r/hospitalist

I am a hospitalist with a generally favorable work environment. Typically see 12-14 (depending on the day) with 1-2 admits (also depending on the day). I consider the work load to be fair and manageable. I tend to be thorough to the degree of neuroticism, but I take ownership of that. Anyway, I see posts here of a mythical thing called “round and go”, and I am just curious: how much of your work do you take home (ie do you do your notes at home?) and how about all the follow up? Over the course of the day, I am getting follow up labs, imaging, consultant recs (including for late discharges), and unstable patients (there’s always one!) and I was just curious how the “round and go” crowd manages this? Do you do it from home?

Personally, I don’t think I would want manage all the follow up, potential consults, potential discharges from afar, but that’s just my personal preference. I also just don’t mind being at the hospital in general.

Hello colleagues! I work hospitalist in a small, rural town: 7000 people, 90 bed hospital, about 2.5 hours drive to our nearest referral centre. The opioid epidemic has not been kind to us.

More often than not we will have admitted a person with a history of IV drug use with some sort of infectious complication. Clearly a very shitty situation for this person, especially when they need like 6 weeks of IV antibiotics for their spinal epidural abscess/discitis/endocarditis/what have you.

Recently, we have had a few patients who have been unable to abstain from regular IV drug use while in hospital, either while on smoke breaks or day passes, or even while in their rooms. They have used their PICCs for access.

For a small town we have a solid addictions team that sees people as both in and outpatients for continuity, a good public health department, I do my best to optimize medical management of withdrawal symptoms, and we offer harm-reduction. But it's the addiction man, it's terrible, both opioids and stimulants.

I'm looking for any insight on how other people have navigated the situation of ongoing IV drug use in admitted patients. Many thanks!

What do you guys do or is your hospital policy when the ER asks you to admit a patient basically because the family “can’t take care of them anymore”? Generally a lot of these patients might have some sort of thing that can get worked up or maybe have a UTI or something you could argue should be treated. I dont love these admissions, but will admit them with much pushback. But what has been your experience when there is really nothing acutely wrong on the workup and they can’t even give a compelling story for something concerning? I don’t know what the admission diagnosis would even be in that instance and how you would justify keeping them in the hospital for it.

I'm a nurse at a major hospital system, so excuse my surface level understanding of how this works.

At my hospital, we have a weekly rotating cast of Community Internal Medicine physicians that come in four weeks a year to serve in a hospitalist-like role (for example one is my wife's PCP, another is my MIL's PCP). They are referred to as the consultant when they are in the hospital. Is this an unusual operation? Do most have all-time hospitalists that also work with residents and senior residents?

When observing rounds, I find they usually follow a very similar script. Outside the room with the door closed, the resident will talk about the patient's admission up to the present, today's assessment, labs, and plan of care to the senior and the consultant. The senior then usually commends the resident on their explanation, asks them follow up questions, then the consultant will chime in and correct anything the senior or resident may have left out or not framed to their liking. They'll sometimes throw in some history lesson interesting facts and how they perceive the situation. They will also ask questions to the resident and senior. Then they'll decide who will speak to the patient and family (usually the resident) and they all go in and let the designated person lead the conversation.

There's really no purpose for nurses to know this so it's really more curiosity from an outsider who speaks basic pathophysiology (listening to rounds is like being a Spanish speaker listening to a conversation in Portuguese). I'm interested in knowing the difference between the conversations during rounds vs conversations that go on behind the scenes in the resident rooms about the patients or otherwise. Is behind the scenes more day-to-day logistics, calls to consulting services, discharge preparing, note writing, admission taking?

Our training is long, arduous, and expensive for a reason. We give up years of earning potential, miss milestones, work nights, weekends, and holidays, and take on enormous responsibility to develop the judgment that patients depend on.

You deserve to be compensated in a way that reflects that sacrifice and allows you to have a good life. It’s recognizing the value of what it took to get here.

If it were up to admin, they’d reduce us to productivity metrics and pretend we’re interchangeable, as if the decade or more spent becoming a physician doesn’t matter.
Don’t buy into that mindset. Your expertise is what you’re being paid for. Volume is simply the easiest thing for administration to measure.

Sincerely,
PGY8 Hospitalist

So i did uworld x3 made flashcards on each question and do them. What else can i do for this test? I feel like i dont have enough to pass ? Please please any advice??!!!

I've heard of ortho and cardiology bringing in medicine teams as a consulting service for patients before. Is this pretty uncommon?

I thought it was interesting because I think of medicine teams as sort of the conductor of the consulting orchestra

Any feelers for how the job market is in Richmond Virginia? Looking to move out of the Midwest in the next year or so. Preferably looking for a reduced full time or parttime roles because of the family commitments.

Anyone working in the northeast specifically NY/NJ/CT or even RI, could you share your salary and work expectations? Nocturnist even better. Thanks!

Welcome! I mean it. I love working with new interns. check these out. They will make a difference for you.

• MDCalc: every clinical score you'll ever need. Free
• OpenEvidence: 100% get this! . Free and awesome!
• UpToDate: check if your hospital gives you access
• Epocrates: quick drug and interaction reference.
• NEJM "Videos in Clinical Medicine" — watch this before you do a procedure
• Thedailystat.com — a daily board-style question sent to you by email
• The White Coat Investor (book + free blog). Honestly I wish i had learned about this before

Everyone, please feel free to add to my list

Little do folks knows that being in the hospital for 18 days while being okay is most definitely a thing. What's your longest record?

Basically the title. What’s something you wish every med-surg knew? I’m looking for education topics to refresh/teach our acute care nurses. Thanks!

I am a new pgy3 and have to start looking for hospitalist jobs. I am kinda noob in this regard and would really appreciate advice regarding what things to consider before signing up for a job ?

I’m looking for a J-1 waiver day hospitalist position starting in March 2027. I’ve been emailing recruiters and applying online, but I haven’t had much luck so far. Most of the opportunities I’m finding are for nocturnist positions, primary care or open icu.

My preference is a day hospitalist role with a closed ICU. I’m open to different states and waiver programs if it’s a good fit.

If anyone knows of hospitals that are hiring, or has any recommendations, I’d really appreciate it. Thanks!

I didn't realize when I became a doctor how abusive it is. I'm so burned out getting yelled at by patients and families (even if it is a minority) when I'm giving them my all. I get people are scared and all but man it makes me want to leave medicine. I don't think I would do this again. Certainly wouldn't recommend it to my kids.

Practice in an inpatient setting. Not like primary care is any better.

Thanks for letting me vent.

I’m looking for some negotiation advice.

I have two hospitalist job offers.

Position A is my preferred job because of the location, team, and overall fit. Position B offers significantly better compensation, including a higher base salary and a much larger sign-on bonus**. (100k sign on bonus vs 30k and 200$ more per shift)**

I reached out to Position A to ask whether there was any flexibility in their offer. They replied that they are flexible on the sign-on bonus but didn’t mention any specific numbers. Regarding the base salary, they didn’t say there was flexibility. Instead, they emphasized that their quality and productivity bonuses can substantially increase total compensation.

At this point, what’s the best way to continue the negotiation?

Should I be transparent and tell Position A that I have a competing offer with a higher base salary and sign-on bonus? If so, should I share the actual numbers, or is it better to keep it more general?

I’m trying to negotiate in good faith because Position A is genuinely my first choice, but I also don’t want to leave a significant amount of money on the table.

I’d really appreciate advice from anyone who has successfully negotiated physician contracts or has been in a similar situation.