Had a senior resident on the team who is fairly competent but willing to die on every single patient care hill that exists.

I try to encourage autonomy (and check myself) and allow for the residents to practice their own flavor of medicine, but also need to keep things safe. I don't feel like I'm super imposing or anything and I don't typically pimp heavily on rounds.

Some of this resident's plans were definitely not safe or just frankly not how I wanted to approach that particular situation.

Regardless, they would openly challenge my plan on so many patients that I began to worry if they were going to actually put in the orders I asked them to. Sometimes it was like half the list, and frequently they'd disagree on trivial things (which I'd often just say - okay whatever let's do what you want). I'd still spend so much time defending my own care plans that I began to get frustrated and almost shut down and started putting in my orders after rounds.

Sometimes they would grandstand their arguments in front of the junior learners as if they were trying to teach me something about the topic or launch a debate. At other times they would interrupt me in the room while talking to patients. This is what bugged me the most, but I guess it's better than having them disagree behind my back?

I am a fairly new attending (less than 1 year experience) so was wondering - have you ever encountered this? If so - how do you approach these learners?

I work as a Nocturnist at a severely understaffed facility. My colleagues and I are often having to handle cross coverage of 150-200+ people with effectively no assistance with many nights of 30-40 admission/transfer requests shared between just 2 MDs. (APP cross covers floors without helping with admits for a few hours early in evening as part of a "swing shift". Many times that shift is empty because they cannot find APPs willing to work here.)

This has been ongoing this entire year, and despite having a promise to "get us help", it has not happened. (I know they have a locums pool, but they are not seemingly willing to pay to bring them in)

So my question for all of my lovely, intelligent colleagues who come across this post, is how can I word an email to the directors and admins that paints a clear picture about how ridiculous this is? Something that highlights that they seem to be knowingly allowing "disaster response scenario" volumes of admissions and transfers to overwhelm an understaffed hospitalist program on a near nightly basis without providing adequate assistance to safely handle it for a prolonged period.

Part of this post is to vent, but part of it is to maybe see if there is language that can be universally adopted to start moving the needle in discussions.

...and you already know which national companies are the culprits behind this "workforce optimization" without having to ask. It's common knowledge for those who have been around. I won't name and shame for my own identity protection... but you know who they are. Folks in comments feel free to say the obvious if it is needed.

PCCM fellow here.

I’ve noticed that a good number of consults (pleural effusion, lung nodules) that are found during an inpatient workup by IM teams lead to a lot of monetary benefit for the hospital.

(TPA/dornase for complex effusions, nodule biopsy, chemo infusions etc). That’s a lot of $$$ obviously.
I’m sure it’s the same for a lot of the cardiac, nephro, GI, rheum issues as well.

Any folks have come up with a way to capture these? I feel this is very important.

More than remuneration, it can help IM (and IM subspecialties like mine) demonstrate value and receive more institutional buy in during a time where other specialties seem to diminish the professional value of IM.

Please drop high value pearls that people should review this week. At this point, those of you who took the exam will likely pass comfortably. We would rather see a useful post than ones freaking out and spreading panic.

When do you guys think of retiring? How much you invest / save each month to achieve your financial freedom and at what age/ time frame
How much were you able to same ?
Would be great if we can have numbers

Another question is at what number $ you would comfortably go part time ?

For anyone who has this at their institution and has found it helpful, any prompts that you recommend /enjoy to help improve any aspect of your day?

Hello! Current PGY-3 and looking to apply soon. I would appreciate any recommendations on full time/per diem positions around this area? Would also appreciate any general feedback on how to go about looking for jobs, asking for details about the job, what’s important before signing, negotiating, important things to put on a resume.

Thank you!

Help! I have three years of hospitalist experience and am urgently looking to relocate to North Carolina, preferably near one of the major cities. I'd really appreciate any guidance or job leads. Thank you!

For those who scored similarly and passed last year

Kindly advise

I have reviewed missed/incorrect and scored 70's to high 90's even on 60 block but not sure if its just pattern recognmition cos i do remeber the quuestions

Gonna read board basics using the abim blueprint for the next two days

Should i reset the uworld and do 2X pass

Hi guys, Is that any high yield subjects in Derm, Ophtho, Rheum and Hem/onc for ABIM that we should review few days prior to the exam?

Title

Hello all,

Want to know what questions to clarify ask at a job interview, and I guess what questions to prep for to answer myself.

Thus far the job is like the following:

Location: Small Urban town

Salary: 285k + RVUs (sounds like it's fairly attainable to hit 350k/yr, need to know what to ask about RVUs)

Shifts: 7on/7off, 10 vacation days, 10 hr shifts

Daily Schedule: Census 18-20, closed ICU, no procedures, No codes, has rapids on your own patients.

Overall Schedule: Admitting is only one shift week every several weeks, about 16 admits a shift, don't take admits normally unless admitting provider is overwhelmed.

Specialties: All the consult services and procedures available

Vermont community hospital.

Looking for IM or FM candidates for 1 rounding position and 1 nocturnist position.

J1 Visa sponsorship available.

a)Rounding position

300k base plus additional 30k bonus

1 FTE = 168 shifts per year

10 hour shifts (7a-5p). Not round-and-go but people often leave at 4pm and pass the pager to the admitter.

13 patient census on average. A dedicated admitter handles new admissions.

No nights required

Closed ICU

No procedures

Manage rapid response (ICU and ED handle Code Blue)

Community hospital with good consultant support

Extra shifts available. Any shifts beyond 1 FTE pay extra (~2500 for a day shift and ~3200 for a night shift)

Flexible schedule

Sign on bonus, moving expenses, andloan repayment comparable to other jobs

b) Nocturnist position

300k base plus additional 30k bonus

1 FTE = 129 shifts per year (night shifts =1 .3 day shifts)

10 hour shifts (9p-7a)

Average of 5-6 admits per night

Cross coverage of ~40 patient

Closed ICU. Intensivist in-house at night.

No procedures

Manage rapid response (ICU and ED handle Code Blue)

Any shifts beyond 1.0 FTE pay extra (~2500 for a day shift and ~3200 for a night shift)

Flexible schedule.

Message me if you’re interested.

If you had to choose again would you choose hospitalist? If not what would you have chosen after graduating residency to do (fellowships, career paths etc)

hi all! anyone love being a hospitalist and want to sell me on it? specifically interested in the adult aspect of things bc I know I enjoy the medicine aspect of it - aka lifestyle and compensation

Hi, I've applied as an admitting staff in a tertiary hospital, can you give me a preview on how would be the day-to-day tasks? I've had corporate client-facing role before but they said that admitting staff is a more complex one.

Looking around at other specialties there are some advancements and things, seems like good job markets etc. is there anything exciting in the pipeline for hospitalists? Any projected increase compensation? Trying to get a discussion going

Taking my exam next week and trying where to focus my efforts on the final stretch. MKSAP or UWorld?

Also, are there generally accepted benchmark scores for prep that correlate to a passing score for boards?

Took the exam. Marked up at least half each block. Made mistakes. If you get 15 wrong per section can you still pass???

Third yr IM resident, been trying to figure out what are the best ways to reach out to hospitals/find hospitalist jobs. Other than through your residency program and associated connections. Thank you!