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  • q-school q-school 
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    Status: Physician
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    Joined: 05/07/2017

    Not sure working at 3 separate hospitals at same time is safe for the patients or wise but to each their own.

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    “can we have a family meeting for goals of care at 1 pm?”

    No sorry I gotta go round on my 2 other hospitals worth of patients

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    How’s that any different than a specialist who rounds in the hospital in the morning then leaves to go to their clinic for the rest of the day?  Or a cardiologist that does procedures at 2 different hospitals each day?  Or a PCP who admits their own patients? (this, of course, used to be the norm).  This is a pet peeve of mine actually.  People wrongly assume that if you’re a hospitalist that it means you need to sit in the hospital all day just to be available for non-emergent things (like impromptu family meetings that could wait until the next day or to sign a form for care management, etc).  We’re not “available-ists”  That would kill the main attraction to the job which is having a decent lifestyle.  I’m sorry, but my time is more valuable than that.  I am being paid to manage a group of patients on a per shift basis.  My priorities are to make sure they are getting the care they need, not to be overly available for things that don’t actually require my immediate attention.

    Anyone that is forced to sit in the hospital for a full 12 hours every day is going to be miserable because it means they have zero life outside of work.  And they’ll probably be bored out of their minds if they are not on call because once their work is done, what can they do other than surf the web?  That’s a recipe for burn out.  ER doctors are required to be in the building the full 12 hours because their entire field revolves around being 100% available 24/7/365.  BUT, they only work 2-3 shifts in a row (typically).  Hospitalists are usually asked to work much longer stretches (7 being the most common).  Good luck surviving for very long working 12 hours a day 7 days at a time.  You can’t possibly have a happy/normal family life with that kind of work requirement.

    Regardless, I fear that this expectation of hospitalists becoming available-ists, is a trend that we can’t actually stop.  It’s something that is slowly becoming the expectation and it’s going to change the field dramatically.  The only way I would ever agree to a job in which I’m required to be in house and physically available all day would be if I were doing no more than 2 or 3 shifts at a time and then getting a few days off.  Even that wouldn’t last very long for me.  It’s one of the many things I see as being an end to my career in medicine and why I’m saving money like mad and living way below my means.

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    i’m sorry, but as you note, the prevailing sentiment is that it is different for hospitalists.  unless you are in private practice without support from the administration, there is for sure a difference in opinion about availability.  things are evolving fast.  even if they haven’t verbalized it to you, that’s how they are thinking.

    the hospitals would rather pay your specialty for your time than for your rvu’s.  the shift in compensation approach will mean that the hospitals can dictate to you that you are in fact an availabilist and you are there to take care of patients AND make documentation pristine AND make sure the procedurists can focus on the lucrative procedures/surgeries rather than admitting, discharging, family meetings, compliance.  that doesn’t make it right, but the ones who control the money get to direct the show.

    in our hospital, they are willing to hire virtually unlimited number of hospitalists to make sure they can admit for every service to maintain efficiencies.  to be fair, hospitalists here are busy for their shifts and the majority are begging for more hospitalists.  as always, daytime shifts seem desirable, nights/swing/weekend seem less filled than the hospital would like.

    OR times are very strapped.  anesthesia can be a bottleneck area.  block time usage is reviewed like crazy.  number of quality meetings and resource meetings and value meetings needing the surgeons and procedurists increased like crazy.  you better be there at designated start time.  it’s just a different treadmill that the specialist doctors are on.

    🙁

    jmo

    ymmv

     

     

    #214651 Reply
    Avatar hospitalist md 
    Participant
    Status: Physician
    Posts: 81
    Joined: 10/31/2017

    just because administrators look at it a certain way does not make it right. It should be perfectly ok for a hospitalist to go home or even go out to grab a lunch and be available for calls and we can even come in if felt necessary. we don’t have to physically be in the hospital the entire 12 hrs…that is just absurd … I for one plan to keep fighting … wether i will get the results or not … just have to wait and see.

    #214661 Reply
    Liked by EndoRobert
    Avatar pulmdoc 
    Participant
    Status: Physician
    Posts: 417
    Joined: 09/19/2016

    I’m primarily an intensivist, 7-7 with 7 on 7 off. Two of us on at a time. I do see my job as being an availabilist; codes/crash intubations etc are obviously unscheduled, many family meetings happen after people get done with work, etc. Most days I finish between 6-7 PM; if everything is wrapped up one person goes home with their pager on and the other stays as emergency coverage until night shift. Sometimes there will be an hour or two of downtime in the middle of the day, just depends on volume of admissions and stability of existing critically ill patients.

