hospitalists making as much or more than ophtho

[OPPforlife]

Your on point with the passion comment. My future career is set with ophthalmology fortunately (current TY at a busy safety net hospital) I was just curious about the hospitalist gig and enjoyed your post. Several of the residents here want to do it although almost all the attendings seem burnt out


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[MstaKing10]

Still, these are such vastly different specialties that using the yearly compensation of each specialty as a "tie-breaker" is utterly ridiculous. I'm sure you can do well doing either financially, thus, really shouldn't be considered in my opinion.

Just thinking of being in inpatient provider for the rest of my life is painful. But then again, I'm likely built differently than those who really enjoy this type of setting. 7 days off is great, but the 7 days on can be pretty rough. Try 5 days of "normal hours" and home call with a decent vacation package in ophthalmology and you will see what I mean. Again, each specialty has its pros and cons so lots to consider when making a decision.

 

[ophthope]

Glad you found a job you enjoy IMICUer and I hope it turns out well. I had a friend who recently accepted a similar position after IM residency at a place with an open MICU and immediately regretted it after they worked him about 120 hours that first week. Quit a couple of weeks later. You can find good and bad jobs in any field. Glad you found a good one.

 

[IMICUer]

Your on point with the passion comment. My future career is set with ophthalmology fortunately (current TY at a busy safety net hospital) I was just curious about the hospitalist gig and enjoyed your post. Several of the residents here want to do it although almost all the attendings seem burnt out


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Glad you found your passion, I think you will like ophtho a lot. I just wanted to clarify a few misconceptions about hospital medicine to help out poor 3rd and 4th year students still trying to find out what their passion is. Hope it helps someone. I do see how burnout would be easier in a safety net type hospital. I for one could not work in such a place long term. Great for training but horrible for when you are out.

 

[IMICUer]

Glad you found a job you enjoy IMICUer and I hope it turns out well. I had a friend who recently accepted a similar position after IM residency at a place with an open MICU and immediately regretted it after they worked him about 120 hours that first week. Quit a couple of weeks later. You can find good and bad jobs in any field. Glad you found a good one.

True that, medicine is not immune to bad set ups just like other professions. Granted your friend should have known that first couple of weeks in any job will be much busier than normal until u find your groove, master the electronic system, know the hospital system well, and become much more efficient. It takes a couple of months for anyone to get there, but 120 hrs still sounds excessive, almost like ortho residency hrs wise. I for one plan on signing out to night doc at 7pm and then peace out.

 

[LightBox]

Most people in Ophtho would shoot themselves if they had to be a hospitalist or do anything related to general Medicine again. I know I would! Different strokes for different folks...

 

[Silent Cool]

I just happened across this and want to clear up something for those maybe on the fence. I just signed a contract for a hospitalist position at a community hospital about one hour from a large city and couldn't be happier with the prospects of 7 on/7 off. My census will be 12-15 pt encounters a day and there are NPs doing a lot of the scut work including discharge summaries and other documentation needs so I can stick with more of the medicine. I will also handle ICU pts which I enjoy because there are more procedures to do at times and treatment in general is more aggressive, making one have to be at the top of one's game. My base salary will be $230K with $20K yearly bonus (easy to make) and $25K per year for loan repayment (x3 yrs). Base goes up every year to just under $300K by 3rd year. I can easily moonlight on my off weeks if I really wanted more (one guy is single and does a lot of this and is clearing $400K yearly). As a hospitalist in a community hospital you will seldom deal with delayed nursing home or other placements like you would in a more urban setting (safety-net type hospital). Also, the week you are "on" you work those 12 hrs but there are down times during the day (may have an hour or so at a time where you aren't getting new admissions and can kick back for a bit -> this obviously depends on where you are, so I consider myself lucky (I know 5 people already working where I will be). Two of the young hospitalists where I am going take an overseas vacation every month, which I can't wait to do as well.

