Am I crazy for thinking that hospital medicine is one of the best lifestyle specialties?

[Prehealth1011]

Nope. Part of that is for the reasons the above post goes over. Part of it is that if any doctors are gone a full day every single week the rest of us have to pick up the slack, and no one really wants to do that.

Thank you

Also, I know you've mentioned it before but please reassure us for those of us going through the hell that is IM "clinic" in residency...

How often do outpatient pcp jobs require you to do the paperwork/calls for prior authorizations?

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[collegestud2013]

I almost decided to not do fellowship and become a hospitalist last year before submitting ERAS. I think the draw of hospitalist is more for the younger crowd. I can't speak for PCP vs hospitalist but for any of the higher paying IM-subspecialties, the following factors would put them > hospital medicine:

1. Schedule - 7 on 7 off is great when you are young and single, but if you have kids, that means you are going to miss half the weekends, holidays, etc
2. Money - While making 300k is nice for just 3 years of training, the financial head start hospitalists have only lasts for 5-7 years, even if assuming you invest a substantial portion of income, before outpatient subspecialists catch up and surpasses exponentially
3. The work - Dealing with bread and butter medicine and dispo issues can be easy right out of residency because we are used to this, but I think 10+ years down the road, hospitalists may get bored of their work or feel like a cog in the system. Having to always answer to admin regarding why patients aren't being discharged and etc can also take a toll.
4. Personal health - This applies more-so to nocturnists or hospitalists who have to rotate with some nights mixed in. As a resident, I moonlighted many nights for that extra money but it took a big toll on my personal health. Even as a pre-30 year old, I was experiencing issues with sleep deprivation, GERD, concentration issues, etc. I can't imagine having to sustain that kind of lifestyle after training.

1. 7on/7off isn't the only hospitalist schedule out there but it's the most common since it's the easiest to schedule. It also works well for people have a 2nd job or travel a lot since it blocks a full week a time but obviously not for everyone.

Some places you an do 5 on/5 off which works better for some people as working 7 days in a row can lead to burnout. And at academic jobs, it's more close to Mon-Fri 9AM-5PM with some days rotating in on call, and rotating in on weekends once in a while.

2. In terms of money, hospitalists actually come pretty close to the higher paying IM subspecialties once you consider the shorter training time, hours worked, and progressively higher tax rates at higher incomes. The typical 7on/7off hospitalist these days starts in low $300k's, but a standard 7 on/7off schedule consisting of 12 hr shifts comes out to 2184 hrs per year, which is less hours most physicians work. For example in cardiology it's very common to work around 60 hrs per week, and with the standard 4 weeks of vacation per year, which comes out to 60 hrs/wk x 48 weeks = 2880 hrs. A hospitalist working the same number of hours would make a bit over $400k at most non-academic places these days. That may be lower than the $500-550k that a cardiologist would get paid but the cardiologist starts working 3 years later, and with Biden's new tax hikes for those making over $400k you can be paying upwards of 50% in combined federal+state taxes if you're in a high tax state. So the amount of time the specialist needs to catch up financially is likely much longer than 5-7 years post-residency and more like late career.

3. HM is definitely far from perfect. Burnout and turnover can be high at many places. Besides transitioning to outpatient IM, doing fellowship, cutting back on shifts, or leaving clinical medicine, one can transition to a cush academic job (with residents on service doing most of the work) or VA job

4. Just like most fields in medicine, future job stability is questionable for HM. It's already getting saturated in the more desirable places and barriers to entry among the lowest since any IM or FM trained physician can do it, and there's some possibility for midlevel creep.

 

[Appellatelove]

Nope. Part of that is for the reasons the above post goes over. Part of it is that if any doctors are gone a full day every single week the rest of us have to pick up the slack, and no one really wants to do that.

Why another doctor would pick up the slack? I've been told multiple times I could work part-time as a primary care doctor (3 days a week) is that not the case?

 

[Prehealth1011]

If you're an academic hospitalist doing week on week off, are you 100% off in your week off?

 

[gutonc]

Why another doctor would pick up the slack? I've been told multiple times I could work part-time as a primary care doctor (3 days a week) is that not the case?

If the group you join is down with that, then you’re fine. If everyone else is doing 4.5 days and you’re doing 2 or 3, there may be some resentment in terms of covering your patients when you’re gone.

YMMV of course.

 

[VA Hopeful Dr]

Why another doctor would pick up the slack? I've been told multiple times I could work part-time as a primary care doctor (3 days a week) is that not the case?

