Yeah this is what turned off my co-residents too. But we had some grads come back and tell us outside of residency clinic, things are much more functional. Went the outpatient route and turns out, yup. Residency clinic is just a shit show and precepting us slow AF.
Mid way second year, after seeing my 3rd hospital DC f/u in a row from a local private hospital on a 15 min time slot. My clinic does everything 15 min, new immigrant prenatal patient with scant care and language other than English and Spanish? 15 min
Less hours, many days off, better pay, more intellectually stimulating, less paperwork, less non-medical tasks in general, no inbasket, no peer to peer, no prior auth, no chronic pain management, flexible scheduling, unlimited day off requests, more interaction with other specialties, able to punt chronic stuff I don't want to get involved in, instant satisfaction (not waiting weeks for labs/imaging/specialty appts), patient compliance (captive audience in hospital versus relying on them to do things outpatient), no annoying chief complaints, no OB, no annoyingly anxious parents of peds patients, less of a dumping ground, the list goes on.
It varies a lot by location for sure. And there are so many other factors that influence how appropriate your compensation is: shift length, round and go vs remain in house, if you have mid-levels or residents covering, is there a dedicated admitter or are you doing admissions while rounding, goal census, social work and care coordination help, any nights required, sign-out process (written or verbal), # shifts per month or year, specialists available, intensivist availability, codes, procedures, open/closed ICU, moonlighting availability and hourly rate, sign on bonus, CME money, quality metrics, wRVU incentive, how much hospitalists actually got of the possible bonus last year, mentorship, EMR, call schedule, mid-level oversight, geographical zoning, you get the point.
I'm finishing up my first year as FM hospitalist in a big east coast city and will be at about $300k, though I did like 10 moonlighter shifts. I'm moving next month to a big west coast city and the several contracts I looked at were base salary ~$300k but for like 20 less shifts per year than I am doing now. And I see emails all the time in the mid-300s. I would say big city could be as low as $250k, rural can be close to $400k.
Maybe in some places, but generally within the same city, hospitalist earns more. And if you calculate the hourly, hospitalist is a lot more unless you are super efficient in clinic.
I do everything, 6 weeks private IM hospitalist, 12 weeks peds academic hospitalist, 6 weeks academic IM and outpatient 3 half days a week during my off weeks as OT. Everything has it pros and cons, no inbasket and being able to spend whatever time i want with whoever i want during private weeks is great. Academic always keeps you on a time table for the residents.
Grass is always greener, but as I near the end of my first year as an outpatient PCP, somehow to my shock and disdain I feel like I have less free time than I did when I was a resident. I realized the problem is that when I was a resident I was often on rotations where I only had one clinic session a week and never had any work to take home. The 12-hour days and missed holidays in the hospital on OB and internal medicine were brutal, and I hated them at the time, missing holidays and birthdays and other important events. Now I am just wishing I was in the hospital for those days instead, and I didn't come home with several hours worth of notes and messages and lab results and patient questions and refill requests and referral questions and coding queries and paper forms and........ To do every single night.
Honestly you know the job that I wish I was doing right now? The job of an attending in the hospital where I did my residency, where the residents write all of their notes and they basically get to chill in the lounge until there's an admission or a code
Work is essentially always on my mind, 24/7, I don't ever feel like I actually get to finish my work and focus on my life. I'm burning out hard. I'd sell a non-essential organ for one entire week where my epic inbox read 0/0 messages remaining.
This is pretty much why I'm trying my hand at urgent care now after just 1 year of doing PCP as an attending. I feel I'm working less than I did in residency, but not much less. That inbox really killed me. I agree with you, since in residency we didn't do 100% clinic, we were more shielded from inbox. I know urgent care will also be brutal, but damn all that unpaid PCP work burned me out.
I did the opposite. Hospitalist to outpatient. Lifestyle is way better. Choose my hours and stick to them. Less stress. Similiar pay. IM gets more per rvu than FM in our system so it’s a win win as all I see are mostly chronic care and hospital follow up.
We have a high retention rate and yes it’s because they did raf scoring and IM had an average above 1 but FM average of 0.7/.8 indicating lower patient complexity=less reimbursement. You are right, Outpatient wise we do have more IM docs in our system than FM but FM has lots of APRNs. Don’t know what to tell ya, I didn’t make the rules and only found out after our merger. it’s not much but it’s based upon those numbers and metrics.
It sounds like the fm docs get lower reimbursement because the aprns in their department see less complex patients? That doesn't make any sense to me. It's hard to believe that the FM docs would be okay with that.
Or are the FM docs seeing less complex patients than IM because of pediatric patients maybe?
