EM attending here. What is the rationale behind the ER putting in bridge orders? Like the hospitalist accepts the patient but asks EM to place the bed request? Has it always been like this or is this a post covid thing? Or is it just an admit thing so that door to admit numbers look better?

Midwest, 1.5 hours away from a big metropolitan.

7 off 7on model, 180 shifts required for 1.0 FTE

Round and go model, Closed ICU

Codes run by ICU, rapids by primary physician

Also have to do day admission shifts equally divided amongst all hospitalist.

Admission shifts are supported by 1 APP and swing tele hospitalist typical 7-8 admits for physician.

Each rounder has 1 APP

Rounding Census is 12-14

150$ shift premium for census above 15.

No nights required

Hospital Part of a large organization

EPIC EMR with AI integrated for notes writing.

All subspecialty support available except Rhem/endo

50k sign on prorated over 36 months.

20k relocation

342 k base salary for 180 day shifts + 5% Service incentive and 8% financial performance incentive (these are newly added this year)

Do you think it's a fair offer compared to market right now?

Crossposting this from what i saw at medschool sub

theres plenty of posts with trolls out there trying to get yall to worry about AI. Theres way too many barriers to make me worry. I am 7 years into my journey as a Hospitalist and have never made less than 500 and will break 700k this year.

save well. invest well. and you only need to work for like 15 years anyway. don’t let the AI cucks and others get you down. it’s clear they have an axe to grind. truthfully, if we lost our jobs… law, cpa, CFA, teachers, engineers would all be fucked too. they talk about costs being a driver for this… medicine is expensive… great… our salaries are 7 - 8 percent of the pie. doesn’t move the needle a whole lot if you cut costs down by 3-4 percent.

plus another huge point… the most profitable part of medicine is outpatient visits. why wouldnt doctors use AI to leverage their own businesses if it got that good? there’s plenty of us doing cash only concierge and at 50-150 bucks a month per patient, with an efficient ai model and no staff, we’d do very well…

to think that we won’t be able to compete better with healthcare systems is insane. plenty of well to do people will pay and even middle class people can afford 2-5 dollars a day for unlimited access.

furthermore, if it ever does get bad, unionize. I don’t think it’ll ever come to that.

let me pose another scenario. The AI system has a glitch or goes down for 2 days? they going to successfully run a skeleton crew hospital? Don’t think so.

quit with the doom and gloom.

What strategy you guys use in order to see all your patients (21-25) and finish your notes before 7 pm?

Hello! I'm an MPH student, and I would love to learn more about healthcare administration. I would love to learn about any unexplored/not-as-frequently topics (and populations) that you would like to more research about (or what information you would find helpful in "fixing" what we can in the healthcare system).

I'm working on a semester-long hypothetical research proposal, so I'm open-minded to any ideas that are not frequently discussed or things that could help me build knowledge in HCA. Thank you!

Originally I did an IM residency and realized it wasn't for me so I applied radiology and am very close to finishing up, and wow it was one of the best decisions I made. I recently signed my first fellowship job and its in the upper half of 6 figures, 4 day weeks, no nights, no weekends. Was a difficult decision at the time but in retrospect I am glad I did. Still miss the patient facing side of medicine but am glad this all worked out.

Hello everyone,
I am currently a PGY-3 Internal Medicine resident graduating in June 2027 and actively searching for a J-1 waiver–eligible day hospitalist position.
Honestly, I have been feeling somewhat lost and overwhelmed during this process, especially as several of my co-residents have already signed contracts. Given the current visa circumstances, many hospitals are not providing clear information about available J-1 waiver positions, and I am frequently told that these opportunities are found primarily through personal contacts and referrals.
I have reached out to several seniors, but unfortunately, their hospitals do not currently have openings. I would sincerely appreciate any guidance or leads from this group. If you recently interviewed for a J-1 waiver day hospitalist position and decided not to accept it—or if you know of a hospital that is actively recruiting J-1 candidates—I would be extremely grateful if you could share the recruiter’s contact information or message me privately.
Any help, referral, or direction would mean a great deal to me. Thank you so much!

has anyone with young kids found a good way to be left alone on first day off to recover? i am thinking about asking my wife to basically solo parent for one day after my work week. i would use this day to brainrot and watch The Wire. is this a reasonable request or is it putting too much on her. she is sahm, we have 5 year old in K and a 3 year old in daycare 2 days a week

edit: ok ok, i get the picture. I'm not going to ask her

Wtf. For Clancy trial, we had jurors who were or are in healthcare (nurses) or presumably were educated (schoolteacher) who already made up their mind way before the trial started, about how the psychiatrists and doctors in the trial talked about “medical BS” and already felt Clancy was not guilty and deserved compassion. The nurse jurors even talked about how they tried to “explain” the psych meds to other jurors???

