Hospitalist/ Big city?

[gozes]

Figured this would be the best place to ask about this. Ive read a few old threads, but I wanted to revive the discussion, as the old thread about this topic were 5+ years ago.

I'm a medical student thinking about their career choices, and I'm interested in doing family medicine, but the idea of being a hospitalist and doing inpatient care excites me a lot more than doing outpatient. (Not that the latter is not exciting, but it doesnt appeal to me as much.)

I know that in a lot of places Family physicians do have Hospital privileges, but I am also picky regionally and would do anything to be able to practice in NYC. How realistic is it that in a big city like NYC (or any other major city on either coast) that a family doc could be a hospitalist?

I only ask because I know Internal physicians have a more competitive advantage when it comes to being a Hospitalist (So Ive heard.)

Any input/advice is appreciated! Thank you.

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[FrustratedFamDoc]

If you really want to do hosiptalist work, you should be able to be hired pretty easily. From what I have seen personally, the only real draw to hospitalist work is the time off. Secondly, they are overworked and carry too many patients. When I ask why they do it, universally I hear the money is good and so is the time off. Never have I heard "because I love it." Sounds like a recipe for burnout to me.

 

[smq123]

You can certainly be an FM trained hospitalist, and get a job in most major cities.

However, if you are truly not that interested in outpatient, I would recommend doing IM instead. FM is very outpatient based, and if you know that you would prefer to be inpatient, you might as well do IM.

Also, are you SURE you want to work in an NYC hospital?

 

[gozes]

You can certainly be an FM trained hospitalist, and get a job in most major cities.

However, if you are truly not that interested in outpatient, I would recommend doing IM instead. FM is very outpatient based, and if you know that you would prefer to be inpatient, you might as well do IM.

Also, are you SURE you want to work in an NYC hospital?

Yeah I figured as much that Internal would be the way to go, but I still wanted to know what my options would be like in Family as well. When it comes to praciticing NYC, yeah I would. I know it's crazy, and people are much more entitled etc., but location outside work is more important to me than the other way around. Maybe that's a naive scope on things, but that's just how I currently see it.

 

[JustPlainBill]

I would go IM -- Purely anecdotal experience: We had a grand total of 6 months of ward medicine at my residency: 3 months as an intern (split up), 6 weeks as a pgy2 doing "supervisory" work -- usually boiled down to helping the interns when the service got busy with 14+patients or handling the difficult cases and then trying to come up with some EBM topic relevant to a patient on the census and then 6 weeks at a pgy3 running the show. Then we did 1 month of ICU work as a pgy2 functioning as an intern on the icu team run by pgy2's from IM.

The IM residency had 6 months of wards and 6 months of ICU and were signed off on all ward procedures within 2 - 4 weeks of starting the residency. By the time they hit pgy2, they were running night ward teams unsupervised and pretty much handling icu call/admissions Q3 on their own with the ICU attending sleeping somewhere in the hospital. They got a lot more time with specialists during years 2 and 3 --- I did a few extra months on wards because I did stupid stuff like question the need of a rectal exam and FOBT on a patient with frank blood in the bedside commode in the ER who had just been in for a colonoscopy/polypectomy and per chart review the note said to admit and call GI if it happened -- I also made the mistake of using the Tarrascon's IM handbook as a therapeutic base rather than an attendings lecture notes when it came to prednisone dosing and used 60mg vs 40mg for an asthma/copd exacerbation -- me being me, I really didn't see a difference in the treatment of the 2 when in the hospital and said so -- big no-no -- common sense was not tolerated at my residency but what the heck --- back to the story -- I wound up taking extra months at the "suggestion" of my program on ward medicine and worked with an attending who had been through the local IM residency -- guy was carrying 24+ and teaching at the same time -- all he ever had with him was his census list but he had everything pertinent committed to memory -- absolute beast on wards....

do the IM if you want hospital medicine.

Oh, and lest you think I'm making up the level of idiocy at my residency -- we actually had, as pgy2s and 3s, to do "supervisory" notes on all patients on the census to demonstrate that we were indeed supervising the interns -- it got so ridiculous that we actually had specialists complain that they couldn't wade through the ton o'notes to get to the pertinent data -- did not matter -- "supervisory" notes continued ----

 

[VA Hopeful Dr]

Oh, and lest you think I'm making up the level of idiocy at my residency -- we actually had, as pgy2s and 3s, to do "supervisory" notes on all patients on the census to demonstrate that we were indeed supervising the interns -- it got so ridiculous that we actually had specialists complain that they couldn't wade through the ton o'notes to get to the pertinent data -- did not matter -- "supervisory" notes continued ----

My FM program required that as did my wife's IM program...

 

[cabinbuilder]

You can certainly be an FM trained hospitalist, and get a job in most major cities.

However, if you are truly not that interested in outpatient, I would recommend doing IM instead. FM is very outpatient based, and if you know that you would prefer to be inpatient, you might as well do IM.

Also, are you SURE you want to work in an NYC hospital?