Say you don't work Thursday or Friday. You have a patient call with an urgent issue Thursday afternoon. There are basically 3 ways to deal with this:

1. You can do what my part time partner does which is check her computer multiple times/day on her days off. Kinda defeats the purpose of taking that time off, but it gets the job done.

2. Direct all patients to somewhere else like an urgent care. Patients don't like that.

3. Your partners will have to deal with it. We don't like that either.

 

[VA Hopeful Dr]

Thank you

Also, I know you've mentioned it before but please reassure us for those of us going through the hell that is IM "clinic" in residency...

How often do outpatient pcp jobs require you to do the paperwork/calls for prior authorizations?

I sign paperwork, I rarely do anything more than that.

I don't do PAs at all, haven't seen one in years. The nurses do 100% of them.

The biggest positive difference is the control you have. Outside the of hitting a very low minimum productivity, I get to make the rules to my schedule as I see fit. My nurses essentially work for me, if they aren't good they get replaced. If a patient shows out, I can dismiss them. No one else is looking over my shoulder and criticizing how I practice.

 

[Appellatelove]

Say you don't work Thursday or Friday. You have a patient call with an urgent issue Thursday afternoon. There are basically 3 ways to deal with this:

1. You can do what my part time partner does which is check her computer multiple times/day on her days off. Kinda defeats the purpose of taking that time off, but it gets the job done.

2. Direct all patients to somewhere else like an urgent care. Patients don't like that.

3. Your partners will have to deal with it. We don't like that either.

Does that mean on vacations- the six weeks mentioned here that partners are upset to cover those days. Does it lead to not taking vacation to ensure that no one is resentful?

 

[VA Hopeful Dr]

Does that mean on vacations- the six weeks mentioned here that partners are upset to cover those days. Does it lead to not taking vacation to ensure that no one is resentful?

Not at all. Vacations don't require coverage every single week. Plus, we all take vacations so its more or less evenly split.

 

[fooli_doc]

Both myself and the other physician in the practice take a full day off per week so the coverage thing balances out. We also each supervise a NP that works on the days we don't. That kind of solves the issue with patient coverage.

I will say the constant inbox influx can be a huge grind. So much so that I will offen clear my box on my day off (Fridays) just to not make my Monday morning worse than it already is naturally. I've made a habit of not leaving anything to the next day. It's probably the only way to not fall behind.

A lot of good outpatient advice here. If you aren't pretty much dictating how you want things done for your practice, you're probably at the wrong job.

 

[Osteoth]

How about traditional practice?

6-8am in the hospital
830-430 in the clinic

At least for the first few years out of residency to pay back the loans

 

[chessknt]

How about traditional practice?

6-8am in the hospital
830-430 in the clinic

At least for the first few years out of residency to pay back the loans

This is an inferior model to dedicated inpatient care. Marginal increase in income (I guess it could be a lot if your inpatient census is high) but how do you coordinate anything if you are only available for 2 hours before social work even starts and round without the nurse since their change of shift happens? What happens if there is an urgent concern (eg crushing chest pain)-- are you going to interrupt your clinic encounters to answer pages immediately every time it goes off? What if the patient has an RRT and the rapid team needs to communicate with you and the patient needs to be assessed to see if there is a need for escalation in care?

 

[AMEHigh]

I agree that it's a matter of preference. No job is perfect.

One of your points does not hold too much water. I used to work at 8-5 job when I was a RN, and by the time I got home it's almost 6pm and there was nothing to do with anybody except close family members. Many of your friends are tired and just stay home to hang out with their family.

However, I agree about not having every weekend off.

Both settings have their pluses and minuses. But hospitalist jobs have more pluses IMO. Hence, it's growing to the point it is kind of its own specialty now.

Maybe it’s cause I live in a large city, but there’s tons of stuff that happens after 6:30pm to do lol.
I just started a knitting class that’s from 7-8 every week. I used to take a foreign language class that started at 7. I often go to dinner with my friends during the week around 6:30 or 7. Gym classes, plays, other random events that start at 7pm, And the list goes on.

Anyway, I work Mon-Thur so to answer OPs question, working 7 days in a row, including weekends and holidays and 12 hour shifts sounds like hell compared to Mon-Thur 7 hours a day.

 

[Splenda88]

Maybe it’s cause I live in a large city, but there’s tons of stuff that happens after 6:30pm to do lol.
I just started a knitting class that’s from 7-8 every week. I used to take a foreign language class that started at 7. I often go to dinner with my friends during the week around 6:30 or 7. Gym classes, plays, other random events that start at 7pm, And the list goes on.

