Any bias against FM working as hospitalist?

[camng11]

Do hospitals hire IM docs over FM docs when it comes to job opportunities as hospitalists particularly in the big cities such as LA/SF etc?

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[Lexdiamondz]

Do hospitals hire IM docs over FM docs when it comes to job opportunities as hospitalists particularly in the big cities such as LA/SF etc?

Yes.

As you go into more suburban and rural areas this bias recedes. In general the more "desirable" the area, the more likely bias exists.

 

[septoplasty]

Yes, I've found this to be true in most of south west too Houston, Dallas, etc.

 

[Keona]

I’m in a rural location. There’s 0 prejudice here about it.

 

[FalseVanilla]

I’m in a rural location. There’s 0 prejudice here about it.

Thanks for posting. I'm about to start my FM residency this July. I know I may be jumping the gun but I'm ultimately interested in becoming a rural nocturnist. Do you have any advice for what I can/should do in my three years to help me prepare for that career?

 

[SLC]

Thanks for posting. I'm about to start my FM residency this July. I know I may be jumping the gun but I'm ultimately interested in becoming a rural nocturnist. Do you have any advice for what I can/should do in my three years to help me prepare for that career?

Rural nocturnist? More than likely you’ll be working in a half-full 15-bed hospital and they’ll want you to cover night and day. (Round in AM, and admit whenever an admission is needed).

 

[Keona]

I don’t work in the hospital. I think ours does 7 days on and 7 off and works a 12 hour shift but not 100% sure. I’m outpatient only.

 

[InternistDO]

I know one of the hospitals that I did my clerkships at hired IM or FM boarded for hospitalists. You could see the Empire State Building from the roof, which is pretty metropolitan. It was a poor area though.

 

[utahgetme2]

Thanks for posting. I'm about to start my FM residency this July. I know I may be jumping the gun but I'm ultimately interested in becoming a rural nocturnist. Do you have any advice for what I can/should do in my three years to help me prepare for that career?

I'm an FM resident on Long Island graduating in a few months. I've been interviewing for hospitalist jobs and about to settle on an offer. Yes, there is bias and many of the hospitals out here won't consider FM candidates. Just the way it is. As far as preparing for this career track, I would say a lot of it depends on the strength and volume of your program's inpatient medicine training. At most of my interviews, I was asked about how many months of inpatient medicine I had and why I felt I had sufficient training from an FM program for hospitalist medicine. If your program only has you doing a few months of medicine per year, you're going to want to take most of your electives on either more medicine service or something inpatient-related (ICU, cardiology, etc). Set up rotations to work with the hospitalists at your location. I used both my 3rd year elective months to work on the hospitalist service. It was good experience, solid boost to the CV and also gave me a couple of great recommendations/references to use when employers asked for them. Hope this helps

 

[Make Or Break]

I'm an FM resident on Long Island graduating in a few months. I've been interviewing for hospitalist jobs and about to settle on an offer. Yes, there is bias and many of the hospitals out here won't consider FM candidates. Just the way it is. As far as preparing for this career track, I would say a lot of it depends on the strength and volume of your program's inpatient medicine training. At most of my interviews, I was asked about how many months of inpatient medicine I had and why I felt I had sufficient training from an FM program for hospitalist medicine. If your program only has you doing a few months of medicine per year, you're going to want to take most of your electives on either more medicine service or something inpatient-related (ICU, cardiology, etc). Set up rotations to work with the hospitalists at your location. I used both my 3rd year elective months to work on the hospitalist service. It was good experience, solid boost to the CV and also gave me a couple of great recommendations/references to use when employers asked for them. Hope this helps

About How many months would you say someone would need to be comfortable in an inpatient setting?

 

[NITRAS]

Be aware different programs can be wildly different.

Where I’m at currently, the FM residency training in inpatient medicine appears to be abysmal. Their census rarely gets to double digits, and they are “protected” from anything that resembles work.

