Family Medicine Working as a HOSPITALIST?!
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- čas přidán 27. 04. 2019
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OUTFIT #4
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Carrigan Jogger (Everglade) - the ones I got are actually no longer available but these are probably better!
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Wyatt and I and fairly active on instastories. Follow us @dr.jennale if you are interested in more behind the scenes of medicine/hospital and home life!
Pertinent points about being a hospitalist in this video:
1. FM is harder to be a hospitalist than IM but not impossible.
2. FM is more likely to be a hospitalist in smaller settings (e.g. not major urban areas, not major academic hospitals)
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3. FM can still do hospitalist work without becoming a hospitalist because FM has continuity of care for patients, can round in the hospital, etc. This can be a plus or minus depending on your perspective.
4. Both IM and FM need to pass a board exam to become a hospitalist
now.
5. My thoughts:
a. I think we should push back on #4.
b. Pediatricians have it worse, but FM/IM hospitalists could get there too. Apparently the American Board of Pediatrics requires pediatricians to do a 2 year hospitalist fellowship in order to practice as a hospitalist now. A lot of that fellowship is "research" and admin work which means less time on the wards too. So the ABP is worsening the debt burden of the lowest paid of all specialties (peds) and also produce worse clinicians. Good job, ABP!
c. At the same time, midlevels like NPs and PAs are increasingly able to practice independently. Yet doctors (peds, IM, FM) have to do more and more for less and less (e.g. do an extra 2 year fellowship at a significantly lower wage just to be able to practice as a hospitalist, pay tons of money for more exams just to be able to practice in something they are already competent at).
d. By the way, this wasn't mentioned in the video, but both IM and FM have hospitalist fellowships. I think they're both one additional year. IM hospitalist fellowships tend to be at major academic centers (e.g. Harvard's MGH, UCSF), whereas FM hospitalist fellowships tend to be more community focused. However, I don't think either IM or FM need to do a fellowship to be a hospitalist. I have the same thoughts about these as I do about the ABP making pediatricians do a 2 year hospitalist fellowship. We need to push back against this. What makes a good hospitalist is more experience caring for patients in the hospital setting. That can be achieved by working and getting paid fairly as a hospitalist. Not by doing an extra hospitalist fellowship which is really for getting lower paid labor out of residents/fellows.
e. I guess the academics like further training, certifications, degrees, fellowships, etc., because they like saying you get an additional degree or training or an extra way to further differentiate yourself from everyone else. However, I think our society is becoming way too hyper-specialized and overly focused on degrees and certificates at the cost of real learning (cue Mark Twain's quote about not letting education getting in the way of his learning). What's next? Extra fellowships on top of a hospitalist fellowship to focus on being a hospitalist on all the different wards in a hospital? So we get cards hospitalists, pulm hospitalists, hem/onc hospitalists, rheum hospitalists, endo hospitalists, etc.? It's becoming ridiculous.
f. I'm not FM, but this is why I highly appreciate FM because they're the true generalists. They can see entire forest, not only the trees. The big picture. And seeing the big picture is very important in a place and at a time when everyone wants to be a super specialist to stand out from the crowd. Generalists are the ones who can step back, take in the big picture, and coordinate it all accordingly. That is a huge benefit for our health care system, not a detriment, like hyper specialization so often is.
I couldn’t agree more! Thank you Stephen for taking the time to comment.
How do we push back though?? I remember asking this question to my mentors during clinical rotations, non had any real answers....and yes, PA's and NP's are encroaching more and more into the Physicians domain..
I didn’t think I’d ever want to do inpatient medicine, but I’m on IM now and I’ll admit it’s nice to have the flexibility in how long you get to spend with patients
I’m a family medicine trained first year hospitalist attending. I had countless job offers though to be fair a majority are in smaller settings. My hospital is by no means tiny though. Town of about 100,000 people with a like a 200ish bed hospital that serves a giant region of our state.
Anyone thinking of doing it I highly encourage. With the caveat that your residency program was hospital medicine focused at least more than the average FM program.
If you’re confident and experienced coming out of training, AND you’re flexible with where you move and live, you will have a ton of very well paying job offers.
So glad I went this route. I legit work my ass off, but they pay me really well, and I love what I do.
There is some beauty in pregnant women
You are looking so lovely your skin glows😍😍😍 reflects the foetus is health - said my grand mother
Thank you 🥰 I think mentally, I am much better during this pregnancy ... but my body feels like it’s about to fall apart.