Anyway, I work Mon-Thur so to answer OPs question, working 7 days in a row, including weekends and holidays and 12 hour shifts sounds like hell compared to Mon-Thur 7 hours a day.

You happen to have the perfect schedule in medicine.

 

[Crayola227]

How about traditional practice?

6-8am in the hospital
830-430 in the clinic

At least for the first few years out of residency to pay back the loans

There's a lot of reasons you don't really see this model practice as much now. And definitely not a big moneymaker over the other models or you'd see it more.

You see it in academia sometimes, and also docs that want to be old school ownership of patient. Also in rural areas where there just aren't as many hospitalists to hand your outpt patients over to.

 

[VA Hopeful Dr]

How about traditional practice?

6-8am in the hospital
830-430 in the clinic

At least for the first few years out of residency to pay back the loans

The increase in income isn't that much and the lifestyle for that can be rough.

 

[Osteoth]

This is an inferior model to dedicated inpatient care. Marginal increase in income (I guess it could be a lot if your inpatient census is high) but how do you coordinate anything if you are only available for 2 hours before social work even starts and round without the nurse since their change of shift happens? What happens if there is an urgent concern (eg crushing chest pain)-- are you going to interrupt your clinic encounters to answer pages immediately every time it goes off? What if the patient has an RRT and the rapid team needs to communicate with you and the patient needs to be assessed to see if there is a need for escalation in care?

Definitely less efficient. Why marginal increase? If you see 15 patients per AM, each progress note is like ~$50, 15*$50=$750/day extra, lets say you do it every day, thats $22,500 per month, or $270,000 per year. Pretty close to the same as clinic pay, no?

Yes answer pages between patients. Obviously can't be there for RRT, but can communicate with code team.

There's a lot of reasons you don't really see this model practice as much now. And definitely not a big moneymaker over the other models or you'd see it more.

You see it in academia sometimes, and also docs that want to be old school ownership of patient. Also in rural areas where there just aren't as many hospitalists to hand your outpt patients over to.

See above, why isn't it a big increase in $?

The increase in income isn't that much and the lifestyle for that can be rough.

Same question, why wouldn't it be a big increase in $? Calculation above.

 

[jdh71]

Eh, this doesn't take into acct other factors like how the way most IM programs are heavily skewed to inpt and how outpt clinic is often structured in a way that on top of inpt duties basically is the best way to expose people to the worst aspects of continuity clinic and the upsides can frequently get lost.

It's been talked about for some time how IM training has contributed to the hospitalist trend, and it isn't necessarily because inpt is so superior to working outpt.

The exposures can also make new attending grads feel pretty lost when it comes to outpt management and issues.

The path of least resistance for many is to work as hospitalists because that is the type of work most similar to what they've done in training.

This.

Working clinic is HARDER than working in the hospital even if there are differences in hours. It takes a long time to get good at clinic. A long time. But at some point, probably about 5 years out from training, you’ll know what you are going to do with a patient even before waking in the room with them. You have to embrace that suck until then. Once clinic gets easy you can kill because taking on extra shifts or adjusting your schedule to see more getting the production machine cranking very nicely.

Being a hospitalist is a lot like getting actually paid to be a resident. You come out of residency knowing how to do the job. ED calls or some surgeon/cardiologist dumps. You admit. You consult where appropriate. You gets the tests as appropriate. You figure out the discharge needs and plans. Done.

Also unless they redo the wrvu for inpatient visits, you can do better while documenting much less seeing 12-14 in clinic every day than the same number in the hospital on a day time day basis.

 

[chessknt]

Definitely less efficient. Why marginal increase? If you see 15 patients per AM, each progress note is like ~$50, 15*$50=$750/day extra, lets say you do it every day, thats $22,500 per month, or $270,000 per year. Pretty close to the same as clinic pay, no?

Yes answer pages between patients. Obviously can't be there for RRT, but can communicate with code team.

See above, why isn't it a big increase in $?

Same question, why wouldn't it be a big increase in $? Calculation above.

In this model these are your clinic patients not just a random census of people. You aren’t going to have 15 inpatients, you might have 2-5.

There is a doc that does this in my community with his inpatients—the care they receive is clearly inferior and he is nowhere to be seen whenever there is a problem.

 

[VA Hopeful Dr]

Definitely less efficient. Why marginal increase? If you see 15 patients per AM, each progress note is like ~$50, 15*$50=$750/day extra, lets say you do it every day, thats $22,500 per month, or $270,000 per year. Pretty close to the same as clinic pay, no?

