Hospitalist job

[SFmed88]

Thoughts on this offer for someone fresh out of residency?

-225K+RVUs
-7 on/7 off
-daily census 30-35, follow ups only. All h&p’s done by admitting doc in ED.
-no mid-level support
-round and leave when done
-no procedures, open icu
-great hospital with good support staff and specialists
-highly desired southeast city location

Any advice would be appreciated. Anyone have experience with this high of a census doing progress notes only?

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[rokshana]

Thoughts on this offer for someone fresh out of residency?

-225K+RVUs
-7 on/7 off
-daily census 30-35, follow ups only. All h&p’s done by admitting doc in ED.
-no mid-level support
-round and leave when done
-no procedures, open icu
-great hospital with good support staff and specialists
-highly desired southeast city location

Any advice would be appreciated. Anyone have experience with this high of a census doing progress notes only?

Hell to the NO!
30-35 pts is insane...leave when you are done is going to be 14 hours later if you are lucky.
Plus you WILL miss something with that many pts...it’s not like all you do is write a progress note...they will have labs, and imaging and procedures to be ordered and reviewed ...never mind the discharge summaries and the placement issues...

Doesn’t matter how much money they throw at you ...not worth your license.

HCA hospital by chance?

 

[CDI]

30-35 = hard pass
Round and leave goes out the window with that census
You should be getting that salary for half that census

 

[CDI]

Hell to the NO!
30-35 pts is insane...leave when you are done is going to be 14 hours later if you are lucky.
Plus you WILL miss something with that many pts...it’s not like all you do is write a progress note...they will have labs, and imaging and procedures to be ordered and reviewed ...never mind the discharge summaries and the placement issues...

Doesn’t matter how much money they throw at you ...not worth your license.

HCA hospital by chance?

I would put my money that it's an HCA facility...or contract is with a company that starts with Team and ends with Health.

 

[jurassicpark]

Heck no. 30-35 patients is a HUGE load and at 225k you're being way underpaid.

 

[blub1212]

Absolutely not. I would never sign for that many patient encounters per day.

 

[end stage fibro]

Right now I'm sitting at 98.3% no. Can you elaborate on the rvu bonus? If you get that base plus a very very generous RVU component then maybe but you'll be putting in minimum 12 hours of real actual work every day. Even this would be short term

 

[deleted480308]

No way you can provide good care to 35 patients. The money is irrelevant

 

[bobow98]

That's a double census. AKA two full time jobs there. For 1x pay. Sounds nuts. You should make 450k for this minimum, even then sounds dangerous.

 

[Shabeer]

Easy no. Is this really where medicine is going? 30 patients??

 

[Splenda88]

Never heard of anything above 18 patients' census... Do people think physicians are stupid?

 

[wjs010]

Thanks to sdn, less of these stupid jobs will be around .

 

[jurassicpark]

Never heard of anything above 18 patients' census... Do people think physicians are stupid?

A lot of physicians will routinely see above 18, because they get the extras involved in their contracts or are independent hospitalists. But to have it contracted to see THAT many in the OP post for so little pay is insane!

 

[Merely]

Thoughts on this offer for someone fresh out of residency?

-225K+RVUs
-7 on/7 off
-daily census 30-35, follow ups only. All h&p’s done by admitting doc in ED.
-no mid-level support
-round and leave when done
-no procedures, open icu
-great hospital with good support staff and specialists
-highly desired southeast city location

Any advice would be appreciated. Anyone have experience with this high of a census doing progress notes only?

I don’t understand how as a hospitalist you can round and leave? Don’t you have to be there for like 12 hour shifts in house in case there’s a code or something emergent for a patient?

 

[jurassicpark]

I don’t understand how as a hospitalist you can round and leave? Don’t you have to be there for like 12 hour shifts in house in case there’s a code or something emergent for a patient?

Codes are usually run by the ER or ICU staff these days in most hospitals. I've only done codes if I'm nearby when it happens. And again, most emergencies are handled by either ER or if they're that criticial they go to the ICU.

 

[NITRAS]

I don’t understand how as a hospitalist you can round and leave? Don’t you have to be there for like 12 hour shifts in house in case there’s a code or something emergent for a patient?

As long as there is coverage, you can leave. We have a series of PAs and docs who are always in house.

 

[Merely]

As long as there is coverage, you can leave. We have a series of PAs and docs who are always in house.

Yeah but like what if your patient develops belly pain, other complaints that need to be evaluated? I thought there were shifts that hospitalist do like 7am-7pm? Is that not a thing anymore?

