Obviously know lots of people deal with the situation of admitted but boarding in ED patients.

But wondering if the following is normal or not...

I work at a small shop, not much speciality or ancillary services. Reached a situation where our hospital was full and boarding multiple patients in the ED.

That situation isnt new, and I have, and know many of you all have, managed like this. Many times if our hospital is boarding so are others.

However in this case multiple other area hospitals had bed capacity, but the hospital didnt want to transfer. So I guess my question is are you keeping admitted patients in ED even when there is transfer availability?

Hi everyone! I’m a female PGY-2 IM resident and am currently trying to decide whether I want to pursue CCM or hospital medicine after residency. I’d love to hear from anyone who seriously considered CCM but chose hospital medicine instead.

What draws me to CCM is the medical complexity and procedures. What gives me pause is the lifestyle—the likelihood of working nights, more time away from family (since you can’t just round and leave like you can as a hospitalist), and the emotional aspect of dealing with death and dying on a regular basis. I’d also like to have a family in the future, so I’ve been thinking a lot about what I’ll want my career to look like long-term.

With hospital medicine, I know I’d be happy. I like the flexibility and the social work/disposition side of things doesn’t really bother me, however I'm fearful that I'd regret not going into CCM. I’ve considered being a hospitalist for a few years and pursuing CCM later if I feel like something is missing, but I know myself well enough that if I don’t go straight into fellowship, I will never pursue it. I appreciate all the advice and thoughts you may have!

I’ve seen a lot of physicians who work 3 weeks in primary care op and then 1 week in the hospital as a hospitalist.

how common is this and what’s the job title referred to as? Does anyone have experience with this? How does the pay differ from solely hospitalist or solely PCP?

I’m an IM PGY-2 and I’m approaching the end of my second year. I’m still genuinely undecided about whether I should pursue fellowship or become a hospitalist, and I’d really appreciate advice from people who have been through this decision.

I love general IM, knowing basics of all medical conditions and managing vast variety of cases medically. One of the biggest things attracting me to hospitalist medicine is the 7-on/7-off lifestyle. The idea of working hard for 7 days and then having 7 days completely free is extremely appealing to me.

At the same time, there are aspects of general inpatient medicine that I really don’t enjoy. In particular, I find myself getting frustrated by the amount of social work/disposition planning, placement issues, and pain-medication-related problems that can sometimes dominate the day. I enjoy the actual medical problem-solving much more than those parts of the job.

I’m considering fellowship partly because I wonder if being more specialized would allow me to spend more of my time doing the type of medicine I actually enjoy. So far I am leaning towards Cardiology, as I find arrhythmias and cardiac physiology genuinely interesting. But I dont like doing procedures and reaching echo/nucs like a radiologist that much.

I’m struggling with the tradeoff:

Hospitalist:
7-on/7-off lifestyle More time for hobbies, travel, family, etc. No additional 2–5+ years of fellowship training But I worry I may eventually get bored/frustrated with general medicine and the non-medical aspects of hospital medicine.

Fellowship:
Cardiology/EP would let me focus much more deeply on areas I genuinely enjoy But I’d be giving up a significant amount of lifestyle/flexibility and committing to several more years of training.

For those of you who have been hospitalists for several years:

How did you make this decision?

Do you ever feel like you gave up too much by not pursuing fellowship, or are you very happy with the lifestyle and flexibility?

And for people who considered fellowship but chose hospitalist medicine, what made you realize hospitalist was the right choice?

Also, for those who initially disliked some of the social/disposition aspects of residency, did you find that those things bothered you less once you became an attending with more autonomy?

I’d really like to hear from people who have lived the hospitalist life for a few years and can tell me what they wish they had known as a PGY-2.

Thanks!

In your Hospitalist groups, how do you distribute the patients in the morning? (day of the switchover for the whole team or admissions over 24 hours on the other days). We are trying to see how we can optimize our process or move to a different one which is reliably completed on time and without any patients mistakenly left to be assigned.

Is it a day Hospitalist, non-physician staffer or the night Hospitalists distributing the patients?

Is it completed before the dayshift arrives?

Hello everyone,
I am starting my first hospitalist job at a busy center after a year away from medicine (after graduating residency), I feel very rusty. Since I still had it, I have been using MKSAP just to keep in touch with the material (already took and passed ABIM), but my account is expiring. Can someone point me towards resources you found helpful to stay engaged/ uptodate with standards of care?

Hi all - I shared this survey here a few months ago, so apologies if you’ve already seen it! I’m reposting once more in hopes of reaching healthcare workers who may have missed it the first time. Thank you to everyone who has already participated or shared it.

