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year 10-12 career- pcp vs hospitalist

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  • year 10-12 career- pcp vs hospitalist

    Someone told me after 10 years, she likes to reflect where she would be or where she would want to be.  I am at that point now.  I have pretty established practice. I am employed. I think my salary is good for pcp, mid300s.  I am exhausted and drained with certain patients that come with the practice.  I try to catch up with all the messages, prepare the charts a week in advance.  Calls are not bad.  I still check messages during the weekend to make sure I come monday with a clear schedule.  I also check my messages during vacation because I know I will come back with a ton of paper work to sign.  It makes me reflect should i switch to hospitalist- nocturnist to be exact.  I have 3 young kids. I want to be truly off with no worries when I am off.  However, I do not want to leave a perfectly good and stable job that I already know the system.  I wanted to give myself 1-2 years to explore going back to the hospital.  I know the acuity is higher, patients are sicker but when you are off, somebody else takes over.  the paperwork of pcp is drowning. i know the grass is not always greener on the other side.  i think about the holidays, but wouldn't I have more time with the kids if it's shift work.  Hospitalists are probably paid higher as well.

    Is there a way to dip my toes  back in the hospital world again? Maybe find a small hospital that needs night coverage on a Fri night.  Are there such opportunities?

    I am also thinking in the future, when my kids go to college, I want to travel and do locums.  there may be more locums opportunists for hospitalists than primary care.  thoughts?

  • #2
    I think there are definitely opportunities to do a few hospitalist shifts (especially nighttime shifts) at small rural hospitals. I know my hospital would use you.

    You are paid well... you must hustle! Would depend on the hospitalist job if you will make the same or more... The hospitalist who are killing' it are working super hard, running for their 7-12hour shifts and then off for 7 days. Nice is that you work 26 weeks a year... usually no additional vacation but 26 weeks is pretty good! (You may have to recuperate for a day after your week finishes.

    Sounds like you need to leave work at work, can you arrange to have people help with those duties while you are away and you will help them when they are away?

    Comment


    • #3
      My hospitalist group hires fellows to do some admitting shifts (typically Friday & Sat evenings/nights)...if you're wanting to dip your toe back in the hospital world, I suspect there are other similar opportunities.

      I've been working as a hospitalist for almost 8 years now...I would caution about "grass is greener on the other side" syndrome.   My other half is a PCP, so I feel fairly aware of the on-the-ground reality of both worlds.   Is it nice to have shift work?  Yes.   However there are down sides to it too - working weekends, nights, Christmas...gets old as well.   I have two small children and the lack of a predictable schedule gets harder, I think, as they get older.

      Will you miss having continuity?

       

       

      Comment


      • #4
        Interesting, I usually hear of hospitalist going into PCP, not the other way.  Maybe you could try picking up a few shifts here and there to see how it goes, how out of date you are (if at all).  I don't think it'll be particularly hard to find, over the years my gen med friends have always talked about the various hospitals they do shifts at.  Depending on your setup, you can even just ask hospitalists in the area to hook you up or inside info on opportunities.  On top of PCP work it may be a lot but at least give you a taste.  I'm not sure nocturnist is a good long term plan, unless you're predisposed to that type of schedule it'll be rough and arguably has negative health effects.  Whats' your finances look like?  If you're on the ball or ahead of the game, a change wouldn't be as difficult due and you can handle a potential disruption in income, in case hospitalist doesn't work out you can always go back to PCP.  I too agree that locums hospitalist is probably easier than PCP locums, one of the great things about gen med is you have plenty of options.

        Comment


        • #5
          Just a thought - if you're making mid 300's as a PCP, you are likely working significantly more than the average outpatient doc.  You could consider cutting back and making mid 200's - this would put you in the range of the average outpatient doc and would represent almost a 30% cut to "full-time" work.

          Comment


          • #6


            I still check messages during the weekend to make sure I come monday with a clear schedule.  I also check my messages during vacation because I know I will come back with a ton of paper work to sign.
            Click to expand...


            I'd stop checking charts 1 week in advance (how many of your patients even book that far in advance??). I'd also stop looking at stuff on the weekend, and just get up an hour early on Monday and make some good coffee.

            And I'd certainly try and take a real vacation. Even if you have the last day be a staycation where you just do paperwork, a real week off will help.

            And, I'd think about working part time.


            However, I do not want to leave a perfectly good and stable job that I already know the system.
            Click to expand...


            There is certainly some value here, hard to measure though. And, it might be nice work to work 8-5 with kids (they'll be in school and after school stuff 8-5 soon enough anyway?!).

            Try some shifts elsewhere, see what you think. Try


            Will you miss having continuity?
            Click to expand...


            I think this would be tough to leave.

             

            Do you think an entire week w/o seeing the kids would be good? Or balanced with the entire week of being home? I'm not sure which is best, just curious.

            Comment


            • #7
              Are the unpleasant parts of your job fixable? Less hours? See less patients an hour? Hire a NP, or 2 MAs or an RN and delegate? Limit your scope of practice?

              What's enjoyable about the current job? Maybe chat more with pleasant patients that care about you. Do you have some control? If not how can you get it?

              I'd burn out on shift work especially with nights/weekends. Also no opportunity to develop relationships with patients and have them see you as more than doc employee of the day.

              Consider teaching. Medical students take uncompensated time, but helps keeps work fresh and interesting. Great feeling mentoring a student and seeing them do well later.

