What is a Hospitalist?

[@StrongMed]

Please note that the number of patients hospitalists care for at one time has dramatically increased in recent years. Anecdotally, ~12-18 is typical of an academic/teaching service (i.e. supervising a team of medical residents/interns), while 15-25 is typical of non-teaching services at private hospitals. While there are hospitals out there that routinely require their hospitalists to see >25 patients a day, I can't imagine working at such a place.

[@md.mojammelhoquemohim8460]

Dear sir, is there any chance to continue the series "approach to symptoms "? Those videos are too much helpful. Thank you.

[@StrongMed]

Yes, I am actively working on this. I'm waiting to record them until I receive an additional piece of equipment (to hopefully make the audio a little better), but I have outlines and all the graphics ready to go for jaundice, diarrhea, edema, hematuria, polyuria, headache, and GI bleeding.

[@md.mojammelhoquemohim8460]

@@StrongMed Thank you. May God bless you. There are some other very common symptoms as like as ABDOMINAL PAIN, URINARY INCONTINENCE, JOINT PAIN, LOW BACK PAIN, RASH, GENERALISED WEAKNESS, UNCONSCIOUSNESS. It would be very much helpful for us who are new students of medicine. Thank you again dear sir. Stay healthy.

[@StrongMed]

@@md.mojammelhoquemohim8460 Thanks for the suggestions and I agree! I plan to cover all of those symptoms too - it will just take some more time.

[@md.mojammelhoquemohim8460]

@@StrongMed We are waiting.

[@Dr.Arsalan]

Sir, mayb my question is too basic but pls guide me, approach to symptoms videos are for step1 or step2 or step3 or they are for trainee residents?

[@md.mojammelhoquemohim8460]

Happy to see you again sir.

[@mrgeek434]

I think one of the benefits of being a hospitalist is that you use almost all the knowledge that you accrued in medical school and much of what you do on a day-to-day basis is very much what the average person would think of when they imagine what a doctor does. The work-life balance and compensation is also very good. If I may ask a couple of questions, please: 1. How easy it it for a hospitalist to pick up additional shifts at their hospital (or via a locum agency) on their week off, if they so desired? Thanks. 2. Have you ever worked as a nocturnist? If so, what was your experience like? Did you enjoy it? Thank you.

[@StrongMed]

1. It depends on the hospital and hospitalist group, but based on my n=3 experience (i.e. working as a hospitalist in 3 different hospitals and 3 different groups), it's very easy to pick up extra shifts. 2. I did a handful of nocturnist shifts immediately after residency (the extra shifts that you asked about). It was not for me. A nocturnist position can work really great for someone who has certain home responsibilities that make being physically at home during the day essential (e.g. being a part-time caregiver for someone else), or someone who participates in a frequent daytime only activity (e.g. group research). But it's brutal on the body, and the fleeting interactions a nocturnist has with patients and family can diminish one's enjoyment of the hospitalist role. I don't know of data on this, but I suspect there are higher rates of burnout among nocturnists.

[@dinkokambourov]

Incredible content, I just finished medical school and started working in ER, hopefully will get into Intensive cardiology care unit to get specialty in Cardiology. Your videos have been of enormous help and I would like to thank you. Could you do a video about cardiac vs pulmonary dyspnea when there are both present in the same patient and differentiate which one is leading at the very moment. I've seen the same patient with pure CHF at one occasion and Pneumonia with CHF the second time I saw him 2 months apart. Thanks you again, I hope my question is written in understandable English !

[@vishveshbhatt9297]

It is soo good to see you back!! I missed your lectures!

[@samratspeaks]

Sir, we are all waiting for your approach to disease series. You have been of immense help :)

[@StrongMed]

Expecting to post the next one on Wednesday morning!

[@samratspeaks]

@@StrongMed Can't wait. Thank you so much for these. We from third world nation cant afford the expensive sites who charge insanely. Thank you so much for these. :)

[@StrongMed]

@@samratspeaks You're very welcome!

[@ragulsen1512]

The long wait S finally over! Welcome back sir! 🙏

[@Conjure66]

Welcome Back !!! I love your videos !! Thank You so much for sharing your knowledge !!

[@chandrew3909]

Nice to see you back

[@shannongreenwell1278]

It’s good to hear that you are a hospitalist and I trust that you would be much better than most doctors. At least you know what EDS is, unlike most other doctors. Way to go and please keep up the great job! Would you know what the proper way is to treat a person who is having a seizure? I have Epilepsy along with my EDS. And one time I was in the hospital and I had a seizure, the nurse put something in my mouth thinking that I would “ swallow my tongue “. Could you please help me bring awareness to Epilepsy.