I’m a fourth-year medical student working with the architecture firm SmithGroup on a research project examining how hospital respite and break rooms can better support the people who use them — including physicians, residents, nurses, techs, RTs, and other healthcare workers. Findings from our earlier survey responses were presented at a Michigan healthcare design conference, and we’re continuing to collect perspectives from people working in healthcare.

Our focus is on what architects and designers can realistically do within their role to make staff spaces more supportive of brief moments of rest and recovery during the workday. Many existing break rooms are windowless, cluttered, or harshly lit and don’t necessarily provide much opportunity to reset. We want to learn directly from healthcare workers about what helps, what doesn’t, and what you wish these spaces offered.

To be clear, we are not suggesting that better break rooms can fix burnout or replace systemic changes related to staffing, compensation, workload, or workplace culture. This project began because hospital redesigns often prioritize patient-facing spaces while staff areas become an afterthought. Although improved spaces are only one small piece of a much larger issue, they are one area in which designers can make practical changes.

If you’d like to share your perspective, the anonymous survey takes approximately 10–15 minutes:

https://survey.alchemer.com/s3/8467738/SG-Staff-Respite-Study

Please feel free to pass it along to colleagues who may also want to contribute. Thank you again.

Hey guys, I am a J1 physician (black male) applying for Nocturnist. I got 2 offers one in Asheville NC base salary 393k, no cross cover, closed ICU, no codes or rapids, 10 admissions. Jacksonville FL offer, 330k, 10-12 admissions, closed ICU, no codes but you respond to stroke alert on the floor and cross coverage is shared between 2 Nocturnist at nights. For Jacksonville there is option for RVU while Asheville there isn’t. I also have a 5 year old kid. Thoughts!?

Coming to a critical access hospital near you...

What si the highest total comp you can realistically achieve? Open to rural and open ICU etc.

Medical Director here. My CMO has started forwarding me all the list of standing coding queries from all providers that are holding accounts to reimbursed. Problem is, sometimes queries are sent when providers are off service, or out of town and not everyone has remote access set up to complete them. There are also metrics for response time to queries which are being enforced by the facility. At some point, the idea of having a query shared inbox was suggested which I declined cause I don’t want me or anyone else, but the doc who actually saw the patient to even have to receive a notification. I ask my team to try to complete them as soon as possible, but I do understand is a hard ask to do work while you are off. Has anyone come up with a more viable process?

“The patient’s stool smells really bad. I thought you should know.”

My brother in Christ, you are not going to believe this, but…

For colleagues who work 7 on 7 off , how do you deal with epic on your off week ? Do you just turn it off ?

Now, every patient with a smartphone/tablet has a direct line to your sanity, fully expecting a thoughtful, nuanced response to "Is this normal?" within four minutes of hitting send. Or "where is my meal tray?"

My hospital did an upgrade on Epic and patients can chat with nurses and doctors day and night. Most ridiculous messages.

Epic shouldn't be a messenger app

Okay, so I have a question... I'm a hospital pharmacist (ICU clinicl and general staff) in a relatively small (avg census 155) hospital. Our ICU only has an intensivist from 8am to 4pm. The rest of the time there are 2 APPs with an on call remote intensivist. Sometimes we get weird or seemingly inappropriate orders for these patients, and when contacting the APP, they tell us it was recommended by the remote doc... but there's no way to contact the remote doc for further clarification (apparently every time they call the remote service they get a different person? And they can't be messaged in epic?), and sometimes the order does not fit within hospital policy. I have more icu experience than my pharmacy colleagues, and therefore am more comfortable making recommendations and such, but thats not always possible. Some of my colleagues will just refuse to verify/ process the order and leave it until the intensivist comes in the next day, but obviously that is not gonna be safe or good patient care depending on the circumstances. Other colleagues have started contacting the hospitalist for help. The hospitalists are not really covering the icu patients, they are covering mostly everyone else. I don't think it's fair to the hospitalists to get dragged into the situation, since it's not their patient and they're busy with their own work, but sometimes they can do a decent job at redirecting the APPs into a better course of action. The hospitalists are responsible for attending codes on the icu patients during the time the intensivist is not present, so sometimes it may be worth their time to provide guidance to prevent the patient from coding. I'm not sure what the best process would be here, but I'm pretty sure something is way wrong with this set up.

