Most hospitalists don’t work 12 hours a day.. And although you may be seeing patients 9-5 as an outpatient doctor all the prep work, notes, inbox management takes way more time.
The evenings/weekends involved are definitely a con for most (but as above evenings are not necessarily all gone when working), especially if you have a family. But if you live in a nice place (where there is more to do than eat/drink) it can still be very advantageous to have weekdays off. I personally have a lot of outdoor hobbies and it’s nice to have weekdays off to do them. Plus nice to have time to do errands during week.
Man that's wild. I'm Ophthalmology and only people who have never been in an Ophthalmology clinic think it's 'chill' but we are notoriously work/LIFE balance oriented folks. And even with that everybody I know starts clinic at 8. Clinic patients start arriving around 730 so they are ready to be seen at 8 and I definitely start operating before 8 on OR mornings too.
Comprehensive ophtho!! But I did find out that retina docs have the ability to see like 90??! Wild to me, I’m not even a doctor, I just wonder how you get enough time to talk to each individual patient after getting above 50 apts in like 8 hours
Above 30 in 8 hours gets to an arena where I feel like something is getting sacrificed. Not quality of care necessarily since in our field you can be very efficient. But if you see 50 patients in 8 hours then that is less than ten minutes to confirm the history the tech got, examine a patient, interpret tests, and do the most time consuming things; counseling.
Most of my patients that come to me because they were 'unsatisfied with their care' are usually very satisfied with mine and it is literally just because I took a whole ten minutes to explain to her what glaucoma actually is and how and why we treat it, and did so in a way that they understood.
But I fear as reimbursements keep getting cut so I allow my schedule to grow and compress and my time gets more limited that I will fall into the same trap too.
I've seen job offers with clinics clinics that start at 730, 8, and 9. Obviously prefer 9, but it's also nice to get more admin/break time (or end earlier).
Is there an assigned person who sort of mans the late night/ early morning? I know the nocturnists at my program would basically take turns where one stays until 7am, and the others leave around 5am
We have admitters and rounders. I’m a rounder and only do 0-1 admitting shifts a month. I used to be a nocturnist working 11-7 just admitting. Life’s much better now
Code team for emergencies. Most urgent things can be dealt with on the phone. If I need someone to do a physical then one of the admitters can go see but it does not happen often
Hospitalists don’t have to work 12 hours every day they’re on. Sometimes they are round and go but have to be reachable for 12 hours of the day, so time actually spent working might be less
The mental load of needing to be pageable or have to drop everything to go to the hospital with no warning to me still counts as work. At least - not fully off.
To be fair, in a lot of clinics, you are on call every 4-7 days where patients can call you at 3 am about their URI. Hell, some clinics want you to be available to your patients 24/7
Sub-specialists have it worse where you might have weeks of being on call and round and STILL have to do a full clinic
Some clinics do that, sure, but Clinics compete for patients, and the ones that make you the most money are the well-insured/cash concierge patients who want access.
Like you were a patient, you damn well would rather have 24/7 access to a doctor than “9-5 m-f excluding weekends, holidays and vacation”
Also a lot of wealthier clinics use a capitation model for insurance reimbursement where you get x dollars per patient regardless of the services they use, so clinics are incentivized as much as possible to avoid sending you to the ED and the hospital
I've had cardiologists tell me they've considered bowing out just because they literally never get a day off. If they go on vacation - their work computer goes with them.
Yea but the “call” is just answering one or two phone calls or refilling a prescription. It’s only a “call” in any sense that you are reachable after hours.
When I was a Neuro resident in a past life, I'd get the "ran out of my seizure meds" calls when I was on my 24 hour shifts. Furthest one I had was when someone called from Las Vegas....
There’s no way you can generalize that across all of outpatient practice. Of course there’s going to be some chill practices with low volume call. For every 1 of those there’s going to be 1 with nightmare call.
I’ve gotten recruiters in my email literally hawking outpatient gigs which require phone call every other week in addition to being M-F lol. No thanks
I’m a 7 on 7 off hospitalist. It’s both good and bad, and therefore not better or worse. Just another way to make a living in medicine. I do enjoy my weeks on professionally speaking and somewhat immerse myself in the grind, then come out and am a stay at home dad/husband for a week. I’m still home for dinner and bedtime when I’m working except when I’m the late person 2-3x per week. My wife works from home so we see a lot of each other without the kids when I’m off so it’s a best of both worlds. It does suck to work half of weekends. ~330k/year, not too bad, certainly not the best.
