r/hospitalist

Hey guys I know this has been brought up multiple times. But heres a small anecdote that happened yesterday. A recruiter from a major hospital group called me and offered 250-260k for 7/7 hospitalist. I categorically refused it in a big major city. I told him base is 300k nothing less. Literally today he messaged same job base 300k. Stop taking their shit. Fight back. 300-350 is base 380 in rural. No codes no procedures. Fight back.
Fresh grad

I’m hoping to relocate to Canada this fall to start a hospitalist position. I completed US IM residency but have had about a 10-month gap since graduation while handling job search, immigration, and licensing. I did not have any attending experience in the US prior to this.
I’m looking for insight from hospitalists (or other physicians) who have made the move from the US to Canada. Ideally IM or FM backgrounds, but I’d welcome experiences from other specialties too, as I’m sure there are many common structural and systemic adjustments.
If you’re willing to share, I’d love to hear:
• How you prepared for the transition (licensing, credentialing, differences in documentation, order entry, etc.)
• What adjustments were most challenging (or smoother than expected) once you started practicing
• Any advice on adapting to the Canadian healthcare system, team dynamics, or daily workflow
Thank you in advance for any guidance – really appreciate the insight

Good morning all

Over the past few weeks I have realized that I need to protect myself and reduce my stress if I want to survive. My job is not particularly bad all things considered, but I find myself feeling rushed and stressed pretty much every day.

I figured I’d stop by here to share some strategies that I find helpful, and to ask you for help and strategies that you find helpful.

One thing I have been reminding myself is to focus on the patient in front of me. I’m generally a people pleaser and I strive for positive feedback. I need to stop this. I need to stop thinking about metrics. I’m not a shareholder in the hospital. Metrics are literally not my problem. My problem is taking good care of the patients in front of me. That’s it.

I’ve also stopped thinking about what my patient experience scores will be. I remind myself that there are people out there that will be unhappy, no matter what. There are a lot of people out there that are just not reasonable. This is also not my problem.

Share with the class

I’m a hospitalist attending, just starting my second year out of residency. My current hospital has been my only attending position, so I don’t really have much to compare it to.

Our hospital has an anonymous reporting system in place that is mostly designed to catch events that may risk patient safety, but also has parameters to catch general grievances. After nearly 10 months of work without issue, I started to find myself on the receiving end of a number of unfounded complaints, and I’m starting to think they’re more personal than professional in origin. I can’t tell exactly who has been submitting them, but I know through context that most of them are coming from ED nurses, with whom I only interact on my rare admitting days.

For example, i am receiving anonymous reports against me for my handling of trivial matters like fluid administration in lactic acidosis or dehydration. Another complaint had them review my handling of potassium repletion in a patient with moderate hypokalemia (who was fully replete in 8 hours btw). For the latter issue, my boss even said that we didn’t need to review it together because it was “BS”, my medical management was sound on his review, and “someone definitely doesn’t like you down there”. Other times I’ll have nurses who refuse to follow through on my orders without me coming and explaining my rationale to them, regardless of how busy I am with more critical patients. Nevertheless, when I ask leadership for how to combat this, or where I can improve if there are some behavioral patterns I’m not seeing, I always get placated that there’s nothing that can be done about this. Even going to HR has left me with empty promises that they’ll “look into it”, without any substantive action.

In my eyes, I’m clearly being put under a microscope and/or targeted by one person or a few people who have grudges against me for whatever reason and who are just throwing things at the wall to hope something sticks against me. I’ve also gone out of my way to become part of the local community, and have made tons of friends over the past year (doctors, nurses, environmental staff) with whom I hang out regularly outside of work.

Leadership has also had nothing but great things to say about me, even during my first annual review last week. They literally wrote “N/A” in the areas for improvement and wrote a great blurb about how valuable of a team member I’ve become.

I hate to think this way, and I hate to feel like I have a target on my back, but I now go to work every day feeling like i have to be absolutely perfect or even the tiniest of errors may come up during these case reviews. It’s just purely unsettling and unsustainable. I would’ve left after the first couple months of this starting, because I don’t want to be put in a position to fail or have my record tarnished for minor errors. However, I’m currently locked in due to my “golden handcuffs“ signing bonus I would have to repay (most of my emergency savings and half of my 401k that isn’t yet fully vested).

My sinking/gut feeling is that this wave of dissent toward me has to do with my race. I’m a 6’3 black man who moved to the northern part of a midwestern state on the Canadian border. I’m a type A personality, like many of us, but I’m fairly laid back compared to my partners. I’m also sure many folks here have never had to take orders from someone so different than their norm. There aren’t many people who look like me in town, and far less in the hospital. I knew this might be an issue moving up here, but I’d hoped it wouldn’t track inside the hospital (I actually feel much more openly welcomed when I’m out in the community). The final piece rounding out this portion of my theory is that on several occasions, I’ve gone to the ED and they were playing uncensored music frequently saying the N-word and nobody bats an eye. It just feels off.