              Stress relief. Maybe work-out in the AM? Take vacations. Maximize quality of time spent with the kiddos while you are there--not looking at phone, listen to them.

              In short, try fixing it before jumping ship.

              Comment


              • #8




                Someone told me after 10 years, she likes to reflect where she would be or where she would want to be.  I am at that point now.  I have pretty established practice. I am employed. I think my salary is good for pcp, mid300s.  I am exhausted and drained with certain patients that come with the practice.  I try to catch up with all the messages, prepare the charts a week in advance.  Calls are not bad.  I still check messages during the weekend to make sure I come monday with a clear schedule.  I also check my messages during vacation because I know I will come back with a ton of paper work to sign.  It makes me reflect should i switch to hospitalist- nocturnist to be exact.  I have 3 young kids. I want to be truly off with no worries when I am off.  However, I do not want to leave a perfectly good and stable job that I already know the system.  I wanted to give myself 1-2 years to explore going back to the hospital.  I know the acuity is higher, patients are sicker but when you are off, somebody else takes over.  the paperwork of pcp is drowning. i know the grass is not always greener on the other side.  i think about the holidays, but wouldn’t I have more time with the kids if it’s shift work.  Hospitalists are probably paid higher as well.

                Is there a way to dip my toes  back in the hospital world again? Maybe find a small hospital that needs night coverage on a Fri night.  Are there such opportunities?

                I am also thinking in the future, when my kids go to college, I want to travel and do locums.  there may be more locums opportunists for hospitalists than primary care.  thoughts?
                Click to expand...


                I am contemplating a similar switch, but my situation is a little bit different.  I'm fairly content where I am now (mostly outpatient clinic, busy but usually not overwhelming), but being single with no kids, there's an appeal to a 7-on 7-off schedule, as that 7 off opens up many possibilities (travel, hobbies or taking classes during the week, etc) as long as I don't get too drained by the 7 straight days of hospitalist work.  I'm also finding myself more drawn to the (relatively small) inpatient aspect of my current job recently, though I wonder if my interest could be due to the novelty, since I am so much more outpatient based.  But similar to your situation, I'm hesitant to give up a good stable job, especially since I work with a great group of people.

                Anyway, I agree with some of the other suggestions mentioned, that maybe you need to cut back on the work first if you are feeling drained.  It could just be that you are taking on too much.  I also agree with your thought of picking up a hospital shift on a weekend if you can find one, to see if it fits your personality.

                Comment


                • #9


                  I am exhausted and drained with certain patients that come with the practice.
                  Click to expand...


                  Consider firing your top 20 most difficult patients.  A PCP colleague of mine did such and says it was a great decision.

                  Comment


                  • #10





                    I am exhausted and drained with certain patients that come with the practice. 
                    Click to expand…


                    Consider firing your top 20 most difficult patients.  A PCP colleague of mine did such and says it was a great decision.
                    Click to expand...


                    Generally you need a reason to do that!  Oh man how sweet my job would be if it were that simple.

                     

                    To the OP.  I agree that 350 for a PCP is moving.  Maybe you just got too much on your plate.  I have little kids so I cut and run at 5pm sharp.  But I come in an hour before anyone else to drink coffee and get all caught up.  I rarely start the day with any extra work on my plate. Leave your work at work.  Take an afternoon a week off.

                    Hospitalists do not usually make more the 350K.  I would be surprised to find good jobs paying that much even.

                     

                    Comment


                    • #11


                      Consider firing your top 20 most difficult patients. A PCP colleague of mine did such and says it was a great decision.
                      Click to expand...


                      I agree it is difficult to do that easily. Unless they are abusive to staff or yourself, you usually cannot justify it because they are difficult and contest your findings and plan of management or take up more than their allocated time. I have had difficult patients soften over time and become wonderful long term patients of ours.

                      Also, we keep these patients to remind us how wonderful the rest of the patients are.

                      Comment


                      • #12
                        But we do offer the ones who do not agree with my diagnosis or plan of action the option to choose a different provider. Many choose to stay with us, some take up the offer and some just go for a 2nd opinion and come back to us.

                        Comment


                        • #13
                          The ones who threaten to leave never do haha

                          Comment


                          • #14





                            I am exhausted and drained with certain patients that come with the practice. 
                            Click to expand…


                            Consider firing your top 20 most difficult patients.  A PCP colleague of mine did such and says it was a great decision.
                            Click to expand...


                            Bad idea.  For an employed physician this will be abandonment with potential suspension of privileges for violating hospital policy.  What grounds would you have for your defense if this generated a state medical board complaint?

                            If you are concierge or PP and can cherry pick what insurances you take, then you might be able to do this under the guise of coverage issues or practice caps.

                             
                            It's psychosomatic. You need a lobotomy, I'll get a saw.

                            Comment


                            • #15








                              I am exhausted and drained with certain patients that come with the practice. 
                              Click to expand…


                              Consider firing your top 20 most difficult patients.  A PCP colleague of mine did such and says it was a great decision.
                              Click to expand…


                              Bad idea.  For an employed physician this will be abandonment with potential suspension of privileges for violating hospital policy.  What grounds would you have for your defense if this generated a state medical board complaint?

                              If you are concierge or PP and can cherry pick what insurances you take, then you might be able to do this under the guise of coverage issues or practice caps.

                               
                              Click to expand...


                              It's not abandonment to fire a patient, with notice

                              Comment

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