 Through medical school and residency, I had the hardest time picking what kind of doctor I wanted to be. Now ultimately, last year, I graduated residency and took my first official job working as a full-time hospitalist working seven days on and seven days off. And after a few months on the job, I decided to pivot and transition to go back into training. And in just a few weeks, I'll be going back to become a cardiology fellow. So in today's episode, I'm going to talk about some of the biggest takeaways, both pros and cons of being a hospitalist now that I have a year under my belt. Some of the things that I absolutely loved and really going to miss, as well as some of the things that I can't wait to not do anymore. Now as a quick breakdown, during my second year of internal medicine residency, this is usually where trainees are making a decision on what kind of doctors they're going to be. I was torn between either being a hospitalist for the rest of my life or going into the field of cardiology. Now a few things that attracted me towards being a hospitalist was one, the tract of schedule. You work seven days on, seven days off and have a nice lifestyle in the weeks that you're not working and still get paid a really good salary for working only half the year. So during my third year of residency, I ultimately decided to go down the hospital route and apply to a bunch of jobs in the city that my wife and I ultimately wanted to be in. Thankfully, we got a great position at a great company. Now after a few months on the job as a hospitalist, some of the pros and cons that we'll talk about today, ultimately steered me to saying, you know what, it makes sense to going back to training to become a cardiologist. If you're interested in why I picked cardiology the first place, I talked about that in this episode right here, which I'll link down below in the description. So now that I'm only three weeks away from becoming a cardiology fellowship at the time of making this episode, I thought I'd break down the pros and cons in case you choose to make it a full-time career for yourself. Now let's start with the pros. Number one has to be the flexible schedule. Now when I first started at the company that I work for, you have a very traditional schedule of a hospitalist of working seven days on, seven days off. And usually your hours about seven in the morning to seven PM at night. Now for me personally, I joined an awesome group that had a really flexible schedule. So it's never really seven days of 12 hour shifts in a row. If you guys are interested, you can see my full day of life as a hospitalist right here or I'll link it down below in the description. But usually we would work anywhere from one to two long days where we truly would be in the hospital for those 12 hours. But the rest of the days usually would be staying and admitting until three PM. And if you were done with your work, which I usually was, I'd be able to go home and spend those hours from four to seven at home working and taking messages from the nurses. And so that meant that even during my week as a hospitalist, I'd still had a lot of flexibility in the later parts of my day. My wife and I wanted to go run a quick errand. I could do so with having my phone in my pocket, answering messages from nurses. And obviously there's tons of flexibility on the weeks I had off. I could work on personal projects, whether it was doing things for the empty journey, recording videos, podcast for you guys, or working on personal milestones, just training for my second marathon, which I ran in Dallas, Texas at the end of 2022. And got really nice PR. I wouldn't have been able to do that if I didn't have so much time to train and try to get a little bit faster in the past year alone. My wife and I have gone to India for about a week and a half. We went to Hawaii for a baby moon for about four to five days. We have gone to New York City or somewhere close to it three times now in the past year. And now in just a few weeks, we'll be going to Canada for our final vacation before starting fellowship and before the little one comes. So definitely tons of time to explore, to do absolutely nothing or doing things like training and working on personal projects. Probably the biggest perk of the job, absolutely. And for those of you guys who've been following my journey and the channel, you know that my schedule is no longer seven days on, seven days off. It's actually much nicer where I work four days on in the middle of the week. And then I have a three day weekend and I do this once more. And then every two weeks, I'll transition to where I only work three days on during the week. And then I'll have a four day weekend and I have that for two weeks and then I repeat the cycle all over again. Now, I definitely lucked into the schedule, but there's tons of pros of having a schedule like this instead of seven days off every other week. One, I have guaranteed weekend. So if there's birthday parties, somebody has an event, somebody has a wedding, I can go to usually knowing my weekends for free. Allows me to be able to do things that are important to me, like going to the temple or church for me on a weekly basis without having to miss every other week and just having some very consistent family time. And then finally for me, knowing that I'm going back to fellowship, where I'll be working on a weekly basis anyways, having a schedule where I'm working a few days, at least every single week, allow me to have a more predictable schedule and transition when it's time. Now, pro number two is flexing those medicine muscles. You spend so much time at medical school and training, actually learning about medicine. And some people will tend to go right into fellowship training to become that subspecialist they wanted to. For me, it doesn't make sense of spending three years and then never really practicing how to manage something like a pneumonia or asthma attack or CPD if you don't choose to be a pulmonologist. And so having a full year where I can really flex all that medicine muscle and knowledge that I've had built up over those past seven years of