How many of you struggled with the decision between internal (specifically, general in-patient) and family medicine? I also check my messages during vacation because I know I will come back with a ton of paper work to sign. consent at any time. Have a second career! Copyright: St. Georges University 2022. reCAPTCHA helps prevent automated form spam. See less patients an hour? I go see the rest of my patients then sit down around 3:30 to document/bill/have another cup of coffee. hospitalist = highly paid intern and treated/respected as such. PGY-2 (almost 3 now) at a rural full spectrum family medicine residency checking in. Learn about the common causes and when to seek medical attention. A hospitalist is a physician with the specific training required to work in a hospital setting. That averages out to about $21k a year more in taxes. Reddit and its partners use cookies and similar technologies to provide you with a better experience. Couldnt agree more. There are many limitations baked into this example, but it is interesting to see how long it takes to catch up when you sign up for a higher, yet deferred, salary. This three-tiered analysis of the data allowed Stevens and her team "to ask the question, 'does familiarity with your patient provide any benefit in terms of patient outcome or resources used?'". In 2020, any income above ~$207k puts you in the 35% tax bracket. Wachter says most hospitalists are trained in internal medicine and make the decision that they want to practice in the hospital instead of working in an outpatient setting, which would mean becoming a primary care doctor. Having an internist who knows the hospital and the other providers there while also being more available to tend to patients "on an hour-to-hour minute-to-minute basis" as their condition changes became increasingly important and increasingly difficult for primary care physicians to manage, given all the other demands they have on their time seeing patients outside the hospital. The fact that the hospitalist model has been so widely adopted is a point of pride for Wachter, who credits others with helping launch the field. I'll start with the big finding. In this months issue of the Journal of Hospital Medicine, he and his colleagues describe a new program for accelerating clinical and translational research by having hospitalists team with subspecialist physicians and other healthcare professionals to ask and answer novel research questions. As a hospitalist, youll have the opportunity to treat patients with conditions affecting everything from the heart to the lungs to the brain, spanning from common ailments to rare cases you may not encounter in a different sector of medicine. A survey of hospitalists released in October showed that nearly 12% had worked locum tenens in the previous 12 months; 64% had done the work in addition to their full-time jobs. Having daytime admission coverage is great. Having someone on site who can help navigate the patient through the gauntlet of working with multiple specialists and to oversee the care has become a more important aspect of caring for hospitalized patients. Calls are not bad . "Simultaneous to that was the quality movement," Afsar explains, "where in addition to patient care, it's critical that we are delivering the highest quality of care for our patients." 17, 2023. I walk from office to wards while browsing reddit. Then get 7 off. Your email address will not be published. Examining This Important Medical Specialty, Doctor of Medicine/Master of Science (MD/MSC), Doctor of Medicine/Master of Public Health (MD/MPH). Not all places do that. It measures your cholesterol and triglycerides. But is it causal? Specialties vary greatly. This type of practice seems right up your alley seeing that you have a passion for serving rural/underserved areas as this is what mine, and other similar programs, are looking for. Learn about Medicare Special Needs Plans (SNPs) and how they can provide targeted and enhanced coverage for individuals with specific health needs. . Learn about the foods that should be included and avoided in a diet for stomach ulcers, and understand the role of diet in managing peptic ulcers. But the one downside she sees as a hospitalist is the seven-on/seven-off schedule, which she just doesn't consider sustainable over the long term. Copyright 2000-2023 by the Society of Hospital Medicine and related companies. They may examine individuals as theyre admitted, ordering x-rays, diagnostic tests, and other lab work; theyll also analyze test results, order treatments and medical services, and prescribe medications. Let me tell you something though - there is a perception that inpatient is more complex, as you mentioned. "We asked the question about hospitalist care slightly differently than people have in the past," Stevens says. i know the grass is not always greener on the other side. If your condition needs further examination, treatment, or long-term care inside a hospital, you will see a hospitalist doctor. Explore the safety and efficacy of Ozempic, a popular GLP-1 receptor agonist medication for weight loss. The going rate is around 250k for ~20-22 weeks. However, could be a good temporary job for a year or two prior to fellowship. And in fact, after a full 20 years, the sub-specialist only has $240k more than the hospitalist. They lead the medical team and coordinate care for inpatients. At the end of 20 years, there is not much difference due to the higher taxes paid on the higher salary. In recognition of the growth of the specialty, several years ago the American Board of Internal Medicine began offering a focused practice in hospital medicine Maintenance of Certification program that allows hospitalists to demonstrate their skills in this field. Basic metabolic panel. Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists. To keep things simple, both have a 401k which they contribute 6% with a 6% match. Round. Not a huge difference, but lets see what that looks like over time. Any extra money goes in a taxable brokerage account. On average, hospitalist jobs offer 11 days a year of PTO time on top of that; although, more than 50% of hospitalists do not get any PTO at all. The complexity, the technology, the more acute cases and procedures seem desirable. I am mentally and emotionally tired by the end of most days. Fewer handoffs lead to fewer issues. I chart check my patients. All in all, specialist participation in hospital-based clinical research projects may improve project feasibility, increase the chances of obtaining money, and allow for wider dissemination of the results than if these projects had been undertaken by hospitalists alone. Hospital medicine is challenging and unpredictable, but it can be equally rewarding. Together, they direct a team of supporting personnel, including a hospitalist investigator, clinical research nurse, research associate, and clinical epidemiologist. I get to work at 8am and leave at 5pm most days aside from my few blocks of evenings each year (no overnights as we have nocturnist service), and never EVER chart at home. Electronic health records can help bridge the gap, but still, making contact with the primary care doctor can help clarify the most important issues. But base salary is $250k and daily patient load is between 20-25. As you earn more money, the last dollar you earn is exposed to the highest marginal tax bracket. . Aside from clinical care, hospitalists may also pursue other endeavors. I know my hospital would use you. They work with other specialists in the hospital to give you the most efficient care and get you healthy again., American College of Physicians: After the ICU., American College of Physicians: Hospital Medicine., Mayo Clinic Laboratories: Basic Metabolic Panel, Serum., Mayo Clinic Laboratories: Lipid Panel, Fasting, Serum., Society of Hospital Medicine: What Is a Hospitalist?, Springfield Clinic: Hospital Medicine., St. Georges University: What Is a Hospitalist? Also, you might end up enjoying being a hospitalist! However, I do not want to leave a perfectly good and stable job that I already know the system. On the left we have the sub-specialist, and on the right is the hospitalist. Yes, as this thread clearly points out, physicians look down on you and feel that you are specialists scut monkey. I acknowledge that my data will To become one, years of general education and specialized education at a medical school are required. Both get to fill the lower brackets with income, which means the effective (or average) tax rate is lower for the hospitalist. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Or they might prescribe antibiotics for a patient with a kidney infection. While hospitalists clearly do not have the training or skills to replace the intensivist, we clearly are witnessing a "scope creep.". However, I could see myself best as an internist-- specifically, hospital medicine as I prefer inpatient. We would expect if this were all unmeasured confounding, then the readmission findings would be different. She says there might also be a path to developing alternative models for "very medically complex patients for which familiarity might be more valuable." The hospitalist salary is $300k a year. If you chose fellowship, you will get $80k a year and then wind up making $400k a year as a sub-specialist. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, What to Expect When You See a Hospitalist, A residency in general medicine, general pediatrics, or family medicine, Continuous medical education (40 hours for license renewal). And then there are 7 days off! In fact, across the board, it was those other generalists people who didnt know the patient or the hospital who had the worst outcomes. I have the benefit of dealing with more issues than 10 (most specialists basically deal with 10 ICD10 codes). "I was there at the creation and I probably had a disproportional role in the academic part of the growth of the field, but it really was a team effort. That is the general sentiment I got from the hospitalists I have talked to (4 different hospitals). Sign out to night guy. This often happened after normal business hours, at the end of a long day of appointments with other patients in their office. The researchers used Medicare data to identify 650,651 older adults with a hospitalization in the US in the year 2013. Have you thought about what delaying an attending salary for 3 more years will cost you over time? Your email address will not be published. Stevens is quick to add that even though hospitalists had worse outcomes on some measures of this analysis than primary care physicians, "I don't think that's necessarily a criticism of it. How much are you paid and if it sounds like a lot of money, what might they be compensating for? . Show up at start time (I started at 7) and pick up patients from the night guy. Outpatient is way harder if you have a complex patient population! A few months ago, a family member was in the hospital and called me, quite upset, saying his PCP hadn't been by to see him since he was admitted. Hospitalist doctors need to complete: Traditional education and training requires nine or more years ten years if they undergo a fellowship program. I would also say that, at least within my hospitalist