 I just had my first week as an attending internal medicine hospitals. That is a mouthful. Let's break down exactly what that means. Hey friends, welcome back to channel. In case you're new here, my name is Lakshman, internal medicine physician. And for the first time on this channel, I can say it, I'm officially an attending, which means I'm the head honcho. And in this channel, we help people just like you succeed on whatever medical journey you're on. But today I want to share about a very special part of my journey as being a physician, which is my first week as a full grown up independent physician. Right now I work as an internal medicine hospitalist and in this video, I'm going to break down exactly what that means, what I did in my first week, what my experience was like, what my hours were like, what my salaries were like, as well as in pros and cons. Break all of that down in today's episode, let's get into it. And before I forget, if you are on your medical journey, there's tons of free resources linked down below in the description that you guys can check out to learn things like studying productivity and so much more. All the goodies will be linked down below. So first let's break down exactly what a hospitalist is. Now it sounds like a very eccentric term, but it's very simple. A hospitalist is basically your medicine doctor that takes care of patients in the hospital. There you go. So that means that any basic problem that would get you into the hospital like an infection, a pneumonia, an asthma exacerbation, a heart attack, heart failure, those would be taken care of by a medicine doctor. But in addition, anything like a surgery where the surgeon may do the procedure and then they want to watch you for a few days as you're recovering, then a medicine physician may take over all of your care while the surgeon is just kind of managing the supervision of whatever they did a surgery on. So a hospitalist is basically a physician who works on a very unique schedule, which we'll get into in a second, but takes care of a variety of problems, but specifically only in the hospital. My job as a hospitalist is very simple. I go to the hospital, take care of the patients that are there at the moment, discharge them when it's time for them to go home, and then I add more patients to my list and repeat the process. So now let's transition into the hours as a hospitalist. I'm going to talk about vague and then I'll get into my own experience in a second. Now the hours of being a hospitalist is probably the most unique part about the job. You're not going to call a doctor pretty much any job. You're kind of used to going to work at eight or nine o'clock in the morning and then finishing around three or five o'clock. Now if you're a surgeon, your hours are going to start earlier and may end later. But typically it's a weekday thing. You may work on the weekends as a doctor depending on a group or if you need to be on consults or whatever, but usually you're a Monday to Friday kind of physician. Hospitalists is different. You work seven days in a row, seven a.m. to seven p.m. and you may say that sounds awful, but you work every other week. That means as a hospitalist right now, for example, I worked Tuesday to Monday, seven o'clock to seven p.m. And then starting the following Tuesday, I didn't have to go to work. No one's calling me about patients. And Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday, you guys get the gist all the way up to the following Monday. I'm off. Vacation. I can go whatever I want and do whatever I want and it's beautiful. That's exactly why a hospitalist's career is so attractive to a lot of new graduating residents and trainees like myself because you have basically half a month that is completely off to do what you want with it. Now, if I've gotten your interest, let me just get to the other side, which is you still work 12 hours a day. So you work from seven to seven, and that means in a week you're pulling off 84 hours or essentially two weeks worth of full-time hours for any other job or any other physician. Now, depending on who you are, you may say that that's awesome or that's a lot of work and it's really busy. I don't know if I can do that. I'll talk to you about my own experience and why it's actually a lot better than I expected. So now let's go ahead and transition into talk about my first week as a hospitalist. Now, I currently work as a group of hospitalists within the hospital that I work with. That means that first I'm an employee of the company that I work with. So they get to determine my salaries and my contracts, etc. And the colleagues that I have around me that are working are all members of this company. But there are also other companies within the hospital that also have their own hospitalist and they take care of a variety of patients. How those patients are distributed usually depends on insurance and things of that sort. So overall to keep it simple, there's about a group of 20 to 30 of us that work on every other week basis and essentially I'll be working with 10 physicians throughout a week and there'll be another 10 physicians that be working on the weeks that I'm not. So now we get into the juicy detail, which is what was my first week as a hospitalist really like. Some people obviously talk about the lifestyle benefits of it and other people talk about the hours and how gruesome they are. My first day was actually not bad. And so my first day I showed up all dappered up, as you guys can see in this photo, essentially showing about 6.30 before anyone got there. Some patients figured out how to work the EMR, wrote my notes and I was pretty much done at four o'clock. Now keep in mind, you still technically have to work till 7, but we'll talk about that in a second. But my second day was a complete overwhelming experience. The reason is is kind of I expected if I had seven patients my first day, maybe discharge to second day, you have a total like 12 patients, something a little bit higher, but nothing crazy. Second day went straight from 7, discharging three patients. I now have like four left over all the way back to 16 patients, full load, just like everybody else and had to figure it out. It was hectic. I didn't know where I was going half the time in the hospital, getting lost in between the ICUs and the normal patients. In the midst of still trying to learn the EMR, trying not to get lost in the hospital, the