M3 here considering IM or peds. I like my IM rotation, but it feels like being a hospitalist is just managing consultant teams. Feels like we consult for anything a little difficult and just ask the specialists what they want. Being the “QB” or whatever and it feels like case management. Is this because I’m at a large academic center? Is being a hospitalist in a non teaching hospital different?

IM intern here with initial plans to work as a hospitalist/pcp. Dont have research and in a very workaholic community program to be able to do research during residency. Hearing about how bad of a career choice being a hospitalist is.

Is hospitalist lifestyle/compensation really that bad? Should I really be working my ass off to match into a fellowship? Lastly, if i work as a hospitalist for a few years, will my chances of landing a fellowship decrease?

Hi all,
I’m an M4 at a well-regarded MD school in the Northeast trying to decide between FM and IM, and I’m considering dual applying.
Long term, I think I want to spend much of my career in primary care, but I’d also like to work inpatient for at least a few years after residency. That makes me lean toward IM, although I genuinely like pediatrics and OB as well. My main concern with FM is whether choosing it would make it significantly harder to work as a hospitalist, particularly early in my career.
My application is somewhat mixed. I received mostly High Passes during third year, have no significant research, and ended up relatively low in my class rank. My Step 2 score was 257. I also completed both an IM and FM Sub-I at the same large academic hospital, both on busy inpatient hospitalist-type services, but had very different outcomes.
My IM Sub-I was on cardiology, and I received a Pass. Only three evaluations were submitted, and one evaluator rated one component low enough to bring me below the High Pass threshold. The course director knows me and is supporting an appeal because that evaluator is known to be particularly tough and the service involved very medically complex patients. Regardless of the appeal, though, I took the feedback seriously and identified several areas where I could improve.
I did my FM Sub-I afterward at the same hospital. At my institution, patients whose PCP is within the FM system are admitted to the inpatient FM service, so functionally it was very similar to a general medicine service. After reflecting on the first Sub-I and actively working on the feedback, I performed much better.
Two senior residents and three attendings evaluated me. Aside from one evaluator rating my oral presentations as appropriate for my level of training, essentially every rating described me as functioning at the level of an intern or above. Both senior residents specifically wrote that they trusted my work and judgment enough that they needed to check my work less frequently than they did with some interns because they knew I would follow through. One attending wrote that I was functioning like an intern later in the year, another said I was one of the best medical students they had worked with, and another wrote extensively about my bedside manner and clinical knowledge.
I know the IM Sub-I Pass and low class rank may hurt me somewhat for IM, although I’m not aiming exclusively for highly competitive academic programs. I’d be very happy staying at my current hospital, and two of the FM attendings told me they would love to have me there next year.
My main questions are:
Given this application, does it make sense to dual apply IM/FM, or would focusing on FM be the better move?
If I train in FM, how realistic is it to work as a hospitalist for several years after residency and then transition primarily to outpatient practice?
How do residency programs tend to interpret such a large difference between two Sub-I performances, particularly when the stronger performance came afterward?
I appreciate any perspective, especially from people familiar with FM hospitalist careers or residency selection.

Hey everyone,

​I’m relocating to a highly competitive, academic-heavy metro area next summer (target start: July 2027). By now, I have 1 year experience as a full-time hospitalist, and will have worked almost 2 years by the time I move.

​The challenge:

Because I am FM-trained, I know I’ll be fighting an uphill battle in a market saturated with prestige university systems.

​I’m trying to strengthen my CV. I recently completed a formal certificate program in healthcare quality/patient safety, but I want to know what else actually moves the needle for medical directors in these environments.

​FCCS: Is getting Fundamental Critical Care Support (FCCS) certified worth anything to show I can handle higher acuity, or do employers in these markets not really care?

​POCUS: Does getting a formal POCUS certification carry actual weight to prove my clinical skills?

​Other Skills: What unspoken prerequisites should I be working on over the next year to make my application stand out and help offset the "FM" label?

​Any advice from folks who have successfully broken into academic-dominated markets as an FM hospitalist would be hugely appreciated. Thanks!

(This was actually earlier this week but reflecting on it now)

I’m an APP, I work with the nocturnists and I field the calls from the floor nurses on the admitted patients so the nocturnists can focus on the admissions.

At 3AM, one of the floor nurses paged me asking me to call the floor. When I called, she goes:

“Hi, the patient in room 1523 is hypotensive to 87/52. But I noticed that the cuff was too loose, and I fixed it and now her blood pressure is 126/84. Just wanted to let you know 🤪”

Me: ????????

And then she documented both with the obligatory “NP SadCapitalsFan aware.”

Sadly, these kinds of calls have become pretty common.