Ophtho is a very interesting and great specialty and I have family members in it as well as some friends, which all seem to still enjoy it. Your lifestyle will be more intense during residency but then will improve and you will make a decent living as well. You will obviously be confined to the eyes so think carefully if you will miss dealing with other parts of the body (most important thing to think about for those of you on the fence). Costs for setting up your practice are also considerable and your start up salary will not be as good as other fields until you get the volume and/or have amazing business skills.

Good luck to any med student out there reading this and wondering what to do. I would suggest you do several rotations in both (especially try going to a non academic, non safety net hospital type place to get more exposure to various settings). In the end you will have enough money to live comfortably no matter what you do (unless you can't control spending) so think about what you would enjoy more, if something more broad or something more confined.

Would you mind saying what city you are near? Boston and OK-City are large cities but very different beasts
How much paid vacation do you get?
Do you plan to be a hospitalist for a career?
What is the night shift differential at your shop?


thanx

 

[DrZeke]

Most people in Ophtho would shoot themselves if they had to be a hospitalist or do anything related to general Medicine again. I know I would! Different strokes for different folks...

Exactly, I'm almost done with intern year in IM and I cannot imagine any sum of money that could possibly buy my interest in hospitalist medicine. Watching the hospitalists triage and admit while on call is painful.

 

[IMICUer]

Exactly, I'm almost done with intern year in IM and I cannot imagine any sum of money that could possibly buy my interest in hospitalist medicine. Watching the hospitalists triage and admit while on call is painful.

And I would shoot myself having to endure endless clinic days doing eye exams and seeing such high volume of pts, essentially restarting med school and forgetting most of what u worked countless hours to learn, not knowing how to treat any other parts of the body, enduring insane repetition to be great at surgery, dealing with stress of post op complications and litigation, drive miles and miles from hospital to hospital when on call, and then being tied down to one city or having to move somewhere less desirable given market saturation and expensive start up costs. Of course none of this matters if u love what u do. Same with hospital medicine in the right environment. So it goes without saying that money can't touch passion. I just want med students to be sure they know their passion before they commit to something, cuz I have known two ophtho residents that didn't end up finishing residency for some of these reasons.

 

[IMICUer]

Would you mind saying what city you are near? Boston and OK-City are large cities but very different beasts
How much paid vacation do you get?
Do you plan to be a hospitalist for a career?
What is the night shift differential at your shop?


thanx

I don't want to get too specific to remain anonymous but basically I am east of Texas and south of New York. I get 3 wks paid vacation to add to the other weeks, so in essence I can take three 2 week vacations a year. For now I plan to work as one for a few years and depending on my itch for more training go back for more, or get more involved with overseas work. I won't work nights at all because there is a designated night doc (who will make more than me). But the nights he is off can be available from time to time for moonlighting on off week which comes to about 150-160/hr

 

[LightBox]

And I would shoot myself having to endure endless clinic days doing eye exams and seeing such high volume of pts, essentially restarting med school and forgetting most of what u worked countless hours to learn, not knowing how to treat any other parts of the body, enduring insane repetition to be great at surgery, dealing with stress of post op complications and litigation, drive miles and miles from hospital to hospital when on call, and then being tied down to one city or having to move somewhere less desirable given market saturation and expensive start up costs. Of course none of this matters if u love what u do. Same with hospital medicine in the right environment. So it goes without saying that money can't touch passion. I just want med students to be sure they know their passion before they commit to something, cuz I have known two ophtho residents that didn't end up finishing residency for some of these reasons.

I didn't realize my 4 to 4:30 pm clinic days were "endless"! I think one of the reasons Ophthos like what they do is because they become an expert on one specific part of the body. Not to bash IM/etc, but my ego could not stomach referring patients out all of the time, or feeling like I was just a coordinator of care.