If you're FM and you want to be a hospitalist, then I'd recommend the following:
1. Don't expect to be a hospitalist at a major urban hospital. At least not right out of residency.
2. However, there are tons of hospitalist jobs and it's completely fair to expect you can get a hospitalist job at a smaller (but still big) hospital that's near a major urban city. Jenny also mentions this is possible in her video. Just go like 30 minutes or maybe an hour outside a major metro area and you can probably find a good hospitalist job. And most people with families don't even want to live in the center of a major urban area anyway, but prefer the suburbs for example. So I wouldn't worry too much at this point.
3. Use your electives during residency to improve your inpatient experience (e.g. more ICU time, more inpatient procedures). Be able to show hospitals what procedures and how many procedures you've done (e.g. central lines, intubations). Doing this is what will show hospitals that you can be a good hospitalist and increase your chances at getting a hospitalist job.
4. Also, you might want to target your job search to open ICUs.
5. Make use of your connections in residency. Ask other FM residents or IM residents who have become hospitalists to help you out. Ask the PDs and aPDs if you're at a good program.
6. Often you can work as a hospitalist at your residency program hospital. This might not be ideal (e.g. you might still be treated by everyone like a resident rather than attending even though you're an attending now), but it will help you gain work experience as a hospitalist. And once you can say you've gained a couple of years' of work experience as a hospitalist, then less and less people will care about your base specialty (FM or IM). They care more about your work experience as a hospitalist. Maybe the only ones who will still thumb their noses down at you are places like MGH, UCSF, etc. They're just snobby like that in academics. And who wants to work at these places anyway? I often hear your salary will be inversely proportionate to the "prestige" of the institution! So that means you could be making $300K/year or more as a hospitalist and on better terms at a community hospital, while making significantly less and with worse terms at "prestigious" academic places.
7. If you desperately want to work somewhere but can't, it might be easier to get a hospitalist job as a nocturnist, because most people don't want that job. Plus you'll get paid more as a nocturnist. This will help build your work experience as a hospitalist too. Eventually you may be able to transition to a better hospitalist job.
8. Locums are always possible. Locums can help in figuring out where you eventually want to end up after graduation too.
9. There are hospitalist consulting firms that will help you find a hospitalist job.
10. You can compare job listings at places like HealtheCareers, PracticeMatch, PracticeLink, etc. to get a feel for what's out there, job requirements, etc.
11. That said, hospitalist jobs aren't for everyone! Sure, the money seems good along with the time off (e.g. $300K/year for working 12 hours per day for 7 days, basically 1 week on and 1 week off, i.e. 6 months out of the year, is common). However, you can often make just as much money in an outpatient setting with more regular hours (e.g. work 4-4.5 days per week, say work Mon-Fri 8-5pm, with a half day on Wed from 8-12pm to break up the week for $250K-$300K isn't uncommon either). It's all about volume and payor mix (and maybe procedures but procedures are more debatable, e.g., the time it takes to set up a procedure when you could be seeing more patients, but perhaps if you have efficient staff it'd be worth it). Work in an area with a high volume of patients and with mostly private insurance. In fact, I know a PCP in a very nice part of Orange County, California (near Dana Point) who makes $450K/year. And many American suburbs are like this. So this isn't a unicorn job either.
12. And there are many other options in FM/IM/PCP (e.g. telemedicine, nursing homes, urgent care pays well).
13. Finally, remember, in the end, interests come and go, procedures become mundane, there's more to life than money and excitement, and nothing matters more than your relationships with people/patients, so consider shaping your practice so that you can make a positive impact on people's lives, because that's what will outlast your career.
What an amazing comment, thank you so much for all the information.
Jenny please cover a topic about health professionals’ safety at work. Especially as a pregnant woman. Both in terms of violent or psych patients and just the dangers of exposure at the hospital.
I’m not sure if there are any set safety rules specially for pregnant providers. But I personally just stay away from those patients. My preceptors have never given me a hard time.
Wow you look amazing! Yes I worked through my three pregnancies too. The first one I was getting admits in the ER and patients became more interested in my giant pregnant abdomen vs their own chest pain.
binging on your FM related vlogs and I'm telling you now that if I end up choosing FM it's def because of your videos :D thank you so much!
Yay FM!! We need more primary care doctors ❤️
OMG, you are pregnant, congratulations Gorgeous! How long did I miss your videos!
I’m 30 weeks!
Your bump is so cute!!! And Wyatt is sounding so good :) thank you for being so informative in regards to family medicine and the different aspects of it :)
I’m huge! I can’t imagine getting any bigger 😭 we’re so happy about how much Wyatt is babbling now. I feel like he learns more and more everyday
Love your videos congratulations again on your new bundle of joy! Yes i love that site most comfy workout wear!
Congratulations, your videos rock!!! I am on my med journey so this was very informative!!!
