Why is IM always at the bottom for career satisfaction?

[jdh71]

interesting. the ccu in my residency would routinely get micu overflow (rarely the other way around), but maybe its different outside of academia sans residents/fellows.

Of course it's different than residency and fellowship.

I also trained in places where all academic services took care if their own patients. Without the small army of trainees in places that aren't academics patients get admitted and taken care of by somebody and those somebodies are the hospitalists and intensivists.

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[mercaptovizadeh]

Low career satisfaction: relatively low pay for the work, lack of patient and colleague respect (which includes being dumped on by the ED and all the subspecialists refusing to take care of their own stuff > hip fractures to IM, chest pain rule outs with known CAD s/p umpteen stents and admitted to cardiology just 3 weeks ago to IM, TIA workups to IM, etc.), paperwork, etc. I recall new diagnoses of MS and Guillain-Barre patients being admitted to IM because the neuro resident team was "capped" and the neuro attending didn't want to write any notes solo. So IM had to babysit primary neurologic disease and carry water for the neuro consultants. And the ED has prerogative and ALWAYS dumps this garbage on IM, even though technically they have the right to decide where people go. They never send the fevering encephalopathic shunted patients to neurosurgery unless neurosurgery says "it's the shunt" (which they almost never do, even when oftentimes it is the shunt).

The structure of compensation in medicine is messed up. Rad onc makes substantially more than heme onc despite less years of training, less grueling training, not managing the comprehensive care coordination, the numerous medical complications, or transitioning to palliative care. Spine surgeons make more than epilepsy surgeons. Gastroenterologists who do routine scopes day in and day out make more than hepatologists who are keeping tenuous liver bombs alive until hopefully transplant, nephrologists who keep patients alive daily with dialysis are paid less than some CRNAs, ENT is paid better than general surgery, ID consultants are paid less than general IM, etc.

 

[IM2GI]

Gastroenterologists who do routine scopes day in and day out make more than hepatologists who are keeping tenuous liver bombs alive until hopefully transplant.

You know that GI/hepatology is one field yea? Outside of the ivory tower of academia/transplant centers, most general GI folks are seeing liver patients. The 4th liver year is a transplant year. And at least at my center, the GI and hepatology folks make the same. Additionally, transplant hepatologists also do routine endoscopy, they just focus their clinic and rounding on liver patients. While they might hit their RVU bonuses differently, your GI analogy is poor.

Endoscopy is also a technically challenging and physically intensive procedure that we deserve to be compensated for. We work hard. No need to tear down other specialities when discussing the unfairly low compensation of other fields.

 

[CCM-MD]

Its all about perception. I pride myself in being able to manage the sickest patients in the hospital regardless of what led them to the ICU. I don't feel like I am dumped on because this is why I chose the field. I decide who comes to the ICU and I decide when they are ready to leave. It's definitely hard work and compensation should be higher for the work but it's not terrible. Intensivists at my institution make similar $ to non invasive cards for working 14-15 days a month. One could argue cards is easier work but they are also on call every 5th weekday and 1 weekend a month, which is pretty terrible also. The grass is always greener on the other side.

 

[Raryn]

Its all about perception. I pride myself in being able to manage the sickest patients in the hospital regardless of what led them to the ICU. I don't feel like I am dumped on because this is why I chose the field. I decide who comes to the ICU and I decide when they are ready to leave. It's definitely hard work and compensation should be higher for the work but it's not terrible. Intensivists at my institution make similar $ to non invasive cards for working 14-15 days a month. One could argue cards is easier work but they are also on call every 5th weekday and 1 weekend a month, which is pretty terrible also. The grass is always greener on the other side.

I find the discussion about income funny.

The median pulmonologist/intensivist in this country makes $360k (MGMA) or $306k (Medscape), in both cases $80-120k more than IM. The range is wide, but if you exclude the people immediately starting out and primarily look at physicians with a reasonably mature career, the median is >$400k.

I can understand that everyone wants to be better compensated, but that's a pretty respectable increase regardless.