[@StrongMed]

I'm so sorry, I'm just seeing your comment now. Seizures are a very complicated and nuanced topic - there's entire fellowships within neurology dedicated just to epilepsy. An overview of anti-seizure medications is presently too far outside my clinical practice for me to feel sufficiently experienced to discuss it here. However, I am working on a video that discusses a diagnostic approach to seizure (i.e. figuring out what the underlying cause is of new onset seizures in adults). I hope to have that posted in a week or two. (FWIW: I have no idea what that nurse was doing!)

[@deepdark795]

Thank you so much for the wonderful video as always, Dr. Strong. I was wondering if I could ask you a question. I am a PGY-2 at the moment and was wondering if you could share some of your thoughts on why you chose to become a hospitalist vs a cardiologist. I’m sort of in that agonizing struggle right now and while I love cardiology, I also love the rest of Internal Medicine. Thank you in advance and I hope you have a great day!

[@SajanAcharya]

Glad to see you back!!

[@PH-xw1ri]

He mentions a "general internal medicine fellowship" at 6:00? Isn't internal medicine only a residency? There is no such thing as an internal medicine fellowship.

[@StrongMed]

There are actually many so-called "general internal medicine" fellowships. Here's a non-comprehensive, searchable directory from the Society of General Internal Medicine: www.sgim.org/career-center/training-directories/fellowship-directory Although they are very diverse, a great example of what a GIM fellowship might look is UCSF's Academic Medicine Hospital Fellowship: ucsfhealthhospitalmedicine.ucsf.edu/fellowships/academic-hospital-medicine-fellowship These fellowships aren't as standardized as fellowships are in the medical subspecialities and are often non-ACGME accredited, so their terminology can vary a bit. For example, Stanford considers its geriatrics and palliative care fellowships to be under the division of General Internal Medicine, though whether one considers these to be true GIM fellowships depends on their perspective. At the Palo Alto VA, we also have a GIM fellowship focused on Quality Improvement, which flies so under the radar that I don't think there's even a description of it on the web.

[@timotatoe]

Not to mention a specific hospital medicine fellowship--there are quite a few offered by various hospitals/academic centers. Sometimes to work as a hospitalist at a certain hospital, these fellowships are mandatory. In particular, Mayo Clinic comes to mind.

[@malharithy]

thank you for this video and for your content in general, it's really helpful. I have 2 Qs: 1- Can family medicine physicians apply to these internal medicine fellowships? 2- Are there certain requirements for a family medicine physician to be a hospitalist (e.g. graduating from an in-patient heavy program)?

[@AbdelhamidBenSelma]

Great video. Can you give us tips and tools on how to document our patients' encounters whether it is an initial H&P or a progress note ? Also, can you comment on the different models of payments used for hospitalists ?

[@StrongMed]

Thanks for the questions. Unfortunately, I'm not sure that I would be the best person to speak about reimbursement models for hospitalists. My own reimbursement/salary is a little convoluted, but the majority of which has been through the Department of Veterans Affairs, which pays a fixed salary and has no consideration of otherwise common features like RVUs. In other words, the specifics of how my reimbursement work are very unusual for a hospitalist. Regarding how to document encounters, I have a brief series on the H&P. It's focused mostly on oral presentations, but most of the general principles apply to written documentation as well. Regarding progress notes, the reason I haven't covered this already is because I strongly dislike the conventional SOAP format that is ubiquitous in American hospitals, and I just can't bring myself to teach it. Maybe someday I'll publish my proposal for an alternative...

[@AbdelhamidBenSelma]

Strong Medicine thank you. We’ll be looking for your upcoming videos.

[@HidayetATILGAN]

Thanks 😊👍

[@Can-tf5xz]

Vay Türk abim :) Merak ettim hangi yoldasın şu anda. Müsaitseniz instagramdan yazabilirsiniz canerdogn. Kolaylıklar...

[@HidayetATILGAN]

@@Can-tf5xz merhaba Can, Almanyadayım. Burda plastik/estetik cerrahi üzerine uzmanlık yapacam.

Te admiro mucho. Deseo llegar a tener un profundo conocimiento sobre la medicina como lo tienes tu. También disfruto mucho enseñar medicina, sobre todo medicina interna que es lo que yo estudie. Muchas gracias por todo.

[@StrongMed]

De nada. Me alegra que hayas disfrutado los videos.

[@khalidbashir7435]

Doc you are a smart guy & a cool fellow too.

