Hospitalist job offer— curious on thoughts

[bd4727]

I am considering a traditional 7on/7off hospitalist IM job in a semi rural town in the Southeast. The compensation is 280/yr + quality and rvu-based bonus that for the average provider is expected to be around 315-325 total.

Shifts are 7-7, 14-16 pt per day, nothing particularly non traditional about the contract.

Curious as to how this stacks up w others?


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[FutureInternist]

Surefire way to be miserable is to keep comparing to other jobs.

Are you OK with the $ and workload?
Is the boss someone you can work with?
Is the location bearable for you?

 

[TraderDoc]

Agreed with Futureinternest. Don't compare your job to others, like you shouldn't be comparing your girlfirend/significant others to other people's. Have to decide whether this is best for you.

For me it was location, location, location. I was adamant that I would only live/work in Metropolitan area with 3+ million people, Im too much of a big city person. My salary is 257K base + quality up to 10% + pick up shifts (night or day) for additional pay (no RVU bonus structure). Most important is I wanted 24/7 intensivist support, excellent sub-specialty availability, and absolute NO procedures.

Some of my co-residents found jobs with higher base salaries + RVU bonuses but they are in smaller rural towns, they are managing vents, picking up 12 hour overnight shifts doing 10-12 admissions, and throwing in central lines. Will gladly make less to avoid these aspects.

You have to decide what YOU want, what would make you happy. Otherwise its job searching year after year.

 

[bronx43]

I don't think he's asking to compare for the sake of comparing. I think he's trying to ask if this is a fair deal for a "semi rural" position in that part of the country. We all know these jobs are at least somewhat negotiable, and if you're not fully aware of the market for your specialty, you may be leaving quite a bit of money on the table. I've seen people negotiate significant bonuses, or changes to RVU structure, etc.

OP, to answer your question, it seems like a decent gig in terms of the numbers. It depends on how "rural" this place really is, but in bigger cities, you probably won't be finding jobs that pay total comp of 300+ while seeing 14-16 pts. In my neck of the woods (larger Midwestern city), you would be looking at all in comp of 250-270k for about 16-20 pts.

 

[bd4727]

Thanks Bronx. Yes I know I want to live in the area etc. trying to gauge the market as Bronx alluded.


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[NITRAS]

I work in a smallish town with a 600+ bed hospital one hour north of a large metro center. No nights, no procedures, closed ICU, 15-16 pts, no admission with the exception of 1-2 weeks a year and rarely bounce backs. Base is 210k and comes out to 260-280ish with comp and RVU. Plenty of ways to moonlight or make more.

 

[jdh71]

I am considering a traditional 7on/7off hospitalist IM job in a semi rural town in the Southeast. The compensation is 280/yr + quality and rvu-based bonus that for the average provider is expected to be around 315-325 total.

Shifts are 7-7, 14-16 pt per day, nothing particularly non traditional about the contract.

Curious as to how this stacks up w others?


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Semi rural?

You need to know what your intensivist, cardiologist, gastroenterologist, IR, general surgeon, and neurosurgeon situation is there. And then if you are comfortable with that situation FIRST before making any other decision.

Sounds solidly busy but not ridiculous. More than a few of those patients are going to need a specialty service emergently or urgently.

 

[Trogghunter]

That's a competitive salary, to be sure. As above, know what your specialty backup is, if you're committed to working 7 to 7, ICU/vents, procedures, case manager availability. Those points can make a competitive salary seem meaningles if you're miserable and your 7 to 7 stretches beyond that. Some people round and go, so they generally only work 8 to 10hrs of the 7-7, for example.

 

[Gastrapathy]

Of course he should compare. He doesn’t need to win but he needs to know he’s in the ballpark. You can bet that the hospital knows.

 

[bd4727]

Thanks for replies. Ive interviewed w a few local competitor hospitals and this is by far best in the region. For personal / family reasons comitted to this region, so hoping to get insight as comparasion and to help me w negotiation.