 

[VA Hopeful Dr]

You know that GI/hepatology is one field yea? Outside of the ivory tower of academia/transplant centers, most general GI folks are seeing liver patients. The 4th liver year is a transplant year. And at least at my center, the GI and hepatology folks make the same. Additionally, transplant hepatologists also do routine endoscopy, they just focus their clinic and rounding on liver patients. While they might hit their RVU bonuses differently, your GI analogy is poor.

Endoscopy is also a technically challenging and physically intensive procedure that we deserve to be compensated for. We work hard. No need to tear down other specialities when discussing the unfairly low compensation of other fields.

I think its cute that you believe general gastroenterologists see liver patients all that often and willingly.

I'm in my 4th location since residency and I've yet to meet a PP GI doc who doesn't try their best to avoid taking liver patients. They 99% of the time either punt to academic center immediately, see them once/year and essentially refuse inpatient consults on them leaving their PCP/hospitalists to deal with them, or conveniently don't take their insurance (but will take the same insurance for screening scopes). In fact I'm seeing more and more large groups being formed who do nothing but screening colonoscopies - there is a group 12 strong in my town that does nothing but. The other group, hospital owned, is 5 strong and can't get anyone else because who wants to take call?

Now I recognize that this is a generalization, but its very much a trend everywhere I've ever been.

 

[VA Hopeful Dr]

I find the discussion about income funny.

The median pulmonologist/intensivist in this country makes $360k (MGMA) or $306k (Medscape), in both cases $80-120k more than IM. The range is wide, but if you exclude the people immediately starting out and primarily look at physicians with a reasonably mature career, the median is >$400k.

I can understand that everyone wants to be better compensated, but that's a pretty respectable increase regardless.

This is an especially valuable viewpoint from someone who's sub-specialty doesn't result in much of an income increase compared to general IM...

 

[IM2GI]

I think its cute that you believe general gastroenterologists see liver patients all that often and willingly.

I'm in my 4th location since residency and I've yet to meet a PP GI doc who doesn't try their best to avoid taking liver patients. They 99% of the time either punt to academic center immediately, see them once/year and essentially refuse inpatient consults on them leaving their PCP/hospitalists to deal with them, or conveniently don't take their insurance (but will take the same insurance for screening scopes). In fact I'm seeing more and more large groups being formed who do nothing but screening colonoscopies - there is a group 12 strong in my town that does nothing but. The other group, hospital owned, is 5 strong and can't get anyone else because who wants to take call?

Now I recognize that this is a generalization, but its very much a trend everywhere I've ever been.

Decompensated cirrhotics should appropriately be managed through a transplant center.

Elevated LFTs, HCV treatment, compensated cirrhosis, are all often and appropriately seen by general GI folks, even in private practice.

 

[CCM-MD]

I find the discussion about income funny.

The median pulmonologist/intensivist in this country makes $360k (MGMA) or $306k (Medscape), in both cases $80-120k more than IM. The range is wide, but if you exclude the people immediately starting out and primarily look at physicians with a reasonably mature career, the median is >$400k.

I can understand that everyone wants to be better compensated, but that's a pretty respectable increase regardless.

I agree with you a 100%. To further your point, 2016 MGMA for intensivists is 400k.

 

[Raryn]

This is an especially valuable viewpoint from someone who's sub-specialty doesn't result in much of an income increase compared to general IM...

I always count my blessings I liked Endocrinology rather than ID or Nephrology. At least my income relative to general IM won't go down, even if it's no better than I could have done straight out of residency. I'll be doing what I enjoy with a typical lifestyle that isn't too bad (though not really better than primary care hour wise), so hopefully that makes up for the two years of opportunity cost.

 

[mercaptovizadeh]

You know that GI/hepatology is one field yea? Outside of the ivory tower of academia/transplant centers, most general GI folks are seeing liver patients. The 4th liver year is a transplant year. And at least at my center, the GI and hepatology folks make the same. Additionally, transplant hepatologists also do routine endoscopy, they just focus their clinic and rounding on liver patients. While they might hit their RVU bonuses differently, your GI analogy is poor.