Yes answer pages between patients. Obviously can't be there for RRT, but can communicate with code team.

See above, why isn't it a big increase in $?

Same question, why wouldn't it be a big increase in $? Calculation above.

How many of your patients do you think will be admitted at any given time?

My panel is over 50% Medicare. Pre-Covid I never had more than 2-3 inpatients at any given time. So you get up early, drive to the hospital, and see a literal handful of patients. Then you have to be answering calls for them throughout the day which delays clinic and you may have to go back to the hospital that evening for family meetings or other follow up.

I can double book two patient appointments during the day and make more than those handful of inpatient visits will make.

 

[VA Hopeful Dr]

In this model these are your clinic patients not just a random census of people. You aren’t going to have 15 inpatients, you might have 2-5.

There is a doc that does this in my community with his inpatients—the care they receive is clearly inferior and he is nowhere to be seen whenever there is a problem.

This exactly.

 

[AMEHigh]

You happen to have the perfect schedule in medicine.

I know multiple people who don’t work 5 days/week who completed family med residency. So I guess we’re all lucky! 7 days a week, no thanks!

 

[Osteoth]

In this model these are your clinic patients not just a random census of people. You aren’t going to have 15 inpatients, you might have 2-5.

There is a doc that does this in my community with his inpatients—the care they receive is clearly inferior and he is nowhere to be seen whenever there is a problem.

How many of your patients do you think will be admitted at any given time?

My panel is over 50% Medicare. Pre-Covid I never had more than 2-3 inpatients at any given time. So you get up early, drive to the hospital, and see a literal handful of patients. Then you have to be answering calls for them throughout the day which delays clinic and you may have to go back to the hospital that evening for family meetings or other follow up.

I can double book two patient appointments during the day and make more than those handful of inpatient visits will make.

Oh wow so in a panel of 3,000-5,000 you usually only have 2-5 inpatients?

I assumed you'd have more.

I guess if I wanted to practice inpatient & outpatient I could join an IPA that would let me see their inpatients in addition to my own and then go to clinic?

 

[chessknt]

Oh wow so in a panel of 3,000-5,000 you usually only have 2-5 inpatients?

I assumed you'd have more.

I guess if I wanted to practice inpatient & outpatient I could join an IPA that would let me see their inpatients in addition to my own and then go to clinic?

Honestly you’re better off in a subspecialty if you want a blended practice. Cardiology, nephrology, and Pulm/crit all have various versions of blended models that are way less clunky than pcp rounding

 

[VA Hopeful Dr]

Oh wow so in a panel of 3,000-5,000 you usually only have 2-5 inpatients?

I assumed you'd have more.

I guess if I wanted to practice inpatient & outpatient I could join an IPA that would let me see their inpatients in addition to my own and then go to clinic?

Those are stupidly large panels. I'm the 3rd busiest FP in my system and I only have 2200ish.

 

[FutureInternist]

I LOVE being a hospitalist.

I used to be in a more flexible job where we had to do a minimum of 5 days in a row, for continuity, up to a max of 10 so we don’t get burnt out.

Now I am in a somewhat strict 7 on/7 off schedule.

I have friends (and enemies 😉) who do PCP, and while the work day may be shorter, they do have to return pt’s messages, follow up on their labs & call in Rxs or have them to go to UC/ED, have to keep asking their pts to get their screening tests, dealing with God Awful “DC summaries” from some of my colleagues which amount to nothing more than a copy/paste of their last note which doesn’t tell them the result of the EGD or cath that their pt had.

My shift is 7a-7p.
Average census of 16
Get there by 630, pts seen, DCs done, orders and notes written… by maximum 1 pm.
If admitter needs help, do some admits for extra RVU.
If not, then home by 330-4, cos leaving at 1 is REALLY rubbing it in the face of the slowpokes in our group.
Phone/epic chat messages till 7, but if you handled everything before leaving then those are a minimum.
Nap for 30-60 mins, and by the time my shift “finishes” I am fresh for hanging out with wife (if she wants 😏), or kid (if she wants, cos I only am noticed when wife is not around 😢).

Weekends are usually even easier ‘cos BCBS, Molina, your local SNF don’t have any staff working, so no DCs, and usually home by noon.

Some of my colleagues work at a rehab on their “on” week as well, so on the way home they will round on 10-14 SNF pts that are very stable and get another $600-900 for their day.

We have a separate nocturnist core group, but even if we didn’t, given our size, I would need to work 1 week of nights Q 3 months.

