r/hospitalist

Hospital
Community hospital with trauma designation
Closed ICU with intensivists
Full subspecialty backup
In-house rapid response team
PCU available
No routine procedures
No scribes

Schedule
7 on / 7 off
7 AM–7 PM
~180 shifts/year
Daytime team of ~5–6 hospitalists

Workload
Usually ~17–20 encounters/day
Hard census cap of 20; additional physician handles overflow
Usually ~3–4 admissions when covering admits
Admissions distributed round-robin
Only about 1 shift/week tends to be a heavier call day with admits + codes/rapids
Most other shifts are primarily rounding with shared/rotating admissions
Residents provide some coverage/support

Compensation
~$300k guaranteed base
~$10–15k/year quality incentive
$25K sign-on bonus available with multi-year commitment (still negotiating)
No relocation bolus

Benefits
Malpractice + tail included
Health/dental/vision
401(k) with employer match after 1 year
Online CME
Visa/waiver support

Updates: Admissions are shared/rotated among the hospitalist team. I would have roughly one heavier call day per week that includes admissions, codes, and rapids. Some days have separate physician coverage for admissions/call, making those shifts primarily rounding and potentially round-and-go once work is completed.

That’s insane. I sent someone home from the hospital on protonix 3 weeks ago and today I get a prior auth request for something that’s 10 bucks for a bottle at Walmart. Insane

It has been a month in my first hospitalist job after graduation. I feel no difference. I fell I am still in the grinding mood. I have a lot of time off that I am relaxing or going out with friends, but I do not feel the excitement about my life that I expected to feel after I finish residency.
Maybe I am burnt out, or maybe that is it!
I keep asking myself, is this what I was trying to achieve for the last then years?! Is it worth it?!
Money hit my account already and I was like, alright!
I am so grateful, but dunno if this is an existential crisis or my brain still did not get it.

Public sector doctor here, decade in, running on fumes. Private practice is tempting (better pay, better hours) but it feels like quitting on the people who need the safety net most. If you've made this jump: did the guilt stick around? Was it worth it? Anyone go private → back to public? Real answers only, not "follow your heart" 🙏

Inpatient denials by insurance. Do you get asked to complete these P2Ps with much communication and reminders leading up to it, only to complete it and get an already-expected repeat denial, then asked for follow up on what exactly occurred, and what the determination was?

Edit to clarify: This is not in reference to SNF denials, I’m referring to when inpatient status is denied because Obs would have been appropriate.

I don’t know about you guys but we have a very aggressive nutritionist team - recommending megace and PPN left and right for cancer cachexia, generally frail elderly unfixable patients, etc

they are not recommending PEG tubes, thankfully but I didn’t train in a system that ever used PPN and here, the culture is to use it like a supplemental protein shake w brunch. it’s crazy.

I’m wondering how you guys intervene on the chronic multisystem multifactorial beast that is the malnourished elderly?

What do you use for appetite stimulation, if anything, ever? This question is posed to me by our nutrition team multiple times per day - are they appropriate for an appetite stimulant? and I often spiral trying to understand what they mean and what the point would be.

Am i insane? It is day 7. I could be insane.

Maybe some one here can enlighten me. I suspect if I asked this at work the CMO would be sending me an email.

Why do you guys submit both body fluid evaluations and cytopathology on the same sample? One goes straight to our lab techs who are good at identifying abnormal things and then sending me the slides for a more in depth diagnosis. The cyto sample comes straight to me. It's almost daily I am looking at a cytospin slide from the lab and the cytology prepared cytospin on the same patient collected at the same time.

My pathology colleagues have said just take the easy money and shut up. The overly ethical side of me gets frustrated at redundant billing. The 88108 is only $21.04 at the Medicare rate, but it just rubs me the wrong way.

Just curious what everyone is getting on an hourly basis for locums these days

If you could, please report Locums company, hourly rate, and day or night shift

This can help make sure all of us are getting paid what we deserve

For example, Echo Locums, $200, both days/nights

PCCM fellow here.

I’ve noticed that a good number of consults (pleural effusion, lung nodules) that are found during an inpatient workup by IM teams lead to a lot of monetary benefit for the hospital.

(TPA/dornase for complex effusions, nodule biopsy, chemo infusions etc). That’s a lot of $$$ obviously.
I’m sure it’s the same for a lot of the cardiac, nephro, GI, rheum issues as well.