Endoscopy is also a technically challenging and physically intensive procedure that we deserve to be compensated for. We work hard. No need to tear down other specialities when discussing the unfairly low compensation of other fields.

Of course I know hepatologists complete GI training first. I'm not singling out GI per se. The point was to illustrate that you will make a lot more money doing private practice nothing but routine colonoscopies than if you work with liver bombs trying to keep them alive until transplant at an academic center. The same is true regarding the academic vs PP discussion everywhere. A cardiologist doing advanced heart failure at an academic center makes way less than someone who does nothing but catheterizations at a private hospital. The system is rigged to favor manual procedures as service over every other form of contribution to the betterment of the patient, most notably the intellectual work of nailing a diagnosis and doing appropriate medical therapy or referral for it. It also takes nothing into account regarding the instability of the patient or their prognosis (and the emotional weight that may have on a provider who sees many of the patients die). It punishes people who see children rather than adults (many times higher income in adult subspecialties than pediatric subspecialties). It punishes those who manage rare disease and rewards those who manage common disease and can upscale the efficiency of the process into a factory: an A/I doctor who does nothing but allergy shots and skin testing makes WAY more than someone who works up and manages SCID, athymic patients, hypocomplementemics, CVID, etc.

 

[chessknt]

Decompensated cirrhotics should appropriately be managed through a transplant center.

Elevated LFTs, HCV treatment, compensated cirrhosis, are all often and appropriately seen by general GI folks, even in private practice.

Have you ever worked in a small hospital? If I transfer a decompensated cirrhotic I get skewered since we "have the capacity to appropriately treat this patient" while our hallowed gi providers can provide the valuable input of "no need for egd ty for consult." I saw a lot of livers as a resident so I don't mind much but some of my colleagues aren't as comfortable. The only way I get them out is id they are listed for transplant. Most ours just drink and dont take meds and roll in with pse or ugib every 3 weeks. Outside of academia the community world is a very different place...

 

[chessknt]

Of course I know hepatologists complete GI training first. I'm not singling out GI per se. The point was to illustrate that you will make a lot more money doing private practice nothing but routine colonoscopies than if you work with liver bombs trying to keep them alive until transplant at an academic center. The same is true regarding the academic vs PP discussion everywhere. A cardiologist doing advanced heart failure at an academic center makes way less than someone who does nothing but catheterizations at a private hospital. The system is rigged to favor manual procedures as service over every other form of contribution to the betterment of the patient, most notably the intellectual work of nailing a diagnosis and doing appropriate medical therapy or referral for it. It also takes nothing into account regarding the instability of the patient or their prognosis (and the emotional weight that may have on a provider who sees many of the patients die). It punishes people who see children rather than adults (many times higher income in adult subspecialties than pediatric subspecialties). It punishes those who manage rare disease and rewards those who manage common disease and can upscale the efficiency of the process into a factory: an A/I doctor who does nothing but allergy shots and skin testing makes WAY more than someone who works up and manages SCID, athymic patients, hypocomplementemics, CVID, etc.

If you look in to the Harvard studies done for cms in the 80s as the foundation of the rvu you'll see that the crux of this problem is finding what is equivalent between two fields who have no idea how to do what the other does. Unfortunately surgeons and anesthesiologists primarily comprised the board of experts during the late and poorly funded phase of those studies and felt that acutely managing the most complex medical patients in the icu was approximately equal to delivering anesthesia to a healthy ob patient. Hence all other lesser management fell far lower.

This is why em relies on massive volume and billing literally every small thing they do from us guided iv placement to smoking cessation and EKG interpretation to make a killing using otherwise **** e&m codes. Think about it--we have 3 e&m codes to describe service for every medical complaint requiring hospitalization while gen surg has at least 5 to just describe an appy and it's variations.

 

[jdh71]

You know that GI/hepatology is one field yea? Outside of the ivory tower of academia/transplant centers, most general GI folks are seeing liver patients. The 4th liver year is a transplant year. And at least at my center, the GI and hepatology folks make the same. Additionally, transplant hepatologists also do routine endoscopy, they just focus their clinic and rounding on liver patients. While they might hit their RVU bonuses differently, your GI analogy is poor.