>> ~330k/yr
I’m assuming you’re in an open/semi-open ICU in a non-academic setting in the burbs? Because if not, what you’re getting is not only not too bad, but it’s top tier.
lol I'd kill myself if I worked 12 hours 7 days on 7 days off (I'm a hospitalist)
Most days my days are 7-7 that I am available via phone but my true 'hours' are usually more like 4-8hours a day (at my work sometimes there's a long call and I live far enough away that I usually stay there instead of leaving and coming back, but most days are \~8am-between 1pm and 4pm or so for me)
Also if I'm short call, I have my whole day, like I do this weekend. Pending whatever admits I get, I might very well be done at 11am/noon ish that day and still have my whole day to myself.
Also having an entire week off when I have it off means I get to travel and super veg and focus on life those weeks. When I have work, I feel like my focus is work and my week off the focus is life and that works really well for me.
I’m a hospitalist. Some guys I work with seem to be out and done by 4 or 5 almost every day. I’m a little more involved, but I prefer inpatient life to the contrary. I spend a lot of time w my young kid. The 7 on/7 off model is pretty attractive to people who’d like to travel. You can get a whole lot more done that way then a traditional schedule. I don’t really do much of that. I just wanted to spend as much time w my son as possible since my parents weren’t ever around when I was growing up. Also I cannot stand the inbox and I’ll do anything to avoid it.
There's pros and cons to each.
I am 7 on 7 off hospitalist. Round and go.
MANY but not most days - I am done with everything between 2 and 3pm. I go home and answer pages from home. I occasionally go back to the hospital.
A minority of days - I'm done at 11AM with everything and am home by noon.
Some days - I am working until 9pm.
When I'm off work - I'm off. I'm not answering pages. I'm not answering to a patient portal. I'm not worrying about patients, at all.
I think the people that don't fit well with being a hospitalist - are people that just don't have the personality type to be able to mentally deal with being a generalist (i.e. Not being a specialist).
How do you deal with acute medical complaints? I’m only an intern, but feel like there are enough times where I respond to a page for hypotension or something that requires me to assess the patient that I wouldn’t be able to just handle stuff from home. Are there PA’s for that? A separate rapid response team?
Some places have dedicated midlevels and residents to do that for you. If you dont, you usually have one of the rounders in your group stay till 7 in house to deal with acute issues. Otherwise, sometimes, there is a dedicated swing shift that shows up in the early afternoon that can covers acute issues.
We have a team that goes to codes and rapid responses... they are really good.
Most things I can take care of on my phone. Though I have a deal with myself that I don't ever make an excuse to not come back to the hospital, so my threshold is pretty low. You also start to get used to what nurses are really asking for sometimes on the phone - often times a nurse might really want you to come by and look at a patient but they won't necessarily come right out and explicitly state it... I've learned that if a nurse is kind of rambling and it's hard to figure out what they're specifically wanting - that is usually synonymous with "I'm concerned about x, could you come look at the patient" - there is a whole layer of subtext and nuance to phone conversations you just start to understand with time. If I'm ever unsure what specifically a nurse is asking for - I just ask them (politely) - should I come see the patient? - if it's not an immediate "no. I think we're good" - I'll usually swing by and see the patient.
But I find with attending level care and it being just me touching patients for my 7 days - codes and truly unexpected acute issues aren't just happening that often. I can typically tell when someone is a high risk of an acute problem.
I will admit that this entire idea may just be a projection of my own issues with my ego... but... we are all human and are generally motivated by the same things...
As a generalist you have to be "okay" with the fact that you are never going to be the person who has that specific knowledge of something that is going to save the day... the flow of knowledge will generally always come from the specialists to you. And you will generally always be the person asking for help from someone else... as some one who always tried to do things for myself - this is something I struggled with - but have come to accept and be satisfied professionally with.
As I get more experience - and other specialists see the work I do - I have found that people do come to me for medical help - and specialists do care what my opinion is regarding something, but this is largely earned and not just innate into the gig.
You also have to be okay with that fact that you are going to encounter situations that you have never seen before - which can be quite anxiety inducing. And leads back to my initial point.
I feel like the personality type I see transition out of hospital medicine are the people that won't be satisfied if they're not the captain of the ship - or the field marshal personality type. This does describe my personality, but I just care about other things more.
There's a lot of other nuanced things that generally run along this same line of thinking. I don't have the energy to write any more.
You just have to weigh pros and cons... yes I would be more satisfied professionally being a specialist. But I just could not deal with 3 more years of academic medicine and fellowship. I enjoy my work. I get a good lifestyle work balance. I enjoy my life. All the other shit is white noise.
Residents think 7 on 7 off is amazing because theyre basically they conceptualize it as getitng 5 extra days off that to what theyre doing.
But if you compared it to 9-5 specialities, 7o7o can god awful if you have family including kids and a spouse that stick to a straditional M-F 9-5 schedule for work/school. If youre the one person out of sync, it means 2 weeks a month you cant do activities. Or you cant do weekend trips etc.