 

[rokshana]

I don’t understand how as a hospitalist you can round and leave? Don’t you have to be there for like 12 hour shifts in house in case there’s a code or something emergent for a patient?

Not if you don’t cover codes...and you still need to be reachable...pager or cell phone accessible.

 

[Merely]

Not if you don’t cover codes...and you still need to be reachable...pager or cell phone accessible.

That’s pretty odd to me, is that common for hospitalist jobs to allow you to not cover codes for your own patients or let you be off site for your shift? Or is that a minority?

 

[jurassicpark]

That’s pretty odd to me, is that common for hospitalist jobs to allow you to not cover codes for your own patients or let you be off site for your shift? Or is that a minority?

It seems pretty common. SOME jobs and sites stipulate you HAVE to be on site. Though often there's a wink and nod and your fellow hospitalist/partner may stay behind and so-forth.

The ER doctors do codes all the time, including the intubations and procedures. In some ways that may be a little safer than an internist who last intubated or coded a patient a year or two ago.

 

[rokshana]

That’s pretty odd to me, is that common for hospitalist jobs to allow you to not cover codes for your own patients or let you be off site for your shift? Or is that a minority?

No, pretty common for others to run the codes...usually residents of the hospital has them...otherwise icu or the ed run them.

Round and go tends to be places that are lower volume and/or less acute...

 

[chessknt]

The ED physicians admit patients with H&Ps? Do they double dip for their ER visit as well because that sounds fraudulent.

It seems pretty common. SOME jobs and sites stipulate you HAVE to be on site. Though often there's a wink and nod and your fellow hospitalist/partner may stay behind and so-forth.

The ER doctors do codes all the time, including the intubations and procedures. In some ways that may be a little safer than an internist who last intubated or coded a patient a year or two ago.

Having a provider who knows jack **** about the person in front of them is always inferior to having one who does. Having someone do procedures is different from actually managing or appropriately handing off a post-arrest patient.

 

[gutonc]

The ED physicians admit patients with H&Ps? Do they double dip for their ER visit as well because that sounds fraudulent.

No, he meant there’s an admitting hospitalist in the ED who does the admissions.

 

[Shabeer]

Having a provider who knows jack **** about the person in front of them is always inferior to having one who does. Having someone do procedures is different from actually managing or appropriately handing off a post-arrest patient.

Where I trained the residents ran all of the rapids and codes. This, of course, meant a hospitalist patient which was due for ICU was handed off by the resident who knew the patient for a short period of time. Needless to say ICU H&P's were a lot of chart biopsy which sometimes uncovered something the hospitalist missed which, with the census at 20-24 isn't surprising. I still can't believe there is a "job" with a census of 30. Good God.

I do know some hospitalists at lower acuity centers who round and leave by 2-3pm after signing out to a PA, and they don't seem concerned. Just depends on where you work and your comfort level with the covering providers.

 

[rokshana]

The ED physicians admit patients with H&Ps? Do they double dip for their ER visit as well because that sounds fraudulent.



Having a provider who knows jack **** about the person in front of them is always inferior to having one who does. Having someone do procedures is different from actually managing or appropriately handing off a post-arrest patient.

The pt who codes in the middle of the night is not going to have someone who “knows the pt”...and it’s the icu that will be managing that post arrest pt.

And if you have 30-35 pts on your census, you probably know as much as the resident on the code team ...

Welcome to the healthcare of today.

 

[chessknt]

The pt who codes in the middle of the night is not going to have someone who “knows the pt”...and it’s the icu that will be managing that post arrest pt.

And if you have 30-35 pts on your census, you probably know as much as the resident on the code team ...

Welcome to the healthcare of today.

Of course, but at 3 pm if the hospitalist is at home playing video games because he did a rush job at rounding and wrote horrible notes to get out as fast as possible then he is part of a problem.

 

[rokshana]

Of course, but at 3 pm if the hospitalist is at home playing video games because he did a rush job at rounding and wrote horrible notes to get out as fast as possible then he is part of a problem.

How old do you think hospitalist are?

 

[CDI]

Of course, but at 3 pm if the hospitalist is at home playing video games because he did a rush job at rounding and wrote horrible notes to get out as fast as possible then he is part of a problem.

How old do you think hospitalist are?

I’m at home by 3pm playing Rocket League...sell your souls to the admin side and you can to!