The backup / speciality care is suprisingly good— all subspecialties in house except like Endocrine. GI and Cards even admit their own patients mostly unless very straightforward. Icu is basically closed and run by intensivist unless its very straightforward and pt will be back to the floor in 48hrs. Surgical stuff is all admitted to surgery. Not round and go per sey but can leave when done as long as you can get back to hospital in 15-20min.

 

[IMreshopeful]

Thanks for replies. Ive interviewed w a few local competitor hospitals and this is by far best in the region. For personal / family reasons comitted to this region, so hoping to get insight as comparasion and to help me w negotiation.

The backup / speciality care is suprisingly good— all subspecialties in house except like Endocrine. GI and Cards even admit their own patients mostly unless very straightforward. Icu is basically closed and run by intensivist unless its very straightforward and pt will be back to the floor in 48hrs. Surgical stuff is all admitted to surgery. Not round and go per sey but can leave when done as long as you can get back to hospital in 15-20min.

Endocrine? What would even end up on an inpatient endo service?

 

[bd4727]

Consult not service


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[CatFactorial]

Endocrine? What would even end up on an inpatient endo service?

Diabetes.

 

[IMreshopeful]

Diabetes.

Man I’d better make sure to go somewhere that they have a heme only service for new DVTs. Or the kidney only service for “AKI”.

Love the partitioning of medicine!

 

[rokshana]

Diabetes.

no.

 

[NewYorkDoctors]

Man I’d better make sure to go somewhere that they have a heme only service for new DVTs. Or the kidney only service for “AKI”.

Love the partitioning of medicine!

Well no one listens to the renal consult service about workup and fluid management of AKI anyway... besides maybe a starry eyed intern or an orthopedics PA... cardiology and ICU just wants renal for backup in case UF or HD is needed. True statement.

 

[rokshana]

Well no one listens to the renal consult service about workup and fluid management of AKI anyway... besides maybe a starry eyed intern or an orthopedics PA... cardiology and ICU just wants renal for backup in case UF or HD is needed. True statement.

uh, there isn't a reason an IM doc should be consulting renal for AKI unless it turns out to be intrinsic or its a transplant pt...you should be capable for fixing pre and post renal issues.

 

[IMreshopeful]

Well no one listens to the renal consult service about workup and fluid management of AKI anyway... besides maybe a starry eyed intern or an orthopedics PA... cardiology and ICU just wants renal for backup in case UF or HD is needed. True statement.

I mean usually nephrology just disagrees with me about diuresing the patient. Then I diurese them until their creatinine gets better.

(All love to my nephrologists)

 

[IMreshopeful]

uh, there isn't a reason an IM doc should be consulting renal for AKI unless it turns out to be intrinsic or its a transplant pt...you should be capable for fixing pre and post renal issues.

Haha oh man. The hospitalists at the community hospitals who refer their patients to us and the one I rotated at in residency consulted renal aaaaaaallllllll the time. It was lazy consult medicine at its worst.

 

[857937]

I have a question that I don't wanna open up a new thread for.

Is two weeks on/ one week off a possible hospitalist job?

 

[NewYorkDoctors]

uh, there isn't a reason an IM doc should be consulting renal for AKI unless it turns out to be intrinsic or its a transplant pt...you should be capable for fixing pre and post renal issues.

You would think...

But usually the intrinsic we are both referring to is ATN in ICU, then yep.. my initial comments stay unchanged

 

[jdh71]

I have a question that I don't wanna open up a new thread for.

Is two weeks on/ one week off a possible hospitalist job?

Yes. But that's a lot of work. Why would you want that schedule?

 

[857937]

Yes. But that's a lot of work. Why would you want that schedule?

Looks doable.

The two weeks on might be slightly overwhelming but in the right place it won't be as brutal.

Then enjoy a week off.

Then work another two.

It's similar to the two weeks on two weeks off but obviously only one week off.

