Pros and cons of being a hospitalist

Pros And Cons Of Being A Hospitalist

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Considering a career as a hospitalist? Read on to discover the pros and cons of being a hospitalist in this article.

In medical school and residency, I struggled the most with deciding what kind of doctor I wanted to be.

Last year, I graduated residency and took my first official job working as a full-time hospitalist, working seven days on and seven days off. After a few months on the job, I decided to pivot and go back into training. And in just a few weeks I’ll be starting my journey as a cardiology fellow.

In this article, I’m going to talk about some of my biggest takeaways, both pros and cons of being a hospitalist now that I have a year under my belt. Here are some of the things that I absolutely loved and will miss, as well as what I’m looking forward to leaving behind.

The second year of residency is usually when trainees make a decision on what kind of doctor they’re going to be. And during my second year of internal medicine residency, I was torn between either being a hospitalist for the rest of my life or going into the field of cardiology.

One thing that pulled me towards being a hospitalist was the attractive schedule. You work seven days on and seven days off, and you have a nice lifestyle in the weeks that you’re not working, and still get paid a really good salary for working only half the year.

So during my third year of residency, I decided to go down the hospitalist route and apply to a bunch of jobs in the city that my wife and I wanted to settle in. Thankfully, we got a great position at a reputable company.

pros and cons of being a hospitalist (hospitalist option)

A few months on the job as a hospitalist, after experiencing the pros and cons, I found myself inclined to go back to training to become a cardiologist.

Now, with only three weeks left until I become a cardiology fellow as I write this article, I figured I’d outline the pros and cons in case you’re considering making it your full-time career.

But wait a minute! If you want this post in a video format, you can check out my YouTube video below! Make sure to subscribe for weekly content and leave a comment if you enjoy this one!

Pros Of Being A Hospitalist

Let’s start by discussing the benefits of being a hospitalist. 

Pro #1 Flexibility

Hospitalists enjoy flexible schedules.

When I initially joined my current company, I had a very traditional hospitalist schedule of working seven days on and seven days off, typically from 7:00 AM to 7:00 PM.

I was even fortunate to join an awesome group that had a really flexible schedule. So it was never really seven days of 12 hour shifts in a row.

Usually, we would work anywhere from one to two long days where we would be in the hospital for the full 12 hours, but for the remaining days, we’d stay and admit until 3:00 PM.

If I finished my work early, which was often the case, I could head home and handle tasks or messages from nurses from 4:00 PM to 7:00 PM.

That meant that even during my week as a hospitalist, I still had a lot of flexibility in the later parts of my day. If my wife and I wanted to run a quick errand, I could do so with my phone in my pocket, knowing I could attend to any urgent matter from nurses.

For a glimpse into a typical day in my life as a hospitalist, check out this video: 

There is a lot of flexibility during my weeks off. I could work on personal projects, such as tasks for TheMDJourney, recording videos or podcasts for you all, or working on personal milestones.

I had the time to train for my second marathon in Dallas, Texas at the end of 2022, achieving a good personal record. I wouldn’t have been able to do that if I didn’t have so much time to train and improve my speed.

Just in the past year, my wife and I traveled extensively. We spent about a week and a half in India, enjoyed a babymoon in Hawaii for four to five days, visited New York City and nearby areas three times, and soon we’ll be heading to Canada for our final vacation before I start my fellowship and before our little one arrives.

So, there’s definitely plenty of time for exploration, doing absolutely nothing, or working on personal things, such as training and projects. Those are the biggest perks of the job.

Now, my schedule is no longer seven days on and seven days off. It’s now much nicer where I work four days in the middle of the week, followed by a three-day weekend.

After two weeks, I’ll transition to working only three days during the week, granting me a four-day weekend, and this cycle repeats.

There are a lot benefits to this schedule compared to the previous one. Firstly, I now have guaranteed weekends, allowing me to attend events like birthday parties or weddings.

Knowing my weekends are free allows me to be able to do things that are important to me, like going to the temple or church weekly and have consistent family time.