Most ophthos I know don't drive "miles and miles from hospital to hospital"...we mainly just stay at our office with parking in front

Anyways, to each his own. I love ophtho because it is interesting, the surgery is fun, the patients really appreciate their outcomes, and it gives me time to pursue other business interests and have time to spend with my family.

 

[IMICUer]

I didn't realize my 4 to 4:30 pm clinic days were "endless"! I think one of the reasons Ophthos like what they do is because they become an expert on one specific part of the body. Not to bash IM/etc, but my ego could not stomach referring patients out all of the time, or feeling like I was just a coordinator of care.

Most ophthos I know don't drive "miles and miles from hospital to hospital"...we mainly just stay at our office with parking in front

Anyways, to each his own. I love ophtho because it is interesting, the surgery is fun, the patients really appreciate their outcomes, and it gives me time to pursue other business interests and have time to spend with my family.

You are right, there are places according to my family members in ophtho that have shorter clinic days with less volume, but those people usually end up taking a pay cut. One of my family members is in an urban center with high volume and his clinic days are certainly never over before 5pm. In residency during clinic days at a safety net hospital, days are certainly very long and then there are consults to do if you are on call, which is pretty frequent. The driving from place to place also mainly applies to residency in most university settings. In terms of referring patients out it is not much different in ophtho as you guys refer out to retina, cornea, and other subspecialists many times as well, and at times admit patients to medicine for us to handle other medical issues. Just because a subspecialist has a certain skill you don't (be it cardiology, GI, retina, cornea, etc), doesn't mean you can't handle and adequately treat a whole bunch of other concomitant issues. In smaller, less urban hospitals with less subspecialists, docs handle a lot more, both in medicine and general ophtho, which is one of the perks to not staying forever in a large academic center.

Anyways, like you said to each his own. I think ophtho is cool and whenever I get my uncontrolled hypertensives or diabetics, or my AIDS pts I always make a point to look at their retinas (after some tropicamide) as it can change my management. I carry an Optyse and have a pan-ophthalmic when needed as well. I also like looking at stuff on the slit lamp in the ED if able, but in the end I enjoy taking care of all the other medical problems going on in complicated, sick patients, which is why I did what I did. But my family members in ophtho enjoy it a lot and if a med student knows for sure that is their passion then they will too. Here's to hoping again that this helps some poor conflicted med student make the right informed decision.

 

[DrZeke]

To sum it up:

1) different strokes for different folks

2) if you think IM sucks, because you are doubting quality of life or pay, realize that being a hospitalist is actually pretty great.

 

[ophthope]

I'm glad we're all hugging it out and sharing our feelings but just so no prospective Young Ophthalmologists are led astray I still think Ophthalmology is objectively a better field to go into than IMED.

Things Ophthalmologists (even in residency) get to say that IMED residents don't:
1. "Call the primary team for that."
2. "Sorry you'll have to talk to your primary doc about those pain medications."
3. "I was off last weekend." / "I'll be home for dinner."
4. "I'll be the one performing your surgery."
5. "Nobody in clinic asked me to sign a disability form for their fibromyalgia today."

Things IMED residents get to do that Ophtho residents generally don't:
1. Sort through 100 pages of faxed in outside patient records to find a lab value and an MRI reading
2. Discharge Mr. Bob to the nursing home, but at the last minute the patient is rejected because that one form wasn't filled out in triplicate and his BP is 160/89 even though that's what it always is they just don't know that because they never check it when he's there.
3. And it's Friday and they don't take transfers on the weekend so you get to watch Bob sit in the hospital and round and write notes on him for three more days.
4. Readmissions for uncontrolled CHF s/p repeat salt binge aka "Patient well known to service and this is his fifth recent admission for similar complaints."
5. Rounding

So you know, like I said, objectively better.


I am glad that some primary care doctors are seeing better pay, because we need good IMED docs. I hope that pay increase trend continues. Glad there are people who enjoy doing it!