In my opinion two weeks off are a bit much. Even one week off might become boring. You can't just travel every week out of town.

Finally why would I want to do it? $$$

I know a guy doing 3 weeks a month (Don't know his exact scheduling).

He's taking home $21k monthly POST taxes.

 

[jdh71]

Looks doable.

The two weeks on might be slightly overwhelming but in the right place it won't be as brutal.

Then enjoy a week off.

Then work another two.

It's similar to the two weeks on two weeks off but obviously only one week off.

In my opinion two weeks off are a bit much. Even one week off might become boring. You can't just travel every week out of town.

Finally why would I want to do it? $$$

I know a guy doing 3 weeks a month (Don't know his exact scheduling).

He's taking home $21k monthly POST taxes.

You'll see.

 

[Mad Jack]

Looks doable.

The two weeks on might be slightly overwhelming but in the right place it won't be as brutal.

Then enjoy a week off.

Then work another two.

It's similar to the two weeks on two weeks off but obviously only one week off.

In my opinion two weeks off are a bit much. Even one week off might become boring. You can't just travel every week out of town.

Finally why would I want to do it? $$$

I know a guy doing 3 weeks a month (Don't know his exact scheduling).

He's taking home $21k monthly POST taxes.

At larger places you might be able to arrange something like that. Be careful what you wish for though...

 

[rokshana]

Looks doable.

The two weeks on might be slightly overwhelming but in the right place it won't be as brutal.

Then enjoy a week off.

Then work another two.

It's similar to the two weeks on two weeks off but obviously only one week off.

In my opinion two weeks off are a bit much. Even one week off might become boring. You can't just travel every week out of town.

Finally why would I want to do it? $$$

I know a guy doing 3 weeks a month (Don't know his exact scheduling).

He's taking home $21k monthly POST taxes.

Lol...you think it’s doable because you haven’t done it yet...the burnout on that type of schedule is about 6-12 months

 

[IMreshopeful]

Looks doable.

The two weeks on might be slightly overwhelming but in the right place it won't be as brutal.

Then enjoy a week off.

Then work another two.

It's similar to the two weeks on two weeks off but obviously only one week off.

In my opinion two weeks off are a bit much. Even one week off might become boring. You can't just travel every week out of town.

Finally why would I want to do it? $$$

I know a guy doing 3 weeks a month (Don't know his exact scheduling).

He's taking home $21k monthly POST taxes.

Working 14 days in a row as a resident sucked. It sucks marginally less as a specialist when on call since the daytime hours aren’t terrible. But working 14 dats as a highly paid but under appreciated, overworked hospitalist and dealing with probably a much higher census and volume of admits than you had in residency ever? No thanks. Abort abort abort

 

[rokshana]

Looks doable.

The two weeks on might be slightly overwhelming but in the right place it won't be as brutal.

Then enjoy a week off.

Then work another two.

It's similar to the two weeks on two weeks off but obviously only one week off.

In my opinion two weeks off are a bit much. Even one week off might become boring. You can't just travel every week out of town.

Finally why would I want to do it? $$$

I know a guy doing 3 weeks a month (Don't know his exact scheduling).

He's taking home $21k monthly POST taxes.

what is the census? will you do only days or will be required to do some nights?

i suspect that the census is high...probably >20 since they probably are understaffed which is why they are looking to work you~ 21 days /month.

are they 12 hour days or 8 hour days? is it round and bounce or will you be expected to stay the whole shift?

and finally do you cover the icu as well? 21 days /month with icu included and the burnout will be closer to 6 months.

and you won't be leaving town every week off...you will be sleeping a good part of that to recover from 2 weeks on.

