What is a hospitalist? A reader asked for my analysis on what it takes to become a hospitalist and what it is like to be a hospitalist? I'm currently a year 2 medical student and seeing our year 4s just match a couple of weeks ago has piqued my interest in residencies and career opportunities. I've heard of hospitalists before but never really knew what they are until I recently did some research and now have a fair grasp of what they do generally (hospital-based inpatient care, ER-like shift work, week on/week off). And I'm liking mostly what I've read so far. (Although some claim it's dog-work like conditions and you are basically glorified IM residents?)
But in any event I was wondering what residencies after med school are geared towards a hospitalist career? Is it just internal medicine? I've read in other places (on studentdoctor.net threads, and on the mdsalaries blog) that Peds, Family Medicine, and even Psychiatry are qualifying residencies for a hospitalist job. I'm not sure if you already covered this in your blog already (and if that's the case a link to that page would be greatly appreciated) otherwise can you list some residencies that qualifies for hospital medicine?
A hospitalist is exactly what the word means. Hospitalists practice medicine exclusively in the hospital. The word hospitalist was first reserved mostly for internists who cared for patients only in the hospital. Use of the term hospitalist has expanded through the years to pretty much include any physician who works exclusively in the hospital. We have neuro hospitalists, pediatric hospitalists, obstetrical hospitalists and even surgical hospitalists.
But in any event I was wondering what residencies after med school are geared towards a hospitalist career? Is it just internal medicine? I've read in other places (on studentdoctor.net threads, and on the mdsalaries blog) that Peds, Family Medicine, and even Psychiatry are qualifying residencies for a hospitalist job. I'm not sure if you already covered this in your blog already (and if that's the case a link to that page would be greatly appreciated) otherwise can you list some residencies that qualifies for hospital medicine?
A hospitalist is exactly what the word means. Hospitalists practice medicine exclusively in the hospital. The word hospitalist was first reserved mostly for internists who cared for patients only in the hospital. Use of the term hospitalist has expanded through the years to pretty much include any physician who works exclusively in the hospital. We have neuro hospitalists, pediatric hospitalists, obstetrical hospitalists and even surgical hospitalists.
For adult medicine, most hospitalists are internist trained. There is a process now in place to recertify in hospitalist medicine instead of internal medicine. Not all of your preconceptions are accurate. Not all hospitalist employment models involve shift work. Some take their own call in 24 hour blocks either in house or at home. You can plan on small hospitals doing home call. Large hospitals doing in house 24 hour coverage. It costs a lot of money to staff a hospital with a physician in house 24 hours a day. Most small hospitals can't afford that. I work in a 24 hour in house shift model coverage hospitalist program.
Many people think hospitalists are employees of the hospital. I work in a private practice hospitalist group that has a contract with my hospital to provide hospitalist services. Some hospitalists are paid strict salary. Some are paid strictly on production and RVUs. But most are paid a combination of both. How you structure your employment contract is entirely up for negotiation. You are a physician. You are not a high school drop out. You don't have to accept what they offer you. You will always have many options. Your services are always in demand.
Those hospitalists that do shift work don't necessarily do seven days on and seven days off. I don't have that schedule. I know many that don't. It's just one of many possible schedules that can be developed. As physicians, you can make your own schedule and figure out how to cover the shifts that need to be covered. That's the beauty of having an education. You have earned the right to manage your own schedule to your own liking. You aren't clocking in or out, despite what some hospitalist haters like to imply. You take care of patients just like everyone else. You just do it in a fashion that keeps your flame burning bright.
As for the dog like conditions and the glorified IM resident attitude, I have never felt like that in seven years at my hospitalist position. I don't do skut work, the essence of being defined as a resident. I manage patient care issues just like physicians who round and head back to their clinics. If you can stay ahead of the recruitment curve, you have half your battles won before the war begins. When our program first started, we were being asked by surgeons to read chest xrays for their line placement after they left the hospital. We put an end to that real soon. It just doesn't happen anymore. We used to get asked to declare patient deaths because we were in house. We put an end to that real quick.
If I get called on blood work on a patient that was ordered by another physician or that is being managed by another physician but I'm just the easiest to call, I will tell the nurse to call the other doctor, even If I know the answer to their question. I am not the nurse's doctor of convenience. Nor am I paid by other doctors to field their calls for them. That's what they pay an NP or PA to do for them. Eventually, those calls end as well, although the convenience factor is an up hill battle.
You must establish parameters for being contacted. Because we are in the hospital doesn't cut it. I am often busy or sleeping, just like doctors who aren't in the hospital. Because I am in the hospital does not mean I'm working. Nor does it mean I'm "clocked in". I don't clock in or out. That's the beauty of having an advanced degree. I have earned the right not to. I will gladly manage issues on my patients which I am managing. I will not do so out of convenience for a nurse or another doctor following the case.
There are good programs and there are bad programs. The good programs have administrators that understand the exceptional value hospitalists bring to the table. Great programs do not run their board certified internal medicine physicians into the ground. If they do, and the physician chooses to stay and work in that environment, that's up to them. I would never put up with such a program. Remember, you went to medical school and residency and you passed the test. If you choose to work in an environment where you are abused, you make your own bed. Live with the consequences.
So what is a hospitalist? It is a doctor who practices exclusively in the hospital If you want to do adult medicine in the hospital the only residency that will fully qualify you for a full scope of practice is internal medicine. Family medicine won't get you there. The intensity of inpatient experience is just not there. With internal medicine training, you can manage the vast majority of all major medical conditions that afflict most adults admitted to the hospital. And you can do it without any subspecialty assistance for a vast majority of cases. It's the culture of care in your hospital that will determine how often consultants are involved.