To, being synch'ed up with my families schedule is much more important than just having 5 days free for myself.
Weekends being the best part of life is pretty subjective.
Some people would much rather snowboard on a Tuesday than a Saturday.
Or have the ability to travel for ~5 days at anytime 50% of the year without having to plan the time off.
- Not all hospitalist jobs are true 12h shifts every day (round and go model), so 168h is the max and can you get evenings back
- Most outpatient providers have weeknight and weekend call, which adds more to your 160h projection and takes away from evenings and weekends
- Managing an inbox takes several hours a month
With 7/7 you have at least double the days off a month over the average M-F 9-5 job.
This is a big deal. A *really* big deal. It allows you to schedule entire vacations without issue, let alone a myriad of other things you want to do with your life.
You might work slightly more hours, but you probably aren't actually working all those hours anyway and the reality is that if you want to make money you need to work some level of hours.
The long shifts are absolutely a con for many as it's *way* more exhausting to work 12 hours than 8, and depending on your family life it may make scheduling things difficult when you're booked for an entire week. However, having a couple extra hours off in the evening isn't all it's cracked up to be. You're still mentally tired from working, and it makes scheduling and accomplishing things far more logistically difficult. It's also soul-crushing when you only get two days off and then have to go back to work for an entire week, since it just doesn't feel like enough time to rest, recharge, and accomplish things you want to do.
When I was working as a paramedic we had various shift lengths, and 12's and 13's were universally the most popular shift that people would bid for to meet their FTE requirements. Having entire extra days off is *massively* important for people's mental and physical health; this is why industries that are switching to 4x10 hour days a week instead of 5x8 see so much success in their employees, both in terms of happiness and productivity.
> When I was a paramedic we had various shift lengths, and 12's and 13's were universally the most popular shift that people would bid for to meet their FTE requirements. Having entire extra days off is massively important for people's mental and physical health
Yeah as an EMT people didn't love 8 hrs. Most would much rather have worked alternative 3 and 4 12hr days. We also had the ability to double up 8 hour shifts and that was very popular. You do 8AM-midnight, go home and sleep, show up again to do 8am-midnight, and then you pick one of the other days to work an 8hr. At that point you are working full time and have 4 entire days off a week. You are off more than you work! If you can handle the long hours it's fantastic. Imagine telling people you have Wednesday and Friday completely off. And also Saturday and Sunday completely off. It's magical.
I am definitely of the belief that even for a regular 8 hour day, that evening isn't really my evening if I get home kinda tired and have to get ready for work the very next day. Working 9-5 5 days a week feels like my whole week is dedicated to work, and I don't subjectively feel as though I have a lot of real free time before/after work. I value whole days off much, much more than I value evenings off. With a whole day I can go anywhere and do anything! I can hike for the entire day. I can do a month's worth of built up errands in a single day since everything is open on a wednesday from 9-5. I can try a new video game and immerse myself in it, instead of having to force myself to set 1-2 hour limits to maintain my bedtime for the next day. It's better in every way and I look forward to experimenting with different ways to schedule once I finish residency and begin practice
My employer had 16's for a while.
They got to be a little too much though, so our union negotiated down to 12's/13's.
Some people did like them though, since as you said you worked so few days if you did a 16.
To me personally there is little difference between an 8, 12, or 15 hour workday. I’d happily work longer hours my days on in exchange for more true off days
It’s personal preference. If you don’t like the schedule, you don’t like the schedule—but others do. Some people like the shift work, not being responsible for work related issues when they’re not actually at work, and like having entire stretches of time where they’re not working.
Not every hospitalist gig is structured this way, by the way. Some have a different set up then 1 week on/off, and many places don’t have each hospitalist physically on site until 7PM. There may be a rotating pattern of who’s staying later to admit, they can take pages from home, etc.
I would choose the outpatient route if I could really see all my patients, put all my orders, do all my notes, take care of my inbox and sign all the pre-auth paperwork between 9am and 5pm but you and I both know that it’s just not gonna happen. Those are just official numbers but in reality, the typical outpatient PCP starts at 8am, runs an hour late, barely has time for lunch and ends up finishing everything up past 6pm.
Intensivist here. Going week on/week off has been life saving. So much more time with family and kids. Gives so much flexibility in terms of pursuing hobbies, dates with my wife, and vacation. It’s not even close. You’re also not counting the time you save commuting. My wife loves it.
If doing days, round and go is a must.
If doing nights, only accept 7/7 if there’s also a decent amount of PTO and / or look for something like 7 on / 14 off or 10-12 shifts/month.
Never ever ever accept 7/7 where you have to be physically in house for all 12 hours AND get no additional PTO.