As I prepare to transition to fellowship, where I’ll be working weekly, having a schedule with regular workdays each week will make the transition smoother and more predictable. 

pros and cons of being a hospitalist (study medicine)

Pro #2 Flexing That Medicine Muscle

After spending so much time at medical school and training, some people tend to go right into fellowship training to become the specialist they wanted to be. 

However, for me, it doesn’t make sense spending three years without truly honing skills, such as managing things like pneumonia, asthma attacks, or COPD, even if you don’t plan to specialize in pulmonology.

Having a full year where I can really flex all that medicine muscle and knowledge that I’ve had built up over the past seven years of training has really been one of the best parts of my experience as a hospitalist.

I’ve seen a lot and learned how to handle many diseases like pulmonary issues and heart disease. Now, as a fellow, I’ll be dealing with even more cases, such as strokes and surgical patient care.

Before, as a resident, there was a formal team who took care of these patients and I didn’t see them much. But now, as an attending, they’re my main focus and I get to help take care of them. 

And so I know that even when I transition to becoming a cardiology fellow, with all those experiences and hundreds of patients I’ve encountered, I’ll feel comfortable managing a pneumonia or renal failure as a fellow.

I no longer feel the need to constantly seek consultations. Instead, I’ve gained significant experience in managing issues as a primary care provider over the past year.

pros and cons of being a hospitalist (patient relationships)

Pro #3 Patient Relationships

One of the greatest benefits of being a hospitalist is the patient relationships and the memories that I’ve made.

Being a hospitalist is similar to being a puppet master. You’re managing many different strings or aspects of patient care, including coordinating with various subspecialists, consult teams, nurses, physical therapists, and social workers. It’s about coordinating everything to be able to help the patient.

Often, as a hospitalist, you are the central figure who ties everything together, translating the inputs from different healthcare professionals into a cohesive plan for the patient’s care—whether it’s preparing them for discharge or outlining next steps in their treatment journey. Because you’re that person who ties entire picture together, usually the patients and their family see you as the main doctor.

I’ve been able to cherish amazing memories with patients sharing hugs, laughter, and sometimes discussing their fears and concerns about their health.

Over time, I’ve been grateful to have patients and families who have stepped out of their way to just say thank you.

In my bookshelf, I have a few notes. One is from a family who knew that I was about to be a dad and just wrote a sweet note for me, my wife, and our little one. I’ll cherish it regardless of my future path in cardiology.

pros and cons of being a hospitalist (having a great team)

Pro #4 Having A Great Team

One of the highlights of my experience as a hospitalist was the incredible team I had the privilege to work with.

The reason I’m going to cardiology has nothing to do with the company that I worked for. It would’ve been even easier to leave had I been with any other company.

I was fortunate to have such a great experience that it was really a torn decision. I had a great boss who was super supportive even when I told him that I was leaving to become a fellow.

I had great colleagues that were like family every time I would come to work. All the other staff members just made the environment super warm and helped me with everything behind the scenes, so I could do my job to the best of my ability.

Now, the unique thing for me is that I’ll be doing fellowship at the same institution where I’ve been working. This means I’ll continue to work with the physicians who supported me during my time as a hospitalist.

I’ll be able to see a lot of those friendly faces that welcomed me nicely into this hospital system. Hopefully, they’ll extend the same warmth and support as I transition to my new role as a cardiology fellow.

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Pro #5 Salary

Lastly, let’s talk about the salary.

As a hospitalist in central Texas, where our earning potential is generally lower than the national average, we were making around $250K. After taxes, contributions to my 401K, insurance deductions, and other expenses, my take-home pay ranged from $11,000 to $14,000 a month.

That gave my wife and I tons of room to save quickly for things that we really cared about. Whether it was building an emergency fund, being financially ready for the arrival of our baby, or covering unforeseen expenses, we had the financial flexibility to handle them. We were also able to save for some personal milestones such as down payment on a home.

That would have not been possible if we didn’t have a great salary as well as a good savings rate, which was important over this past year.

So working really hard as a hospitalist has allowed my wife and I to create a nice nest egg as well as a comfortable home where we can thrive.

Those are some of the biggest benefits and aspects of being a hospitalist that I love the most. If I missed any or if you have any questions make sure you add in the common section down below!

