A reader asks the question: How do you go back to hospitalist employment based medicine after eight years?
From a medical standpoint? You need to decide if you're going to do ICU medicine. If you are, realize it's hard to practice ICU from the clinic. Also figure out if you are going to be one of those docs that just show up to write consults for other docs. Are you going to be that doc at 2 am that tells the ED doc to have GI admit for a GI bleed or have renal admit for ARF or have cardiology admit for chest pain? If you are that doc, you will bring no value to your patients care.
Eight years is a long time out of the hospital. Any readers have some suggestions on how to get rid of the rust?
A lot has changed in eight years. I wouldn't even know where to begin. I suppose many things are like riding bicycles. But so much as changed. Even the documentation games that we play change yearly. Hospitals don't like you outpatient guys much because you don't play the documentation games hospitalists do. Games that bring in millions of extra dollars a year in pure gravy. Quality initiatives that are required for hospitals to get their full cash cow as well.Happy,I have followed your blog for some time now. I have always been a hospitalist at heart, but have been doing "traditional" internal medicine for the past 8 years. I have been working with a group who only does outpatient medicine and I have now made the plunge and just signed on to a new position with a new group in my town.
Any recommendations on getting back up to speed? I'm not too bad rusty, but it couldn't hurt to brush up on a few things.
Thanks!
From a medical standpoint? You need to decide if you're going to do ICU medicine. If you are, realize it's hard to practice ICU from the clinic. Also figure out if you are going to be one of those docs that just show up to write consults for other docs. Are you going to be that doc at 2 am that tells the ED doc to have GI admit for a GI bleed or have renal admit for ARF or have cardiology admit for chest pain? If you are that doc, you will bring no value to your patients care.
Eight years is a long time out of the hospital. Any readers have some suggestions on how to get rid of the rust?
Happy,
ReplyDeleteI am the one who initially wrote that and, as I read it again, I may have mis-stated my current situation. Currently in a "traditional" practice and doing inpatient with it for the past 8 years. However, recently joined an all outpatient group and am miserable with this and signed on with a hospitalist group.
Now that I cleared that up, suggestions? Happy's readers' suggestions?
Thanks!
The standard stuff is the standard stuff. If you haven't done a lot of consults, look read about peri-op care (you'll do a lot of it).
ReplyDeleteIf you did residency 10 yrs agom, brush up on stroke and hip fracture.
Other than that, never be afraid to ask for help and consult whenever you or the patient need the consult.
I'm in a similar situation. My advice:
ReplyDelete1. Read a little every day on inpatient care-CHF,CVA, hypertensive emergency, pre-op care, etc.
2. Get some of the peripheral brains ready-MAss general handbook, Sanford guide,etc or have on your PDA
3 Read this blog and others to keep abreast of other inpatient related issues and other tips.
I'm getting ready to make the jump to full time hospitalist and looking forward to it.
Thanks for the advice, folks. Andymc, are you in a "traditional" practice now? How long? When do you officially make the leap?
ReplyDeleteI have 4 interviews in the next couple of weeks. Time frame is roughly 3-4 months depending on different factors and how the interviews go.I've been in a mixed inpatient/outpatient setting for 4 years. Questions for you anon:-have preferred block 7 on 7 off schedule?or M to F? Has a base salary worked best or total incentive based? Employee or independent contractor set -up? Have you had caps? Things I'm wondering going into interviews.
ReplyDeleteAndymc,
ReplyDeleteI would be interested to also get Happy's input on this but the SHM web site has lots of good information about this, specifically Dr. John Nelson who has written about the pros and cons of various employment strategies.
From a scheduling standpoint, I am fairly indifferent as long as it is a regular schedule that I can bank on. I can live with a 7 on, 7 off and be fine with that. My new group is going to start with 3 of us and the schedule we are going to do is a hybrid. The other docs want a 7/7 so they will do this and I will do M-F. We will alternate night call when we are on. As the practice grows, I'm sure we will need to make adjustments to this.
I personally like the independent model but contracting with the hospital for a "subsidy" to help cover the costs with the uninsured, etc. A good balance is the employment model with a base salary then productivity incentives.
I hope this helps!