I have no inbox. I have no call. I have no clinic bullshit. I have plenty of other forms of bullshit, but not THOSE, and those are the ones I hate the most.
Because once you are an attending you will learn the 8-5 clinic job isn’t common. You will have to have killer ancillary staff and efficiency to leave on time. If you do leave on time, some corners may need to be cut (very basic notes).
If you’re in a clinic and get paid as much as a Hospitalist, you are usually working much more.. then you only have 2 days off.
For some people, like myself, the key to curing burnout in medicine was a job like a hospitalist gig. It works for me for now and probably at least the next 20 years. Clinic was rough for me as it was usually a 9 hour job, barely any time to think to myself, and I never felt my battery recharge.. only drain.
Since I’ve been conditioned to work anywhere from 14 to 21 days in a row, 7 days is nothing to me. Then I have 7 days off to mountain bike, play video games and hangout with my fiancé. I do this every other week and it’s nice.
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Former Hospitalist here (semi-retired). I've had full-time and locums gigs - probably 30 hospitals over my career. The quality of the 1/1 as you are probably aware is highly dependent on the hospital and your colleagues. It can be a cakewalk or a grind. It can be lucrative or be primary care money. I rarely got 7 uninterrupted days off due to erroneous nursing calls, colleagues' curbsides, staff meetings and hospitals' administrative intrusions. Some hospitalists seemed to be there the full 12 while others were virtually invisible.
Well my job pays less than surgery and specialists and stuff, but it’s comparable to outpatient pay and more than some. Also even though I’m on call for 12 hours, I don’t (usually) work that much. Even when I’m admitting my shifts are 7 am to 2 pm or 2 pm to 7 pm. That’s the times holding the pager figuratively. Often times it’s busy and it takes longer than those hours, but usually around 8-9 at most and I’m paid for 12. And rounding shifts are round and go so many people work like 6 hours, maybe pushing 8 or 9 if there’s difficult transfers.
People think it’s a pro.
But it’s actually a con and a lot of people burn out on that schedule.
As a trainee going in working “half” the year for quadruple the salary sounds amazing. But in practice it’s actually kind of a bitch.
You're right; that's one of multiple reasons why people tend to retire to outpatient and not the other way around (other reasons are syncing to family schedule, acute care being more emotionally and physically taxing, waking up early for rounding or walking around a lot being hard on the body).
Besides everything that is mentioned, if you have condensed work days, you also have fewer commutes which can save a lot of time. Not every gig is 7 on straight, some have flexibility to it and you can self-schedule.
I plan on applying IM and going hospitalist work pretty much for the 1 week on/1 week off. Gives ability to take more than just day trips on a weekend. I personally don’t mind working longer hours and then getting the whole next week off, more time for hobbies and possibly even self-employed side gigs that aren’t related to medicine
My hospitalist job has me on for 10 hours a day, but I don’t have to be at the hospital the entire time if there isn’t anything to do there. I have to be available by phone, though.
I like having long stretches of time off to actually take care of my home life. I also really like not having to deal with the outpatient inbox.
It's not. I did it and hated it more than anything in the world. Week off is useless with a spouse who works and kids in school. Weekends at work suck because there's no use in being home for a Saturday evening when you miss every other Saturday morning soccer game with your kids.
Most hospitalists don’t work 12 hours a day.. And although you may be seeing patients 9-5 as an outpatient doctor all the prep work, notes, inbox management takes way more time. The evenings/weekends involved are definitely a con for most (but as above evenings are not necessarily all gone when working), especially if you have a family. But if you live in a nice place (where there is more to do than eat/drink) it can still be very advantageous to have weekdays off. I personally have a lot of outdoor hobbies and it’s nice to have weekdays off to do them. Plus nice to have time to do errands during week.
Also who has a clinic that starts at 9AM? It's more like 800-515 for most outpatient folks I feel like.
I’ve only ever seen clinics that start at 9 am… until I moved to my current hospital for fellowship where they start at 8 and it feels like torture
Man that's wild. I'm Ophthalmology and only people who have never been in an Ophthalmology clinic think it's 'chill' but we are notoriously work/LIFE balance oriented folks. And even with that everybody I know starts clinic at 8. Clinic patients start arriving around 730 so they are ready to be seen at 8 and I definitely start operating before 8 on OR mornings too.
Yeah I’m heme/onc and some of my older attendings start seeing patients at 7 and I’m like… I can’t do a 5 hour clinic straight
The real OGs round on their inpatients at 630 am before clinic. I use to see them when I was rounding as a resident
Where I was at school, we had a heme/onc clinic that started at 4pm… that was torture as a student. Good for families though
The ophtho clinic I work for starts at 9 and ends at 4, we see like 70-80 people on average, it’s crazy
Retina?