Any folks have come up with a way to capture these? I feel this is very important.

More than remuneration, it can help IM (and IM subspecialties like mine) demonstrate value and receive more institutional buy in during a time where other specialties seem to diminish the professional value of IM.

I work as a Nocturnist at a severely understaffed facility. My colleagues and I are often having to handle cross coverage of 150-200+ people with effectively no assistance with many nights of 30-40 admission/transfer requests shared between just 2 MDs. (APP cross covers floors without helping with admits for a few hours early in evening as part of a "swing shift". Many times that shift is empty because they cannot find APPs willing to work here.)

This has been ongoing this entire year, and despite having a promise to "get us help", it has not happened. (I know they have a locums pool, but they are not seemingly willing to pay to bring them in)

So my question for all of my lovely, intelligent colleagues who come across this post, is how can I word an email to the directors and admins that paints a clear picture about how ridiculous this is? Something that highlights that they seem to be knowingly allowing "disaster response scenario" volumes of admissions and transfers to overwhelm an understaffed hospitalist program on a near nightly basis without providing adequate assistance to safely handle it for a prolonged period.

Part of this post is to vent, but part of it is to maybe see if there is language that can be universally adopted to start moving the needle in discussions.

...and you already know which national companies are the culprits behind this "workforce optimization" without having to ask. It's common knowledge for those who have been around. I won't name and shame for my own identity protection... but you know who they are. Folks in comments feel free to say the obvious if it is needed.

Had a senior resident on the team who is fairly competent but willing to die on every single patient care hill that exists.

I try to encourage autonomy (and check myself) and allow for the residents to practice their own flavor of medicine, but also need to keep things safe. I don't feel like I'm super imposing or anything and I don't typically pimp heavily on rounds.

Some of this resident's plans were definitely not safe or just frankly not how I wanted to approach that particular situation.

Regardless, they would openly challenge my plan on so many patients that I began to worry if they were going to actually put in the orders I asked them to. Sometimes it was like half the list, and frequently they'd disagree on trivial things (which I'd often just say - okay whatever let's do what you want). I'd still spend so much time defending my own care plans that I began to get frustrated and almost shut down and started putting in my orders after rounds.

Sometimes they would grandstand their arguments in front of the junior learners as if they were trying to teach me something about the topic or launch a debate. At other times they would interrupt me in the room while talking to patients. This is what bugged me the most, but I guess it's better than having them disagree behind my back?

I am a fairly new attending (less than 1 year experience) so was wondering - have you ever encountered this? If so - how do you approach these learners?

Has anyone here taken the DO internal medicine board certification exam recently? Any tips, advice, or suggestions on how to spend these last few weeks preparing? Besides UWorld, any other QBank suggestions that mimic the aobim exam? There is very little online from the AOA, in terms of practice questions or content percentages. Thank you all in advance.

When do you guys think of retiring? How much you invest / save each month to achieve your financial freedom and at what age/ time frame
How much were you able to same ?
Would be great if we can have numbers

Another question is at what number $ you would comfortably go part time ?

Please drop high value pearls that people should review this week. At this point, those of you who took the exam will likely pass comfortably. We would rather see a useful post than ones freaking out and spreading panic.

How would you rate this? is it worth going for it?

• Open ICU - with intenvist support (vent, pressor, etc) - 2-3 patients in list
• Specialist support
• 19-20 census daily - no admissions
• 7-on;7-off scheduling
• Respond to Codes and RRTs - once a month when on call
• No procedures required
• No PTO
• $324000 - relocation and signon bonus
• Can take extra shifts if available
• EMR - EPIC
• 401 K - match 60% of what you contribute on the first 6% of your pay

Title

I recently discovered that on epic you can control A in the notes section and copy every single note in the chart. If you paste that into open evidence under new patient and then tell it to write a note… well it does and the note is really good. At least in the limited time I’ve spent playing with it in the last hour. I’m debating using this for my notes… it’s honestly better than mine and I have noticed any issues. Obviously I’m reluctant and skeptical… but the notes I’ve had it write are frankly pretty good. Outside of it not being my exact format and the fear of getting lazy and putting something in that I shouldn’t… I kinda want to use this. Is anyone doing this?