Cons Of Being A Hospitalist

Now, here are the challenges and drawbacks of being a hospitalist. Let’s explore the cons.

pros and cons of being a hospitalist (patient disposition)

Con #1 Patient Disposition

One of the primary challenges faced by hospitalists is the focus on patient disposition.

As the primary physician, as soon as a patient comes into your care, your main question is this: What do I need to do for this patient to get them to their next disposition, both medically and from a social work perspective?

Is discharge to home feasible? Would they benefit from rehabilitation or nursing home care? These decisions require careful coordination and planning.

Some cases are straightforward, like a surgery patient who just had a knee or hip procedure and needs physical therapy. A social worker can help you with their insurance and figure out the best places that they can go to. You also work with the families to organize that. That part’s easy.

My involvement in providing medical care and the time I dedicate for such patients are quite limited. If their disposition is straightforward, I simply wait for the social worker to tell me when it’s time for them to go.

Some cases are more complex. There are patients who don’t have the proper funding, insurance, or family support to get the care they need. And it becomes very tricky.

And often, a patient may remain in the hospital for 10 or 12 days, but the amount of direct medical attention I provide to them may only equate to 3 or 4 days.  But I’ve spent a week or more trying to figure out how we are going to get this patient from the hospital to a suitable facility, especially if returning home isn’t feasible. 

You can imagine working week after week and patient after patient, encountering this scenario repeatedly. It becomes quite daunting and tiresome.

And so patient disposition isn’t exactly any hospitalist’s favorite task, but it’s one of the primary responsibilities we have in addition to improving the health and well-being of our patients.

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Con #2 Medicine Happens Without You

This is something that I needed to think about, but medicine often happens without you.

As a primary physician, you think you would be making many decisions, especially if you’re working at a big hospital like where I work. But in reality, a lot of things get done without my input. I need to call in other experts like consultants, social workers, or physical therapists. 

Sometimes, a nutritionist or a nurse will take action, like putting a patient on a diet to make them stronger. Or the patient might already have a cardiologist that can take care of them without me needing to do much. 

And so I often come in and there very few patients each week where I’m not really doing much, even though I’m their primary physician. There are a lot of ancillary teams that are managing their care.

Sometimes it feels like things are just happening without me, which can be both a pro and a con.

It’s a little bit of a hit to your ego when you wish you could be doing more. You may wonder why you’re the main doctor if you’re not doing much for this patient.

But at the same time, it’s reassuring that the system works well enough that things can happen without me being involved in every little step.

The biggest takeaway here is a lot of times we get into medicine because we want to make an impact. And if we don’t see that happening with every patient we deal with, it can feel that you’re not making much of a difference.

That is especially if you have a day with 15 or 20 patients and you realize that a majority of them have other people working on their behalf. When you get home, sometimes it feels like the job is not as fulfilling.

And then on the flip side, you’ll definitely have days and a weeks where you’ll be the primary decision maker on majority of your patients and feel a sense of control and sometimes overwhelm on how many decisions you have to make.

Again, it’s more of a hit to the ego, but it is something that I’ve found to be a downside.

Money in Medicine

Con #3 Financial Consequences Are Out Of Your Control

The third issue is a little bit of a flip side to the financial aspect that we talked about.

While your salary is great as a hospitalist, understanding that financial controls and consequences of the hospital system are out of your control.

As a hospitalist, you are probably not going to be the primary focus of the hospital. That may change depending on where you’re working. But usually, attention and resources are directed towards consultants, surgeons, and other specialties that generate revenue for the hospital.

And so if you want a pay raise, it may not happen. If people need somebody to take on more work, it tends to be dumped onto the hospitalists.

For example, if the surgeons want to spend more time doing the surgeries but not managing their patients post-op, those get handed off to the hospitalists.

And most hospitalists are used to this. They’re happy to take the work and happy to help, but over time, this kind of dumping onto hospitalists could feel like a burden.

In the past six months, I’ve seen my company, the hospital that I work in, face financial constraints. We used to have PAs and nurse practitioners, but they got laid off just because of financial issues. We had doctors who were also at the risk of being let go.