other issue that I had is that often the patients that you get are not all new patients. So as a hospitalist, one thing we didn't talk about is you're always having new patients join your list or your service. You may have new patients that may have been admitted by the team over nights. There's a team of hospitalists that just work nine times. They're taking care of the patients and then they distribute across the group equally. So every time I go to work now and every time I had to go on my first week, there's always new patients I would take care of. But in addition, let's say one day you had 10 doctors working and the next day you have nine. That means that the patients taken care of by that last doctor that's not there because they're sick or maybe they're just covering a shift, get redistributed. So you may be taking care of a patient that had been in the hospital for 40 days, but it's your first day taking care of them and you have to read about all their charts and still take care of all your other patients. And in addition, on my second day, I was a full blown hospitalist. That means I was also having to take admissions, which we'll talk about in a second. So you can see how overwhelming this gets really quickly. But hopefully for those of you guys that are not new to the channel, you know that I'm really big on efficiency. So by day three, I had figured out the things that was slowest at, which was the EMR and finding the rooms to my patients actually see them. And my third day, I was essentially done with all my notes and seeing my patients by 12 PM, which was awesome. And so I get into my first pro or my first great experience about being a hospitalist is that once you kind of have the system figured out, once you know where you're going, how to write your notes, how to write your notes even quicker, then things are super quick and you can be very efficient. You don't have to around. You don't have to present to an attending because you are attending. I feel still pretty weird and cool to say at the same time. And things kind of go on your schedule. If you needed to just take a 30 minute break to go for a walk because you're just like tired, you can do that versus in residency or in training. You're kind of on somebody else's schedule and time to try to do things. If there's an admission in the emergency room that I have to see and I still have to see for more patients, I can quickly put orders in for that patient in the emergency room. Take care of those four patients I have left to see and then go see the patient. The schedule is how I want to run it, which is pretty nice. Now I'll get into my second probe, which is actually admitting patients constantly. As a trainee, it's pretty normal that you would have days that you'd be admitting and then another day where your colleague would be admitting, but maybe you wouldn't. Again, it depends on your institution about at least where I went. We would be admitting new patients about every four days, which felt like a good pace. The problem was is that your experience and your exposure is pretty much every four days. You take care of current problems. You have those patients. You get smaller and then on the fourth day, you're dumped again until you're fully packed. As a hospitalist, you're always kind of getting packed and so I'm always admitting patients. So some of them are very simple. Some of them are very complicated, but I get that experience of being a medicine physician and trying out different things and learning different things by simply having new admissions on a daily basis. On some days I'll admit maybe just with two or three patients. On some days it may be four or five. It really just depends, but constantly there is a mix of experience that I'm getting. And on that note, pro number three is that you're no longer taking care of only medicine patients. I thought that this was going to be a con. This is actually something that surprised me, but as a hospitalist, depending on where you're working, it's very common that you won't just be taking care of medical problems. For example, where I work, the general surgeons, the orthopedic surgeons, the urologists, and some of the cardiology services don't have their own kind of group of patients where they take care of all of them. They may take care of that problem. They may, for example, do a femur repair and then I have to manage that patient on other channels. I admit the patient. I take care of the patient. They're managing their surgery related things, and then when they are ready to be discharged and they're ready to be discharged on me, I take care of their discharge. I thought I wouldn't like managing patients for neurology, for cardiology, for orthopedic surgery, for general surgery. They're going to, for example, get an L2, L3 decompression surgery. Just need physical therapy the next day. Somebody managed their blood pressure and their diabetes overnight and then get discharged. That patient is very easy for me to take care of. On the other end, I may have admitted to a patient, which also this is something we haven't talked about, that actually needs an ICU. And as a hospitalist, as a trainee, it would just be you take care of patients in the ICU or they're not in ICU, but depends on the service you're on. As a hospitalist, I take care of patients that are in the ICU that may not require intubation or anything like that. But if they need ICU level care, I'm still their doctor. But if they're on the normal medical floor, is what's something more simpler, like an asthma, exacerbation, and ammonia, or DKA, then I also take care of them. So again, there's a nice variety between simple patients, complex patients, patients that are very bread and butter medicine, and makes the day very kind of intriguing and definitely not boring. So now let's go ahead and transition to some of the cons. Some of the ones I've already talked about. Number one is that you can have a day that can be very overwhelming and on the other days that can be very slow and relatively boring. There is also going to be hills and valleys in your week in terms of how interesting, how exciting, or how boring it is depending on how acute or how busy your patients are going to be and require of you. And so after going through my first week it just wasn't helpful that my second day was the busiest day I had my entire week because I was trying to learn the system. But as I went throughout the