 

[TraderDoc]

Working 14 days in a row as a resident sucked. It sucks marginally less as a specialist when on call since the daytime hours aren’t terrible. But working 14 dats as a highly paid but under appreciated, overworked hospitalist and dealing with probably a much higher census and volume of admits than you had in residency ever? No thanks. Abort abort abort

Our noctunrists work 5 on/ 10 off, average 5-10 admissions. 350K, respond only to rapids, codes are resident ran. They deal with zero social issues, much smaller census than daytime rounders (12-15). Let me just say. They are very happy. Some work more for $500K

The whole “underappreciated, glorified resident thing” about being a hospitalist is ridiculous. Our higher paid consultant colleagues may make more money, but they are not sitting back and smoking cigars, every dollar is earned.

I think being a hospitalist making $300K to do what we do is a blessing. I have far more free time than my fellowship trained colleagues amd the stress of my job is far less overall. There are ample ways to make additinal income at much lower levels of stress. Smart investing, responsible allocation of income, and working reasonably hard is key to financial well being.

I know plenty of high paid specialists, even bankers who are making 7 figure salaries who deal with financial stress from being reckless in terms to financial spending.

 

[rokshana]

The whole “underappreciated, glorified resident thing” about being a hospitalist is ridiculous.

eh, depends on where you work...you may be lucky in your experience, but some places this rings true.

 

[VA Hopeful Dr]

eh, depends on where you work...you may be lucky in your experience, but some places this rings true.

My wife, who spent three years as a hospitalist, routinely called being a hospitalist "a glorified resident"

 

[rokshana]

My wife, who spent three years as a hospitalist, routinely called being a hospitalist "a glorified resident"

i do too...well paid, but nonetheless...

 

[IMreshopeful]

Our noctunrists work 5 on/ 10 off, average 5-10 admissions. 350K, respond only to rapids, codes are resident ran. They deal with zero social issues, much smaller census than daytime rounders (12-15). Let me just say. They are very happy. Some work more for $500K

The whole “underappreciated, glorified resident thing” about being a hospitalist is ridiculous. Our higher paid consultant colleagues may make more money, but they are not sitting back and smoking cigars, every dollar is earned.

I think being a hospitalist making $300K to do what we do is a blessing. I have far more free time than my fellowship trained colleagues amd the stress of my job is far less overall. There are ample ways to make additinal income at much lower levels of stress. Smart investing, responsible allocation of income, and working reasonably hard is key to financial well being.

I know plenty of high paid specialists, even bankers who are making 7 figure salaries who deal with financial stress from being reckless in terms to financial spending.

Never said that all hospitalists are unhappy
Never said that specialists make bank without work. They work their butts off, but it’s a different level of stress when you are not the primary team
Obviously if you spend money recklessly and have no financial brains you’re going to be under stress... that goes for whether you’re a hospitalist OR a specialist
My point was that no matter how much you love being a hospitalist, in most institutions you end up taking a lot of junk admits, you have high volumes of patients to round on and admit, and you have similar stresses to those that you had as a resident - and no senior or attending to back you up because it’s all you. Your model of low census and low admit numbers making 350k for 5 on/10 off is highly atypical, and in most places where you have higher census numbers etc working 14 on/7 off would be murderous

 

[deleted480308]

uh, there isn't a reason an IM doc should be consulting renal for AKI unless it turns out to be intrinsic or its a transplant pt...you should be capable for fixing pre and post renal issues.

I have seen a number of consults for hyponatremia by 1pt for 1 lab....,nephrology was not pleased

 

[NITRAS]

Depends on the hospital. If your census is 24+, then you are consulting to do basic work.

My census is 15-16, and don’t do admissions. I get to practice lots of medicine, and even a fair amount of critical care on the floor.

I also do 14 on 14 off. One of our guys does 1.0 FTE Hospitalist, 0.5 nocturnist, and helps run the SNF/LTAC associated with our institution. One of our nocturnist is 2.0 FTE.

I don’t travel a ton, but between a couple days to recover, a few days of moonlighting, 14 days isn’t what most people think. :

 

[Gastrapathy]

GI/Cards admitting their easy ones isn’t a plus.

 

[PlutoBoy]

Haha oh man. The hospitalists at the community hospitals who refer their patients to us and the one I rotated at in residency consulted renal aaaaaaallllllll the time. It was lazy consult medicine at its worst.