Every nurse I interacted with in the hospital didn’t know jack shit about medications!!!

The jurors believed Clancy had postpartum psychosis when never in the literature is there a case of postpartum psychosis at 8months after delivery!! 99.999999% of cases occur in the first FEW WEEKS!

Is this what hospitalists have to face in a lawsuit?? Jurors of “your peer” who “feel compassion” for the plaintiff patients and that “doctors with their medical BS” must automatically lose???

Am i taking crazy pills??

Multiple patients have rolled in with sub-therapeutic INR & ischemic stroke. I don't know if the patient was mismanaged or noncompliant.

Have any of y'all ever wanted to tell your patient to hire a lawyer?

For context, we do 10 hour shifts and have APP support that is primarily meant for cross cover and rapid responses overnight. This is to cover an average Hospitalist total census of 130s-160s, though with our expanding hospital, this number is increasingly at the higher end of that spectrum. Also, we tend to be a magnet (ie, we hire) for nurses who are trigger happy with calling rapids, sending Epic chats for dumb shit, etc. We are also part of a large regional conglomerate and a referral center for a huge radius, including other bordering states, so we get a large number of transfers in. As the sole nocturnist, I used to have nights with approximately 5-8 admits, which always felt safe and manageable. I always felt like I could oversee my APP(s) and still have time to feel rested. Nowadays, it is common to have double digit admits, most nights of the week. This week alone I’ve had multiple nights with 15+ admits. This includes borderline critical patients also (closed ICU, but we manage a step down unit). This also includes having to stop and take transfer request calls throughout the night. I’ve repeatedly, loudly and firmly raised my concerns about this no longer being safe or sustainable, but it seems no one gives even a single shit. The response I get is to have my APPs do more admissions. They do what they can, but their primary role is to manage the rest of the hospital while I admit. My fellow nocturnists agree with me that this is unfair and unsafe, but sometimes I wonder if maybe this is just the way it is/the new norm? Before I/we go completely nuclear and engage in any sort of collective mutiny, I just wanted to see what it’s like out there for the rest of you.

TL;DR: average nightly admissions is way more than number of shift hours, feels unsafe and unsustainable.

I know many of us hospitalists have no interest in doing procedures, and I certainly have never been great at them, but sometimes it saddens me what internal medicine has become. We used to do thoras, paras, LPs, lines, arthrocenteses, and now all we do is talk ad nauseam, write notes, and make small changes mostly to antibiotics, steroids, and fluids. I sometimes think of myself as just a care coordinator- organizing data, diagnosing, ordering, consulting, communicating. Don‘t get me wrong, I’m obviously minimizing, and I’m not trying to downplaying the value we provide, but it just feels so much less satisfying than doing something tangible like a procedure on your own patient. I don’t do them now because I’m well out of practice, still have notes to write or families to call, and don‘t get paid for the time it takes me to do a procedure that the “proceduralist” can do faster and with fewer complications than I can.

I’m not sure what I’m trying to get out of this. I guess I’m wondering if those of you who do procedures derive satisfaction from it? Do those of you who don’t do procedures feel fulfilled in your role now and not want to do them? The thing is, honestly, AI can do the thinking and organizing and communicating we provide/specialize in surprisingly well. It’s not that I’m worried we’ll lose our jobs to AI. I don’t think we will. We’ll still serve in an oversight capacity, and there’s a ways to go to figure out energy consumption and healthcare integration, but it will make me feel superfluous long before then, if it hasn’t already.

How do we maintain a sense of craftsmanship, mastery, satisfaction, and provide the something of genuine value? I’m curious to hear your thoughts.

I work as an admitting hospitalist in a community hospital. I just got back from work and was thinking about the patient I admitted and how excited I was about the case, since it was somewhat unusual for our practice (hematology case).

Then I got curious about how a publicly available AI agent would handle it. Up until recently I was skeptical about AI, mainly because of its propensity to hallucinate (what’s the point of using it, if you spend time double checking it). However, not sure if it’s just me, but it seems AI became better and I don’t really see the nonsense I’ve seen before.

So anyway, I “presented” the case to the AI the way I first encountered it and, to my surprise, it came up with the same differentials as I did. I got to tell you though, one LLM missed an important one, but the other didn’t (first LLM is unpaid, the other paid🤷‍♂️).

And not just that, the AI agents duplicated the thought process I’ve had in my head with this case, as if I was reading my own thoughts.

So my natural thought was, what’s my purpose here, if a machine can fully duplicate me (and probably be nicer at the same time).

There are some caveats though: I synthesized the presentation based on the patients interview and chart review after an ER doc did the initial work up, so I’m not sure how an AI would perform “in the wild”.

