Home hospitalist positions?

[laserbeam]

Home Hospital Physician for Hybrid Work Model - Full Time, Part Time, and Moonlighting Opportunities - Newton, Massachusetts job with Mass General Brigham Community Physicians | 711031

Mass General Brigham Medical Group is expanding our Home Hospital programs and are looking for physicians

www.nejmcareercenter.org

Saw this job ads today. It is a hospitalist position for home hospital program requiring hospitalist travelling to patients' homes. I can not help wondering, how is this an efficient and safe way taking care of patients? How does this make economic sense? Why would us hospitalists be willing to travel to patients' homes? Just trying to understand things that is unthinkable on first impression.

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[gutonc]

Hospital at Home is a program that people have been talking about for decades, but it took the COVID pandemic to actually make happen. My former and current hospital systems have them. The intention is to manage patients who are not quite sick enough to stay in the hospital, but still need daily follow up and potential intervention. My former hospital uses it a lot for the heart failure and ESLD services. Patients needing IV diuresis but not a bumex drip, improving, but not baseline hepatic encephalopathy. Generally nursing shows up every day (sometimes 2 or 3x a day) and the physician checks in either in person or virtually every couple of days. An MA swings by in the morning to get VS, weights and labs.

I can't speak to how this would be as a job for a physician, but I can say that it worked out really well for my neighbor with CHF who had already spent 6 weeks in the hospital getting mostly, but not completely, tuned up.

 

[DrMetal]

Not a fan, and I'd stay away from it, unless it were strictly telework. May too much liability, and I'm not interested in going to someone's home (unless they're a celebrity, then I'm very interested).

If you're well enough to be home, you're well enough to take PO meds, that's called outpatient medicine. Maybe you see your doctor once a week in the immediate time period, for something more acute or subacute.

If you need IV medications, close monitoring, if you need the daily attention of doctors and nurses, that's what a hospital is for.

Let's keep the distinction clear, let's end the madness. {our problem in hospital medicine, is that we don't respect this distinction, and we admit way too much bull****. We've flooded the system, hence this desire to make some kind of intermediary step, a home-hospital program. That's ridiculous. Your home is not a hospital.}

 

[laserbeam]

Hospital at Home is a program that people have been talking about for decades, but it took the COVID pandemic to actually make happen. My former and current hospital systems have them. The intention is to manage patients who are not quite sick enough to stay in the hospital, but still need daily follow up and potential intervention. My former hospital uses it a lot for the heart failure and ESLD services. Patients needing IV diuresis but not a bumex drip, improving, but not baseline hepatic encephalopathy. Generally nursing shows up every day (sometimes 2 or 3x a day) and the physician checks in either in person or virtually every couple of days. An MA swings by in the morning to get VS, weights and labs.

I can't speak to how this would be as a job for a physician, but I can say that it worked out really well for my neighbor with CHF who had already spent 6 weeks in the hospital getting mostly, but not completely, tuned up.

Glad to know that things worked out well for your neighbor. I suppose this would work if: 1. Insurance/Medicare is very willing to pay for the expenses and even rewards such programs generously. 2. There is an oversupply of healthcare workers (physicians, APPs, nurses, MAs) in the area, Boston?

 

[laserbeam]

Not a fan, and I'd stay away from it, unless it were strictly telework. May too much liability, and I'm not interested in going to someone's home (unless they're a celebrity, then I'm very interested).

If you're well enough to be home, you're well enough to take PO meds, that's called outpatient medicine. Maybe you see your doctor once a week in the immediate time period, for something more acute or subacute.

If you need IV medications, close monitoring, if you need the daily attention of doctors and nurses, that's what a hospital is for.

Let's keep the distinction clear, let's end the madness. {our problem in hospital medicine, is that we don't respect this distinction, and we admit way too much bull****. We've flooded the system, hence this desire to make some kind of intermediary step, a home-hospital program. That's ridiculous. Your home is not a hospital.}

Agree with everything, except for the part with celebrity - no celebrity patients for me, please.

 

[Ubba]

Dashing from one patient's house to another's mouse-infested apartment to another's government-subsidized housing complex with nonexistent visitor parking sounds like an even worse lifestyle than hospital medicine.

Then again, anyone who's thinking of working for Brigham is probably a masochist anyway.

