PCPs: Admitting your own pts?

[Wings3496]

Background: I'm a second-year family med resident in the midwest. I've found that I very much enjoy hospital medicine in addition to the outpatient clinic setting. I'm starting to put out feelers to local practices looking for jobs, and I think I might enjoy a practice where I admit my own patients (at least to the single closest/largest local hospital). I'm not sure how financially viable this is, and I don't want to get too deep into the job/contract dance just to find out it's a bad idea. Many of my faculty members do both in- and out-patient, but they do so in an employed faculty role, so the reimbursement would be different.

My question: Anyone with experience have some advice? Is this financially viable or would it be better to simply spend all my time in clinic seeing patients?  My program director mentioned that I would be able to potentially team with the residents for extra inpatient coverage (helps increase their inpatient census as well), which could be nice as well as I enjoy teaching.

Any info is appreciated, thanks!

[G]

I work at a big hospital with a medical staff of a couple hundred.  There is exactly one old-timer primary care guy who admits his own patients....  The conversations in the lounge often mention the hassle isn't worth the money.

[pulmdoc]

I am a specialist at a large hospital with several hundred PCP's.  There are a grand total of 2 PCP's who admit their own patients, both old timers in concierge practices.  Things are different out in the rural communities where there may only be 1-2 PCP's in the entire community and not enough volume to support a hospitalist, there isn't a choice.  Be realistic with yourself how badly you want to do it, because the lifestyle can be closer to 7-7 plus weekend (or worse) than 9-5 because you will round on patients before clinic, go to clinic, then come back to the hospital to admit patients and figure what happened during the day.  You'll also be gettng paged in the middle of clinic for your patients as well.  Only you can answer whether any increased pay and job satisfaction from seeing inpatients will be worth it.

[drcolleen]

This may not be what you are look for, but I am rural full service FP with 8 other FPs and we rotate as hospitalist every 7 weeks so at this point I feel like I get plenty of inpatient experience.  We also cover the ER with an additional 2 docs and now some floaters in the rotation pool so this month I am only in clinic 7 days.  So if you are really wanting to do it all and don't feel tied to the city consider rotating somewhere rural.  We have residents and medical students scheduled almost constantly for the next few years and PA students frequently so teaching while rural is an option too.

[nachos31]

1. I think the best way to get a mix of in- and outpatient is to do what drcolleen said above: have dedicated time (usually a week) away from clinic where you round as a hospitalist. The caveat is that you round on whoever is admitted, not just your own patients. A lot of faculty at my old residency program do this--they'll do 13 weeks inpt (0.5 FTE) and the other 0.5 FTE clinic.

2. Having been a resident on a busy inpt service where we had a primary team with our hospitalist attending and then 1-2 puts with an old school FP doc who was in clinic every day. I can say it was terrible all around. We never rounded with him and were note/order monkeys (more than even usual). We could never get a hold of him which meant we could never tell patients definitively if they were going home, when to expect him, etc. since we could never staff pts. The nurses hated that setup too. As residents we also never got any teaching from him.

3. See #1

[redsand]

Where I did peds, there were many PCPs who admitted their own newborns to the newborn nursery.  They were supposed to cover their own newborn patients at that hospital, although sometimes they asked the residents to provide non-urgent or non-emergent care.

Fewer pediatricians in the community would admit their pediatric patients to the inpatient unit when they were sick, but I can recall at least 9 who did, and I only had the experience of one of the attendings doing any floor/bedside teaching.  It was difficult to get ahold of most of them due to clinic schedules.  Some were difficult to contact at night when their patients would get admitted.  Sometimes we would have to step out of teaching rounds to talk with them because their availability was limited by their clinic schedules.  Over the years, I think that many of the pediatricians have stopped admitting their own inpatients (other than newborns) at that hospital.  For the pediatricians who did admit their own patients, I know that some of the parents appreciated that the pediatrician took care of their child in the hospital, the continuity of care is nice.  Just need to have a flexible enough clinic schedule to allow for you to have time to take care of the inpatients.

[RetiredERdoc]

One thing to consider is that the hospital might make you take er call for admitted patients as a price for having admitting privaleges. This is much less common with the rise of the hospitalist. This would depend on whether the hospital had a hospitalist program that admitted all er patients. At my small community hospital the hospitalist did the majority of calls, but there were a few days with a local fp or internist covering.