The worst part of nephrology is that every patient that makes it to a hospital has their creatinine checked at least twice. The potential for interesting nephrology consults is immense.

 

[bd4727]

Depends on the hospital. If your census is 24+, then you are consulting to do basic work.

My census is 15-16, and don’t do admissions. I get to practice lots of medicine, and even a fair amount of critical care on the floor.

I also do 14 on 14 off. One of our guys does 1.0 FTE Hospitalist, 0.5 nocturnist, and helps run the SNF/LTAC associated with our institution. One of our nocturnist is 2.0 FTE.

I don’t travel a ton, but between a couple days to recover, a few days of moonlighting, 14 days isn’t what most people think. :

How do you not do admissions?


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[NITRAS]

There is an accepting doc who takes all calls from ED and outside transfers. He also directs admitters, which are mostly PAs. There is usually a resident at some point. They get admitted to a large team and they get distributed to the primary teams in the AM. I see them on the second hospital day and so on.

 

[meerkat111]

There is an accepting doc who takes all calls from ED and outside transfers. He also directs admitters, which are mostly PAs. There is usually a resident at some point. They get admitted to a large team and they get distributed to the primary teams in the AM. I see them on the second hospital day and so on.

How much do you get paid?

 

[NITRAS]

I work in a smallish town with a 600+ bed hospital one hour north of a large metro center. No nights, no procedures, closed ICU, 15-16 pts, no admission with the exception of 1-2 weeks a year and rarely bounce backs. Base is 210k and comes out to 260-280ish with comp and RVU. Plenty of ways to moonlight to make more.

How much do you get paid?

 

[laserbeam]

My wife, who spent three years as a hospitalist, routinely called being a hospitalist "a glorified resident"

That sounds like low self esteem.....

 

[VA Hopeful Dr]

That sounds like low self esteem.....

Classy

 

[IMreshopeful]

That sounds like low self esteem.....

Nah the job can be like that if you’re not in a good place. Chasing down consultants, writing dozens of notes a day, answering endless pages for Tylenol and “abnormal vitals”, admitting BS social admits, admitting babysit surgical/GI/cards patients, being talked down to by consultants and other specialties etc

I’m sure there’s good hospitalist gigs out there but doing what I did as a resident for the rest of my life even if paid well would make me miserable

 

[NITRAS]

Consultants stop talking down to you when you become staff, especially after you stop asking stupid questions.
Fellows give you push back for consults they don't want to do, but you they will end up doing seeing patients you want them to. . . and it really just lets you know who a good fellow is from a bad one.

There are some really malignant places out there, but I like where I work at right now. I get to see sick people, my co-hospitalist are friendly, my boss is awesome, and I can drive 12 minutes to my home with a year and creek. I have plenty of variety. I have a nice mix of cancer, infection, and social admits right now.

 

[rokshana]

Consultants stop talking down to you when you become staff, especially after you stop asking stupid questions.
Fellows give you push back for consults they don't want to do, but you they will end up doing seeing patients you want them to. . . and it really just lets you know who a good fellow is from a bad one.

There are some really malignant places out there, but I like where I work at right now. I get to see sick people, my co-hospitalist are friendly, my boss is awesome, and I can drive 12 minutes to my home with a year and creek. I have plenty of variety. I have a nice mix of cancer, infection, and social admits right now.

you apparently got lucky, but just because you did doesn't mean that others aren't right as well...working locums, i've seen a lot of crappy places.

 

[WonderBoy]

Nah the job can be like that if you’re not in a good place. Chasing down consultants, writing dozens of notes a day, answering endless pages for Tylenol and “abnormal vitals”, admitting BS social admits, admitting babysit surgical/GI/cards patients, being talked down to by consultants and other specialties etc

I’m sure there’s good hospitalist gigs out there but doing what I did as a resident for the rest of my life even if paid well would make me miserable

This is the similar sentiment shared by most of my partners at a tertiary center. All the new partners are looking for an escape. But this sums up the life of a hospitalist and I haven't talked to one of my partners you joined in the last year or two who sees themselves doing this for the rest of their life. Some are trying to get into admin positions where they have less clinical positions but those jobs are harder at our place than fellowships lol.

