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Hospitalist Jobs: The Good, Bad, and Ugly

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  • CM CM 
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    I am a hospital-employed medical sub-specialist under contract through the end of next year. I could retire at that point, but I don’t want to retire; I just want a less stressful job.

    The shift work aspect of a hospitalist position appeals to me (assuming no nights), but seven consecutive 12-hour shifts under an avalanche of work at a high-volume center would not be an improvement on my current job.

    Do low-volume jobs exist? (Rural location is ok.) If so, how can you confidently assess the volume prior to starting the job. (I would not trust the assessment of a recruiter or employer.)

    Also, what do you consider low volume?

    Years ago, I worked as an intensivist before that was a well-recognized specialty. During my first year we covered two hospitals. One was a small facility 30 minutes beyond the outer edge of the suburbs. It was so quiet that admissions were a welcome sight. There were long periods with nothing to do. That was low volume.

    I don’t want a job so slow that it’s boring. I just want one where I don’t feel rushed and pushed throughout the day. I’d just like to start every day with the idea that it’s likely to be a good day.

     

    I realize that hospitalists frequently burn out, but that would probably be uncommon if all jobs were low volume and no one took extra shifts. Do you disagree?

    Putting compensation aside, am I crazy to think that low-volume hospitalist work would be more enjoyable than (non-invasive) medical sub-specialty work?

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #171061 Reply
     jacoavlu 
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    How about you just keep doing what you’re doing but do it at half speed? Work less time. See fewer patients. Tell your employer precisely what you want and what you’re willing to do and put it in writing. And be prepared to walk away if they won’t give you what you want.

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

    #171071 Reply
    Liked by Vagabond MD
    CM CM 
    Participant
    Status: Physician
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    Joined: 01/14/2017

    How about you just keep doing what you’re doing but do it at half speed? Work less time. See fewer patients. Tell your employer precisely what you want and what you’re willing to do and put it in writing. And be prepared to walk away if they won’t give you what you want.

    Click to expand…

    That is my first choice, but I have no idea what their response will be. I want to be prepared for, “No thanks.”

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #171075 Reply
    Liked by Vagabond MD
    fatlittlepig fatlittlepig 
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    Status: Physician
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    Yes they exist but i believe they are few and far between. Fatlittlepig happens to be fairy lucky as workload at current position is very manageable ~10-12 pts a day sometimes less and rarely more.

    Fatlittlepig would absolutely not take any position where you are committed to being in the hospital for 10-12 hrs a day. That’s unacceptable at least for Fatlittlepig. In addition 7/7 schedules also similarly do not seem sustainable. If you can find a good hospitalist gig then yes I think it could very well be better than what you are doing.

    #171110 Reply
    CM CM 
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    In addition 7/7 schedules also similarly do not seem sustainable.

    Click to expand…

    It seems > 90% of jobs are 12-hr shifts, 7 on 7 off. That’s not ideal but would be ok with me if volume was fairly light.

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #171111 Reply
    Liked by Vagabond MD
    fatlittlepig fatlittlepig 
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    In addition 7/7 schedules also similarly do not seem sustainable. 

    Click to expand…

    It seems > 90% of jobs are 12-hr shifts, 7 on 7 off. That’s not ideal but would be ok with me if volume was fairly light.

    Click to expand…

    You could retire but would choose to work 12 hr days 7 days in a row for presumably less pay than you are now getting. Fatlittlepig would pass. You may want to look into the VA system.

    #171113 Reply
    CM CM 
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    Joined: 01/14/2017
    You may want to look into the VA system.

    Click to expand…

    For a hospitalist job?

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #171114 Reply
    fatlittlepig fatlittlepig 
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    upon further thought, i don’t know of a single retirement age medical subspecialist who i could envision doing hospitalist work after a career as a specialist. i do not think you will be able to hack it, or be happy doing it. makes no sense.

    #171141 Reply
     mxg67 
    Participant
    Status: Resident
    Posts: 48
    Joined: 11/25/2016

    I have some hospitalist friends who don’t do 7/7, but more of random shift schedule like EM seems to do.  Also, not all hospitalist gigs are super busy, I know some who “work” 12hr shifts but are pretty much done by early afternoon, this seems to vary by institution.  Some of these gigs hospitalists run the show while others they’re glorified secretaries or NP’s.  Does it have to be full-time hospitalist work?  I know another IM person working in chill ER.  I know others who do part-time hospitalist, nocturnist (maybe not for you).  I’ve heard of folks doing weekend or call coverage (for IM or even your subspecialty), clinic coverage or vacation coverage (IM or subspecialty), nursing homes, home visits, etc.

    #171150 Reply
    Liked by CM
     engerland66 
    Participant
    Status: Physician
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    Joined: 03/17/2017

    A hospitalist job at a VA affiliated with a residency program can be pretty cush. The hospitalists had it very good when I was in residency. They’d cap at around 10 and would often take placement issues from the teaching teams. And they’d sign out to the admitting resident of the day usually around 3 or so. And they’d rotate through the teaching teams where the residents would do all the work.