I know other programs work them hard on their inpatient months, and I’ve seen good FM hospitalists. Of the 40+ hospitalists in my group I believe there is only one FM. So, yes. If you want to work hospitalist jobs, IM will open more doors.

 

[utahgetme2]

About How many months would you say someone would need to be comfortable in an inpatient setting?

I agree with Nitras' comments. The number of months may not be the most important factor, but rather the quality of the training during those months. Where I am, the FM inpatient training is pretty strong and the hospital has hired many past grads as hospitalists.

But programs definitely vary wildly. I specifically remember interviewing at an FM program that told the candidates at the start of the interview day that if we were looking for a good inpatient medicine experience, this was not the place for them; that the focus of the program was solely on its outpatient training.

I also agree with Nitras that if you're serious about hospitalist work, IM is the way to go. I love FM and don't regret my decision, but it's definitely the non-traditional route for a hospitalist and I know I won't have as many opportunities as my IM colleagues.

 

[SLC]

Be aware different programs can be wildly different.

Where I’m at currently, the FM residency training in inpatient medicine appears to be abysmal. Their census rarely gets to double digits, and they are “protected” from anything that resembles work.

Dear lord,

We regularly capped out (20 patients) in our 2 intern team. We had terribly ill patients. Our attendings weren’t “hands off” in a negative way, but they sure trusted us, and expected a lot from us. As a senior resident, you really needed a strong reason to call for their backup in the night, like a patient better be dying and you not have a clue what to do (and then, expect a 1:1 “lesson” the next day).

We got worked hard, but we got excellent training. Multiple folks in my class are hospitalists now. I was just approached with a request to take over the hospitalist program at my current job, and I’m less than a year out of training.

 

[LeroyJenkinsMD]

There is bias against family medicine at some hospitals. I would estimate 10%. Fortunately it’s still easy to find a position because there are far more jobs available than people to fill them. There are still lots of jobs available to FM even in large cities at large hospitals. This bias is also lessening. Family physicians with a focused practice in hospital medicine can teach internal medicine residents since this exam is the new standard and was created jointly by ABIM and ABFM.

 

[MedicineZ0Z]

Be aware different programs can be wildly different.

Where I’m at currently, the FM residency training in inpatient medicine appears to be abysmal. Their census rarely gets to double digits, and they are “protected” from anything that resembles work.

I know other programs work them hard on their inpatient months, and I’ve seen good FM hospitalists. Of the 40+ hospitalists in my group I believe there is only one FM. So, yes. If you want to work hospitalist jobs, IM will open more doors.

So why do places take midlevels to be hospitalists with minimal supervision? They have less inpatient exp than I do in my 4th year now lol.

If you're at a consultant heavy place (basically any big hospital), you're almost like a secretary who treats CHF/COPD. Now if you're at those places where you have to respond to everything, intubate/put in central lines, manage vents/open ICUs etc. then yes absolutely you need a ton of quality inpatient training. But the ironic thing is, a lot (basically most) of IM residents aren't prepared for those jobs either!

 

[deleted87716]

So why do places take midlevels to be hospitalists with minimal supervision?

 

[MedicineZ0Z]

View attachment 254813

and until that issue is addressed, no reason for any doctor to claim that FM cannot do hospitalist work.

 

[deleted87716]

and until that issue is addressed, no reason for any doctor to claim that FM cannot do hospitalist work.

You are correct, sir.

 

[MedicineZ0Z]

You are correct, sir.

Stretches to other areas too. Always wondered why we hold such a high standard for doctors doing X work but then let people with a a minimal fraction of the training do that exact same work with minimal to no real supervision.

 

[deleted87716]

Stretches to other areas too. Always wondered why we hold such a high standard for doctors doing X work but then let people with a a minimal fraction of the training do that exact same work with minimal to no real supervision.

Sometimes (frequently), doctors are the ones making bank off the midlevels. Blame your colleagues.

