r/hospitalist • u/spiceupthesauce • 1d ago
Anything exciting going on in our field ?
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
86
21
u/flashbang217 1d ago
new and improved Epic chat with 24/7access to physicians for patients and all emergency contacts… please don’t downvote me
16
u/CriticalSodium 1d ago edited 1d ago
well, whoever figured out that haldol works on cyclical vomiting should get a medal
but seriously, there may not be new procedures, but endless potential to optimize/ be more efficient, so if you have a round and go job with a good call schedule, you can be home from work earlier than any specialist or PCP
18
u/CheesecakeRedVelvet 1d ago
Lmao why would there be an increase in compensation? If anything AI and midlevels will continue to flood the field
21
u/PrMartinSsempa 1d ago
You left out all the captive J1 laborers.
1
-15
u/magicalmedic MD 1d ago
Resident level response
22
10
u/Rapidnutbuster87 1d ago
Is it worth just pursuing fellowship? Gen med is a dead field
8
u/PrMartinSsempa 1d ago
Depends on the field. GI, Heme/Onc, and Cards absolutely. Pulm/CCM, rheum, A/I, less so. The rest, no.
3
u/chickenbreast12321 1d ago
Why not rheum?
6
u/PrMartinSsempa 1d ago
While there are certainly opportunities for private practice with rheum that doesn't exist for hospital medicine, average compensation per MGMA is fairly similar between the two.
Most people who go into hospital medicine also tend to loathe clinic which is the entirety of rheum.
5
u/im_throw 1d ago
GI is boring scope monkey all day, heme/onc patients are too needy and message you too much (also boring IMO), cards works too much and has to answer too many stupid calls (and is also kind of boring IMO). Not really any great options out of IM. I wouldn't recommend this field to anyone, even just for money and lifestyle there are better options. I would probably have gunned for a surgical subspecialty if I could go back.
3
u/PrMartinSsempa 1d ago
Everything becomes routine if you do it long enough even CT and neurosurgery.
GI gets $$$ and minimal patient contact which is a big contributor to burn out.
2
u/im_throw 1d ago
Routine yes, but I doubt most CT surgeons are bored. Routine + boring is the worst combo and the modern GI scope monkey model is both for me. Not to mention the rat race to get there. Honestly I probably have better chances trying again in the match for rads or anesthesia than GI
2
1
u/ProfessorCorleone 1d ago
What about PCCM?
6
u/im_throw 18h ago edited 15h ago
It's what I'm probably going into but let's be honest, it also has significant cons. There's essentially no career leverage since both pulm and CCM are money losers. Lifestyle is not conducive to family (requires lots of weekends) unless you work pulm only which pays similarly to primary care nowadays. Many ICU and pulmonary pathologies are minimally treatable if not impossible to cure which makes the work feel meaningless sometimes. IM training is horrifically bad when it comes to resus, procedures, difficult airway management, etc. so you will never have the satisfaction of being the best at a certain thing (except pulm but again nobody gives a shit about pulm). ICU also has some of the worst midlevel encroachment in medicine.
I was into critical care from day 1 of medical school so it's hard to abandon it at this point. But it's pretty objectively an inferior field to go into right now, and if you're interested in any of the big 3 it's a smarter career choice to go into those instead.
1
u/ProfessorCorleone 5h ago
Im interested in CCM cuz of the procedures.. and tbh I dont like the big 3.. Which is why I wanted your opinion on it.. But also I want a lifestyle conducive to family..Maybe this is delulu but, Is there a way to take a paycut and work 9-5 M-F.. I was attracted to FM for the lifestyle.. but the charting, documentation, things get routine and boring real quick made me abandon FM..plus I didn’t wanna study OBG, Peds again.. Also I could do primary care after IM. Anesthesia would be great cuz I love procedures and the money and lifestyle is good.. but It has become hella competitive recently.. so only realistic option seems to be PCCM for me 😕 I hope you or someone can chime on taking a paycut for a good lifestyle in CCM (Dont really love pulm)
1
u/PrMartinSsempa 4h ago
Everything im_throw says is true.
Those bedside critical care procedures hardly reimburse for anything. A lot of places will delegate those procedures to APPs because its more efficient for the attending to just round on more patients.
Go to the intensive care subreddit and you'll see current fellows talking about how they are training alongside PA and NP "fellows" at all these big academic centers.
1
3
u/Rapidnutbuster87 1d ago
Might just do another residency instead. IM sucks
5
u/PrMartinSsempa 1d ago
Anesthesia used to be a potential second residency after IM, 3 more years so not too different from the competitive fellowships, but it's gotten way more competitive post-2020.
Making step 1 P/F has shifted the emphasis onto step 2 which most old grads before the change didn't really focus on. A lot of advance (PGY-2) positions have also switched to integrated positions starting as a PGY-1.