It’s really great that they allow that flexibility, same as the UK! I’ll definitely be doing both. Ps: Your bump is so cute 😍
It’s gotten so big over the last month!
Love this video! And no joke, you look so so beautiful in all of them lol
It’s definitely hard getting use to this pregnancy bod. But I’m handling a lot better than the first time
You have stayed such a good size and the baby bump is so cute. Plus you’re glowing!
I feel like the tummy is huge! But so far I’ve gained less than my last pregnancy.
I was wondering if Fabletics was good quality or not. My friend got some and she didn't like them, but they really don't look bad at all. :) You're getting so close to birth-day! So exciting and you look radiant. :)
Thank you for the information!
I nanny for a hospitalist in Rhode Island. Very cool 😎 video
Hey Jenny, your videos are great and you're such a relatable, bright personality so thanks for your content! Do you know of a resource to find out which states allow family med to be hospitalists? Also, in your area, how are the clinics arranged? are there medical groups where doctors are managed? How do you feel about medicine becoming more of a business?
I think it all comes down to research. I haven’t done interviews yet (coming next year!) but there are clinic who are part of bigger organizations such a hospitals vs private practice vs physician owned. Medicine has always been a business controlled by bigger corporations. Unfortunately small private practices are dying. I think that’s one of the large reasons why there is so much physician burn out. Zdogg MD made a video good video about it
Got a fabletics ad and read the description... for a second I thought I clicked on the wrong video
Thank you so much for this video!!
TYSM for watching!
loved this video!! keep up the good work❤️
Thanks! 🥰
Hi Jenny, can you tell what else you do to treat your severe allergies, I’m also struggling with that myself year round . Thank you in advance
I use an antihistamine like Zyrtec (cetirizine) everyday. The nasal rinses. And Flonase. I know for some people who get really bad allergies elect for allergy shots. Should be covered by insurance
How do you do it? Be a physician, have a kid and be pregnant?
Like the Nike slogan - just do it 💪🏼👩🏻⚕️
Do all hospitalist jobs require 80 hour weeks?
Do you ever feel overworked and burnt out working 80 hour weeks or is that normal for residents? Is that normal for all residents or just of your specialty?
It’s very common to work 80 hour weeks especially in US residencies. Surgical specialities may do more. The cap use to be 100 hours a week and before that, there was no cap on the amount of hours a resident worked ... that’s why we’re were called residents. Because we basically lived at the hospital 😅
I do feel over whelmed at times but the further I go through my medical training and the more medical knowledge and confidence I gain - I feel like stressed. I also feel very supported by my program which helps.
I am currently in high school and It’s the time of life where I need to figure out what I wanna be and I’m thinking of being a fm doctor and I have a lot of questions but I just wanna ask do u ever get physically or mentally tired of doing your job
Yes. Especially during this pandemic. But I think that can happen with any job. You choose the challenges you want to face.
2 Qs:
Do you have to do fellowships in order to work in specific areas as a FM physician, like in the ED or something? How does that work?
Clinic work is not something that sounds fun to me and I’d much rather be in the hospitals, so how much can a FM physician be in a hospital setting? Are there things that one can do to make themselves work in the hospitals more than in the clinics?
I think it depends on the hospital if they require fellowship training. Most are moving towards that now. If you are only interested in working in the hospital then you should look into Internal Medicine (they are more geared to becoming internist).
I don’t know if internal is for me because I have kids and I feel like their schedule wouldn’t allow me to still be around my children. But I suppose I can’t have my cake and eat it too?
Working as an Hospitalist as an Family Medicine vs Internal Medicine would be the exact same job with the same hours.
Ah, I understand!
@@drjennale Internal Medicine docs are also called internists and are used interchangeably.... You also have a lot of other misinformation in your video. It is not hard to find a hospitalist job, and you don't need board certification to become one. You know how many "Hospitalist" fellowships there are in the entire country? 60 with only a couple spots at most each year for each across peds, family medicine, and internal medicine COMBINED, and they are geared towards research and leadership duties. You absolutely do not need a hospitalist fellowship let alone be board certified hospitalist medicine to practice hospitalist medicine. These are new fellowships, and probably 99% of hospitalists are not board certified as such.
Can u drop kids in hospital daycare being a resident?
Unfortunately there’s no hospital daycare at our hospital. That would be great though!
What's your Salary mam ?
What's the point in telling people about being a hospitalist then explain it's difficult to become one?
It’s also difficult to become a doctor, climb Mt. Everest, backpack around the world with little money, etc - people just want to know that it is possible, insight on challenges, and maybe tips to overcome them.
Stupid comment.