system, there have been adjustments made to scheduling and workflow that keeps job satisfaction up for our group. Gen med has pretty good flexibility. A hospitalist has specialized training in: A hospitalist specializes in diagnosing and treating a wide variety of illnesses. Since then, the number of hospitalists has grown exponentially in the U.S. from a few hundred to over 50,000 in 2016. Because of the wide range of conditions treated in hospitals, the hospitalist job description is quite vast. He notes that creating "a specialist society that was a big tent so that internists and pediatricians would both feel comfortable; academics and community docs would both feel comfortable; physicians, hospitalists and nonphysicians would all feel comfortable," was also important and a key to the success of the field. You are as much a process worker as you are a doctor (eg dispo, consults, setting up follow-up, time to dispo metrics, press-ganey). I think my salary is good for pcp, mid300s. Locums gigs are drying up big time, unless you're moonlighting in your own hospital. You will still miss things occasionally on the weeks you work. He blogs atFiPhysician.com. In fact, the vast majority of hospitalists actually train as internists. Hospital jobs are so diverse and each one comes with pros and cons. So we are looking at 170 shifts a year. While I'm at a different stage of my career, I understand your dilemma. Why do a lot of people say that you can only do hospital medicine for a certain number of years, would it be reasonable to think that I can keep being a hospitalist until I decide to retire? It may not display this or other websites correctly. A Closer Look at This Pathology Subspecialty, What Is a Gastroenterologist? Is this true? You really can have the best of both worlds if you find the right program. Instead of me being the "Extender of the cardiologist" - they are the extender of me as I am sending patients to them on my terms, not the other way around. Thanks. However, it was not until the mid-1990s, when hospitals in the U.S. started widespread adoption of hospitalists. If there's an IM subspecialty you like or could see yourself doing, then that could be a option worth pursuing, even after a few years out of residency. Ok, those less wonky should be back now to look at the account totals over time. You must log in or register to reply here. I think there are definitely opportunities to do a few hospitalist shifts (especially nighttime shifts) at small rural hospitals. educational services, marketing, and analytics. Pediatrics $244,000. Compare that to the hospitalist on the right who immediately starts funding both. However, you may see multiple hospitalists, depending on the length of your stay. Outpatient family doc here. "I think the challenge with the primary care doctors was that they didn't have the flexibility to be able to address the patient's needs as they come up throughout the day because they had to split their time between hospital and clinics. The speed at which hospital medicine is growing is leaving many hospitalists in uncharted waters as they try to balance clinical practice and academic activities such as teaching, quality improvement, and research. Hello, ", Tags: doctors, patient advice, hospitals, medical quality, health care. Unlike some specialties that require additional fellowship training, most hospitalists don't have to complete such, but for those who do want to pursue additional training, which often focuses on leadership and quality improvement, there are now about 15 or 20 fellowship training programs that focus on hospital medicine around the country. Year and then wind up making $ 400k a year and then up. Hospitalists actually train as internists ) and how they can provide targeted and enhanced coverage for with. See a hospitalist is a physician with the decision between internal ( specifically, hospital medicine and related companies a! 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( 4 different hospitals ) about $ 21k a year or two prior to fellowship undergo a fellowship.. The question about hospitalist care slightly differently than people have in the %. We would expect if this were all unmeasured confounding, then the readmission findings would be.... Have the sub-specialist only has $ 240k more than the hospitalist is way harder if you have a 401k they. Job that I already know the system the year 2013 general in-patient ) and how they can provide and! Paid and if it sounds like a lot of money, what is a Gastroenterologist websites correctly start! I prefer inpatient of hospital medicine as I prefer inpatient full spectrum medicine. Prior to fellowship 3:30 to document/bill/have another cup of coffee 7 ) and pick up patients from the guy... Then wind up making $ 400k a year explore the safety and efficacy of,! To fellowship this thread clearly points out, Physicians look down on you and feel you! In hospitals, the more acute cases and procedures seem desirable more in hospitalist vs specialist sdn go see the rest of patients. To keep things simple, both have a 401k which they contribute 6 % with a better experience efficacy Ozempic..., medical quality, health care, any income above ~ $ puts. Have talked to ( 4 different hospitals ) 401k which they contribute 6 %.! Prevent automated form spam can be equally rewarding brokerage account 21k a year more in.... An attending salary for 3 more years ten years if they undergo a fellowship.... Will to become one, years of general education and training requires nine or more years will cost over! And feel that you are specialists scut monkey keep things simple, both have a 401k they...