If you are an internal medicine resident, considering whether to enter an office practice or a hospitalist practice, pay close attention to this information before you make your decision. I've put together my top ten list on reasons why you should pick being a hospitalist over being a clinic based outpatient internist. These ten advantages are based on my nearly decade long experience as a practicing community hospitalist at a major regional referral hospital system.
#10. You'll never have to do another pelvic exam ever again. Refer back to PCP or if a patient of yours is sick enough to require an emergency inpatient pelvic exam on your hospitalist service, then it's time to consult the gynecologist. Besides, after a couple months of hospital work, you'll forget how to do them. Yeah. That's it. Pelvic exams are outside your scope of practice.
#9. Chronic abdominal pain does not meet inpatient criteria. Nor does chronic headache or chronic dizziness or the chronic state of refusing to leave the ER. Tell the patient their insurance won't cover the hospital stay because it won't. Then, discharge the patient from the ER and refer back to PCP. Oh, and if by chance they come in on observation status, after 48 hours, their chronic problems won't get paid for either. Tell the patient that, then refer back to the PCP. The most you'll have to deal with chronic anything is 48 hours.
#8. Refer patients requesting you fill out paperwork for a motorized electric mobility scooter back to their PCP. You're just not trained for that.
#7. Nor are you qualified to fill out their disability paperwork. Everyone in the hospital is disabled. Your patient needs the keen eye of their outpatient doctor making unbiased determinations as to whether their fibromyalgia, headaches, chronic back pain, having too many kids or not having enough motivation qualifies them for disability. Refer back to PCP.
#6. Fax pharmacy refill requests back to the pharmacy with the notation "send to PCP". Or not. Eventually, the patient will figure out why they aren't getting their medication and call their PCP or just not care enough to fill it.
#5. Social workers. Having social workers available for hospital disposition is like swimming in a pot of gold at the end of the rainbow. Good social workers are magical in their abilities to perform near miracles. On the other hand, bad social workers will wreak havoc on your day. Overall though, social workers are a victory for hospitalists. You aren't going to have social workers at your disposal in your office practice. They're called secretaries. And they are too busy putting hosptialists on hold who are trying to update the PCP on their patient's discharge.
Facebook Humor: I can only imagine what a cocktail party with a bunch of hospital social workers would be like...."You should have seen the terrible discharge I had yesterday..."
#4. No more calls from nursing homes. Nothing will break your spirit as an internist more than getting calls from nurses in nursing homes regarding, well, just about anything. As a hospitalist, the closest you'll ever come to talking to a nursing home nurse is, well, I take that back. You'll never have to talk to a nursing home nurse again. Don't get me wrong. Nursing home nurses are nice. They just don't share the same medical vocabulary as hospital based medical professionals.
#3 Our frequent fliers already have 12 fully transcribed H&Ps in the last year. It doesn't get any easier than that. The vast majority of our patient's have a rather high level of continuity that few non-hospitalists can appreciate. We aren't strangers to our patients. We know many of them very well. We aren't starting from scratch when we see them for the first time. This month. We are reviewing, copying and pasting just like the rest of the EMR world does.
#2 We get paid to sleep on the job. As a physician hospitalist, you simply aren't required to report to any superior if you want to take a break and catch a few hours of sleep during a difficult night shift so you can prepare your mind for the next critical care admit that may roll in any second. Sleep or don't sleep. It's up to you. Try sleeping during your office practice with patients piled up in the waiting room. Your nurses will quit on you.
And the #1 reason to choose hospitalist over outpatient office based clinic internist is, on discharge, we get to write "follow up with PCP within a week". It fills the hospitalist with a peace and tranquility that only the hospitalist psyche can fully appreciate. We hold this feeling dear to our hearts. I only wish all physicians could experience the same.