Sorry for all the questions, I'm just a little indignant that FM would be compensated less than IM lol
It’s mostly because our FM is a referral mill, hate to say it. Yes on the aprn complexity. one cardiologist stopped coming to our office because he was managing basic blood pressure for one of the docs, it was crazy how little this FM doc did, his notes were atrocious and in pretty sure half the time he didn’t know why the patient was there. This guy has been in practice for 20 years, just like most of our docs.
Our FM chose to have 10 min visits, quantity over anything, 2 problems max, and they prefer uri/sick visits over chronic care. It’s very different than what I have known primary care to be.
Asinine. I wonder if maybe it is because FM would be seeing peds, which if a lot of medicaid would likely be reimbursing significantly less. Either way, horrible.
At least 50% of our residents over the past 5 years went that route and I identified the following:
- Pay is better. The best offer I saw for hospitalist was just over $400k. Almost all are 300k+. The best outpatient offers I’ve seen top out in the mid 200’s.
- Outpatient clinic in residency is not real clinic; it’s much worse. They see noncompliant Medicaid patients with lots of comorbidities. A relatively healthy patient under 50 is almost never on their schedule. We all have those patients but they don’t make up 95% of what we do.
- At the time they start job shopping they are more comfortable with inpatient medicine. By early to mid 2nd year they’ve done 5-6 months of inpatient and seen about 250 outpatient visits. We may be a little more inpatient heavy in our unopposed program than others but no doubt they feel more confident in inpatient medicine than outpatient medicine for the first half of residency.
I’ve spent hours with residents letting them know that residency clinic is not real life clinic, but they’re more likely to trust personal experience. Combine comfort in job duties with better salaries and you have the majority opting for hospitalist jobs.
A few classmates at my program went the Hospitalist route because our clinic was so shitty it ruined outpatient medicine for them as a whole
Yeah this is what turned off my co-residents too. But we had some grads come back and tell us outside of residency clinic, things are much more functional. Went the outpatient route and turns out, yup. Residency clinic is just a shit show and precepting us slow AF.
That’s basically it.
Wow it was the opposite for me.
Residency clinic was….better? Lol
I absolutely loved my residency clinic and it prepared me entirely for attending life.
This
Mid way second year, after seeing my 3rd hospital DC f/u in a row from a local private hospital on a 15 min time slot. My clinic does everything 15 min, new immigrant prenatal patient with scant care and language other than English and Spanish? 15 min
Sounds like a shitty office. If this was the alternative, I would go hospitalist as well.
Yep! MAs and front desk also started cc’ing director on all messages I don’t reply to within 48 hrs. Despite them knowing I’m in the hospital etc
Malignant office.
Less hours, many days off, better pay, more intellectually stimulating, less paperwork, less non-medical tasks in general, no inbasket, no peer to peer, no prior auth, no chronic pain management, flexible scheduling, unlimited day off requests, more interaction with other specialties, able to punt chronic stuff I don't want to get involved in, instant satisfaction (not waiting weeks for labs/imaging/specialty appts), patient compliance (captive audience in hospital versus relying on them to do things outpatient), no annoying chief complaints, no OB, no annoyingly anxious parents of peds patients, less of a dumping ground, the list goes on.
> better pay What would be expected for inpatient hospitalist work these days?
It varies a lot by location for sure. And there are so many other factors that influence how appropriate your compensation is: shift length, round and go vs remain in house, if you have mid-levels or residents covering, is there a dedicated admitter or are you doing admissions while rounding, goal census, social work and care coordination help, any nights required, sign-out process (written or verbal), # shifts per month or year, specialists available, intensivist availability, codes, procedures, open/closed ICU, moonlighting availability and hourly rate, sign on bonus, CME money, quality metrics, wRVU incentive, how much hospitalists actually got of the possible bonus last year, mentorship, EMR, call schedule, mid-level oversight, geographical zoning, you get the point. I'm finishing up my first year as FM hospitalist in a big east coast city and will be at about $300k, though I did like 10 moonlighter shifts. I'm moving next month to a big west coast city and the several contracts I looked at were base salary ~$300k but for like 20 less shifts per year than I am doing now. And I see emails all the time in the mid-300s. I would say big city could be as low as $250k, rural can be close to $400k.
(Aren’t those salaries comparable to outpatient FM ? 👀)
Maybe in some places, but generally within the same city, hospitalist earns more. And if you calculate the hourly, hospitalist is a lot more unless you are super efficient in clinic.