I second the question about NYC hospital. I did 1 week there starting a gen surgery residency and fled away quickly albeit not fast enough. There were patients in the hospital for 6 months or longer. It reminded me of what the Nazi's did to the Jews experimenting on patients - only this time it was the residents experimenting and practicing on people. Just saying.........

Training for hospitalist really comes down to the residency program you have. My program was very inpatient heavy and I did 12 months of inpatient over the 3 years. However, my ICU time was very limited as that was determined by how many of your patients were in ICU - there was no actual ICU rotation. I never learned about ventilators so am not comfortable with that management. So when I did hospitalist I always had some one else do the vent settings but I still took care of the rest with a vented patient. I agree if you plan to be an intensivist, critical care, ICU, run codes, etc. do an IM residency.

 

[JustPlainBill]

My FM program required that as did my wife's IM program...

For us -- what should have been a 2 liner "agree with current note -- plan discussed and implemented" or something indicating that you looked at the note/discussed the plan with the intern and agreed with what they were doing as an addendum line to their note turned into a full blown, standalone note -- I thought it was more busy work than anything else -- and I've been wrong before ---

 

[AFMD]

You can certainly be an FM trained hospitalist, and get a job in most major cities.

However, if you are truly not that interested in outpatient, I would recommend doing IM instead. FM is very outpatient based, and if you know that you would prefer to be inpatient, you might as well do IM.

Also, are you SURE you want to work in an NYC hospital?

I have to disagree, although I may be wrong. I feel like many family medicine programs have more than enough inpatient to train residents to be hospitalists. Our program, for example, is very inpatient heavy (our third years barely get the minimum required outpatient visits to graduate residency each year). We are pretty heavily recruited for hospitalist jobs, and a significant portion of our graduating residents become hospitalists. In IM you don't have the option to do pediatrics or OB, and ER is harder.

 

[smq123]

I have to disagree, although I may be wrong. I feel like many family medicine programs have more than enough inpatient to train residents to be hospitalists. Our program, for example, is very inpatient heavy (our third years barely get the minimum required outpatient visits to graduate residency each year). We are pretty heavily recruited for hospitalist jobs, and a significant portion of our graduating residents become hospitalists. In IM you don't have the option to do pediatrics or OB, and ER is harder.

I did not say that FM doesn't train you adequately to be a hospitalist.

But my point is that if you want to do inpatient medicine, and are sure that you have no interest in outpatient medicine, then why not go for IM? FM has a very large outpatient component, no matter which program you go to; why bother getting that outpatient training if it isn't what you want to do?

 

[JonMonkey]

Ultimately this decision is on you and you have to make it. The question I would ask myself is how much inpatient vs outpatient do you want to do? If the answer is all inpatient and absolutely ZERO outpatient then go IM for sure. If you don't mind some outpatient then I would consider FM.

All IM residencies will give you more inpatient ward and ICU training however all FM residencies have a minimum amount of time you have to spend on inpatient management and that is 6 months. Some do more but as far as I know ACGME does not allow less than 6 months. ICU training is variable as others have mentioned. Hospitalist medicine does have a degree of burnout and this is something that I would talk about with some current hospitalist just to get their take.

I would look at FM programs that have a robust or solid in patient experience with their own clinic patients so that you can see them both inpatient and follow them outpatient. My program for example did inpatient work on our clinic patients but due to my clinic being an FQHC with very under-insured patients many ended up in other hospitals rather than our large predominately private tertiary center so we did not see a lot of them. Our sister program however was an unopposed program and their clinic patient dominated their day to day census.

With that in mind being FM trained and then working as a hospitalist might be a good idea with the plan to do primarily or solely hospitalist medicine with a fall back to outpatient medicine as you get older. You will have to added burden of staying up to date with outpatient care as it will continue to change and evolve in your absence.

 

[JustPlainBill]

I have to disagree, although I may be wrong. I feel like many family medicine programs have more than enough inpatient to train residents to be hospitalists. Our program, for example, is very inpatient heavy (our third years barely get the minimum required outpatient visits to graduate residency each year). We are pretty heavily recruited for hospitalist jobs, and a significant portion of our graduating residents become hospitalists. In IM you don't have the option to do pediatrics or OB, and ER is harder.

Are you military? AFMD -- at least to my background -- implies Air Force -- reason I'm asking -- I've got a few colleagues that trained in the Navy and they're universally good and well trained. From what I know, they do an intern year then a year as a general medical officer and then finish up the residency -- supposedly in the GMO year, they're responsible for small hospitals, etc. --- again, second hand info. I assume the Air Force is similar.

 

[Atlas Shrugged]

Are you military? AFMD -- at least to my background -- implies Air Force -- reason I'm asking -- I've got a few colleagues that trained in the Navy and they're universally good and well trained. From what I know, they do an intern year then a year as a general medical officer and then finish up the residency -- supposedly in the GMO year, they're responsible for small hospitals, etc. --- again, second hand info. I assume the Air Force is similar.

GMO is a given for most people in the navy, but FM actually tends to go straight through. AF is similar, especially with FM; GMO is unlikely/unnecessary. For army, GMO is all but discontinued and actually seen as a negative (unless you have a good reason, like strong desire to be a flight surgeon) for GME purposes.

Source: current USUHS army student.