e_is_hv Posted February 13, 2011 Report Share Posted February 13, 2011 Hi Everyone, I'm not sure if I'm interested in family medicine, but this stream sounds really interesting to me. I find it really hard to get information on this fellowship (the only school I can find with a website on it is Toronto's). Where do these physician's work? Is this an ultra new thing? Anyone with any experience or thoughts? Is this fellowship available at U of T? Not to sound offensive but are you just the Internist's lackey? Many thanks, e_is_hv Link to comment Share on other sites More sharing options...
rmorelan Posted February 13, 2011 Report Share Posted February 13, 2011 Hi Everyone, I'm not sure if I'm interested in family medicine, but this stream sounds really interesting to me. I find it really hard to get information on this fellowship (the only school I can find with a website on it is Toronto's). Where do these physician's work? Is this an ultra new thing? Anyone with any experience or thoughts? Is this fellowship available at U of T? Not to sound offensive but are you just the Internist's lackey? Many thanks, e_is_hv We just had a talk about hospitalists at our school - apparently that is the 2nd fastest growing specialist in Canada right now. They work in the hospital doing what originally I thought was the general internists job and they are not under anyone. In community hospitals they can run the entire show. I am actually having a hard time figuring out the difference between a general internist and a hospitalist - it so far feels kind of like the difference between a lot of the +1 ones and their 5 year counterparts (ie in clinical terms often not much). Link to comment Share on other sites More sharing options...
thebouque Posted February 13, 2011 Report Share Posted February 13, 2011 In major cities hospitalists are mostly internists. In smaller areas family doctors act as hospitalists, and the general internists there act as consultants to these doctors. Link to comment Share on other sites More sharing options...
olecranon Posted February 13, 2011 Report Share Posted February 13, 2011 In vancouver hospitalists take care of the people admitted to hospital who do not have a family doctor with privileges and are needed to follow up with their care. Internists are called only when consults are needed regarding work up of something. Link to comment Share on other sites More sharing options...
cardiomegaly Posted February 13, 2011 Report Share Posted February 13, 2011 Hospitalist service varies depending on which health region you work in, as everyone has stated above. In Calgary, hospitalists are family doctors who decide to work on inpatient units at all 3 major hospitals. They work 8-12 hour shifts and do admissions from the ED, round upstairs and cover all ward issues (their patient load is quite high for the number of staff that work). Most of their patients are less acute than internal medicine but still bread and butter pneumonias, UTI's, failure to thrive etc. A lot of older populations but you'll also see younger adults who just happen to get sick. In Edmonton, a lot of family docs do hospitalist work and will cover the ward for a week at a time rather than work solely as a hospitalist. I think each of the 4 hospitals has a service. One could argue that there isn't much difference between a hospitalist and a general internist, other than a slight drop in acuity. It pays well and helps keep your skills up. Lots of people like having some hospital privileges to add to the variety that defines family medicine Edit: you don't need a fellowship. You can do an elective in hospitalist medicine at some schools if you'd like to try it out. Link to comment Share on other sites More sharing options...
Ollie Posted February 14, 2011 Report Share Posted February 14, 2011 In vancouver hospitalists take care of the people admitted to hospital who do not have a family doctor with privileges and are needed to follow up with their care. Internists are called only when consults are needed regarding work up of something. Not exactly. At the teaching hospitals, the vast majority of medical patients are admitted under CTU. Less acute patients will go to the hospitalists to take some of the weight off CTU (although St Paul's actually got rid of the hospitalist program last year). At the suburban hospitals (like Richmond, Burnaby), more acute patients will go to internal medicine and less acute patients will go to the hospitalist or their family doc if they admit. Further out, like Eagle Ridge, hospitalists are the only admitting service, and of course consult internal medicine and other specialties as needed. To the OP, you don't need to do a fellowship in order to do hospitalist. You can do it right out of residency, unless you feel that you need extra training. Link to comment Share on other sites More sharing options...
moo Posted February 14, 2011 Report Share Posted February 14, 2011 There aren't that many hospitalist jobs in Vancouver right now. There were no openings in 08 in Richmond where I inquired. I worked briefly as a hospitalist in Delta but didn't like it. I did not like the acuity and I did not feel I had adequate back up. God that seems like a long time ago... public health suits me so much more. Link to comment Share on other sites More sharing options...
gb35 Posted February 14, 2011 Report Share Posted February 14, 2011 There aren't that many hospitalist jobs in Vancouver right now. There were no openings in 08 in Richmond where I inquired. I worked briefly as a hospitalist in Delta but didn't like it. I did not like the acuity and I did not feel I had adequate back up. God that seems like a long time ago... public health suits me so much more. Do hospitalists typically work on salary, or billings as well? (Forgive me if this is a silly question). Link to comment Share on other sites More sharing options...