There also is a lot more to actually do for the patient, given their acute issues and hospitalisation, whereas outpt can have some “my opinion is that nothing needs to be done for your chronic insomnia, back pain, etc” and from my very brief stint in outpt (while waiting for 2 hospitalist to move so I could take one of the spots), there can be a sense of disappointment for the pt, and maybe some not so nice “discussions” about you not taking care of them.

Having said ALL that, PCPs help keep pts out of the hospital, and help them live better, longer lives…. And I would shoot myself in the brain if I ever have to do it (maybe at 55 yoa when I’m planning on going down to part-time)

IF you have a day admitter, and IF its a “round and go”, then you can really get things done early, and be home before you get completely burnt out.

A lot of places have a 2-3 year contract with a sign-on bonus.
Nothing says you can’t try it, while maybe even working 1-2 days on your week off as a PCP (or UC) just to get a feel for it and then make the switch when contract is up.

 

[FutureInternist]

How about traditional practice?

6-8am in the hospital
830-430 in the clinic

At least for the first few years out of residency to pay back the loans

Recipe for disaster.
Who would cover for you at hospital, or lay eyes on a pt that needs to be assessed?
If a rapid gets called?
Consultants call back at all hours of the day, so clinic pts will keep getting interrupted.
With so many hospitals having a hospitalist team why would they willingly give you their business?

“Never half-ass two things, whole ass one thing” - Ron Swanson

 

[Osteoth]

I LOVE being a hospitalist.

I used to be in a more flexible job where we had to do a minimum of 5 days in a row, for continuity, up to a max of 10 so we don’t get burnt out.

Now I am in a somewhat strict 7 on/7 off schedule.

I have friends (and enemies 😉) who do PCP, and while the work day may be shorter, they do have to return pt’s messages, follow up on their labs & call in Rxs or have them to go to UC/ED, have to keep asking their pts to get their screening tests, dealing with God Awful “DC summaries” from some of my colleagues which amount to nothing more than a copy/paste of their last note which doesn’t tell them the result of the EGD or cath that their pt had.

My shift is 7a-7p.
Average census of 16
Get there by 630, pts seen, DCs done, orders and notes written… by maximum 1 pm.
If admitter needs help, do some admits for extra RVU.
If not, then home by 330-4, cos leaving at 1 is REALLY rubbing it in the face of the slowpokes in our group.
Phone/epic chat messages till 7, but if you handled everything before leaving then those are a minimum.
Nap for 30-60 mins, and by the time my shift “finishes” I am fresh for hanging out with wife (if she wants 😏), or kid (if she wants, cos I only am noticed when wife is not around 😢).

Weekends are usually even easier ‘cos BCBS, Molina, your local SNF don’t have any staff working, so no DCs, and usually home by noon.

Some of my colleagues work at a rehab on their “on” week as well, so on the way home they will round on 10-14 SNF pts that are very stable and get another $600-900 for their day.

We have a separate nocturnist core group, but even if we didn’t, given our size, I would need to work 1 week of nights Q 3 months.

There also is a lot more to actually do for the patient, given their acute issues and hospitalisation, whereas outpt can have some “my opinion is that nothing needs to be done for your chronic insomnia, back pain, etc” and from my very brief stint in outpt (while waiting for 2 hospitalist to move so I could take one of the spots), there can be a sense of disappointment for the pt, and maybe some not so nice “discussions” about you not taking care of them.

Having said ALL that, PCPs help keep pts out of the hospital, and help them live better, longer lives…. And I would shoot myself in the brain if I ever have to do it (maybe at 55 yoa when I’m planning on going down to part-time)

IF you have a day admitter, and IF its a “round and go”, then you can really get things done early, and be home before you get completely burnt out.

A lot of places have a 2-3 year contract with a sign-on bonus.
Nothing says you can’t try it, while maybe even working 1-2 days on your week off as a PCP (or UC) just to get a feel for it and then make the switch when contract is up.

Yeah it seems like your job is a unicorn. I'm a PGY2 casually looking at jobs now and it seems like there are A LOT of bad hospitalist jobs out there. It seems like the median PCP job is better than the worst hospitalist, but obviously jobs like yours are way better than the median PCP job.

Any tips for landing a gig like this? I'm in socal, so very competitive...

 

[FutureInternist]

Yeah it seems like your job is a unicorn. I'm a PGY2 casually looking at jobs now and it seems like there are A LOT of bad hospitalist jobs out there. It seems like the median PCP job is better than the worst hospitalist, but obviously jobs like yours are way better than the median PCP job.

Any tips for landing a gig like this? I'm in socal, so very competitive...

