Advice on FM hospitalist vs GIM

[coffeeaddict 12]

Could you please comment on their scope of practice in community hospitals? i.e. Is it usually limited to ALC/rehab patients or is there possibility for more acuity?

[PeterPatting 53]

On 9/3/2019 at 11:38 AM, toastman said:

i was working in a major canadian city. dont care if you believe me or not. i can show you my billing submissions privately if you like. For the month of August with 6 days off in total I billed 62k+ from all sources. Many of my days were 13 hour minimums, lots of 24-36 hour periods. Not sustainable long term. 

You're a beast.

Also, if I'm not mistaken hospitalists pay none or very little overhead right? Have you incorporated? If yes/no how much are you taking home from the ~62K+? 

Thanks for the insight. Very helpful.

[LittleDaisy 288]

On 9/7/2019 at 3:50 PM, PeterPatting said:

You're a beast.

Also, if I'm not mistaken hospitalists pay none or very little overhead right? Have you incorporated? If yes/no how much are you taking home from the ~62K+? 

Thanks for the insight. Very helpful.

They pay no overhead. All physicians who work in hospital primarily pay essentially no overhead if at all--> very minimal amount like 5%. 

Like threads above, you don't have to be a specialist or be a rural FM doc to make money. It's a FFS, i.e, it depends on how efficient you are and how many patients you are seeing. However, you have to be careful for quality of care provided and patient safety; otherwise, you will run into trouble with the college later down the road.  There were a few Family Doctors on the top 10 Physicians paid by Ontario government published by Toronto Stars. 

The caveat is that you will be required to do calls and depend how large your group is and how nice they are to young attending, your life will not be very friendly for the first 5 years of practice. Just my two cents. 

[JohnGrisham 1,695]

24 minutes ago, LittleDaisy said:

They pay no overhead. All physicians who work in hospital primarily pay essentially no overhead if at all--> very minimal amount like 5%. 

Like threads above, you don't have to be a specialist or be a rural FM doc to make money. It's a FFS, i.e, it depends on how efficient you are and how many patients you are seeing. However, you have to be careful for quality of care provided and patient safety; otherwise, you will run into trouble with the college later down the road.  There were a few Family Doctors on the top 10 Physicians paid by Ontario government published by Toronto Stars. 

The caveat is that you will be required to do calls and depend how large your group is and how nice they are to young attending, your life will not be very friendly for the first 5 years of practice. Just my two cents. 

Depending on where you work, many hospitalists are also hourly.. lots of variation in fee structures and if you can bill for extra things etc.

[blueoval177 13]

On 9/6/2019 at 11:30 PM, coffeeaddict said:

Could you please comment on their scope of practice in community hospitals? i.e. Is it usually limited to ALC/rehab patients or is there possibility for more acuity?

The community hospital I trained at the hospitalist team functioned close to general IM. 20-30 pts per Dr, maybe half more long term waiting placement/palliative/rehab. Acute care side could vary from sepsis, urosepsis, delirium, COPD exacerbations, STEMI, post-surgical recovery, post-trauma, PE, strokes, AKI's, acute CHF, cancers, and so forth. Most specialists were consult based so there was a lot of coordinating and responsibility. If a pt didn't have an admitting GP, you would take pts from ER or transfers that Nephro, ICU, and Surgery would not.

[guy30 6]

On 9/14/2019 at 11:47 AM, blueoval177 said:

The community hospital I trained at the hospitalist team functioned close to general IM. 20-30 pts per Dr, maybe half more long term waiting placement/palliative/rehab. Acute care side could vary from sepsis, urosepsis, delirium, COPD exacerbations, STEMI, post-surgical recovery, post-trauma, PE, strokes, AKI's, acute CHF, cancers, and so forth. Most specialists were consult based so there was a lot of coordinating and responsibility. If a pt didn't have an admitting GP, you would take pts from ER or transfers that Nephro, ICU, and Surgery would not.

I would agree with this.  I think from what I've seen in general, community hospital FM hospitalist teams tend to take on more acuity with an average patient load of roughly 25 patients (some ALC/rehab type patients may be in the mix too). 

Large academic centers on the other hand tend to use their FM hospitalist service for lower acuity patients probably owing to the huge GIM teams staffed by tons of residents able to take on higher acuity cases.  These are of course generalizations and as staff, you can often dictate the type of acuity you are willing to accept as well.  Things will also be quite different province to province depending on how FM docs are utilized in a province.

There are not many enhanced skills (+1) hospitalist programs in the country and all the FM hospitalists I've seen have not had additional training but pretty much all practice full scope FM (some are even doing deliveries in the same hospital while on hospitalist service, in an urban center!) or hospitalist full time at multiple centers.