week the patients were more familiar because I already knew them. It was easier to take care of situations and kind of had the gist of what to do and things became a lot more smoother. Con number two is trying to balance the multiple responsibilities including the responsibility of being the admitter. So this is something that we have been talked about, but as a hospice you likely will triage and work with your teammates of deciding who gets the call from the emergency room and saying hey doctor we have somebody that we'd like to admit to the hospital and have you take care of them. It kind of doesn't make sense if you have a group of ten doctors that are working for one company for all of them to get calls by the emergency room. So instead as you can imagine there's one person that gets designated to be the admitter or the triager for that group. And so at those days in the place that I work you call the quarterback you essentially have a phone that basically will get calls and text messages from the emergency rooms but also from other hospitals that need to transfer patients for X amount of reasons to your hospital. While you're doing that you're trying to send those patients to the next person that's in line waiting for a patient but also trying to manage your patients. So you can see how there's a lot of juggling going on. And so my first day of managing and being a quarterback I was getting maybe four to five transfers in about two to three hours. You have to call the facilities, understand that the patients are responsible and somebody who is appropriate to come to your facility manage where they go and then keeping track of them. Manage patients who are coming from the emergency room and sending them to the hospital who are waiting to get admissions and then still manage the patients that you've taken care of while taking care of admissions yourself. There's a lot to do there but again after doing it multiple times there's a nice little bit of triage that you can do and hopefully throughout the channel if you guys are interested I'll share the tips that I've learned as in attending how to be more effective how to be more efficient and still do really well at your job. And then finally con number three is not really con but more of an observation is that there's a comfort of being used to how things were done at wherever facility you were. So whether you were attending before or if you're a resident going to a new hospital there's going to be different things. New policies, new things that you have to do, new EMRs to learn, new physicians to kind of master in terms of like a path to interact with a surgeon who's a nice one, who are the mean ones. What do they like to do? What do they want me to do on behalf of them without asking? Just learning those little kind of unsaid rules is something that requires a little bit of time. I still haven't done it. I've been a very silly doctor where I still felt like I was in my residency kind of hat but then I realized that I'm actually attending. It's okay for me to ask these questions of specialists and professionals because man frankly I just don't know the answer of what they prefer out of me. So learning these policies and just going through the repetition is how I learn through them but there's always going to be a level of discomfort when you're starting the job as I'm about to start my second week. Now to wrap up this video we'll talk about my schedule and my hours and finally kind of salary over overall hospitalist in case you guys are interested. So my hours and as I alluded to earlier in the episode is really where things get nice. Yes I have every other week which is amazing. I had to take my board exam this past week for my internal medicine exam and having a week off where I didn't have to try to find somebody to get coverage which I had to do in residency that was pretty nice. And then having a weekend where I can enjoy time with my family and still know that there's like multiple days after this I still get to enjoy with you that's also nice but in terms of hours again you work from 7 to 7 that means you have to show up to the hospital at 7 o'clock in the morning you will get patients overnight that people admitted that will likely be added to your list and where I work we have a roster as well as the patients they're taking care of so I can simply look at that list and say who do I not recognize from yesterday and say these two or these three are new admits from overnight let me look up their chart and add them to my roster and my list and so that way now I know who to follow up with for today now what I do between the 7 to 7 slots differ but for the majority of the time when I get there at 7 o'clock between about 7 to 745 I'm looking at my list at 15 to 17 patients and making sure that their vitals are stable on a piece of paper this is not one of my notes but I'm just kind of going patient by patient so when I walk outside the room I'm saying this Jones today needs X, Y and Z or there's nothing really needed to be done we're just waiting for her to go to a rehab center those kinds of mental notes especially when you have so many patients helps now between 745 and about 845 9 o'clock I'm seeing my list of 15 patients usually as a resident seeing 15 patients in an hour and a half seemed impossible as an attending it's both necessary and doable because again I suggest the plan that you want to make with them anyways without waiting to discuss with an entire team of other residents and attendees I make the decision so if the patient tells me they're nauseous we can start something for their nausea I don't have to talk and get permission for somebody else to do though so that part is nice and by the time 9 o'clock hits usually I have an hour window before I have to meet with the social workers and all the other team members of the patients like the pharmacist the physical therapist and nutritionist to discuss each of our patients so from 9 to 10 I usually will come to a meeting with the social workers to discuss some of the things that I have been interested in using one of those mics this is not a mic but if you've ever used a dragon for taking notes it's really cool essentially I can dictate my notes and say all the things that a patient talked about adjust my notes and my plan and so usually during this time I can write about 9 to about 8 notes and then have a little less than half of my list on the same page of what