moo Posted February 14, 2011 Report Share Posted February 14, 2011 Do hospitalists typically work on salary, or billings as well? (Forgive me if this is a silly question). Depends on where, but usually it's by shadow billing. So you see a patient, you bill for it, and the money goes to the hospital. It then gets divided up amongst your group based on hours worked. So there's no incentive for you to see more patients, it all goes into the pot. The good thing about shadow billing is that you get paid no matter how many you see. The bad thing is, you don't get rewarded for seeing more. Typically, the going rate is 125-150 per hour. I can make way more than that doing clinics/nursing home stuff. For example, on Saturday, I billed a total of $2700 working from 9-5. Even after overhead, it's still almost 1800 bucks for 8 hours of work, about 225/hour. I personally find the hospital disgusting now, so I don't do it anymore. I have my public health stuff to get me away from the clinic. But some people need a break from the office and the hospital offers that for them. Link to comment Share on other sites More sharing options...
gb35 Posted February 14, 2011 Report Share Posted February 14, 2011 Thanks moo! I ask mostly because I am very interested in family medicine, but the idea of having to set up and run a practice is not that appealing to me. Of course I'll make the sacrifice if that's what it takes, but I've just always hoped I could find a way to do family medicine 40 hours a week on a salary. Bit of a pipe dream eh? Link to comment Share on other sites More sharing options...
rmorelan Posted February 14, 2011 Report Share Posted February 14, 2011 Thanks moo! I ask mostly because I am very interested in family medicine, but the idea of having to set up and run a practice is not that appealing to me. Of course I'll make the sacrifice if that's what it takes, but I've just always hoped I could find a way to do family medicine 40 hours a week on a salary. Bit of a pipe dream eh? There are a lot more family doc office setups that seem to be pretty close to that - I know one group of 6 docs who have their own office manager who handles all of the non med stuff very well. 8:30 - 5:00 days with one late night till 8 every 2 weeks. Pretty much they just pick up a cheque every month. Link to comment Share on other sites More sharing options...
gb35 Posted February 14, 2011 Report Share Posted February 14, 2011 There are a lot more family doc office setups that seem to be pretty close to that - I know one group of 6 docs who have their own office manager who handles all of the non med stuff very well. 8:30 - 5:00 days with one late night till 8 every 2 weeks. Pretty much they just pick up a cheque every month. Interesting; thanks a lot. This is something I'll need to look into a lot going forward. Just have to worry about getting in to med school first! Link to comment Share on other sites More sharing options...
moo Posted February 14, 2011 Report Share Posted February 14, 2011 Thanks moo! I ask mostly because I am very interested in family medicine, but the idea of having to set up and run a practice is not that appealing to me. Of course I'll make the sacrifice if that's what it takes, but I've just always hoped I could find a way to do family medicine 40 hours a week on a salary. Bit of a pipe dream eh? Coming out of residency I was just like you. Didn't want to run a practice. So I just worked in various clinics, let them take my money but didn't have the headaches of managing a practice. However, after a couple years, I realized that they were just taking money away from me. I pay the same amount of overhead (30-35%) regardless of how much I make which doesn't make sense. Rent should stay the same, you pay your staff the same, even if it's busy and equipment costs are minimal. Thus, overhead as a percentage should go down if you bill more but this wasn't the case. I calculated that really, clinic owners (many of whom are doctors) should only charge you about 18-19% overhead (assuming reasonable rent--which is really what they should money on). The rest 10-15% was pure profit for them. Thus, I am going to go into business with some other folks and keep what's rightfully mine, mine. Link to comment Share on other sites More sharing options...
gb35 Posted February 14, 2011 Report Share Posted February 14, 2011 Coming out of residency I was just like you. Didn't want to run a practice. So I just worked in various clinics, let them take my money but didn't have the headaches of managing a practice. However, after a couple years, I realized that they were just taking money away from me. I pay the same amount of overhead (30-35%) regardless of how much I make which doesn't make sense. Rent should stay the same, you pay your staff the same, even if it's busy and equipment costs are minimal. Thus, overhead as a percentage should go down if you bill more but this wasn't the case. I calculated that really, clinic owners (many of whom are doctors) should only charge you about 18-19% overhead (assuming reasonable rent--which is really what they should money on). The rest 10-15% was pure profit for them. Thus, I am going to go into business with some other folks and keep what's rightfully mine, mine. Good to hear from someone who, at one point, was like-minded and has had some experience change their thinking. How tough is it to go into practice alone though with no start-up capital, and already in debt from school? I mean, the timing of med+FM residency would mean I'd be looking to work around the same time I'd be looking to buy a house and have a kid. Is your best bet to find somebody ready to retire whose practice you can essentially take over? Or to try and work your way into a partnership with another established family doc and talk them down from 30% overhead? Link to comment Share on other sites More sharing options...