training has really been one of the best parts of my experience. Because I've seen so much and I've learned to manage and become comfortable with so many diseases, such as managing basic things like those pulmonary issues or managing heart disease. Like it will be so much more in the house of fellow as well as managing conditions like strokes or certain surgery patients where as a resident, it was normal to have a formal team that would take care of those patients. I would never see them, but now as an attending, those are my primary patients and I get to play a role in their care. And so I know even when I transitioned to becoming a cardiology fellow, all those experiences, the hundreds and hundreds of patients that I've seen over the past year, I feel comfortable managing a pneumonia as a fellow or managing renal failure as a fellow. And I don't feel like I need to always call a console just because I haven't seen that. I've taken care of all those things as a primary care provider for the past year. And number three has to be the patient relationships and the memories that I've been able to make. Now, being a hospice is very analogous to being a puppet master. You're managing so many different strings in regards to improving your patient's care. Different sub-specialties, console teams, nurses, physical therapists, social workers, and really just having to coordinate everything to be able to help that patient. And often you get to be the person every single day that just ties everything together, saying this is what this consultant said, this is what the nurses have been telling me, here's what physical therapy and social work is telling me, this is what it means for when you get to go home or what we're gonna do for you before it's time. And as a hospice, because you're that person who ties entire picture together, usually the patients and their family see you as the main doctor. I've been able to cherish amazing memories with patients sharing hugs and laughs and even at times some fears and concerns about their future conditions. And over time, I've been grateful enough to have patients and families who have just stepped out of their way to just say thank you. And this bookshelf behind me that I have here I have a few notes, one from a family who knew that I was about to be a dad, just wrote a really sweet note to myself, my wife and the little one that I'll cherish regardless of how far in cardiology I decided to go. Now, number four is the team that I worked with. Now, I have to say this, that the reason I'm going to cardiology has nothing to do with the company that I ended up working for. It would have been even easier to leave if I worked for any other company to become a cardiologist, but I had such a great experience that it was really a torn decision. I had a great boss who was super supportive, even when I told him that I was leaving to become a fellow, I had great colleagues that I worked with and really made me feel like it was a family every time I would come to work. And then all the other staff members that really just made the environment super warm and are able to help with everything behind the scenes so I could do my job as best as I could. Now, the unique thing for me is that I'll be doing fellowship at the same place that I'll be working. So thankfully I'll be interacting with a lot of those physicians, who will not be attending, so I'll be a fellow, hopefully they treat me nicely, but I'll be able to see a lot of those friendly faces that really were able to welcome me nicely into this hospital system and then ideally be able to help them as a cardiology fellow. And then finally, you can't go without talking about the salary. Now, as a hospital in Central Texas where our percentile is definitely lower than the rest of the national average, we're making about 250K, which after taxes and money going into 401Ks and insurance, et cetera, I was making anywhere from 11 to $14,000 a month, which gave my wife and I tons of room to save and save really rapidly for things that we really cared about, whether it's having an emergency fund, having money for this baby that's coming up and just being able to pay for all those expenses and things that we don't even know will be coming up, as well as save for some of those personal milestones, such as the down payment on a home, which we just closed on and that would have not been possible if we didn't have a great salary as well as a great savings rate. That part's important over this past year. So working really hard as a hospitalist over the past year as well as saving a ton of money, it definitely has allowed my wife and I to create a nice nest egg as well as a house to my wife, myself, and our future daughter can grow into. So those are some of the biggest benefits and the parts about a hospitalist that I love the most. If I missed any or if you have any questions if it's a problem, make sure you add it in the comment section down below. Now we have to transition to the cons. The number one probably for every hospitalist is the focus on disposition. Now, as the primary physician, as soon as the patient comes into your care, your main question is what do I need to do for this patient both medically as well as working on a social work side to get them to their next disposition? Is it home? Is it rehab? Is it a nursing home? Where is it and how do you work on getting those tied together? Now some patients are very simple. If you have a surgery patient that just had procedure done on their knee or hip, they may need physical therapy. A social worker can help you with their insurance and figure out the best places that they want to go and working with the families to organize that. That part's easy. My medical kind of expertise and how much time I spend doing medicine on that patient is very minimal. Their disposition easier. I just wait for the social worker to tell me when it's time for them to go. Other patients that are a lot more complicated or don't have the proper funding or insurance or maybe family support to get the care they need become very tricky. And often it may be where a patient is in the hospital for 10 