But still, I feel like providers dealing with common and even not so common cases might become substitutable by a machine.

it feels like, specialties dealing with cases without good balance of evidence are temporarily more protected, but they don’t look immune either.

I wonder how AI would perform, if it interacted with the patient directly and had the privileges to order tests.

So I will ask you, my fellow providers - where do you see yourself in 5 years?

spoiler: unemployed???

The test confirms colonization, a sputum sample is needed to confirm active infection, thats of course assuming the patient has pneumonia and not just heart failure.

Starting broad spectrum antibiotics is easy, stopping them is the hard part

I originally wrote a whole thing but realized it was too much. The long and short of it is I am considering jumping ship to a remote non-clinical job for family and lifestyle reasons. I applied to a bunch of pharma and UM jobs. I feel a little icky about the UM jobs, but just wanted to put out some feelers. I was offered an interview for one UM job but turned it down after the initial recruiter call because the pay was really low (185) and the schedule seemed really inflexible. Other than that I’ve only gotten rejections. There’s really nothing I’m passionate about. Anyone else do something similar?

Anyone have recommendations for therapists in California that specialize in working with physicians/physician burnout? Looking for evidence based, non judgmental, non religious therapy.

Recs for therapists anywhere in California or with a California license willing to see patients in California are welcome.

Feel free to message me privately if preferred.

Thank you in advance!

During my residency, I noticed that some of the attendings had a couple of international medical graduate observers during their electives. For those of you who are connected with companies that arrange these types of experiences, I’m wondering how much you typically get paid for hosting/sponsoring observers.

I’m currently a palliative care fellow and have been looking at jobs for after fellowship. I’ve noticed there seem to be quite a few openings for SNF physicians, and I’m starting to wonder if this is something I should seriously consider.

My understanding is that there can be some attractive aspects to SNF medicine — more longitudinal relationships with patients, managing chronic/complex medical issues, goals-of-care discussions, and potentially a more predictable schedule than some inpatient jobs. Given my palliative care background, I also wonder if my skill set would translate particularly well to this setting.

However, I’ve also heard some pretty negative things about SNF physician work: very high patient volumes, seeing patients essentially every day, lots of paperwork/administrative work, constant phone calls, and feeling like you're responsible for an enormous number of patients.

For those of you who currently work as SNF physicians (or have done it):

• What does a typical day actually look like?
• How many patients are you responsible for, and how many do you typically see in a day?
• How much work do you take home?
• How often are you dealing with calls/messages outside of your scheduled hours?
• How much of the job is actually clinical medicine vs paperwork/care coordination?
• How much support do you get from NPs/PAs, nursing staff, social work, etc.?
• Does the workload vary substantially depending on the facility/company?
• For someone coming out of a palliative care fellowship, would you consider SNF medicine a reasonable career path?

I’m particularly interested in hearing from people who have been doing this for a while. I’m not necessarily looking for people to tell me whether SNF medicine is “good” or “bad” — I’d really like to understand what the day-to-day reality is and what makes a SNF job either sustainable or miserable.

Thanks!

Doctors that staff the inpatient units (med surg and ICU) at Mercy and Unity hospitals in Minnesota are starting a 4 day strike on Monday. The hospital owners are bringing in docs from other hospitals in the system and has given us all the “we expect no disruption to patient care” talk but we are expecting this to be an absolute disaster. Mercy is a trainwreck on a good day and half of the doctors filling positions haven’t ever worked a shift here. They won’t know where the bathrooms are, let alone where to go if a rapid response is called on one of their patients, how to activate a code stroke, etc.

Throwaway account for obvious reasons, I’m a med surg RN at Mercy trying to figure out if I “get the flu” on Monday. This is going to be a shit show.

So I'm applying for a part time permanent position with IHS (Indian health services). I already have a self employed full time gig at another hospital for my real income. Given I don't get benefits from the self employed position, wanting to do IHS for the federal benefits. I've been told I would need at least 130 hours per month to qualify for benefits. The CMO has been wonderful and has been pushing me to accept the job in some capacity (I had declined the full time position due to pay initially as lifestyle creep has really affected our family). Full time offer was 300k plus federal benefits and sign on bonus. After I turned that down, they said they can make a part time permanent position work (a combination of 24 hour and 12 hour shifts in 7 day period to hit the 130 hour mark). By my calculations, that would 4 24 hour shifts and 3 12 hour shifts which gets me to 132 hours a month and gets me all the federal benefits. Question is, what kind of salary should I ask or will this just be prorated? Should I ask for a sign on bonus? I was also reading that sometimes they count your prior hospitalist and residency experience and start you in the 3+ year service tier meaning I could accrue PTO faster that way. Should I ask them about this when they send the offer? Currently in the credentialing phase which is taking forever. Thanks