 

[Splenda88]

Dashing from one patient's house to another's mouse-infested apartment to another's government-subsidized housing complex with nonexistent visitor parking sounds like an even worse lifestyle than hospital medicine.

Then again, anyone who's thinking of working for Brigham is probably a masochist anyway.

Hospital medicine lifestyle is NOT bad. In fact, I think I probably have the best lifestyle of FT working docs, unless there are docs out there that work FT Monday thru Wednesday.

 

[Osteoth]

I wonder what the pay is like…

 

[NITRAS]

We have started a program at our shop. The rn comes by twice daily and doctor listens in with virtual visit I have no interest at this time. Only a limited number of payers do it.

 

[dozitgetchahi]

Dashing from one patient's house to another's mouse-infested apartment to another's government-subsidized housing complex with nonexistent visitor parking sounds like an even worse lifestyle than hospital medicine.

Then again, anyone who's thinking of working for Brigham is probably a masochist anyway.

Your post reminds me of my geriatrics rotation during residency. On part of the rotation, we had to make house calls with the attending. Before we went in the first house, he warned me not to sit on anything, or even to touch anything other than the patient. I asked what the story was behind this…he tells me that a few years earlier, he was sitting on a couch with a resident in some patient’s filthy apartment when they realized that the couch was covered in bedbugs…

The day ended with himself and the resident driving back to the hospital in their boxers, with their clothes in garbage bags in the trunk of his car. The resident had to beg one of the chiefs to bring scrubs out for them to change into…

 

[DrMetal]

Your post reminds me of my geriatrics rotation during residency.

Ah yes, let me guess, was this a VA geriatrics patient? The VA has a geriatric home program.

Not only did I refrain from touching anything in the house, I refrained from touching the patient too. The Attending didn't even leave his car. Of course, we documented a comprehensive physical exam.

 

[dozitgetchahi]

Ah yes, let me guess, was this a VA geriatrics patient? The VA has a geriatric home program.

Not only did I refrain from touching anything in the house, I refrained from touching the patient too. The Attending didn't even leave his car. Of course, we documented a comprehensive physical exam.

County hospital. We rotated at the VA too, but the geriatrics rotation didn’t go there.

 

[collegestud2013]

Home Hospital Physician for Hybrid Work Model - Full Time, Part Time, and Moonlighting Opportunities - Newton, Massachusetts job with Mass General Brigham Community Physicians | 711031

Mass General Brigham Medical Group is expanding our Home Hospital programs and are looking for physicians

www.nejmcareercenter.org

Saw this job ads today. It is a hospitalist position for home hospital program requiring hospitalist travelling to patients' homes. I can not help wondering, how is this an efficient and safe way taking care of patients? How does this make economic sense? Why would us hospitalists be willing to travel to patients' homes? Just trying to understand things that is unthinkable on first impression.

The idea of physicians making home visits is hardly new. However, agree that it doesn't make as much sense from a productivity standpoint since the travel times would be significant and hence the patient volume you will be able to see will be much lower, assuming you're taking insurance in which you probable wouldn't be reimbursement for per visits than just seeing the patient in an office or hospital setting. The only way it can make financial sense is if it's marketed to wealthier patients as a concierge medicine service and patients are willing to pay for a good amount of cash for it (and IMO patients should pay more for home visits, since having the physicians go to their home at the patient's convenience is a luxury service).

 

[DrMetal]

The idea of physicians making home visits is hardly new.

Oh it's pretty new alright, in the 21st Century.

Home visits, using the physical exam as your sole method of diagnosis, no labs, no rads, tucking the patient in bed every night . . .this was wonderful medicine, in 1953.

Of course, in 2023, we still baby our patients, but at least we make 'em come to our office for that.

 

[Splenda88]

Oh it's pretty new alright, in the 21st Century.

Home visits, using the physical exam as your sole method of diagnosis, no labs, no rads, tucking the patient in bed every night . . .this was wonderful medicine, in 1953.

Of course, in 2023, we still baby our patients, but at least we make 'em come to our office for that.

What if the patient demands to get an MRI?

It seems like every patient that I have demands to have an MRI.

 

[DrMetal]

What if the patient demands to get an MRI?

It seems like every patient that I have demands to have an MRI.

Depends on their BMI. I love it when they're too fat to fit in the scanner.