I would say that as much as we all say not to choose a field for the money, most working-class citizens (aka most of the patients you see every day) chose their field for the money and nobody finds that to be absurd. I think it's within reason to consider pay when choosing what to do for the rest of your life. Very few of us would be doing any of this for a lot less, because it's a hard job. All fields of medicine are challenging compared to other jobs just due to the nature of the practicing medicine, but try to find something that doesn't stress you out or make you miserable. Then make sure the pay is enough after that.

 

[IMICUer]

I'm glad we're all hugging it out and sharing our feelings but just so no prospective Young Ophthalmologists are led astray I still think Ophthalmology is objectively a better field to go into than IMED.

Things Ophthalmologists (even in residency) get to say that IMED residents don't:
1. "Call the primary team for that."
2. "Sorry you'll have to talk to your primary doc about those pain medications."
3. "I was off last weekend." / "I'll be home for dinner."
4. "I'll be the one performing your surgery."
5. "Nobody in clinic asked me to sign a disability form for their fibromyalgia today."

Things IMED residents get to do that Ophtho residents generally don't:
1. Sort through 100 pages of faxed in outside patient records to find a lab value and an MRI reading
2. Discharge Mr. Bob to the nursing home, but at the last minute the patient is rejected because that one form wasn't filled out in triplicate and his BP is 160/89 even though that's what it always is they just don't know that because they never check it when he's there.
3. And it's Friday and they don't take transfers on the weekend so you get to watch Bob sit in the hospital and round and write notes on him for three more days.
4. Readmissions for uncontrolled CHF s/p repeat salt binge aka "Patient well known to service and this is his fifth recent admission for similar complaints."
5. Rounding

So you know, like I said, objectively better.


I am glad that some primary care doctors are seeing better pay, because we need good IMED docs. I hope that pay increase trend continues. Glad there are people who enjoy doing it!

I would say that as much as we all say not to choose a field for the money, most working-class citizens (aka most of the patients you see every day) chose their field for the money and nobody finds that to be absurd. I think it's within reason to consider pay when choosing what to do for the rest of your life. Very few of us would be doing any of this for a lot less, because it's a hard job. All fields of medicine are challenging compared to other jobs just due to the nature of the practicing medicine, but try to find something that doesn't stress you out or make you miserable. Then make sure the pay is enough after that.

This will be my last post here. Just wanted to clarify a few things said in this post. First, hospital medicine (aka hospitalists) are NOT primary care doctors and they defer most of the same things to outpatient PCPs. Anything that is not urgent is deferred, and in terms of filling out the few forms some patient about to be discharged may hand us, we have nurse practitioners We don't have clinics and don't care for them usually, which is one of the perks. Another thing I will get to say is that I'll be home for almost all dinners during my 7 days of work and then home for breakfast, lunch, and dinner during my subsequent 7 days off. We also get to say: "I know its been tough seeing so many doctors, I'll be your main doctor while you are here and will make sure the right workup and treatment are done."

Also, IM is not the same as family practice, which is mostly outpatient or clinic-based. During IM you will rotate through all of the subspecialties where you will be essentially saying the same things any other specialist (including ophtho) will.

In terms of the inpatient points brought up most of them apply to tertiary referral centers and county hospitals (aka safety net hospitals for the uninsured), which a less urban community hospitalist will not deal with. Also, nursing homes do take patients on the weekend and a good social worker will get the job done without you having to do anything. Problem is most county or safety net hospitals have crappy social workers that are underpaid and overwhelmed and that is what prelims, transitionals, and interns have to deal with. In the real world people would get fired and replaced with someone more competent if they don't do their job well. Lastly, when you are a hospitalist there is no "rounding" unless you are at an academic/teaching hospital. Otherwise you just go see and take care of your patients and have excellent autonomy. In short, don't let the hassles of a county hospital make you think it is that way everywhere. And if you really just want more options, then you can always subspecialize into your area of choice (way more options to choose from: cards, GI, pulm, crit care, heme/onc, renal, endo, rheum, allergy, infectious disease, international medicine, political medicine, HIV/AIDS, sports medicine, outpatient IM, lifestyle type medicine, and countless others). So if you are undecided, it is a great way to go to buy you time while you try to find your passion.