    #171172 Reply
    Liked by CM
     Anne 
    Participant
    Status: Physician
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    Joined: 11/07/2017

    If you think you might like working for the VA, you could also see about working in your medical sub specialty there, if your current employer is not amenable to a slower pace.

    #171178 Reply
    Liked by q-school
     SValleyMD 
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    Status: Physician
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    Joined: 05/12/2016

    Yes. You can find some really cush Hospitalist gigs if willing to go rural. Some of these rural hospitals in my neck of the woods are having to start “mini” Hospitalist programs as nearly all outpt “providers” are midkevels and older in/out pt docs are retiring and u can’t recruit that type anymore

    My buddy rounds on 4-10 patients (pna, copd flares, uti). Admit 1-3 a day. Sick ones shipped out. No ones dying on you. He’s home by 11 and swings by from 3-4 to admit if he has to.

    With that said, most of these small rural hospitals would also love to have an outpt cardiologist to see 8-12 pts in clinic and most importantly read all their noninvasive studies (echo, stress, nuc, vascular) so they can keep those facility fees. Or they link up with competing tertiary centers to feed patients.. That seems just as easy.

    #171189 Reply
    fatlittlepig fatlittlepig 
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    Status: Physician
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    Yes. You can find some really cush Hospitalist gigs if willing to go rural. Some of these rural hospitals in my neck of the woods are having to start “mini” Hospitalist programs as nearly all outpt “providers” are midkevels and older in/out pt docs are retiring and u can’t recruit that type anymore

    My buddy rounds on 4-10 patients (pna, copd flares, uti). Admit 1-3 a day. Sick ones shipped out. No ones dying on you. He’s home by 11 and swings by from 3-4 to admit if he has to.

    With that said, most of these small rural hospitals would also love to have an outpt cardiologist to see 8-12 pts in clinic and most importantly read all their noninvasive studies (echo, stress, nuc, vascular) so they can keep those facility fees. Or they link up with competing tertiary centers to feed patients.. That seems just as easy.

    Click to expand…

    LOL good luck finding a rural cush hospitalist gig, the more typical rural gig you’ll find is more like your one of two hospitalists at a hospital rounding on 15-20 pts and also rounding in the unit, having to wean and intubate patients, with a lack of subspecialists around to consult.

    I would love to see someone who has spent their career as a GI or cards, jumping into a hospitalist job. A GI getting called on patients having chest pain, pneumonia patients getting more dyspneic. Dealing with the social stuff, ain’t going to happen, not a pretty sight.

     

     

    #171194 Reply
    Liked by q-school
     llessac15 
    Participant
    Status: Physician
    Posts: 63
    Joined: 01/17/2016

    Yes. You can find some really cush Hospitalist gigs if willing to go rural. Some of these rural hospitals in my neck of the woods are having to start “mini” Hospitalist programs as nearly all outpt “providers” are midkevels and older in/out pt docs are retiring and u can’t recruit that type anymore

    My buddy rounds on 4-10 patients (pna, copd flares, uti). Admit 1-3 a day. Sick ones shipped out. No ones dying on you. He’s home by 11 and swings by from 3-4 to admit if he has to.

    With that said, most of these small rural hospitals would also love to have an outpt cardiologist to see 8-12 pts in clinic and most importantly read all their noninvasive studies (echo, stress, nuc, vascular) so they can keep those facility fees. Or they link up with competing tertiary centers to feed patients.. That seems just as easy.

    Click to expand…

    LOL good luck finding a rural cush hospitalist gig, the more typical rural gig you’ll find is more like your one of two hospitalists at a hospital rounding on 15-20 pts and also rounding in the unit, having to wean and intubate patients, with a lack of subspecialists around to consult.

    I would love to see someone who has spent their career as a GI or cards, jumping into a hospitalist job. A GI getting called on patients having chest pain, pneumonia patients getting more dyspneic. Dealing with the social stuff, ain’t going to happen, not a pretty sight.

     

     

    Click to expand…

    At the hospital my clinic is affiliated with, there are a couple retired Cards, one ID, and one fam practice guy that now do Hospitalist work. They seem to work the 7 on/7 off (12’s), but say it’s nice to not deal with the headache that comes with a regular practice. I think all clinic based sub specialists can relate for sure. I know a Pulm guy that takes 2-3 Hospitalist shifts a month and says it’s very nice to just round on 15-25 patients a day in the hospital with no concern about all the ancillary junk that comes with a clinic. Hospitalist definitely work as hard as anybody, but it’s a different kind of busy.

    #171210 Reply
    fatlittlepig fatlittlepig 
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    Status: Physician
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    Very odd to the fatlittlepig. must not have managed their money well to have to or want to work 12 hour days 7 days in a row as a retired cardiologist. Very odd indeed.

    #171214 Reply
    Liked by childay, octopus85

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