    I know for a fact that my hospital takes the attitude of “if you don’t need to do a full days’ work, we’ll get rid of some of you until the worked needed to be done fills the day of everyone left.” Multiple hospitalists fired for taking outside 2nd jobs which violated their contract to be exclusive. If you want a job with the flexibility to leave early, your best bet is to be an IC or find a PP hospitalist group not employed.

    #214662 Reply
    Liked by Dusn, Tim
    Avatar Brains428 
    Participant
    Status: Physician
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    Joined: 11/09/2017

    @jessikaur

    Sorry if you covered this… are you not violating non-competes?

    Also, as efficient as you may be, do you think it’s a detriment to spread yourself so thin.

    Not trying to criticize, just seems like a lot of work.

    #214668 Reply
    Lordosis Lordosis 
    Participant
    Status: Physician
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    Joined: 02/11/2019

    I have been involved with 2 hospital systems while they transitioned to a hospitalist system.  It is sold to the PCPs, Patients, Admin, specialists, and anyone else who would listen that the benefits of adding these docs would be their availability in the hospital.

    I am not saying it is right or wrong but that is how it is promoted.

    “Never let your sense of morals prevent you from doing what is right.”

    #214669 Reply
    Liked by pulmdoc, jessikaur
    Avatar Panscan 
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    Status: Resident
    Posts: 719
    Joined: 03/18/2017

    Ya I’m sure you’re making sure they’re getting the care they need when you’re 2 hospitals away… Give me a break. Why should you not be in the hospital for 12 hours? It’s literally what you’re paid to do, ie take care of patients.

    I don’t get it. The job is usually like 7 on 7 off. It’s set up that way because it’s understood you’re in the hospital a lot when you’re on, thus you work half the year. It’s like you want to have your cake and eat it too.

    Also I really don’t think going out for lunch for 30 min to an hr is the same thing as rounding at 3 hospitals on same day.

    I don’t think it’s appropriate for specialists to operate or do procedures at multiple hospitals on same day. Someone at clinic can leave their clinic and go see a patient if needed. What if you have sick patient at both? ” hey can you go see this patient that is crumping, I’m rounding at another hospital or taking care of someone crumping at this one.”

    A hospital is an availablist, thats literally the job. Hence why you work a ton when you’re on, and off half the year typically.

    If the job was popping in and rounding on patients and going home then every primary doc would see their own patients.

    You can delude yourself all you want but there’s huge conflicts of interest here with working at numerous hospitals simultaneously and it’s going to result in poor care.

    #214674 Reply
    Liked by MaxPower
    Avatar Panscan 
    Participant
    Status: Resident
    Posts: 719
    Joined: 03/18/2017

    It’s not working 12 hrs a week if you’re sitting on your butt in the call room for half the day. People apparently have time to round at 3 hospitals, but doing 1 for 7 days straight would be exhausting? That’s not logically consistent.

    Makes no sense. What would we say if an Ed doctor said ” why should I have to stay in the hospital all the time?” inpatients can have emergencies too. Literally the job. Availablist is literally the perfect discription of what a hospitalist is. That’s the entire point why the job was created.

    #214677 Reply
    Lithium Lithium 
    Participant
    Status: Physician
    Posts: 1054
    Joined: 02/15/2016

    Working 84 hours a week is absolutely not sustainable even if it is every other week. Maybe if it was every third week or 2 out of every 5 weeks it would be doable. Would you ever take a job where you’re expected to work 42 hours a week 52 weeks a year? Because those are the same hours. That kind of job is just an extension of residency.

    #214681 Reply
    fatlittlepig fatlittlepig 
    Participant
    Status: Physician
    Posts: 667
    Joined: 01/26/2017

    @hospitalist md, your job is in sorely need of schedule revamping. As you alluded you, staying until 7PM when your work is finished is the very definition of soul crushing, it would be an absolutely untenable situation for FLP. you need a swing shift, or to have a rotating rounder who stays until 7PM so others can go home. it sounds like there isn’t much support within your group, many physicians do not mind or even like being in the hospital.. so good luck with that. my advice would be to secure another job, then agitate strongly for change, if it doesn’t happen then- adios.