 

[JayZBlue]

Come on people, IMICUer has been awesome to have in our discussions. We go into different fields for different reasons, and one reason is no "better" than another. The things that ophthope bring up 2 posts ago will not appeal to most of us in ophthalmology, including myself, but my friends in hospitalist medicine actually do enjoy some of those aspects, and enjoy figuring out systemic mysteries, and I (and many others) have lots of respect for that. Thanks to IMICUer for the informative posts.

 

[LightBox]

One thing that I worry about in being a hospitalist is whether the field will be obsolete in the future. Is there any threat from NPs and/or PAs to replace you guys eventually? I look at "regular" PCPs and can't imagine their profession lasting too much longer. They are undervalued and the alternative providers (e.g. NPs) are much cheaper to produce.

 

[ophthope]

I figured my post was obviously in jest since I bolded 'objectively' better. People are obviously suited for different fields. My last comment about pay was basically to say that if you pull any random Joe off the street and tell them you'll pay them $240,000/yr to work a 7 on 7 off schedule but the work was going to be just absolutely horrible, they'd probably still take the job. And hospitalist work ain't that bad in some places, as IMICUer has been demonstrating. Buuuuuut since we've got the option Ophtho is still better.

This will be my last post here. Just wanted to clarify a few things said in this post. First, hospital medicine (aka hospitalists) are NOT primary care doctors and they defer most of the same things to outpatient PCPs.

Please don't take my above post to have been literal - just messing around.

I will say though that the hospitalist attendings in the IMED program where I'm at definitely consider themselves to be primary care. And they can be a little disparaging when it comes to 'specialists' even though I'm of the opinion that the hospitalist profession *is* a type of specialist. Almost nobody is 'general practice' anymore (doing both inpatient and outpatient work for their patient base). You're either an outpatient PCP, or you're a specialist in inpatient medicine. And it's probably for the best since there's a large volume of unique issues in either of those fields. But 'specialists' are evil so my advice is just keep saying that hospitalists are primary care for as long as you can, lest you be lumped with us money-worshiping specialists!

Also if you have the chance please disseminate this hospitalist pay information to your fellows in IM so they don't continue to tell me I'm going to make $500,000/yr working 3 days a week as an Ophthalmologist.

I know a few hospitalists from my home State who are in non-county, non-tertiary referral center, non-level-1-trauma hospitals and while I think their schedule is overall pretty great they do come home late pretty frequently and they still complain about social work and disposition issues. Less frequently than in residency but that's true of residency complaints in any field. Ophtho doesn't run in to the local ED because of a red eye outside of training institutions.

As to the subspecialties in IM - I think that's a whole different ballgame. You'll probably find a lot of Ophtho residents who enjoyed cardiology or GI. You'll probably find more who enjoyed ENT or Anesthesiology though.

Anyway I hope that wasn't actually your last post because I think it's been a good discussion even with my scathing humor.

 

[Mirror Form]

One thing that I worry about in being a hospitalist is whether the field will be obsolete in the future. Is there any threat from NPs and/or PAs to replace you guys eventually? I look at "regular" PCPs and can't imagine their profession lasting too much longer. They are undervalued and the alternative providers (e.g. NPs) are much cheaper to produce.

Oh come on, that's just like saying ophthalmologists will be obsolete b/c of competition from optometrists. Fully trained physicians will always be welcome in primary care, hopsitalist roles, or as ophthalmologists, etc.

In regard to different schedules, back when I was young and single, a 7 on / 7 off schedule would have been awesome. I think such a schedule would be tough once you have kids though, especially young ones. You're won't be sleeping in and resting on your 7 days off!