I’m in ABQ, NM.
Didn’t really look for a job since needed to stay here for family reasons.
Guess I got lucky.

 

[InternistDO]

Who would cover for you at hospital, or lay eyes on a pt that needs to be assessed?
If a rapid gets called?
Consultants call back at all hours of the day, so clinic pts will keep getting interrupted.
With so many hospitals having a hospitalist team why would they willingly give you their business?

“Never half-ass two things, whole ass one thing” - Ron Swanson

While this is all true, there are still a decent amount of PCPs who do traditional practice and I believe when studied there’s no difference in mortality between them and dedicated hospitalists.

The big issue is that my attendings who did this worked their butts off keeping up with all the things you mentioned. If you have a midlevel or resident service covering during the day/overnight it’s probably more doable.

 

[Splenda88]

I LOVE being a hospitalist.

I used to be in a more flexible job where we had to do a minimum of 5 days in a row, for continuity, up to a max of 10 so we don’t get burnt out.

Now I am in a somewhat strict 7 on/7 off schedule.

I have friends (and enemies 😉) who do PCP, and while the work day may be shorter, they do have to return pt’s messages, follow up on their labs & call in Rxs or have them to go to UC/ED, have to keep asking their pts to get their screening tests, dealing with God Awful “DC summaries” from some of my colleagues which amount to nothing more than a copy/paste of their last note which doesn’t tell them the result of the EGD or cath that their pt had.

My shift is 7a-7p.
Average census of 16
Get there by 630, pts seen, DCs done, orders and notes written… by maximum 1 pm.
If admitter needs help, do some admits for extra RVU.
If not, then home by 330-4, cos leaving at 1 is REALLY rubbing it in the face of the slowpokes in our group.
Phone/epic chat messages till 7, but if you handled everything before leaving then those are a minimum.
Nap for 30-60 mins, and by the time my shift “finishes” I am fresh for hanging out with wife (if she wants 😏), or kid (if she wants, cos I only am noticed when wife is not around 😢).

Weekends are usually even easier ‘cos BCBS, Molina, your local SNF don’t have any staff working, so no DCs, and usually home by noon.

Some of my colleagues work at a rehab on their “on” week as well, so on the way home they will round on 10-14 SNF pts that are very stable and get another $600-900 for their day.

We have a separate nocturnist core group, but even if we didn’t, given our size, I would need to work 1 week of nights Q 3 months.

There also is a lot more to actually do for the patient, given their acute issues and hospitalisation, whereas outpt can have some “my opinion is that nothing needs to be done for your chronic insomnia, back pain, etc” and from my very brief stint in outpt (while waiting for 2 hospitalist to move so I could take one of the spots), there can be a sense of disappointment for the pt, and maybe some not so nice “discussions” about you not taking care of them.

Having said ALL that, PCPs help keep pts out of the hospital, and help them live better, longer lives…. And I would shoot myself in the brain if I ever have to do it (maybe at 55 yoa when I’m planning on going down to part-time)

IF you have a day admitter, and IF its a “round and go”, then you can really get things done early, and be home before you get completely burnt out.

A lot of places have a 2-3 year contract with a sign-on bonus.
Nothing says you can’t try it, while maybe even working 1-2 days on your week off as a PCP (or UC) just to get a feel for it and then make the switch when contract is up.

My gig is not as good as yours since I cant leave at 3-4pm, but 5 days/wk as outpatient PCP is a non starter for me. 4 days/wk (M-Thur) PCP is actually great.

 

[VA Hopeful Dr]

While this is all true, there are still a decent amount of PCPs who do traditional practice and I believe when studied there’s no difference in mortality between them and dedicated hospitalists.

The big issue is that my attendings who did this worked their butts off keeping up with all the things you mentioned. If you have a midlevel or resident service covering during the day/overnight it’s probably more doable.

No mortality difference. Lower cost for traditional, shorter LOS for hospitalist.

 

[Osteoth]

My gig is not as good as yours since I cant leave at 3-4pm, but 5 days/wk as outpatient PCP is a non starter for me. 4 days/wk (M-Thur) PCP is actually great.

A lot of my seniors have been getting $250k+ 4-4.5 days per week PCP gigs. 4-6 weeks vacation.

 

[Prehealth1011]

^ Same. The outpatient PCP offers my seniors are getting are substantially better than hospitalist offers

 

[Splenda88]

A lot of my seniors have been getting $250k+ 4-4.5 days per week PCP gigs. 4-6 weeks vacation.