rmorelan Posted February 14, 2011 Report Share Posted February 14, 2011 Good to hear from someone who, at one point, was like-minded and has had some experience change their thinking. How tough is it to go into practice alone though with no start-up capital, and already in debt from school? I mean, the timing of med+FM residency would mean I'd be looking to work around the same time I'd be looking to buy a house and have a kid. Is your best bet to find somebody ready to retire whose practice you can essentially take over? Or to try and work your way into a partnership with another established family doc and talk them down from 30% overhead? You can do that. There are also turn key offices that ready to go as it where - particularly in mid size communities or smaller. However you mentioned you are attracted to the 40 work week ie easier life style. Some of those groups practises might then be more to your taste as the some of the things are distributed (call, and evening work, etc) and are already setup. Just my two sense Link to comment Share on other sites More sharing options...
gb35 Posted February 14, 2011 Report Share Posted February 14, 2011 You can do that. There are also turn key offices that ready to go as it where - particularly in mid size communities or smaller. However you mentioned you are attracted to the 40 work week ie easier life style. Some of those groups practises might then be more to your taste as the some of the things are distributed (call, and evening work, etc) and are already setup. Just my two sense Thanks again. you have both given me lots to think about. I'm still really interested in a couple of other things, so I'll just have to keep my fingers crossed that I get in, and see how I like some electives. As an aside, is there any sort of job listing (eg: a workopolis for doctors) that would show some of the openings in given communities, or group practices looking to add another doctor? I'm interested mostly for family medicine to see how common these setups are, but it would be also interesting to look at other things like medical genetics/hematology Link to comment Share on other sites More sharing options...
rmorelan Posted February 14, 2011 Report Share Posted February 14, 2011 Thanks again. you have both given me lots to think about. I'm still really interested in a couple of other things, so I'll just have to keep my fingers crossed that I get in, and see how I like some electives. As an aside, is there any sort of job listing (eg: a workopolis for doctors) that would show some of the openings in given communities, or group practices looking to add another doctor? I'm interested mostly for family medicine to see how common these setups are, but it would be also interesting to look at other things like medical genetics/hematology Once you get into med school there are recruitment drives that happen all the time - it is kind of scary going into some of them to be honest as you get kind of swarmed by recruiters Family doctor teams are everywhere now - actually the older style of single doctor practise seems to be going onto the way side it seems. Link to comment Share on other sites More sharing options...
gb35 Posted February 14, 2011 Report Share Posted February 14, 2011 Once you get into med school there are recruitment drives that happen all the time - it is kind of scary going into some of them to be honest as you get kind of swarmed by recruiters Family doctor teams are everywhere now - actually the older style of single doctor practise seems to be going onto the way side it seems. Good to know. One of my biggest interests aside from family is medical genetics, but I fear the job market would be an issue there. Specifically, finding a job where I want one. With family, I feel like I'd have a lot of flexibility with my career, and get to see lots of interesting things. Link to comment Share on other sites More sharing options...
Ollie Posted February 18, 2011 Report Share Posted February 18, 2011 on Saturday, I billed a total of $2700 working from 9-5. Even after overhead, it's still almost 1800 bucks for 8 hours of work, about 225/hour. How did you bill $2700 in one day? Wouldn't you have hit your cap way before that? Unless there's tons of private stuff in there. Link to comment Share on other sites More sharing options...
moo Posted February 18, 2011 Report Share Posted February 18, 2011 How did you bill $2700 in one day? Wouldn't you have hit your cap way before that? Unless there's tons of private stuff in there. Haha... when you add in nursing homes, CDM fees, privates, WSBC, ICBC, and the new prevention fees... yup 2700 bucks on one Saturday. Link to comment Share on other sites More sharing options...
Wachaa Posted February 21, 2011 Report Share Posted February 21, 2011 Where are you seeing the bulk of your patients? In the hospital/nursing home? Or in the clinic? Because if nursing homes is where most of your pay comes from, then is there any overhead? Link to comment Share on other sites More sharing options...
moo Posted February 21, 2011 Report Share Posted February 21, 2011 Where are you seeing the bulk of your patients? In the hospital/nursing home? Or in the clinic? Because if nursing homes is where most of your pay comes from, then is there any overhead? Most of my work is still in clinic. But nursing homes have no overhead... if you do your own billing. Link to comment Share on other sites More sharing options...
olecranon Posted February 22, 2011 Report Share Posted February 22, 2011 how does payment work for nursing homes? Link to comment Share on other sites More sharing options...
moo Posted February 22, 2011 Report Share Posted February 22, 2011 about 63 bucks for the first patient per day, then 31.5 per patient after that. Can only bill once per two weeks in BC, unless other medical issues. Everytime a nurse calls you or faxes you, you can bill 15 bucks per call (once per day). There are also conference care fees. Link to comment Share on other sites More sharing options...
leviathan Posted February 22, 2011 Report Share Posted February 22, 2011 I personally find the hospital disgusting now, so I don't do it anymore. I have my public health stuff to get me away from the clinic. But some people need a break from the office and the hospital offers that for them. Just curious moo, what's your end game? Part time clinic, part time public health? What exactly would you do in the public health realm? I'm interested. Link to comment Share on other sites More sharing options...
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