 

[NITRAS]

Ahhhh. Classic SDN. Medical students trashing professions and mid levels.

 

[DO2015CA]

Sometimes (frequently), doctors are the ones making bank off the midlevels. Blame your colleagues.

Bingo. I know I have heard a lot of my peers saying they will never take a midlevel but we are young and idealistic. I wonder what will really happen when greed sets in.

 

[MedicineZ0Z]

Ahhhh. Classic SDN. Medical students trashing professions and mid levels.

Actually a lot of younger attendings do as well.

 

[deleted87716]

Bingo. I know I have heard a lot of my peers saying they will never take a midlevel but we are young and idealistic. I wonder what will really happen when greed sets in.

I'm old and crotchety, and I'll never work with a midlevel.

 

[DO2015CA]

I'm old and crotchety, and I'll never work with a midlevel.

And sir, that is why I respect you.

 

[camng11]

Thanks guys, I guess its just safer to choose IM if you plan to be a hospitalist right? You can always transition to outpatient after?

 

[LeroyJenkinsMD]

Depends on what type of outpatient you’re talking about eventually doing. Cash only or DPC? FM is safer. Cog in the machine? Doesn’t matter IM or FM.

 

[Sardonix]

Depends on what type of outpatient you’re talking about eventually doing. Cash only or DPC? FM is safer. Cog in the machine? Doesn’t matter IM or FM.

Safer? As in easier to get into?

It sounds like if they're dead set on being a hospitalist first, IM is definitely safer route to go. Anyone can do outpatient though, and IM is equally capable of DPC practices as well.

 

[septoplasty]

Anyone can do outpatient though, and IM is equally capable of DPC practices as well.

Well, not quite. DPC is less "marketable" if you only cater to adults. Parent's generally don't like to shaft kids from getting healthcare.

 

[VA Hopeful Dr]

Well, not quite. DPC is less "marketable" if you only cater to adults. Parent's generally don't like to shaft kids from getting healthcare.

I mean, kinda?

Not doing immunizations (and very few DPCs do) will cut the peds numbers down a fair bit.

Besides, the outpatient IM market is very good at present (mainly a shortage issue) so they can do DPC just fine from what I've seen.

 

[Sardonix]

Well, not quite. DPC is less "marketable" if you only cater to adults. Parent's generally don't like to shaft kids from getting healthcare.

I see your point, but the first DPC I met in person was an IM doc who was disillusioned with hospitalist life and started a DPC in the Midwest. He was actually one of the more successful DPC evangelists in the area and seemed to be doing pretty well. I'd imagine the Midwest's huge elderly population and their desire to see the physician for 30-60min tends to help with that.

 

[VA Hopeful Dr]

I see your point, but the first DPC I met in person was an IM doc who was disillusioned with hospitalist life and started a DPC in the Midwest. He was actually one of the more successful DPC evangelists in the area and seemed to be doing pretty well. I'd imagine the Midwest's huge elderly population and their desire to see the physician for 30-60min tends to help with that.

Pluses and minuses. You do lose out on some of the folks that want their whole family to see you. But there are still patients out there who think internists are better at adult outpatient medicine than we are. Probably about balances out.

 

[deleted87716]

Pluses and minuses. You do lose out on some of the folks that want their whole family to see you. But there are still patients out there who think internists are better at adult outpatient medicine than we are. Probably about balances out.

Internists who do DPC will likely be more challenged regarding the stuff they normally refer out, especially anything involving procedures (e.g., derm and ortho) unless they take some additional CME courses.

 

[VA Hopeful Dr]

Internists who do DPC will likely be more challenged regarding the stuff they normally refer out, especially anything involving procedures (e.g., derm and ortho) unless they take some additional CME courses.

I had thought about mentioning that, but my wife recently transition from hospitalist to outpatient and she's picking up procedures pretty quickly just using a good procedure book.

Now admittedly this might not be as easy if someone made the transition at age 50 compared to age 34.