Endoscopy is also a technically challenging and physically intensive procedure that we deserve to be compensated for. We work hard. No need to tear down other specialities when discussing the unfairly low compensation of other fields.

Do you admit to your own service?

 

[IM2GI]

Do you admit to your own service?

yes, but that is a huge outlier and a total ivory tower thing to do.

 

[Raryn]

yes, but that is a huge outlier and a total ivory tower thing to do.

How many interns and residents take care of your service?

 

[jdh71]

Its all about perception. I pride myself in being able to manage the sickest patients in the hospital regardless of what led them to the ICU. I don't feel like I am dumped on because this is why I chose the field. I decide who comes to the ICU and I decide when they are ready to leave. It's definitely hard work and compensation should be higher for the work but it's not terrible. Intensivists at my institution make similar $ to non invasive cards for working 14-15 days a month. One could argue cards is easier work but they are also on call every 5th weekday and 1 weekend a month, which is pretty terrible also. The grass is always greener on the other side.

That isn't correct though. You don't get to decide who comes into your unit. If a patient can't be managed on any other unit, they come to the ICU. If no one else will admit then someone has to be a *doctor* and you admit. Too often it's not about taking care the sickest of the sick, which isn't some kind of heroic cause, nor is it all that hard with training, but rather who can get away with the least amount of responsibility for the things that do not pay or compensate well so they can go and do things that will pay. The game is to make some other poor SOB deal with the horse**** and all the while making a lot more than the folks who are getting dumped on. And it is a dump.

At the end of the day it does eventually add up. But the lack of respect and underlying attitude of "I don't deal with anything but my procedure" is galling. And it's no wonder job satisfaction is low in that context. Everyone reconciles this they need to because it is the way it works. I'm just tired of people excusing the abuse and bad attitude towards colleagues.

 

[jdh71]

yes, but that is a huge outlier and a total ivory tower thing to do.

So you probably don't really know what it's like "out there".

I gave a good working relationship with my GI docs. They are available no questions asked in the middle of the night for bleeds. They are fantastic proceduralists. But I can't get a reasonable opinion from them on any liver, chronic abdominal pain, inflammatory GI disease, or diarrhea. So I stopped asking. They also don't admit, not even basic floor coffeee ground types without anything else wrong with them.

I also know what they get paid.

Must be nice.

 

[CCM-MD]

That isn't correct though. You don't get to decide who comes into your unit. If a patient can't be managed on any other unit, they come to the ICU. If no one else will admit then someone has to be a *doctor* and you admit. Too often it's not about taking care the sickest of the sick, which isn't some kind of heroic cause, nor is it all that hard with training, but rather who can get away with the least amount of responsibility for the things that do not pay or compensate well so they can go and do things that will pay. The game is to make some other poor SOB deal with the horse**** and all the while making a lot more than the folks who are getting dumped on. And it is a dump.

At the end of the day it does eventually add up. But the lack of respect and underlying attitude of "I don't deal with anything but my procedure" is galling. And it's no wonder job satisfaction is low in that context. Everyone reconciles this they need to because it is the way it works. I'm just tired of people excusing the abuse and bad attitude towards colleagues.

I don't know how things are set up where you are but I definitely decide on who comes to the ICU and refuse patients that are not appropriate. Abuse and bad attitude is probably more about the culture at your institution, this is definitely not the case where I am.

 

[jdh71]

I don't know how things are set up where you are but I definitely decide on who comes to the ICU and refuse patients that are not appropriate. Abuse and bad attitude is probably more about the culture at your institution, this is definitely not the case where I am.

If a patient needs the ICU for one reason or another that where they go. It doesn't matter where you are. If no one else will admit you will have to. Also doesn't matter where you are. You have very little control. Less than you think. And I find it cute you think you have this control.

We all tell ourselves what we have to.

 

[CCM-MD]

If a patient needs the ICU for one reason or another that where they go. It doesn't matter where you are. If no one else will admit you will have to. Also doesn't matter where you are. You have very little control. Less than you think. And I find it cute you think you have this control.

