First Job Offer, Im lost

[gutonc]

Same. From the med onc perspective how is it perceived to get these autos back after D+30? Assuming that they are tucked in with central line removed, no transfusion requirements or lingering regimen related toxicity, and otherwise straightforward visits for maintenance therapy and the like?

I'll send them somewhere else next time. Seriously.

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[CatFactorial]

For the most part unless you are doing transplants regularly one doesnt keep up with all the new protocols and required schedules. If they come back D30+ with a plan from the transplanter then its fine.

I'll send them somewhere else next time. Seriously.

Interesting, what’s the objection if there’s a plan as described by MD46?

Wouldn’t it be easy follow up revenue?

 

[hotsaws]

"Shortages" are also the result of the high maintenance and neediness of the American public. In less affluent countries, you go to the doctor, get a diagnosis, receive a medication, then you go home. You get maybe 5 minutes with the doctor. The doctor won't hold your hand, spend 30 minutes discussing every detail you want to know, then jump through 10 hoops to convince you to take a medication with favorable risk versus benefit. They won't entertain the anecdotal concerns you have from reading webmd or the online help group on reddit. If you didn't have a disease, the doctor told you to go home and you do. The doctor doesn't sit there and listen to symptoms of the human condition for 50 minutes then offer no specific therapy.

The fact that seeing 18 patients in this country takes you the whole day (not to mention all the paperwork and unnecessary interfacing with the EMR) is a cosmic joke. If medicine made any sense at all, we would all be seeing 50/day and the shortages would disappear instantly.

This is one reason I wish we could bill the way lawyers do (or countless professions, for that matter). Let me bill in 6 min increments and I would be more inclined to treat the human condition. It's senseless that we are reimbursed relatively the same for treating straightforward disease in a high functioning patient as we are for treating complex disease in someone with challenging socioeconomic factors. Imagine trying to pay mechanics the same for an oil change on a new car as they get for some kind of complex engine repair...or lawyers the same for defending a dui vs a white collar fraud case...or accountants preparing a W2 employees taxes vs a small business...etc etc. Sure, there are some caveats, ie you can code a level 5 e/m visit based on time and or tag on some modifier in some cases but still quite different.

 

[MD46]

This is one reason I wish we could bill the way lawyers do (or countless professions, for that matter). Let me bill in 6 min increments and I would be more inclined to treat the human condition. It's senseless that we are reimbursed relatively the same for treating straightforward disease in a high functioning patient as we are for treating complex disease in someone with challenging socioeconomic factors. Imagine trying to pay mechanics the same for an oil change on a new car as they get for some kind of complex engine repair...or lawyers the same for defending a dui vs a white collar fraud case...or accountants preparing a W2 employees taxes vs a small business...etc etc. Sure, there are some caveats, ie you can code a level 5 e/m visit based on time and or tag on some modifier in some cases but still quite different.

And I have known people to get audited "randomly" if they bill too many level 5s. I had a senior partner before get in trouble for that by internal audit.

 

[hotsaws]

And I have known people to get audited "randomly" if they bill too many level 5s. I had a senior partner before get in trouble for that by internal audit.

Same. I think a lot of us are a bit hesitant to bill the level 5s, even when we legit spent the appropriate amount of time on the encounter for that very reason. I have been told by some of our senior partners that they have been doing it when appropriate and there hasn't been any problems. I have done it a few times and probably not done it when I should have.

 

[Choсolate]

Can someone please clarify in regards to the original job offer as whether it is typical to have only ONE week off per year as a hospitalist (besides the 7 on 7 off) schedule? It seems really low, and not something that sounds appealing.

 

[rokshana]

Maybe for the ones employed by a private practice, but I doubt hospital employed specialists (even in specialties that are primarily outpatient based) will be able to get out of inpatient duties at their respective hospitals. The non-procedural specialists often don't have to admit themselves from the ED at most hospitals (may be they do if it's their own scheduled elective admission), but they will still be expected to be on responsible for ED and inpatient calls for consults even at night. For example, if there's a stat consult on an endocrinology emergency like thyroid storm in in the middle of the night from the ED, they will need to come in and see the patient.

No I don’t…I talk to intensivist, since that is going to the icu, give recs for the medications that need to be started and see them the next day. It’s an emergency that needs to be aggressively treated…and I take that phone call at 2 am, but I don’t have to go in at 2am…

 

[Nocturnist]

Can someone please clarify in regards to the original job offer as whether it is typical to have only ONE week off per year as a hospitalist (besides the 7 on 7 off) schedule? It seems really low, and not something that sounds appealing.

You are seen as having 26 weeks off a year. It's actually pretty ATYPICAL to have any PTO as a hospitalist.

 

[Choсolate]

You are seen as having 26 weeks off a year. It's actually pretty ATYPICAL to have any PTO as a hospitalist.

Yes, that is obviously the case, but on the weeks you are working, you are putting in 80 hours and these hours spread out over two weeks means you are basically working full time all of the time. Like, what can someone even do outside of work when working 80 hours? Probably little to nothing.

 

[Nocturnist]

Yes, that is obviously the case, but on the weeks you are working, you are putting in 80 hours and these hours spread out over two weeks means you are basically working full time all of the time. Like, what can someone even do outside of work when working 80 hours? Probably little to nothing.

Preaching to the choir homie. What other professional working a full time job doesn't get paid vacation in this country?
I've always thought this was the biggest rip off in hospital medicine but I've given up on shaking my fist at them.

Agree you can't do much on your on weeks, the flip side is the rest of humanity is lucky to get a few 3 day weekends a year. They spend their Fridays unwinding from the week and Sunday dreading it. Any time off longer than a weekend has to be approved by your boss ahead of time.
I've been able to travel abroad almost monthly without asking for anyone's approval.

 

[Splenda88]

If anyone is interested. Posted in the hospitalist FB group

Portsmouth NH
Days 7-7
Community Academic with Tufts Affiliation
Academic appointments available
7 services daily:
5 IM, 1 FM, 1 non teaching
Currently recruiting for IM as FM service staffed
Average census 17
330k/year
5 K CME
1 hour to Boston and a beautiful area
No sales or income tax
DM or email me
[email protected]