I do everything, 6 weeks private IM hospitalist, 12 weeks peds academic hospitalist, 6 weeks academic IM and outpatient 3 half days a week during my off weeks as OT. Everything has it pros and cons, no inbasket and being able to spend whatever time i want with whoever i want during private weeks is great. Academic always keeps you on a time table for the residents.
Grass is always greener, but as I near the end of my first year as an outpatient PCP, somehow to my shock and disdain I feel like I have less free time than I did when I was a resident. I realized the problem is that when I was a resident I was often on rotations where I only had one clinic session a week and never had any work to take home. The 12-hour days and missed holidays in the hospital on OB and internal medicine were brutal, and I hated them at the time, missing holidays and birthdays and other important events. Now I am just wishing I was in the hospital for those days instead, and I didn't come home with several hours worth of notes and messages and lab results and patient questions and refill requests and referral questions and coding queries and paper forms and........ To do every single night. Honestly you know the job that I wish I was doing right now? The job of an attending in the hospital where I did my residency, where the residents write all of their notes and they basically get to chill in the lounge until there's an admission or a code Work is essentially always on my mind, 24/7, I don't ever feel like I actually get to finish my work and focus on my life. I'm burning out hard. I'd sell a non-essential organ for one entire week where my epic inbox read 0/0 messages remaining.
This is pretty much why I'm trying my hand at urgent care now after just 1 year of doing PCP as an attending. I feel I'm working less than I did in residency, but not much less. That inbox really killed me. I agree with you, since in residency we didn't do 100% clinic, we were more shielded from inbox. I know urgent care will also be brutal, but damn all that unpaid PCP work burned me out.
I did the opposite. Hospitalist to outpatient. Lifestyle is way better. Choose my hours and stick to them. Less stress. Similiar pay. IM gets more per rvu than FM in our system so it’s a win win as all I see are mostly chronic care and hospital follow up.
IM gets more per RVU? That is bananas. They must really not want to retain FM trained docs
We have a high retention rate and yes it’s because they did raf scoring and IM had an average above 1 but FM average of 0.7/.8 indicating lower patient complexity=less reimbursement. You are right, Outpatient wise we do have more IM docs in our system than FM but FM has lots of APRNs. Don’t know what to tell ya, I didn’t make the rules and only found out after our merger. it’s not much but it’s based upon those numbers and metrics.
It sounds like the fm docs get lower reimbursement because the aprns in their department see less complex patients? That doesn't make any sense to me. It's hard to believe that the FM docs would be okay with that. Or are the FM docs seeing less complex patients than IM because of pediatric patients maybe? Sorry for all the questions, I'm just a little indignant that FM would be compensated less than IM lol
It’s mostly because our FM is a referral mill, hate to say it. Yes on the aprn complexity. one cardiologist stopped coming to our office because he was managing basic blood pressure for one of the docs, it was crazy how little this FM doc did, his notes were atrocious and in pretty sure half the time he didn’t know why the patient was there. This guy has been in practice for 20 years, just like most of our docs. Our FM chose to have 10 min visits, quantity over anything, 2 problems max, and they prefer uri/sick visits over chronic care. It’s very different than what I have known primary care to be.
That’s so interesting; I find the lifestyle of a hospitalist way better. I hated the inbox; felt like I was never off.
That's interesting. I can say almost the same things after going from outpatient to hospitalist haha.
> IM gets more per rvu than FM in our system Is this true only for inpatient?
Outpatient. I’m not sure about inpatient.
Asinine. I wonder if maybe it is because FM would be seeing peds, which if a lot of medicaid would likely be reimbursing significantly less. Either way, horrible.
At least 50% of our residents over the past 5 years went that route and I identified the following: - Pay is better. The best offer I saw for hospitalist was just over $400k. Almost all are 300k+. The best outpatient offers I’ve seen top out in the mid 200’s. - Outpatient clinic in residency is not real clinic; it’s much worse. They see noncompliant Medicaid patients with lots of comorbidities. A relatively healthy patient under 50 is almost never on their schedule. We all have those patients but they don’t make up 95% of what we do. - At the time they start job shopping they are more comfortable with inpatient medicine. By early to mid 2nd year they’ve done 5-6 months of inpatient and seen about 250 outpatient visits. We may be a little more inpatient heavy in our unopposed program than others but no doubt they feel more confident in inpatient medicine than outpatient medicine for the first half of residency. I’ve spent hours with residents letting them know that residency clinic is not real life clinic, but they’re more likely to trust personal experience. Combine comfort in job duties with better salaries and you have the majority opting for hospitalist jobs.
So tell me more about this abdominal pain. "Back in 1949 I felt nauseous after eating chips" 
RemindMe! 24 hours