We all tell ourselves what we have to.

If a patient is critically ill they will come to the ICU. If I find the patient is not critically ill and does not need to be in the ICU, the hospitalist service is forced to take the patient. The hospitalist on call cannot refuse to take a patient.

I'm sorry you hate your job. I love mine.

 

[chessknt]

I don't know how things are set up where you are but I definitely decide on who comes to the ICU and refuse patients that are not appropriate. Abuse and bad attitude is probably more about the culture at your institution, this is definitely not the case where I am.

And what happens if that patient ends up being transferred or having a bad outcome due to poor care from a provider who was not able to appropriately handle the pathology? At my institution that would absolutely come back and nail me within a few days of administration becoming aware. I am employed by the hospital so this is less concerning than if I worked for a private group who held a contract in a competitive environment. In that scenario it would be downright suicidal to piss off administration.

Also don't underestimate the blowback from the nursing side from leaving a patient they don't feel comfortable with on the floor. If you get a reputation for that there are formal and far more informal consequences.

 

[CCM-MD]

And what happens if that patient ends up being transferred or having a bad outcome due to poor care from a provider who was not able to appropriately handle the pathology? At my institution that would absolutely come back and nail me within a few days of administration becoming aware. I am employed by the hospital so this is less concerning than if I worked for a private group who held a contract in a competitive environment. In that scenario it would be downright suicidal to piss off administration.

Also don't underestimate the blowback from the nursing side from leaving a patient they don't feel comfortable with on the floor. If you get a reputation for that there are formal and far more informal consequences.

Not leaving patients to die in an unsafe environment but am often called for patients that can be safely managed on the floor. I'm at an institution where there aren't enough ICU beds for the number of patients the ED wants to admit to the ICU. Someone has to make the decision about who needs to be in the ICU, at my institution it is the intensivist.

 

[jdh71]

If a patient is critically ill they will come to the ICU. If I find the patient is not critically ill and does not need to be in the ICU, the hospitalist service is forced to take the patient. The hospitalist on call cannot refuse to take a patient.

I'm sorry you hate your job. I love mine.

I don't hate my job.

You are either lying or a bad physician.

 

[CCM-MD]

I don't hate my job.

You are either lying or a bad physician.

I have no reason to lie. You can disagree with what I have to say but there is no reason to call me a bad physician. You don't know me.

 

[rokshana]

If a patient is critically ill they will come to the ICU. If I find the patient is not critically ill and does not need to be in the ICU, the hospitalist service is forced to take the patient. The hospitalist on call cannot refuse to take a patient.

I'm sorry you hate your job. I love mine.

and when they call a rapid response or a code on the floor for that pt, you end up having to take them and in a more emerent manner than if you had taken them before they tipped over the edge....

and you betcha as a hospitalist one can refuse the pt...if they feel that the pt is not stable for the floor, needs closer monitoring, heck not suitable for the nursing care on the general ward (which can mean involving the nurse manager...) and documents that as such that the pt would be better served to be in the icu...the pt will go to the icu...either yours or somewhere else...enough goes to somewhere else (meaning the hospital is losing that revenue) someone from administration will be having a discussion with the head of the icu...

 

[VA Hopeful Dr]

Decompensated cirrhotics should appropriately be managed through a transplant center.

Elevated LFTs, HCV treatment, compensated cirrhosis, are all often and appropriately seen by general GI folks, even in private practice.

Not anywhere I have ever worked...

 

[meerkat111]

I appreciate all of the above discussion, and yes. Crayola rocks!

No one mentioned the meanness of nurses towards female attendings. This real and nasty. Nurses should learn how to be more professional in their training. One time a nurse asked me if I could be rounding with pt for few more min so she could go check on her relative who was hospitalized upstairs!

 

[IM2GI]

Not anywhere I have ever worked...

Really? Disappointing to hear.

 

[VA Hopeful Dr]

Really? Disappointing to hear.

Agreed. On the plus side, I've gotten pretty good with the new Hep C drugs

 

[IM2GI]

Agreed. On the plus side, I've gotten pretty good with the new Hep C drugs

hcvguidelines.org is all you need

You are treating HCV in an outpatient primary care clinic? Surprising.