I have an OK job right now where I can make 400k/yr if I want to work a little bit extra without killing myself. In addition, my job is not that hard either. Outpatient medicine comes with its headache that I dont want to deal with right now. Let's just say I can tolerate the inpatient BS better than the outpatient...

 

[Osteoth]

I have an OK job right now where I can make 400k/yr if I want to work a little bit extra without killing myself. In addition, my job is not that hard either. Outpatient medicine comes with its headache that I dont want to deal with right now. Let's just say I can tolerate the inpatient BS better than the outpatient...

Yeah the big thing is that corporate America is trying to strangle small primary care. The big value add is ancillaries for PCP, doing your own ekg, labs, X-ray.

 

[VA Hopeful Dr]

I have an OK job right now where I can make 400k/yr if I want to work a little bit extra without killing myself. In addition, my job is not that hard either. Outpatient medicine comes with its headache that I dont want to deal with right now. Let's just say I can tolerate the inpatient BS better than the outpatient...

And that's really the key: finding the job that you can tolerate the BS aspects of the best.

 

[tylerb1800]

A lot of my seniors have been getting $250k+ 4-4.5 days per week PCP gigs. 4-6 weeks vacation.

The thing to remember about outpatient positions is that this is base salary. Every position I looked at hit maximum income in 3 to 5 years. RVU bonus can be significant depending on your contract as well as value-based compensation from the medicare advantage plans. My RVU bonus started rolling in at the 2.5 year mark. Value-based monies continue to increase for me as well.

 

[Appellatelove]

The thing to remember about outpatient positions is that this is base salary. Every position I looked at hit maximum income in 3 to 5 years. RVU bonus can be significant depending on your contract as well as value-based compensation from the medicare advantage plans. My RVU bonus started rolling in at the 2.5 year mark. Value-based monies continue to increase for me as well.

What’s the average bonus one can expect?

 

[Osteoth]

The thing to remember about outpatient positions is that this is base salary. Every position I looked at hit maximum income in 3 to 5 years. RVU bonus can be significant depending on your contract as well as value-based compensation from the medicare advantage plans. My RVU bonus started rolling in at the 2.5 year mark. Value-based monies continue to increase for me as well.

Yeah it seems like quick money hospitalist is better long money PCP probably wind.

What do you think your max salary is going to be? Also how hard is it to find small partnerships in primary care these days?

 

[VA Hopeful Dr]

What’s the average bonus one can expect?

Depends on how busy you are and how much vacation you take

 

[tylerb1800]

Bonus depends on a slew of factors. Contracts can vary between collections vs RVU-based. Typically with collections-based contracts, your only bonus will be value-based money from Medicare advantage plans but you get to collect money from your ancillary services. RVU-based contracts and collections-based contracts, at least in the city that I am in, were fairly similar for compensation. My bonus this year will be >100k easy. I am unsure yet what my value money will be for this year but I know it will be more than last year.

Primary care at the end of the day is whatever you want to make it. You can make good money or you can make more depending on how much you want to work. None of the primary care docs in my town work 5 days a week. Most do either 4 or 4.5 days.

 

[Appellatelove]

Bonus depends on a slew of factors. Contracts can vary between collections vs RVU-based. Typically with collections-based contracts, your only bonus will be value-based money from Medicare advantage plans but you get to collect money from your ancillary services. RVU-based contracts and collections-based contracts, at least in the city that I am in, were fairly similar for compensation. My bonus this year will be >100k easy. I am unsure yet what my value money will be for this year but I know it will be more than last year.

Primary care at the end of the day is whatever you want to make it. You can make good money or you can make more depending on how much you want to work. None of the primary care docs in my town work 5 days a week. Most do either 4 or 4.5 days.

Good to know- I was actually worried about the opposite problem that the base was too high to reel ppl in and then once it became collections, you'd make alot less.

 

[tylerb1800]

Good to know- I was actually worried about the opposite problem that the base was too high to reel ppl in and then once it became collections, you'd make alot less.

With primary care, the clinic or hospital is essentially subsidizing your pay for anywhere from 1 to 3 years. That is the main reason salaries are lower initially than hospitalist. I remember when I first started that I had days where I saw four or five patients since I was brand new to the clinic. You know the clinic is losing money on that.
My friend who has been in practice for a few years more than me is on collections. His take home before taxes is around ~30k/month seeing 20 to 24. That does not include value-based bonus.

 

[PrimaryCareDOToBe]

Most outpatient docs I know don’t do 5 FULL days of clinic like you describe. Some do, but most do 4-4.5. Even if you do 5, you’re basically working normal job hours. You think engineers and financiers go home at 2pm everyday?