Side note: A colleague of mine started a new hospitalist gig, was asked to see 41 patients total (including 16 admissions). My last week in the hospital, I think I saw that many patients total.

 

[deleted480308]

I’m at home by 3pm playing Rocket League...sell your souls to the admin side and you can to!

Side note: A colleague of mine started a new hospitalist gig, was asked to see 41 patients total (including 16 admissions). My last week in the hospital, I think I saw that many patients total.

I’m assuming they told the hospital to pound sand

 

[Trogghunter]

Of course, but at 3 pm if the hospitalist is at home playing video games because he did a rush job at rounding and wrote horrible notes to get out as fast as possible then he is part of a problem.

Or they're doing errands/life things and accessible by phone and able to come in for an emergency/clinical change and remotely or verbally do all necessary work once the work for the day is done.

 

[pgy0246]

At one program the attending physician see 35, but then 20 of those are managed by the residents team

 

[rokshana]

At one program the attending physician see 35, but then 20 of those are managed by the residents team

Attending still has to see EVERY pt...not worth it.

 

[blub1212]

At one program the attending physician see 35, but then 20 of those are managed by the residents team

It's more work to see patients with residents than by yourself....

They do save some time by taking the pages; however, the time that you spend teaching and doing academic rounds takes up way more of your time than if you were to just do everything yourself.

 

[FutureInternist]

Yeah but like what if your patient develops belly pain, other complaints that need to be evaluated? I thought there were shifts that hospitalist do like 7am-7pm? Is that not a thing anymore?

In 6 years, I've had to come back a total of 3 times for unexpected issues.
Worth it, since on all other days I get to go home around 3 pm.

 

[Merely]

In 6 years, I've had to come back a total of 3 times for unexpected issues.
Worth it, since on all other days I get to go home around 3 pm.

So you work 7am-3pm 2 weeks a month and make 300k?

 

[rokshana]

So you work 7am-3pm 2 weeks a month and make 300k?

15 days a month? not unusual.
250-275k is probably more the norm though

 

[NITRAS]

Median is like $288k I think on our last comparative analysis.

 

[Merely]

So as a hospitalist you can work 7 am to 3pm everyday of the year and make around 600k? 600k to end work at 3pm everyday? Seems too good..

 

[rokshana]

So as a hospitalist you can work 7 am to 3pm everyday of the year and make around 600k? 600k to end work at 3pm everyday? Seems too good..

dude, i know you are not stupid or new...did you just feel like trolling today?

 

[Merely]

dude, i know you are not stupid or new...did you just feel like trolling today?

?

 

[FutureInternist]

So you work 7am-3pm 2 weeks a month and make 300k?

We start our shift at 8, but I get in around 7.
13-15 pts. Maybe 1 admit, if its busy.
Home by 230-3.
On call for Qs till 6.
270K.

 

[bronx43]

So as a hospitalist you can work 7 am to 3pm everyday of the year and make around 600k? 600k to end work at 3pm everyday? Seems too good..

It's not humanly possible to work everyday of the year as a hospitalist. You would go insane about 6 months in.

 

[Merely]

It's not humanly possible to work everyday of the year as a hospitalist. You would go insane about 6 months in.

It’s only till 3 tho that’s my point

 

[bronx43]

It’s only till 3 tho that’s my point

Doesn't matter. Those 7 hours can be brutal. I was a hospitalist for a year.

 

[rokshana]

It’s only till 3 tho that’s my point

Think of it as mental time off...

 

[Merely]

Ok I understand, kinda like ED in a way, thx for the insights

 

[wjs010]

We start our shift at 8, but I get in around 7.
13-15 pts. Maybe 1 admit, if its busy.
Home by 230-3.
On call for Qs till 6.
270K.

Is that including rvu? Sounds like a fair gig. Do you moonlight?

 

[Splenda88]

Hospitalist job can be brutal... Had my first night float 3 days ago and had to admit 7 patients... Boy I was so tired the day after. I am considering a fellowship now .

 

[Splenda88]

Is that including rvu? Sounds like a fair gig. Do you moonlight?

People don't usually include RVU when they are talking about salary... One of PGY3 just showed me his contract as a nocturnist and the salary part said 318k + RVU

 

[bobow98]

People don't usually include RVU when they are talking about salary... One of PGY3 just showed me his contract as a nocturnist and the salary part said 318k + RVU

Depends what RVU threshold is in the first place. Some places have ridiculously impossible RVUs, some places have pretty decent RVUs, some places don't have it at all actually.