Insurance isn't giving you pushback?

 

[VA Hopeful Dr]

hcvguidelines.org is all you need

You are treating HCV in an outpatient primary care clinic? Surprising.

Insurance isn't giving you pushback?

Cash only practice, so I'm getting pretty good at patient assistance programs.

I'm actually having to do a lot that I normally wouldn't because of ****ty local specialists. I manage a few autoimmunepatients on biologics because local rheum refuses to see uninsured patients, no exceptions.

 

[maverickdoc]

Admitting pts in the unit does not bother me. In an ideal world , things could/ should be different . It is my job to take care of sick people and I pride myself in that .
I would have zero job satisfaction doing screening colonoscopies. My partners make more money than general cards/ general surgeons in our hospital

So you probably don't really know what it's like "out there".

I gave a good working relationship with my GI docs. They are available no questions asked in the middle of the night for bleeds. They are fantastic proceduralists. But I can't get a reasonable opinion from them on any liver, chronic abdominal pain, inflammatory GI disease, or diarrhea. So I stopped asking. They also don't admit, not even basic floor coffeee ground types without anything else wrong with them.

I also know what they get paid.

Must be nice.

 

[Ermundo]

Random question, but what is the average compensation for a hospitalist not at an academic center or big city (new York/Chicago) in..say...the Midwest. The range of salaries I see online are very wide.

 

[jdh71]

Admitting pts in the unit does not bother me. In an ideal world , things could/ should be different . It is my job to take care of sick people and I pride myself in that .
I would have zero job satisfaction doing screening colonoscopies. My partners make more money than general cards/ general surgeons in our hospital

You can find folks under all walks of horrible situations in history who "don't mind". Find reasons to excuse bad behavior. You don't get a prize from me and you're not a hero. But thanks for letting me know. Now I know.

 

[jdh71]

Random question, but what is the average compensation for a hospitalist not at an academic center or big city (new York/Chicago) in..say...the Midwest. The range of salaries I see online are very wide.

Probably 250+

 

[maverickdoc]

You can find folks under all walks of horrible situations in history who "don't mind". Find reasons to excuse bad behavior. You don't get a prize from me and you're not a hero. But thanks for letting me know. Now I know.

But that is the job you signed up for . Outside of academics , all sick pts come to a micu under an intensivist .
The freedom to do shift work with a fixed schedule is what I love about my job . I never said I am a hero for doing my job . And I agree there is no excuse for bad behavior and physicians need to be nicer to each other

 

[jdh71]

But that is the job you signed up for . Outside of academics , all sick pts come to a micu under an intensivist .
The freedom to do shift work with a fixed schedule is what I love about my job . I never said I am a hero for doing my job . And I agree there is no excuse for bad behavior and physicians need to be nicer to each other

I'm aware of the world I live in. Wasn't the point. Try to keep up.

 

[DaTruMD]

Cash only practice, so I'm getting pretty good at patient assistance programs.

I'm actually having to do a lot that I normally wouldn't because of ****ty local specialists. I manage a few autoimmunepatients on biologics because local rheum refuses to see uninsured patients, no exceptions.

How is the market for dpc? Are a lot of places hiring and what is the lifestyle like compared to typical pc and hospitalist jobs?

 

[VA Hopeful Dr]

How is the market for dpc? Are a lot of places hiring and what is the lifestyle like compared to typical pc and hospitalist jobs?

The market it quite good. I started from scratch 2 years ago, now at 80% capacity. At that time I was the third DPC practice in my state. Now there are 10, all doing well. I also know quite a few DPC groups actively hiring they're so busy.

Lifestyle is variable. During warmer months I see 4ish patients per day, so usually leave the office around 3 or so. Get maybe 3-6 after hours emails/texts per week. During cold/flu season it's more like 8 patients per day and 10-12 after hours contacts per week.

Unlike employed docs, I'm almost always on call. I'm rarely actually needed, but it's always possible. I can share call with another doc here in town, but I only do that if I'm out of town.