[@argawarga2735]

10-15 pts on average? I want to work where you work! I usually carry 18-20, but I've gotten as low as zero before (the nurses actually closed the unit when that happened!)

[@StrongMed]

Yeah, one of the draws of my current job was the census. It actually averaged 8-12 when I started there 10+ years ago, and has slowly inched upwards since (despite adding an additional inpatient team). Before that, when I was at a private community hospital, it was probably closer to 15-18. >20 was a really bad day.

[@Chiko-sc1gz]

Hello welcome back:)

[@StrongMed]

Thanks! It's been too long.

[@JUDALATION]

What about the myth that Hospitalist like to kick patients that are fall risk out to assisted living centers? PMD hospital care is unpractical and really a thing of the past...thanks for the educational video.

[@StrongMed]

I totally agree that PMD-driven inpatient care is becoming increasingly impractical. Regarding your first point, I don't know if this is directly related, but there was an interesting (and partially controversial) paper published in JAMA in 2017 that compared outcomes between hospitalized patients cared for by hospitalists and those cared for by their PMDs. jamanetwork.com/journals/jamainternalmedicine/article-abstract/2663254?redirect=true The article was not without limitations, but the bottom line is that the hospitalists had shorter length of stays, were more likely to discharge to SNFs (rather than home), and had slightly worse mortality compared to the PMDs. (That last observation was the cause for the biggest controversy). I certainly would never frame that hospitalists are prone to "kick patients" out to assisted living centers if they are fall risks, but I do think we are slightly more likely to recommend discharge to SNFs. I don't know if that's good or bad, and the difference is really small.

[@shif442]

next meded topics you will upload?

[@StrongMed]

I hesitate to list specific topics here because in the past I've said "I'm going to cover X, Y, and Z" but then only deliver on X +/- Y for a variety of reasons. As I mentioned in another comment, I'm working the most on the Approach to Symptom videos, and aside from them, will probably focus on finishing some of the currently unfinished series (e.g. ECGs, hemostasis, etc...). I'm also planning on posting a video called "My experience as a patient in my own ER" (or something like that), as long as it doesn't upset too many of my colleagues.

[@GuilleBRGG]

Glad you are back! Hugs from an intern from Brazil :D.

[@yolandajustme9122]

Great videos.

[@kenmiguel2986]

Dr. Strong I need some advice. I like Internal Medicine because you get to use all the pathophysiology you learned in med school. My only issue is that you're overworked sometimes or maybe most of the time. In short the quality of life is not that great. Please correct me if I'm wrong but thats just what I see and been told by my seniors and attendings. I also like psychiatry. It has always interested me. Others find it boring. My only issue is that you won't be able to use everything you've learned from medical school ( like treating simple consults like asthma or diabetes). Family members do ask you for medical advice all the time. But a psychiatrists' life style is great with no weekends and no calls. Got any advice for me?

[@TheArkwhaler]

Do what you like. I don’t feel that internists are overworked. Hospitalist jobs offer a decadent amount of time off, but it might not be when you want it. If you love psychiatry go for it.

[@kenmiguel2986]

@@TheArkwhaler thanks! Ya I just want to make up my mind before I apply for the match in 2020

[@strongDr]

@@kenmiguel2986 How did the match go Doctor?

[@Daniel-rk2qz]

Dr Strong i thought u were a cardiologist for some reason

[@StrongMed]

Lol. That's a common perception, even of students who I teach in person. The final career decision I made along the way was hospital medicine vs. cards, so maybe that pro-cards bias has continued to filter into my choice of topics I teach on.

[@SKARTHIKSELVAN]

Thanks for your video.

[@ColonelMarcellus]

Funnel doctor?

[@kjkgood]

DO WE HAVE A NEW TOOL FOR YOU DR --VERY SOON PROJECT THOR WILL ARRIVE" FOR ALL OF IM AND HOSPITALIST COMMUNITY BE READY TO LOVE IT

[@StrongMed]

This sounds a little ominous. Should we be worried?

[@Raja-vg8og]

In india, they are called "duty doctors" and play a big role in all the tiny hospitals and nursing homes. 1. Lowest salary, treated like dirt by one and all including patient's 2. Absolute dead end job, no futute . After about 10 years, you will lose all interest to practise medicine

[@StrongMed]

That's sad to hear. The experience of academic hospitalists in the US is very different than your description. I only spent one year as a community hospitalist (i.e. non-teaching hospital, no trainees or students), and it was...not as good; but it also was >15 years ago.