or 12 days, but how much medicine I really spent on them is equivalent of maybe three or four. I've spent a week or more trying to figure out, okay, how are we going to get this patient out of the hospital into a place that is going to eventually get them home if home is not the next spot? And you can imagine if you're working week after week and patient after patient, if you're seeing that over and over again, it really starts to kind of get dreadful and a little bit mundane. And so this position is probably not any hospital's favorite thing, but it's probably the most primary thing that we do in addition to just improving the health and care of our patients. Now, number two, now this is something that I had to give a lot of thought to, but medicine happens without you often. Now, as a primary physician, you think that you wouldn't be making a lot of the calls, but especially if you're working at a big center like myself, if you're gonna call consultants or you're gonna call social workers, or you're gonna call physical therapists, the nice thing is that the system that I work at, a lot of things get done without my input. And so I may see a patient who a nutritionist or a nurse may call a nutritionist and then eventually they're on a diet that's making them stronger. Or they already have a primary cardiologist who's aware that they're in the hospital and they're just gonna consult themselves to be able to follow and take care of that patient. And so often I come in and there are so few patients every single week where I'm not really doing anything primary, even though I'm their primary physician, there are a lot of other ancillary teams that are managing and improving their care. And so sometimes it does feel like things are just happening without you, which is both a pro and a con. It's a little bit of a hit to your ego where you wish you could be doing more or at least wish that, why am I the primary physician if I'm not doing so much for this patient and somebody else should be. But at the same time, it's definitely a vote and confidence for the system of how lots of things can happen without my input where a patient can improve and be able to go home and I don't have to be involved in every single little step along the way. But the biggest takeaway here is a lot of times we get into medicine because we wanna make an impact. And if we don't see that every single patient that we work into especially if you have a day where you have a panel of 15 or 20 patients and you realize that a majority of them have things in consultants working on their behalf and you're not the primary driver of them improving or when they get to go home, sometimes it feels like, okay, this job is not as fulfilling. And then on the flip side, you will definitely have days and weeks where you'll be the primary decision maker on majority of your patients and definitely feel a sense of control and sometimes overwhelmed on how many decisions you have to make. But there are times where I have a list of patients saying, I'm not really sure what I'm doing for these subset of patients. I'm not sure if I'm really their primary physician. Again, more of a hit to the ego but it is something that I've found to be a con. Number three is a little bit of a flip side to the financial aspect that we talked about. Now, while your salary is great as a hospitalist, understanding that financial controls and consequences of the hospital system are out of your control. Now as a hospitalist, you are probably not going to be the primary focus of the hospital. That may change depending on where you're working but usually a lot of the consultants, a lot of the surgeons, people who bring the money in for the hospital are going to be where the money focuses. And so if you wanna pay your raise, it may not happen. If people need somebody to take on more work, it tends to be dumped onto the hospitalist. For example, if the surgeons want to spend more time doing the surgery, making more money for the hospitalist but not managing their patients post-off, those get handed off to the hospitalist. Now most hospitals are used to this, they're happy to take the work, happy to help but over time, this kind of dumping onto the hospitalist is very common. Now in the past six months, I've seen my company, the hospital I work with, basically have to make financial constraints. We used to have PAs and nurse practitioners work for us that immediately got laid off just because of financial issues. We had doctors who were at the risk of being let go. I've made an episode about how I was almost laid off and how that actually turned into a good thing. You guys can check that out in the description down below. But I was able to see how the constraints of the hospital system, how much money everyone else is making will ultimately trickle down to us at the very end. And that can lead to consequences on how many patients we see, how many colleagues get to keep their jobs. And it basically told me it was probably the right time to make that transition to going back to fellowship where I can have a little bit more secure job in the field of cardiology. The number four is the upward growth. Now for me personally, I don't like admin things. I don't want to be the person managing decisions on what's happening in terms of quality or what type of policies the hospital is doing or being able to manage schedules or issues and conflicts between physicians. I want to be able to take care of patients. And so if I'm not working as a hospitalist, really the only way I can make more money is either working more as a hospitalist, doing low-come jobs at another hospital or working an admin job. And neither of those are great options for me. But for me personally, being a medical director or managing an admin role is not very attractive to my personality. I'd rather just be interacting with patients, not so much that people take care of those patients. And so understanding that that upward growth was not possible as much as I wanted in the hospital was definitely a big con. The number five, now this one's a duh, but you're the primary doctor. So that means that if the