 

[Blessthefall]

The market it quite good. I started from scratch 2 years ago, now at 80% capacity. At that time I was the third DPC practice in my state. Now there are 10, all doing well. I also know quite a few DPC groups actively hiring they're so busy.

Lifestyle is variable. During warmer months I see 4ish patients per day, so usually leave the office around 3 or so. Get maybe 3-6 after hours emails/texts per week. During cold/flu season it's more like 8 patients per day and 10-12 after hours contacts per week.

Unlike employed docs, I'm almost always on call. I'm rarely actually needed, but it's always possible. I can share call with another doc here in town, but I only do that if I'm out of town.

Hope this isn't an overstep: but what is your compensation like when compared to a contracted physician?


Sent from my iPhone using SDN mobile

 

[VA Hopeful Dr]

Hope this isn't an overstep: but what is your compensation like when compared to a contracted physician?


Sent from my iPhone using SDN mobile

When I hit full capacity, I'll be making about 180k. So, less than most full time hospital employed doctors. That said, If I raised my fees by $1/month that number would go to about 210.

But I also don't work nearly as hard, and there's an intangible value of being your own boss - as well as some added stress.

 

[Blessthefall]

When I hit full capacity, I'll be making about 180k. So, less than most full time hospital employed doctors. That said, If I raised my fees by $1/month that number would go to about 210.

But I also don't work nearly as hard, and there's an intangible value of being your own boss - as well as some added stress.

That's incredible!


Sent from my iPhone using SDN mobile

 

[Captain DO]

Some good responses here. I want to respond to a few of the negatives of being a hospitalist to share a different perspective (though i do agree with many of the negatives that have been mentioned, even the ones im addressing.)

Getting dumped on: It happens in every field. More so in IM, yes, but even in cards you will have to deal with crap you dont want to.
Also, before med school, i worked several entry level jobs. i always got dumped on. it is the nature of almost every job. however, without the medical degree, you dont have as many options so you are more "Stuck" and have to swallow more BS than you would with more options.. you also get $10/hour and nowhere else to go if you cant take it... I feel like the docs who complain the most are from more affluent families and havent really experienced that sort of thing...theyve always been well-off.
To me, shoveling monkey poop while people curse at me is ok so as long as 250k hits my bank account. I mean holy crap i used to live on 22k a year taking orders from a-holes who got the job cause they kiss ass better than me. having to take an admit i dont want, deal with paperwork, etc is going to be a piece of cake...


Less pay: i feel like this is the biggest reason. and the main culprit for the frustration even with the other reasons. If IM paid the same as all others, it wouldnt be a discussion. but:
- making 250 right out of residency vs fellowship pay for another 3 years...unless you're at the top % of earners as a subspecialist itll take you about a decade to make up for this and start to surpass the hospitalist. also added loan interest x3more years...worth it? not for me....
- cards right out of fellowship doesnt get top pay right away do they? do hospitalist make 250 right out residency?


Switch jobs every 2 years: i see this as a plus, not a red flag. IM in much higher demand than other fields + more jobs + more locations = more opportunity, not tied down to one place. if there are bad changes, you dont like the work culture, you need to change cities, states for whatever reason, you can leave and find another job easy. You can negotiate harder if you like more rural areas like me.
cards doesnt have the luxury of moving to whatever town they feel like, or switching jobs as easily.


and for me...i dont really have passion for something specific that would lead me to a certain subspeciality. i also dont like doing procedures at all...and i dont care about status and respect within the hospital (or outside of it). i wanna do a good job while im there and i wanna get paid well for it. thats it.


like i said just trying to bring another perspective in. i agree with what was mentioned, and its a pain, but this was some of my logic that lead me to go ahead and go for hospitalist in spite of those negatives. i feel it fits well with my personality and goals. however, for people reasing this, i havent experienced working as a hospitalist yet, and others who posted here have. i start residency this july so what do i know...maybe ill sound more like the others here 5 years out

 

[ItsSurgicallyComplicated]

Because it's literally the worst field in medicine

Uh No, that trophy goes to GS