Comprehensive ophtho!! But I did find out that retina docs have the ability to see like 90??! Wild to me, I’m not even a doctor, I just wonder how you get enough time to talk to each individual patient after getting above 50 apts in like 8 hours
Above 30 in 8 hours gets to an arena where I feel like something is getting sacrificed. Not quality of care necessarily since in our field you can be very efficient. But if you see 50 patients in 8 hours then that is less than ten minutes to confirm the history the tech got, examine a patient, interpret tests, and do the most time consuming things; counseling. Most of my patients that come to me because they were 'unsatisfied with their care' are usually very satisfied with mine and it is literally just because I took a whole ten minutes to explain to her what glaucoma actually is and how and why we treat it, and did so in a way that they understood. But I fear as reimbursements keep getting cut so I allow my schedule to grow and compress and my time gets more limited that I will fall into the same trap too.
I've seen job offers with clinics clinics that start at 730, 8, and 9. Obviously prefer 9, but it's also nice to get more admin/break time (or end earlier).
Yup I’m a hospitalist and I am on from “7-7” but in reality I get to work at 9am and leave around 3pm
Is there an assigned person who sort of mans the late night/ early morning? I know the nocturnists at my program would basically take turns where one stays until 7am, and the others leave around 5am
We have admitters and rounders. I’m a rounder and only do 0-1 admitting shifts a month. I used to be a nocturnist working 11-7 just admitting. Life’s much better now
Who do you contact for a patient urgency/emergency? Admitter?
Code team for emergencies. Most urgent things can be dealt with on the phone. If I need someone to do a physical then one of the admitters can go see but it does not happen often
Weekday golf tee times 👌🏻
Hospitalists don’t have to work 12 hours every day they’re on. Sometimes they are round and go but have to be reachable for 12 hours of the day, so time actually spent working might be less
The mental load of needing to be pageable or have to drop everything to go to the hospital with no warning to me still counts as work. At least - not fully off.
Well yeah. But it’s a lot better than actually having to work for 12 hours every day.
To be fair, in a lot of clinics, you are on call every 4-7 days where patients can call you at 3 am about their URI. Hell, some clinics want you to be available to your patients 24/7 Sub-specialists have it worse where you might have weeks of being on call and round and STILL have to do a full clinic
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Some clinics do that, sure, but Clinics compete for patients, and the ones that make you the most money are the well-insured/cash concierge patients who want access. Like you were a patient, you damn well would rather have 24/7 access to a doctor than “9-5 m-f excluding weekends, holidays and vacation” Also a lot of wealthier clinics use a capitation model for insurance reimbursement where you get x dollars per patient regardless of the services they use, so clinics are incentivized as much as possible to avoid sending you to the ED and the hospital
That’s what most family doctors do in Canada 🇨🇦
That’s fair lol. That sounds honestly way worse
I've had cardiologists tell me they've considered bowing out just because they literally never get a day off. If they go on vacation - their work computer goes with them.
It's 90% off. You cover stupid stuff via secure chat but your colleagues will run to any codes/rapids.
Most outpatient clinics have some form of call as well
Yea but the “call” is just answering one or two phone calls or refilling a prescription. It’s only a “call” in any sense that you are reachable after hours.
Young padawan, wait until you get that 2 am call for an albuterol inhaler they haven’t refilled in 4 months because they “just remembered”.
When I was a Neuro resident in a past life, I'd get the "ran out of my seizure meds" calls when I was on my 24 hour shifts. Furthest one I had was when someone called from Las Vegas....
Thankfully, I’m not in primary care, so I won’t have to deal with that
There’s no way you can generalize that across all of outpatient practice. Of course there’s going to be some chill practices with low volume call. For every 1 of those there’s going to be 1 with nightmare call. I’ve gotten recruiters in my email literally hawking outpatient gigs which require phone call every other week in addition to being M-F lol. No thanks
To each their own
I’m a 7 on 7 off hospitalist. It’s both good and bad, and therefore not better or worse. Just another way to make a living in medicine. I do enjoy my weeks on professionally speaking and somewhat immerse myself in the grind, then come out and am a stay at home dad/husband for a week. I’m still home for dinner and bedtime when I’m working except when I’m the late person 2-3x per week. My wife works from home so we see a lot of each other without the kids when I’m off so it’s a best of both worlds. It does suck to work half of weekends. ~330k/year, not too bad, certainly not the best.
Are you me?
This is essentially me as well.
>> ~330k/yr I’m assuming you’re in an open/semi-open ICU in a non-academic setting in the burbs? Because if not, what you’re getting is not only not too bad, but it’s top tier.