Any advice?

Typical day. While I am examining this male in his 50s. He is in bed awake. I put my stethoscope on his chest. He closes his eyes. As I remove the stethoscope from my ears and was moving towards his abdomen and talking to him he yells the loudest “Boo” and I got startled. He started laughing out loud 🤣 and I didn’t know what to say. This has never happened to me in my whole career in medicine. He later apologized but obviously I didn’t take it as an offense

In the past year, I’ve discharged the most of my group and 100 patients more than the next hospitalist but my discharge before 11 is shit. How serious is this shit? Will they fire me this?

I joined a job post residency about 4 years back. During that time in the job market the usual census was around 16-18 and more than 20 seemed kind of rare and undoable. Due to various concerns like increasing census and administrative burden I am exploring for the job opportunities and now it seems like census around 20 is a norm. Even in places with census around 16-17 there seems something tied to it like nights, supervising APPs. And many places have APPs tied to physicians these days. They advertise as no admissions and in reality there is some APP admitting patient under your lisence. Some places boast on round and go but they have census of 25-28 and how it is possible to round and go when you have more than 25 patients. On top of that corporate medicine has been increasing a lot of burden on health care workers and physicians with different metrics before 9, LOS, press ganey and so on. While talking with seasoned Hospitalist it looks like patients are getting more and more demanding. Might be there are some unicorn jobs but not sure what will it looks like further few years down the road. There are few good weeks but after finishing most of the weeks, it feels like coming out of war.

Day hospitalist 70n 7 off 6am-6pm

450 Beds

1 swing from 12pm

Census: 18-20

Run codes

Open 56 bed ICU with intensivist onsite

$320k

20k sign on

I’m trying to apply for a radiology tech school but to even have a chance to get in I need 900 healthcare hours when can I volunteer as a 17 Y/o I want to atleast get 100 hours if possible

Not sure if this is a good deal. Soon to graduate. Have been offered job in Southeastern area; base salary of $300k, $10k sign in , 18-20 patient, 7/7 schedule
Swing shift (12pm to 10pm) every 5 week (10weeks if I include off weeks) no codes but have to go for rapids.
Closed ICU (but was told if patient is expected to stay in icu for 24 hours like DKA then will have to manage patient in ICU) wRVU $25 after 6000 rVus.

PGY-2 here looking to do nocturnist. Currently at a community program where the ICU team runs essentially all floor codes. As a result, I feel like my direct experience leading codes has been somewhat limited compared to programs where Hospitalists run them independently.

For those of you currently practicing as Hospitalists/ nocturnist • How comfortable were you running • Any recommendations on getting more comfortable/confident before graduation?

Spoke with a friend in a larger hospital system with OMT consult service. They said patients love it and the billing aspect is lucrative. Seems fairly easy to add on to inpatient visits if indicated, snag some extra RVUs

I recently moved from a hospital where a consult meant placing an order; to a larger academic hospital where we are expected to call or epic message the consultant for every consult. This often ends up being a lengthy conversation with the consultant telling them the whole clinical story, or arguing why the consult is needed- it’s exhausting! I’m curious what method is more common across the United States. I miss simply placing the order.

Looking for advice from anyone who has dealt with Texas licensure issues related to the USMLE timeframe rule.

I’m ABFM board certified already have an academic/faculty hospitalist position lined up in Texas. TMB recently informed me I’m currently ineligible because my USMLE exams were not completed within the required timeframe.

Although the Medical Practice Act, Texas Occupations Code Annotated §155.051(c), Examination Required, does
allow for the time limit for examinations to be extended to ten years, it was not applicable to your situation either.
This section specifically provides that:
(c) The time frame to pass each part of the examination described by Subsection (a) is extended to 10 years and the anniversary date to pass each part of the examination described by Subsection(b) is extended to the 10th anniversary
if the applicant:
(1) is specialty board certified by a specialty board that:
(A) is a member of the American Board of medical Specialties; or
(B) is a member of the Bureau of Osteopathic Specialists; or
(2) has been issued a faculty temporary license, as prescribed by board rule, and has practiced under such a
license for a minimum of 12 months and, at the conclusion of the 12-month period, has been recommended to
the board by the chief administrative officer and the president of the institution in which the applicant practiced under the faculty temporary license.
There are exceptions in the statute, and you may be eligible for one in the future, but not at this time. The
exception applicable to your situation - Tex. Occ. Code, Sec.* 155.0561 (see attached) allows exceptions to exam
requirements* **for individuals who meet certain additional requirements.
This applies to an applicant who:
• is fully licensed and has been actively practicing, after completion of an acceptable training program, in
another state, Canada or US territory for at least one year; and
• has never held a medical license subject to any restriction, disciplinary order or probation; and
• has no pending investigations by a licensing authority or law enforcement; and
• has never been subject of peer review that has resulted or may result in limitation, restriction, suspension or
other adverse action of privileges.
Location Address:

My options are:

1. Retake and pass USMLE Step 2 CK (within 3 attempts before 2031), OR
2. Be fully licensed and actively practice for at least one full year in another US state, Canada, or territory before reapplying under the exception pathway.

I’m trying to understand:
Has anyone successfully appealed or obtained Executive Director review in a similar case?

Did anyone take the “practice one year elsewhere” route and later get approved in Texas? And at this point why will I take the hassle of reapplying and relocating etc…

Which states are generally friendlier for physicians with exam timeframe issues?

Has anyone used Ontario/CPSO licensure as a bridge before eventually obtaining Texas licensure?

Is it worth involving a healthcare licensing attorney at this stage?

Also since it’s a faculty position- would it be worth applying for a faculty temporary license if full didn’t work out.

I’m also wondering if anyone has successfully obtained a faculty temporary license first for an academic appointment and then transitioned to full licensure afterwards.

Would appreciate any advice or similar experiences.

Was recently notified by our medical director they are implementing twice daily MDRs (once in the AM & afternoon), eliminating round and go (we need to ask for permission if we need to leave early), and want us to call our discharged patients the next day to discuss how they are doing, answer questions, etc. they want us to log these calls in a shared word document.

Ironically we have frequent nonsensical hospitalist meetings and this was never brought up during any of them.

This is keeping in mind our census has gone up consistently for the last few months. Round & go was a huge selling point in me signing a contract with this group (granted I don’t leave that early but I like the freedom of knowing I can leave if I want).

At this point, I am looking at other opportunities. I already feel bogged down on a daily basis with high census + countless endless messages + MDRs + the inevitable admin/hospital meeting once or twice a week that is supposed to be 30 mins but gets dragged on to over an hour some days.

Has anyone experienced this transition to twice daily MDRs and if so - what does that process look like? And calling patients after discharge? It is my understanding we have discharge nurses and additional random ancillary staff to do this, correct?

I'm an ER doc. There has been discussion about starting a subcu insulin protocol for mild-moderate DKA.

Usually these are pretty much a guaranteed IV drip and admit to the step-down unit. However, apparently a few health systems have protocols for admission to a floor bed, prior to closing the gap. No ICU unless pH 7 or something.

Anyone doing this? Any observations to share about how it has gone? Or, conversely, how would you react to attempts to implement this at your place?

I’m an MBBS-qualified General Physician with completed FCPS Part 2 training in General Medicine from Pakistan. Alongside my medical background, I’ve recently been exploring remote work opportunities including AI/data annotation, healthcare support roles, content evaluation, research assistance, medical writing, and other non-clinical remote jobs.
If anyone knows about any remote job opportunities, please let me know.

Hospitalist here. Had a patient with suspected overdose/serotonin syndrome while in er. Apparently in our state/hospital these cases trigger an admin review/root cause analysis.

Issue is: patient later wanted her phone, which was inside her belongings bag, so I handed her the bag as she asked for it. It qas just next to her.

The bag was not sealed.

She took meds again while still in ER and overdosed.

I contacted posion control and evaluated her again as nursr informed shr is drowsy etc. And treated her for same.

At that point I was not thinking of it as sealed medication evidence/chain-of-custody because initially I did not know this would become an overdose-related investigation.

Now I have a meeting next week regarding the handling of the belongings bag. Leadership says it is non-punitive and more of a systems/process review, but obviously I’m anxious.

For people who’ve gone through similar RCA/admin meetings:

- How would you answer this professionally?

- How much detail is too much?

- I dont get it how am i wrong in handing a bag to a pt.

Would appreciate advice from other hospitalists/ED people/risk management folks.

We have noticed a trend that patients who go to skilled nursing facilities on salt restrictive diets often end up being readmitted with volume overload. Most often these are Heart Failure exacerbations. According to the patients, their families, even the facilities – they don't have salt restricted diets available. Have y'all also noticed this? Any ideas about what can be done?

Graduating this summer and planning to start working shortly after.

• What are the mistakes you wish you hadn’t made as a newbie attending?

• Efficiency hacks?

• General life-after-residency advice?

Thx