    @jessikaur i’m on the fence of being not sure if you are making some of this stuff up, or telling the truth. I’m leaning towards the latter. Fatlittlepig gets it, you like to be productive, you like making money, you enjoy the hustle- but seriously it’s not “normal” or healthy to work 50 days in a row. Sorry, nothing you say will convince me otherwise. physicians, and humans in general, need days off to destress, unwind and to recharge. As to working at multiple hospitals/jobs during the same day, that to me seems odd– what if you are paged about a patient you saw at hospital #1 and you are at hospital #3. I can understand if you are a day laborer, or waitress, the need to work multiple jobs out of necessity.. but as a physician finding one decent paying job seems to me to be a more sensible proposition.

     

    #214684 Reply
    Liked by MaxPower
    Avatar jacoavlu 
    Moderator
    Status: Physician, Small Business Owner
    Posts: 1833
    Joined: 03/01/2018

    @panscan you realize radiologists that do procedures and cover multiple ERs and hospitals is not entirely dissimilar to a hospitalist that isn’t always in one hospital, especially out in the vast non-academic world

    many radiologists travel to smaller hospitals, do procedures, and then leave and go somewhere else and do more procedures. Or I’ll be on call (by myself) covering more than one facility, traumas and strokes and urgent IR procedures and the like can happen simultaneously, it helps to have partners and arrangements in place for situations that can come up. Stuff happens. It helps to have good relationships with our non-radiologist colleagues and in my experience they understand we can only really do one thing at a time.

    I wouldn’t be so quick to mandate what someone else’s job should be.

    The Finance Buff's solo 401k contribution spreadsheet: https://goo.gl/6cZKVA

    #214690 Reply
    Avatar HikingDO 
    Participant
    Status: Physician
    Posts: 288
    Joined: 03/09/2017

    Working 84 hours a week is absolutely not sustainable even if it is every other week. Maybe if it was every third week or 2 out of every 5 weeks it would be doable. Would you ever take a job where you’re expected to work 42 hours a week 52 weeks a year? Because those are the same hours. That kind of job is just an extension of residency.

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    Agree, it sounds like hell. A good friend of mine works one week on one week off, 12 hours per day as a hospitalist, and has for 20 years. I have no idea how he does it.

    #214698 Reply
    Avatar hospitalist md 
    Participant
    Status: Physician
    Posts: 81
    Joined: 10/31/2017

    @flp- yes… it does… we have 4 teams on during day …. i am trying to convince them that 2 teams can go home every other day at 5 pm while the other 2 teams cover and we alternate so everybody gets to go home a little early every other day . it makes a huge difference to my day jus being early home at 5 pm instead of 7 pm. this does not even need a whole lot of revamping. just some willingness from the group to consider it.

    #214703 Reply
    Avatar Panscan 
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    Status: Resident
    Posts: 719
    Joined: 03/18/2017

    Not sure how that’s relevant, and I also don’t consider it appropriate. If you’re in middle in Montana and covering 2 tiny community hospitals I guess it’s ok but not ideal and not what I’d want for my family.

    I don’t think many people are taking stroke call at multiple hospitals and actually doing interventions commonly.

    Not sure what you mean having a good relationship or how my views about it being inappropriate to round at 3 hospitals relate to a relationship with other physicians? As a resident I’ve personally seen numerous cases where care is delayed because attending is at another hospital. It’s inappropriate. I call out bs when I see it.

    #214706 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2333
    Joined: 05/07/2017

    @flp- yes… it does… we have 4 teams on during day …. i am trying to convince them that 2 teams can go home every other day at 5 pm while the other 2 teams cover and we alternate so everybody gets to go home a little early every other day . it makes a huge difference to my day jus being early home at 5 pm instead of 7 pm. this does not even need a whole lot of revamping. just some willingness from the group to consider it.

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    i totally agree with your comments regarding the ease of lifestyle when you can get out at 7 pm.  my comments are mostly based on your statement that administration told you to knock it off when you handed the pager off.  that suggested to me a mindset which would not be receptive to the (reasonable) changes you request.

    if i read too much into that statement, then by all means, convince them.

    good luck.

     

    #214709 Reply
    Avatar Tim 
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    Status: Accountant
    Posts: 2075
    Joined: 09/18/2018

    “ I am being paid to manage a group of patients on a per shift basis. “
    I am sure the number patients and time are factors.
    The question is a hospitalist paid for time or number of patients in the “group”? No answer is right, different compensation models. One interpretation is the service needs to be available during the shift. The family meeting is for the patient and family and shouldn’t be put off for the convenience of the hospitalist. The patient and family have no idea the schedule. 12 hrs for 7 days works for some and not others. I can see why 8 hrs for 7 would be a lot more appealing. That’s really a scheduling service issue, not a compensation issue.
    I would be curious, how did 7 on 7 off get started?
    I seems to be the pits.

    #214721 Reply

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