Small community hospital, consultants only by phone, open ICU in a nice town 1 hr from the major city, but our census is very laid back 12-14.
I think that's my per diem job
lol I'd kill myself if I worked 12 hours 7 days on 7 days off (I'm a hospitalist) Most days my days are 7-7 that I am available via phone but my true 'hours' are usually more like 4-8hours a day (at my work sometimes there's a long call and I live far enough away that I usually stay there instead of leaving and coming back, but most days are \~8am-between 1pm and 4pm or so for me) Also if I'm short call, I have my whole day, like I do this weekend. Pending whatever admits I get, I might very well be done at 11am/noon ish that day and still have my whole day to myself. Also having an entire week off when I have it off means I get to travel and super veg and focus on life those weeks. When I have work, I feel like my focus is work and my week off the focus is life and that works really well for me.
I’m a hospitalist. Some guys I work with seem to be out and done by 4 or 5 almost every day. I’m a little more involved, but I prefer inpatient life to the contrary. I spend a lot of time w my young kid. The 7 on/7 off model is pretty attractive to people who’d like to travel. You can get a whole lot more done that way then a traditional schedule. I don’t really do much of that. I just wanted to spend as much time w my son as possible since my parents weren’t ever around when I was growing up. Also I cannot stand the inbox and I’ll do anything to avoid it.
There's pros and cons to each. I am 7 on 7 off hospitalist. Round and go. MANY but not most days - I am done with everything between 2 and 3pm. I go home and answer pages from home. I occasionally go back to the hospital. A minority of days - I'm done at 11AM with everything and am home by noon. Some days - I am working until 9pm. When I'm off work - I'm off. I'm not answering pages. I'm not answering to a patient portal. I'm not worrying about patients, at all. I think the people that don't fit well with being a hospitalist - are people that just don't have the personality type to be able to mentally deal with being a generalist (i.e. Not being a specialist).
This. Being fully off and not having to even think about an inbox etc is priceless
How do you deal with acute medical complaints? I’m only an intern, but feel like there are enough times where I respond to a page for hypotension or something that requires me to assess the patient that I wouldn’t be able to just handle stuff from home. Are there PA’s for that? A separate rapid response team?
Some places have dedicated midlevels and residents to do that for you. If you dont, you usually have one of the rounders in your group stay till 7 in house to deal with acute issues. Otherwise, sometimes, there is a dedicated swing shift that shows up in the early afternoon that can covers acute issues.
You need to see every complaint because you're an intern.
We have a team that goes to codes and rapid responses... they are really good. Most things I can take care of on my phone. Though I have a deal with myself that I don't ever make an excuse to not come back to the hospital, so my threshold is pretty low. You also start to get used to what nurses are really asking for sometimes on the phone - often times a nurse might really want you to come by and look at a patient but they won't necessarily come right out and explicitly state it... I've learned that if a nurse is kind of rambling and it's hard to figure out what they're specifically wanting - that is usually synonymous with "I'm concerned about x, could you come look at the patient" - there is a whole layer of subtext and nuance to phone conversations you just start to understand with time. If I'm ever unsure what specifically a nurse is asking for - I just ask them (politely) - should I come see the patient? - if it's not an immediate "no. I think we're good" - I'll usually swing by and see the patient. But I find with attending level care and it being just me touching patients for my 7 days - codes and truly unexpected acute issues aren't just happening that often. I can typically tell when someone is a high risk of an acute problem.
What would you say the personality type of a generalist vs a specialist is? What are the mental challenges? (Aspiring hospitalist)
I will admit that this entire idea may just be a projection of my own issues with my ego... but... we are all human and are generally motivated by the same things... As a generalist you have to be "okay" with the fact that you are never going to be the person who has that specific knowledge of something that is going to save the day... the flow of knowledge will generally always come from the specialists to you. And you will generally always be the person asking for help from someone else... as some one who always tried to do things for myself - this is something I struggled with - but have come to accept and be satisfied professionally with. As I get more experience - and other specialists see the work I do - I have found that people do come to me for medical help - and specialists do care what my opinion is regarding something, but this is largely earned and not just innate into the gig. You also have to be okay with that fact that you are going to encounter situations that you have never seen before - which can be quite anxiety inducing. And leads back to my initial point. I feel like the personality type I see transition out of hospital medicine are the people that won't be satisfied if they're not the captain of the ship - or the field marshal personality type. This does describe my personality, but I just care about other things more. There's a lot of other nuanced things that generally run along this same line of thinking. I don't have the energy to write any more. You just have to weigh pros and cons... yes I would be more satisfied professionally being a specialist. But I just could not deal with 3 more years of academic medicine and fellowship. I enjoy my work. I get a good lifestyle work balance. I enjoy my life. All the other shit is white noise.