Anyway, I was fortunate to get into fellowship this year so I am done with hospitalist life but I have a whole lot of respect for them and will definitely give them leeway with consults in future. You will hear about jobs where you make 300-400 as hospitalist but those jobs aren't sustainable, you will burn out in 2-3 years max and then what. Just my two cents after a year as hospitalist. Above quote is spot on.

 

[laserbeam]

This is the similar sentiment shared by most of my partners at a tertiary center. All the new partners are looking for an escape. But this sums up the life of a hospitalist and I haven't talked to one of my partners you joined in the last year or two who sees themselves doing this for the rest of their life. Some are trying to get into admin positions where they have less clinical positions but those jobs are harder at our place than fellowships lol.
Above quote is spot on.

Looks like working as a hospitalist in a tertiary center is not much fun. I worked in two community hospitals as a hospitalist, one is a big hospital, another one is a community hospital affiliated with big name major academic center. Almost all specialists in these places are easily approachable and consults are seen within 24h. Specialists need business.... We of course have some social admissions/drug seekers, but there are way more a variety of other cases. So the effect is diluted. Answering pages about tylenol is better than answering numerous emails from patients. It is trade-off. I have some colleagues who have been working as hospitalists for 10-20 years. So no peer pressure to pursue any fellowship. In general, I am probably lucky to have a sustainable hospitalist job.

 

[IMreshopeful]

Looks like working as a hospitalist in a tertiary center is not much fun. I worked in two community hospitals as a hospitalist, one is a big hospital, another one is a community hospital affiliated with big name major academic center. Almost all specialists in these places are easily approachable and consults are seen within 24h. Specialists need business.... We of course have some social admissions/drug seekers, but there are way more a variety of other cases. So the effect is diluted. Answering pages about tylenol is better than answering numerous emails from patients. It is trade-off. I have some colleagues who have been working as hospitalists for 10-20 years. So no peer pressure to pursue any fellowship. In general, I am probably lucky to have a sustainable hospitalist job.

Yeah there’s trade offs from both sides, although I find that answering emails is less burdensome than answering pages. But to each their own! I think it’s also a matter of what’s is fulfilling personally. I like having my weekends mostly free and I don’t like a lot of the diseases dealt with by a large portion of IM (osteo, IBD, chronic panc... yuck). I’m sure in another life I could have been happy as a hospitalist but the few extra years of training is def worth the trade off

 

[VA Hopeful Dr]

Looks like working as a hospitalist in a tertiary center is not much fun. I worked in two community hospitals as a hospitalist, one is a big hospital, another one is a community hospital affiliated with big name major academic center. Almost all specialists in these places are easily approachable and consults are seen within 24h. Specialists need business.... We of course have some social admissions/drug seekers, but there are way more a variety of other cases. So the effect is diluted. Answering pages about tylenol is better than answering numerous emails from patients. It is trade-off. I have some colleagues who have been working as hospitalists for 10-20 years. So no peer pressure to pursue any fellowship. In general, I am probably lucky to have a sustainable hospitalist job.

Depends on the specialists. I've been places where a large cardiology group covered multiple hospitals. You'd better believe they didn't like going to the small, outlying hospital that didn't have a cath lab.

I've yet to meet the orthopedist who likes inpatient consults. As their elective surgery patients come almost entirely from outpatient doctors, they feel no need to really care about inpatient beyond maintaining privileges.

The ones that seem to be the best at working with hospitalists, all other things being equal, are those that actually work with them - by that I mean work to treat the same diseases in the same patients. Pulm/CC and general surgery being the best. ID coming not far behind that.