happy as a clam.  Here’s my experience, so you can see if it resonates with you:

    I became a hospitalist because I enjoyed the higher acuity stuff in residency, found resident clinic equally satisfying and stressful (the usual reasons: never enough time to follow up and give good care, super high-risk population etc).  And, in my experience, academic medicine takes a rather snobbish view of primary care.  In med school and residency I heard over and over that smart people go into specialties, primary care is a dead end etc etc.  I considered fellowship but ruled it out for family reasons.

    My year as a hospitalist was OK but I knew it wasn’t right long-term.  The truly sick kids were stressful, I missed the continuity, found that I was doing the same thing over and over and really didn’t have strong collegial relationships because I only saw the other hospitalists for hand-offs.

    My first primary care job covered inpatient (deliveries, admissions, ED) as well, and that was incredibly stressful.  I couldn’t do both, well.  So now I am 100% outpatient.

    I love being a primary care physician.  I love seeing families grow, love having patients who trust me, love seeing my colleagues every day.  I don’t feel dumped on by specialists – they do their job, I do mine – and I get to do mine during business hours and sleep in my own bed at night :).

    I can’t say the same would be true for IM vs peds, or for you, but I’m so glad I made the switch.  I would say that if you are unhappy after just one year, then hospital medicine is not for you.  Best of luck.

    Click to expand…

    Thanks I totaly see where you are coming from.  I onbviously know very little about pedes; i imagine the inaptient stuff you describe as being alot more stressful than mine would be; i also imagine your well child visits would be a lot more routine and stress free compared to my “well” patient population in the area i practice, but other than that alot of what you say rings true for me, especially that you liked aspects of your job but knew that it wasnt right for you long term.  If I had to do this forever, I could change some things around, make it work, and still be happy.  Most of us are fortunate enough to have options to try and “optimize” our career to achieve longevity and maximal personal impact while still being happy, which is why im interested in hearing other people’s paths as a curiosity while I think about my own.

    I went from a hospitalist to a fellowship. First, I was working at different hospitals and there are large differences between them..

    The private practice/community hospital setting was the best as the nurses respected you. Also the specialists/surgeons would call personally as they wanted a good relationship (and referrals to their practice).

    Academic hospitalist work was a huge drag compared as not as respected by nurses and the surgical teams.

    Hospitalists are the whipping boys/girls of hospitals, but at least in the private practice setting it felt more like a team along with more respect.

    Now, going to fellowship from attending/hospitalist. To be honest it was very painful especially the first year. Especially all the journal clubs giving presentations, sitting around waiting for attendings, having to deal with different personalities in attendings, etc.

    That being said, it was the best decision I have ever made, and now have a job that I could see myself doing until I retire.

    Click to expand…

    Can I ask what specialty you wound up going into?  Thankfully, nurses are excellent which is a reason I like working here.  Surgical residents are surgical residents, fellos are fellows and can be lazy or attempt to block rarely but attending to attending if needed is nothing short of professional.

     

    #237346 Reply
    Liked by Duckworth
    Avatar hightower 
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    OP, I’ve worked as a hospitalist now for 9 years, so I completely understand everything you’re saying about being frustrated with the job.  You have legitimate points.  I’ve been super frustrated with all the things you mention many times in the past.  I’ve dealt with burn out and looked for ways out and considered switching to something else as well.  The thing that prevents me from actually following through (though I someday dream of leaving medicine altogether), is the fact that I have such a flexible schedule and the job requires relatively little effort on my part.  Especially since I’m working as a prn…meaning I don’t have a full time contract with benefits.  I’m paid per shift, basically however many I want.  Right now I’m only working 11 or 12 shifts a month, 12 hours each.  The rest of the month I’m OFF.  I have zero responsibilities.  I can travel if I want (though I have a 1 year old, so not really happening much these days).  But, even working a reduced schedule of only 11 days a month, I can still pull off close to $250k a year no problem and with my wife working full time we’re pulling $310k/yr easy.  If I want to work just 1 or 2 more shifts per month, that number can hit $350k no problem. And the work is pretty easy for the most part.  I work in a rural location about 30 minutes outside of the city, so that’s how I pull off a higher rate in combination with the prn status.  The other benefit to working rurally is that it’s a smaller, generally less busy place, with lower acuity patients…i.e. less stress.  It’s not perfect by any stretch of the imagination, especially during flu season, but compared to when I worked at a busy community hospital in the city, I feel like I’m on vacation most days.

    I’ve learned to just ignore the things that irritate me (like the bedside multi-disciplinary rounds they make us do, or the BS admits for consultants, or the fact that I have to baby sit NPs, inheriting someone else’s mess, etc)…because at the end of the day, I realize I’m very unlikely to find a job that pays this well and requires so little of my time and effort.  Any fellowship and subsequent sub-specialty practice is likely going to require a lot more of your time with fewer days off.  And definitely being a PCP is going to be a lot more difficult.  Again, I can take vacations whenever I want without even asking permission or needing to worry about my partners covering for me.  I just ask that they don’t schedule me for shifts.  I can go overseas for 2 weeks and no one in my group even knows about it.

    Sure, I can find a lot to complain about with this job, but I can easily just ignore that stuff and look at what I’m making and how many days off I have and be just fine.  It’s a pretty sweet deal right now.  I don’t necessarily think it’s going to last though.  Eventually we’ll see NPs/PAs taking over most hospitalist positions IMO and we’re likely to see drastic cuts in physician pay in the future, but I’ll continue to make hay while the sun is shining for now.

    #237379 Reply
    Avatar rdo 
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    I had the opposite question few months ago.  I considered switching from PCP to hospitalist. I decided not to make a move.  I have spoken to several hospitalist friends.  There are definitely pros and cons with every position.  I am sure you can make your own lists of pros and cons.  I already have a mature panel.  Starting out, I was trying to build my patient panel.  I do get difficult ones.  It gets easier since I already know them and I know what to follow. I have learned to be efficient at this job and maybe I am not open to stress of relearning hospitalist work.  I have reconciled that instead of making a switch is to decrease hours.  I hope to implement that by next year.  If I am still frustrated, I may check my options again.

    Some folks here made recommendations how to make hospitalist work better for you.  It may be something you will consider trying.

    The good thing is your first job does not have to be your last.

     

    #237580 Reply
    Liked by q-school

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