For new hospitalists, the right job means the right mix

Practice size, service time and vacation are top considerations.

At an Internal Medicine 2011 session on “Life after Residency,” Valerie G. Press, ACP Member, instructor in the section of hospital medicine at the University of Chicago Medical Center, offered herself as a prime example of the flexibility of hospitalist careers.

“I like to do a lot of different things, and I get to do a lot of different things,” said Dr. Press, a part-time academician and part-time hospitalist who completed a research fellowship at the University of Chicago. She advised residents and students at the session to keep an open mind when looking for a hospitalist job.

“There are lots and lots of different ways to be a hospitalist,” she said. “Just like we can't get up here and tell you how to be a doctor when you're done, same with hospitalists.”

Practice options are one thing to consider when you start your job search, Dr. Press said. Hospitalists can work for large regional groups, for local private groups, as locum tenens, or at academic centers as part-time academicians or in nonteaching roles. Joining a group that covers several different hospitals can give you a chance to figure out what suits you best, she noted.

“That can be fantastic, especially if you're kind of trying to figure out exactly the right size and style. It's a way to sign with one group but actually get a lot of experience,” she said.

Depending on the model you choose, you could be an employee, a partner or shareholder, an academic faculty member, or any combination of the above.

Dr. Press described how she spends her time as a part-time researcher and part-time clinician. On her days off service, “I compare myself to a small business owner in the sense that I'm in control of my schedule, but if I don't go into work, I hurt myself,” she said. “I don't move my projects forward if I'm not there.”

On these days, she focuses on her research projects—recruiting patients, collecting and analyzing data, and preparing manuscripts and grant applications. She also meets with the students and the housestaff she mentors, participates in committee meetings, and does volunteer work. These are usually 8- to 10-hour days, she said, but “it's a little bit flexible. There's no one sort of watching over me. If I need to go to the dentist, I can go to the dentist.”

When she is on service, Dr. Press said, her days are longer, typically 12 to 13 hours. Although she focuses mainly on her clinical duties, such as rounding with the inpatient team, seeing new admissions, performing procedures, meeting with families, catching up on rounds and reviewing medical records, “I still have to keep things moving forward. I still have to go to meetings,” she said. “But I'm not always on service, and so there's a nice balance between the two.”

Since hospital medicine is “not one cookie-cutter job,” Dr. Press said, there are many factors to consider when determining what hospitalist position is right for you. They include:

  • Service time and hours. What will your service time be like? How is scheduling done? “Are you going to be able to plan? Are you going to get sort of a month at a time, weeks, weekends? How is it going to work?” Dr. Press said. As for hours, you should decide whether you prefer shift work, such as 7 to 7, or whether you'd work on a service (teaching or non-teaching), without strict shifts.
  • CME and vacation time. Determine how you'll fit in your required CME and what's considered your vacation time, Dr. Press advised. “In the ambulatory world, it's pretty clear that usually clinic is Monday through Friday, maybe some Saturday mornings, you can count up the half-days, etc. But hospitalists work on the weekends and at night as well, so when is your vacation going to be?” Dr. Press said.
  • Night work. As a new hospitalist, you'll need to decide if nocturnist work suits you, she noted. It can be great for people who want to be at home during the day or want to work one week on, one week off, Dr. Press said. “On the other hand, if you have finished residency and you hope to not spend another night in the hospital, you want to make sure that you are clear on whether that's going to be you or not.”

Compensation, of course, is another consideration when deciding on a job, Dr. Press said. She cited some recent numbers to show new entrants into the hospitalist job market what they can expect. In surveys from the American Medical Group Association, the median salary for a hospitalist in 2009-2010 was $205,000, she said. Five percent of hospitalists made more than $300,000, while 14% made less than $150,000.

Amounts can vary significantly by practice type and by region, she noted, and can be based on just salary, just production, or, as is becoming more common, a base salary plus production or incentives for care quality and patient satisfaction.

“All of this can vary from site to site,” Dr. Press said. “But these are the things you want to keep in mind when you're looking.”

Once you've found the ideal job, however, your work isn't over. It's now time to negotiate the employment contract, and salary is just one part of it, said Greg J. Davis, ACP Member, one of Dr. Press's copresenters.

“That's the one thing that we think a lot about, because we're all $200,000 in the can and we have to pay that back,” but there are many things to look at, said Dr. Davis, who is director of intensive care and pulmonary rehabilitation at St. Joseph's Medical Center in Brainerd, Minn.

When reviewing a contract, look for things like malpractice insurance and tail insurance; health, dental and disability insurance; retirement plans; and whether the contract includes a noncompete or restrictive covenant clause, Dr. Davis advised. He strongly recommended hiring an attorney who specializes in physician contracts to help with your review, calling the fees “money well spent.”

Don't assume that you can't add things to the contract, Dr. Davis said. You may be able to negotiate for a signing bonus, moving expenses, paid CME, more vacation or sick leave, and protected time for outside activities and speaking. And make sure you look at the term of the contract and how and by whom it can be terminated, Dr. Davis noted. “You need to know what it takes to lose your job,” he said.

Your contract should also include particulars about work responsibilities, Dr. Davis added. “You want to have your call duties in your contract,” he advised. “If you're going to be on call every second night, you need to know, and whatever it is should be written in.”

Dr. Press agreed, saying that specifically as a hospitalist, the contract should include the “nitty-gritty” of your schedule. “You can't just sign and say ‘OK, I'll be a hospitalist at your institution.’ How many weeks, how many days, how many shifts?”

Finally, and perhaps most importantly, both speakers stressed the necessity of having a written agreement on all terms before accepting a job offer, so that you're not left scrambling if circumstances change unexpectedly.

“Everything you discuss, you want it in writing,” Dr. Press said.