Hospitalists give up half of their weekends, which some find to be untenable. For people that don’t, it’s a fine lifestyle assuming the night shift problem is solved (have nocturnists at your shop).
Ultimately, I view hospital medicine as in a precarious situation given they are completely at the mercy of hospital admin. Most places are moving to midlevel staffing model, which I suspect will only expedite in the future.

in the outpatient world, there’s only so much market share midlevels can take since a lot of patients refuse to pay full price for a lesser practitioner. I’m seeing this more and more

No matter what there will be hospitalists overseeing midlevels and needing to see their own patients. I think with COVID putting a strain on things, of course there is probably a sudden flux in midlevels seeing more patients, but no matter what these patients are very sick if they're being admitted........ NPs/PAs just don't have the clinical finesse to work alone. I'd rather a PA be on each team acting like a perma intern forever than being off seeing their own patients.

I've heard of stories in the complete reverse - PAs and NPs hired in mass in the hospital -- Then suddenly they had to shift gears because the specialists/techs complained about the useless consults / imaging / labs , etc.

 

[PrimaryCareDOToBe]

Are there any Hospitalist jobs that are more 7-3 or 4 M-F rather than 7-7 for 7 on 7 off? I understand the reasons behind 7 days of continuity, but, in reality, couldn't you kinda be really helpful to the overall team if you were more of a consistent "Floating" force who is just a Primary Care/Emergent Hospitalist who is always around M-F 7-3/4? I feel like the consistency of one or two people always being there during major hours can be helpful. And of course maybe that person changes every few months or so.

 

[aafisahar]

Are there any Hospitalist jobs that are more 7-3 or 4 M-F rather than 7-7 for 7 on 7 off? I understand the reasons behind 7 days of continuity, but, in reality, couldn't you kinda be really helpful to the overall team if you were more of a consistent "Floating" force who is just a Primary Care/Emergent Hospitalist who is always around M-F 7-3/4? I feel like the consistency of one or two people always being there during major hours can be helpful. And of course maybe that person changes every few months or so.

Nobody is paying you for hanging out and a 5 day schedule means they still need a hospitalist to cover the days you aren't around. You're there to see patients not potentially see patients. Either it's admitting duty or rounding. You're looking for more like prn duty which you can find but it'll come without benefits or consistency.

 

[Splenda88]

Are there any Hospitalist jobs that are more 7-3 or 4 M-F rather than 7-7 for 7 on 7 off? I understand the reasons behind 7 days of continuity, but, in reality, couldn't you kinda be really helpful to the overall team if you were more of a consistent "Floating" force who is just a Primary Care/Emergent Hospitalist who is always around M-F 7-3/4? I feel like the consistency of one or two people always being there during major hours can be helpful. And of course maybe that person changes every few months or so.

My gut feeling based on the limited pool of hospitalist I have worked with so far is that 75% would be against a M-F 8-5pm shift if offered... Some of these guys love the 7 days on/off. A few of them maintain 2 residences in 2 different states and fly every week.

One guy at my place do 2 FT jobs, nocturnist/hospitalist and it seems like he has been doing it for ~3 yrs.

Some of these guys finish their work by 2-3pm and just stand around doing nothing.

I think the hospitalist shift is of one that you either HATE it or LOVE it.

 

[AshNiffler]

No one will have all sick patients in their panel. I have had anywhere from 14-18 patients since I started and ~5 them are really sick.

I trained in the biggest trauma center in my state and half of the patients in our census of 18 were really sick.

No one is saying there is a perfect job out there. But I think hospital medicine offers a good work-life balance.

I typically see well over 18 consistently but maybe like 5 or less are actually sick. A lot of admits for caths or ablations, stable to discharge the next day. The Watchman procedure patients go home the same day!

 

[bronx43]

No matter what there will be hospitalists overseeing midlevels and needing to see their own patients. I think with COVID putting a strain on things, of course there is probably a sudden flux in midlevels seeing more patients, but no matter what these patients are very sick if they're being admitted........ NPs/PAs just don't have the clinical finesse to work alone. I'd rather a PA be on each team acting like a perma intern forever than being off seeing their own patients.

I've heard of stories in the complete reverse - PAs and NPs hired in mass in the hospital -- Then suddenly they had to shift gears because the specialists/techs complained about the useless consults / imaging / labs , etc.

I must clarify. I don't mean that ALL hospital medicine will go to midlevels - just enough to destroy the job market. Even at my academic institution, they are hiring midlevels. At smaller hospitals, it's getting close to 50/50.