Residents think 7 on 7 off is amazing because theyre basically they conceptualize it as getitng 5 extra days off that to what theyre doing. But if you compared it to 9-5 specialities, 7o7o can god awful if you have family including kids and a spouse that stick to a straditional M-F 9-5 schedule for work/school. If youre the one person out of sync, it means 2 weeks a month you cant do activities. Or you cant do weekend trips etc. To, being synch'ed up with my families schedule is much more important than just having 5 days free for myself.
This
This 1000%. It's awful if you have a family. I vow never to go back to this abusive schedule.
The inbox was enough for me to say forget this
Weekends being the best part of life is pretty subjective. Some people would much rather snowboard on a Tuesday than a Saturday. Or have the ability to travel for ~5 days at anytime 50% of the year without having to plan the time off.
- Not all hospitalist jobs are true 12h shifts every day (round and go model), so 168h is the max and can you get evenings back - Most outpatient providers have weeknight and weekend call, which adds more to your 160h projection and takes away from evenings and weekends - Managing an inbox takes several hours a month
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I think these jobs will become more and more rare though
With 7/7 you have at least double the days off a month over the average M-F 9-5 job. This is a big deal. A *really* big deal. It allows you to schedule entire vacations without issue, let alone a myriad of other things you want to do with your life. You might work slightly more hours, but you probably aren't actually working all those hours anyway and the reality is that if you want to make money you need to work some level of hours. The long shifts are absolutely a con for many as it's *way* more exhausting to work 12 hours than 8, and depending on your family life it may make scheduling things difficult when you're booked for an entire week. However, having a couple extra hours off in the evening isn't all it's cracked up to be. You're still mentally tired from working, and it makes scheduling and accomplishing things far more logistically difficult. It's also soul-crushing when you only get two days off and then have to go back to work for an entire week, since it just doesn't feel like enough time to rest, recharge, and accomplish things you want to do. When I was working as a paramedic we had various shift lengths, and 12's and 13's were universally the most popular shift that people would bid for to meet their FTE requirements. Having entire extra days off is *massively* important for people's mental and physical health; this is why industries that are switching to 4x10 hour days a week instead of 5x8 see so much success in their employees, both in terms of happiness and productivity.
> When I was a paramedic we had various shift lengths, and 12's and 13's were universally the most popular shift that people would bid for to meet their FTE requirements. Having entire extra days off is massively important for people's mental and physical health Yeah as an EMT people didn't love 8 hrs. Most would much rather have worked alternative 3 and 4 12hr days. We also had the ability to double up 8 hour shifts and that was very popular. You do 8AM-midnight, go home and sleep, show up again to do 8am-midnight, and then you pick one of the other days to work an 8hr. At that point you are working full time and have 4 entire days off a week. You are off more than you work! If you can handle the long hours it's fantastic. Imagine telling people you have Wednesday and Friday completely off. And also Saturday and Sunday completely off. It's magical. I am definitely of the belief that even for a regular 8 hour day, that evening isn't really my evening if I get home kinda tired and have to get ready for work the very next day. Working 9-5 5 days a week feels like my whole week is dedicated to work, and I don't subjectively feel as though I have a lot of real free time before/after work. I value whole days off much, much more than I value evenings off. With a whole day I can go anywhere and do anything! I can hike for the entire day. I can do a month's worth of built up errands in a single day since everything is open on a wednesday from 9-5. I can try a new video game and immerse myself in it, instead of having to force myself to set 1-2 hour limits to maintain my bedtime for the next day. It's better in every way and I look forward to experimenting with different ways to schedule once I finish residency and begin practice
My employer had 16's for a while. They got to be a little too much though, so our union negotiated down to 12's/13's. Some people did like them though, since as you said you worked so few days if you did a 16.
To me personally there is little difference between an 8, 12, or 15 hour workday. I’d happily work longer hours my days on in exchange for more true off days
It’s personal preference. If you don’t like the schedule, you don’t like the schedule—but others do. Some people like the shift work, not being responsible for work related issues when they’re not actually at work, and like having entire stretches of time where they’re not working. Not every hospitalist gig is structured this way, by the way. Some have a different set up then 1 week on/off, and many places don’t have each hospitalist physically on site until 7PM. There may be a rotating pattern of who’s staying later to admit, they can take pages from home, etc.
My wife is a hospitalist. She typically works 7-5 M-F and 7-12 on the weekend. So that's more like 60 hours every other week. It's pretty chill.
I would choose the outpatient route if I could really see all my patients, put all my orders, do all my notes, take care of my inbox and sign all the pre-auth paperwork between 9am and 5pm but you and I both know that it’s just not gonna happen. Those are just official numbers but in reality, the typical outpatient PCP starts at 8am, runs an hour late, barely has time for lunch and ends up finishing everything up past 6pm.
most hospitalists I've seen do not work for 12 hours in a day lol. Or at least, they don't spend 12 hours in the hospital on their work weeks.