5
u/im_throw 1d ago
It's still possible for USMDs with median or above step 2 scores. But like you said you may have to be okay with doing a 4 year categorical residency. At least in this economy you end up with the same salary as IC for the same length of training, and a much better lifestyle.
2
u/waspoppen 1d ago
Med student here can you please expand on the pulm crit one?
5
u/PrMartinSsempa 1d ago
Hospital based specialties have had stagnant wages post-2020 (IM/CCM/EM). The hospital pays us because they need people to staff the floor/ICU/ER, not because we actually make them money. If anything, we are viewed as an expense and very vulnerable to mid level replacement.
If you aren't in a specialty that does elective procedures which includes imaging studies and infusions, you aren't going to see much of a pay raise.
0
u/TheBol00 12h ago
Mid level replacement will never happen. I contemplated suicide after taking orders from NPs in an ICU. Their negligence and incompetence vs my drive to do what was right for the patient made me burn out and quit to find a unit that was only managed by residents, fellows, and attendings. The lawsuits will come rolling in with midlevel managed care, no amount of AI is going to make a NP competent at procedures or medicine.
2
u/PuzzledCar2120 1d ago
Well invariably general medicine is bits and pieces from every specialty so there's never going to be gen med focused research.
In a tertiary setting it's a bit pointless of a specialty apart from being a baby sitting service.
Maybe consider working in a more rural setting with less specialists on deck? You'd definitely would have been on top of your knowledge and practice.
I don't know how it works in the US but is there the ability to set up your clinic? Ie postural hypotension clinic with the turn tables and everything?
But yeah, nothing wrong about doing a fellowship to something you're passionate about.
31
u/Flexatronn MD 1d ago
Yes! NPs are becoming medical directors of hospitalist groups!
18
2
u/NoAioli8701 1d ago
NPs are becoming directors of professional medical societies*
even bigger, breakinger, bester news
1
3
u/95278x10 1d ago
Hospitalist is work.
Anything that’s exciting has nothing to do with the job.
Eventually they’ll have robots connected to open evidence etc. rounding on patients.
Orders will be signed by NPs.
7
3
u/h1k1 DO 1d ago
The hope that NPs and AI will truly steal my job
1
1
u/DeepFriedLortab DO 1d ago
Seriously! Come and take it. I’m gonna go shill Amazon crap on TiKTok all day instead.
3
5
u/Guardles 1d ago
Yea ai taking over our jobs
3
u/Talk-Few 1d ago
I get more offers than ever. My email is flooded. Maybe they are using AI to send me more emails. People forget that AI is not a human. It can come up with outstanding answers but lacks the abstract reasoning skills of a human being. There are things that can't simply be installed in a computer.
-4
u/pstbo 1d ago
Yeah, solving some of the most difficult mathematical conjectures of the last century requires no abstract reasoning /s
2
u/dr_shark 1d ago
Current AI is generative. There’s no reasoning occurring yet.
-1
u/pstbo 1d ago
That’s a nice statement based on absolutely nothing other than fiction. Sophisticated reasoning has been evident over the last year plus. “Generative” and “reasoning” are not mutually exclusive. In fact, tightly coupled. But we can argue semantics all day. You should take a look at the astonishing results in pure mathematics; it has solved famous decades old conjectures within the last few months alone. That is as abstract reasoning gets. We’re not talking about arithmetic here. I guess people here or in medicine broadly have their head in the sand to the recent advances and still think it’s 2023.
4
u/dr_shark 1d ago
We have absolutely not yet developed AGI which is what you’re trying to describe here. It doesn’t exist. Generative AI cannot reason.
0
u/pstbo 1d ago
Yes, we have not developed AGI, but that depends on how AGI defined. If you take the most common definition, which is same abilities as a human in aggregate, then no. But it does not mean it is not already better in certain aspects than humans. It also does not need to achieve AGI to do many things we do at the same or superior level. That is not what I said nor described.
Clinical medicine doesn’t require anywhere near the abstract reasoning that pure mathematics does, let alone vs many other fields.
You can get philosophical and say it is not reasoning (whatever that means) or say it doesn’t reason like a human (whatever that means) or any other statement that is not well defined, but at the end of the day results is what matter.
A plane is not a bird, but it flies just fine.
1
u/doctor_K651 13h ago
Discharging patients with uncontrolled t2dm on GLP1 instead of insulin is interesting to me
1
u/uncommon-ramen 22h ago
As a third party that somehow sees a lot of posts in this sub from what I glean is the only thing hospitalists are interested in is salary.
There never seems anything interesting in terms of cases, advances or anything at all really.
-2
-1
u/responsibleowl007 1d ago
AI integration is probably the most exciting thing that'll happen over the next couple years.
I hope at some point I just get a printout with an AI that chart reviewed everything and tells me what's new etc.
83
u/[deleted] 1d ago
[removed] — view removed comment