family wants to talk to anyone, the nurses are gonna message you. And that means that even if you spoke to a family member early in the morning and somebody else wants to talk to you, you're gonna have to go back and kind of pause what you're doing at that moment and go talk to them and update them. I also made some speaking to patients multiple times. They have concerns of what you talked about in the morning and they wanna make an adjustment. You make an adjustment, it's not working, they're gonna wanna see you again. If you have patients who have big anxiety issues or patients that are definitely controlling, you're gonna be interacting with them multiple times. And each of these interactions can be anywhere from five to 20 minutes. And again, if you have a panel of 15 to 20 minutes, that could be very costly to your efficiency. And again, being able to manage other people. And then finally, you deal with the things that every patients have, but some patients may be having more of. So things like pain or issues that you medically can't explain. As a hospitalist, you're not interested in managing pain. You're interested in managing a diagnosis, a condition where you can actually make an improvement. If somebody's been dealing with chronic pain all the time, it's not always likely that you're going to be able to make a regimen that's suddenly gonna make that patient feel no pain at all. And dealing with those patients are a little bit of a, okay, fine. So you're more in the way that it's gonna happen and as a primary doctor, you're gonna have to deal with it, but again, not your favorite part of the job. Now, number six is the job itself can get very mundane. I've seen days where I've had panels very full of surgery patients, that have pain as well as very kind of basic bread and butter and medicine cases like pneumonia or heart failure, exacerbations. And so you imagine going into work really wanna make a difference and knowing that some of your patients are surgery patients that were not really managed by you. You're just kind of helping coordinate the care. You have some patients who are chronic pain patients where you may not be able to please them regardless of what you do. And you have some patients where you're like, well, you know, I've identified you had a pneumonia or the emergency room doctor identified that you had a pneumonia and now we're just waiting for your antibiotics to kick in or your cultures to come back. You just kind of say hi, make sure they're improving and often they are, that's kind of the end of what you're doing. And so if you have one day like this, it may seem like an easy day. If you have a few in a row, it could just kind of become redundant and mundane. And so if you have things outside of the hospital that you're looking forward to, like in a few months, I'm just gonna have a daughter at home waiting to interact with me that I would love to interact with. And if the job is not fulfilling, that's all I'm gonna wanna spend time doing. And so having a job that you're actually looking forward to going to enjoying your time while you're there and then can come home and spend time with the priorities is really what I was looking for. Now, overall, again, being a hospice was a great experience. I was able to basically solidify the knowledge that I learned at residency in medical school. I feel like a much better physician, even as a cardiologist, I feel like I managed a lot of those conditions without the help of a general medicine doctor or a consultant, because I've done it for an entire year. All of those patient experiences and memories, all these cards behind me that I have are going to be carried forward to me as I become a cardiology fellow. And know for a fact that I was very lucky to join the group that I ultimately did. And I'm very lucky that I'll be in the same hospital system, still working alongside them as a cardiology fellow. And if you have any questions about being a hospice, maybe it's a career that you're considering just like I was, it is a great field. It can work very well for who you are, especially if a lot of those outside of the hospital things matter more to you than your job satisfaction. For me, it's a 50-50. I wanna love what I'm doing for 20, 30 years and also be able to spend time with those things and people that I really care for. And so this is why I ultimately chose to go and fill the cardiology again if you're interested in why I did that. I'll link down below that episode down below. But if you guys have any questions about being a hospice, let me know in the comment section down below. If you're on your medical journey and you're like, I just wanna make sure I crushed it. I wanna make sure I avoid all the mistakes that this guy did and I wanna make sure that I make my own failures and thus be able to reach a higher point of success. Every single week I'm updating this document called the Med School Success Handbook with all the things that I wish somebody would have just told me so I can do this, don't do that. If you guys want it, it's absolutely free, I'll link it down below. If you're interested in working with myself and my team either through one-on-one coaching or just being able to use our guidance to help you study better, be more productive or just help you on a medical journey, be MCAT, board exams, residency, whatever it may mean, go ahead and check out the link down below for the Med Elite Academy where you can basically get lifetime access to group coaching with myself and the rest of our awesome medical students who are a part of our team. And if you enjoyed this episode, all I really ask you to hit that like button to just show your support and telling me to make more episodes like this one. And if you enjoy this one, you'll probably enjoy this one right here, my full day of the life as a hospitalist as well as this one and why I chose to feel the cardiology in the first place. As always, my friends, thank you so, so much for being a part of my journey and making it to the very end of this episode. Hopefully that was a little help to you guys and yours and I'll catch you guys in the next one. Peace.