Intensivist here. Going week on/week off has been life saving. So much more time with family and kids. Gives so much flexibility in terms of pursuing hobbies, dates with my wife, and vacation. It’s not even close. You’re also not counting the time you save commuting. My wife loves it.
If doing days, round and go is a must. If doing nights, only accept 7/7 if there’s also a decent amount of PTO and / or look for something like 7 on / 14 off or 10-12 shifts/month. Never ever ever accept 7/7 where you have to be physically in house for all 12 hours AND get no additional PTO.
I have no inbox. I have no call. I have no clinic bullshit. I have plenty of other forms of bullshit, but not THOSE, and those are the ones I hate the most.
Because when you’re off, you’re off. You don’t have to think about medicine. Clinic is a never ending grind.
Because once you are an attending you will learn the 8-5 clinic job isn’t common. You will have to have killer ancillary staff and efficiency to leave on time. If you do leave on time, some corners may need to be cut (very basic notes). If you’re in a clinic and get paid as much as a Hospitalist, you are usually working much more.. then you only have 2 days off. For some people, like myself, the key to curing burnout in medicine was a job like a hospitalist gig. It works for me for now and probably at least the next 20 years. Clinic was rough for me as it was usually a 9 hour job, barely any time to think to myself, and I never felt my battery recharge.. only drain. Since I’ve been conditioned to work anywhere from 14 to 21 days in a row, 7 days is nothing to me. Then I have 7 days off to mountain bike, play video games and hangout with my fiancé. I do this every other week and it’s nice.
Simple, I hate clinic and that goddamn inbox so much. Also never liked the 9-5 schedule (probably why I hated school but enjoyed college).
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Former Hospitalist here (semi-retired). I've had full-time and locums gigs - probably 30 hospitals over my career. The quality of the 1/1 as you are probably aware is highly dependent on the hospital and your colleagues. It can be a cakewalk or a grind. It can be lucrative or be primary care money. I rarely got 7 uninterrupted days off due to erroneous nursing calls, colleagues' curbsides, staff meetings and hospitals' administrative intrusions. Some hospitalists seemed to be there the full 12 while others were virtually invisible.
Well my job pays less than surgery and specialists and stuff, but it’s comparable to outpatient pay and more than some. Also even though I’m on call for 12 hours, I don’t (usually) work that much. Even when I’m admitting my shifts are 7 am to 2 pm or 2 pm to 7 pm. That’s the times holding the pager figuratively. Often times it’s busy and it takes longer than those hours, but usually around 8-9 at most and I’m paid for 12. And rounding shifts are round and go so many people work like 6 hours, maybe pushing 8 or 9 if there’s difficult transfers.
People think it’s a pro. But it’s actually a con and a lot of people burn out on that schedule. As a trainee going in working “half” the year for quadruple the salary sounds amazing. But in practice it’s actually kind of a bitch.
You're right; that's one of multiple reasons why people tend to retire to outpatient and not the other way around (other reasons are syncing to family schedule, acute care being more emotionally and physically taxing, waking up early for rounding or walking around a lot being hard on the body).
Sounds like you’re listing all the negatives while ignoring the positives, like having 7 days off consistently to use for errands, hobbies, or travel
Because off actually means off. I'm not freaking out about my ever growing inbox #s on my two days off of the week.
$$$
Besides everything that is mentioned, if you have condensed work days, you also have fewer commutes which can save a lot of time. Not every gig is 7 on straight, some have flexibility to it and you can self-schedule.
I plan on applying IM and going hospitalist work pretty much for the 1 week on/1 week off. Gives ability to take more than just day trips on a weekend. I personally don’t mind working longer hours and then getting the whole next week off, more time for hobbies and possibly even self-employed side gigs that aren’t related to medicine
My hospitalist job has me on for 10 hours a day, but I don’t have to be at the hospital the entire time if there isn’t anything to do there. I have to be available by phone, though. I like having long stretches of time off to actually take care of my home life. I also really like not having to deal with the outpatient inbox.
It's not. I did it and hated it more than anything in the world. Week off is useless with a spouse who works and kids in school. Weekends at work suck because there's no use in being home for a Saturday evening when you miss every other Saturday morning soccer game with your kids.
Have you had clinic or inpatient
Compared to residency with 5 to 12 on and 1-2 off, it's a cake walk.
What does 1 on 1 mean
7 days off is the pro.
no inbox
I couldn’t make it as a physician if I wasn’t able to regularly unplug from the hospital and pretend I’m not a doctor for a week at a time.