I’ve made an episode about how I was almost laid off and how that actually turned into a good thing. You can check that out in the YouTube video below: 

I was able to see how the constraints of the hospital system and how the money everyone else is making will ultimately trickle down to us at the very end. And that can lead to consequences on how many patients we see and how many colleagues get to keep their jobs.

And it basically told me that it was probably the right time to make that transition to going back to fellowship where I can have a more secure job in the field of cardiology.

Con #4 Limited Upward Growth

Personally, I’m not fond of admin tasks. I don’t want to be the person managing decisions on what’s happening in terms of quality, what type of policies the hospital is doing, managing schedules, issues, and conflicts between physicians. I just want to be able to take care of patients.

And so if I’m not working as a hospitalist, the only way I can make more money is either working more shifts, switch to another hospital, or take on an administrative role. None of those options appeal to me.

The limited upward growth as a hospitalist was definitely a big con.

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Con #5 You’re The Primary Doctor

The fifth downside is being the primary doctor.

This means that if the family wants to talk to anyone, the nurses will contact you. So, even if you’ve already spoken with a family member earlier in the day, if someone else wants to talk to you, you’ll need to pause your current tasks and provide an update.

This also means speaking to patients multiple times. If they have concerns or want to make adjustments to their treatment plan, you’ll need to address them promptly.

There are patients with anxiety or patients that are definitely controlling. You’re going to be interacting with them multiple times and each of these interactions can be anywhere from 5 to 20 minutes. This can affect your efficiency, especially if you have a lot of cases to manage. 

And then finally, you’ll encounter common issues like pain management, which can be challenging. As a hospitalist, you’re not interested in managing pain, but you’re interested in managing diagnoses.

If somebody’s been dealing with chronic pain, it’s not always likely that you’re going to be able to make a regimen that’s suddenly going to make that patient feel no pain at all. As the primary doctor you have to deal with it.

But again, that is most probably not your favorite part of the job.

how to focus in a boring lecture in med school

Con #6 The Job Can Be Mundane

I’ve seen days where I’ve had panels full of surgery patients, those experiencing pain, and those with basic bread and butter medicine cases like pneumonias or heart failure exacerbations.

Despite the desire to make a difference, some patients may not require much direct management from me. Instead, my role is mainly to help coordinate their care.

There are chronic pain patients who may not find relief regardless of the interventions provided. And there are cases where we’ve identified that a patient has pneumonia, and we’re just waiting for the response to antibiotics or test results. 

You just say hi, and make sure they’re improving. Often they are. And that’s the end of what you need to do. 

If you have a day like this, it may seem like an easy day. But if you have a few in a row, it can just become redundant and mundane.

It’s good to have things outside of work that you’re looking forward to, like having a daughter at home to interact with. If the job is not fulfilling, I’d rather focus on my priorities outside of work.

Having a job that I’m looking forward to and enjoying my time while I’m there is really what I was looking for.

[Free Download] Want to have everything you need to be a top student on your medical journey? Get FREE access to our Med School Success Handbook to get 60+ tips including the best study, time management, mindset tips you need to be a top student. Download it here. 

Conclusion

Overall, being a hospitalist was a great experience. I was able to  solidify the knowledge that I learned at residency and medical school. I feel like a much better physician.

As I transition into cardiology, I feel confident in managing various conditions independently, thanks to the hands-on experience gained over the past year.

All those patient experiences and memories are going to be carried forward as I become a cardiology fellow. I know for a fact that I was very lucky to join the group that I was with. And I’m very lucky that I’ll be in the same hospital system working alongside them as a cardiology fellow.

Now, if you have any questions about being a hospitalist, just drop them in the comments section below. Maybe it’s a career that you’re considering just like I was. It is a great field.

It can work for you, especially if a lot of those outside of the hospital things matter more to you than your job satisfaction.

For me, it’s a 50-50. I want to love what I’m doing for 20 or 30 years and also be able to spend time with the things and people that I really care for.

And so this is why I ultimately chose to go to the field of cardiology.

If you’re interested about why I picked cardiology, check out this YouTube video:

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Until next time, my friend…

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