type of things a patient needs before they can go home in case there's somebody that I need help with getting a facility to go to or getting medications ready before it's time to get discharged that way everybody's on the same page and the patient has a safe discharge plan now after that 1030 slot which is usually what I'm done with the rounding with all of the different groups of multidisciplinary staff then I basically will try to get a patient the second time especially if they're sick from 12 to 1 I usually will grab a lunch really quickly while I'm finishing my notes and usually by this time I've done all my work now this is where the schedule gets very nice as I mentioned you have to technically work from 7 to 7 but no one says that you have to stay in the hospital all the way to 7 p.m. this is the part that surprise me part that I like and depending on the facility part that's what it means you definitely have to stay in the house up to those hours and then there's some afternoons that you will be taking patients and admissions only from 3 to 7 that means you can show up early take care of only your patients and not be expected to take patients from the emergency room but then from 3 to 7 a few times a week that's when your admission kind of timeline works and starts there'll be a group of 3 to 4 of us that work the ladder shift and a group of 7 8 of us 7 because you're taking admissions all the way to up to 659 but on the days where you're not in that second shift if it's 3 p.m. you've done all your work all your patients are stable your discharges are ready all your patients and their families have been called so there's still a lot of work to do then and you feel comfortable you can step away from the hospital take messages from your phone your pager and if something needs to be done you can take care of it on your work computer or your home computer all of this will vary depending on where you work but it's definitely made my first week a whole lot easier because I essentially worked 2 to 3 of those ladder shifts but that means 4 of my 7 days I was not in the hospital all the way to 7 p.m. I was still checking out my patients on my computer screen but then I could still hang out with my dog my wife and get a workout in at home or just relax which is very nice so definitely something that surprised me and something that I will definitely be enjoying about this job now before we get back let's talk about today's sponsor which is Picmonic now if you're unfamiliar with Picmonic and you're on your medical journey they have hundreds and hundreds of videos for literally any class or material that you may need and what makes Picmonic so unique is that in addition to having so many videos on literally any topic you need so for example here where in microbiology you can click on any videos so here's Staph Aureus and their videos themselves are very short so this video is about 1 minute 54 seconds but essentially will break down the most high-yield components that you have to know and there's a very nice Oreo cookie that essentially will link an image to your brain on an important concept about that and the future videos you may find that the same memorable image is included in another related video so then you can link together concepts for example here this venom jar with green represents food poisoning so any bacteria that may cause food poisoning may have this image in their overall picture and video so you can say okay I know all different bacterias that have food poisoning and then whatever you feel comfortable with their relatively short video and quiz phase and actually quiz yourself on the various different high-yield components now in addition to having a very unique and easy way to remember information for your quizzes and tests you can also add all of the videos you're watching into a relative playlist so if you're studying for a microbiology class you can go ahead and essentially click all of the videos that you add and add it to those playlists and then whenever it's time you can come back to your individual playlists and either watch those individual videos again or ask for specific quiz questions related to the videos that you've now said that you've mastered scratching the surface in terms of features that Picmonic has to help you on your medical journey other cool things include having a weakness guide so you can see which topics you're the weakest in as well as their study scheduler so you can actually say these are the topics I need to know and here's my test day and then it will essentially give you a study schedule based off of that so if you're looking for an all-in-one resource for your on your medical journey and you haven't quite found it definitely recommend checking out Picmonic if you're interested they'll be linked down below and our friends at Picmonic have also been nice enough to include an extra 20% discount on your medical journey at checkout and so if you're interested in learning more about Picmonic that link will be down below and as always thanks to Picmonic for being today's sponsor and now last because I know you guys are interested is salary now talking about salary I will be much more broad because these numbers will be higher or lower depending on where you're working so it doesn't really make sense for me to just share my name majority of hospitals will make about $250 to $300,000 again all this will vary depending on where you're based off your productivity so if you see a patient you can essentially bill and this is something I'm still learning on the complexity of the patient if somebody is an ICU level patient they're going to give bill a very high level complexity if somebody on the other end is someone who you're not doing very much for maybe you're just waiting for them to get accepted to your rehab center and you're not making any changes to their medical plan you'll do a hybrid where you get a base salary for either every shift or every month and then you get a percentage of what you bill and then the final group is just going to give you a base salary you can see 30 patients or 5 patients you're going to get paid the same amount and so the income that you make is likely going to be on the higher end if you're an IRVU model which basically means that you make what you bill it's pressure to see more patients because you make the same money regardless now I currently work in a hybrid model which means that I make a certain amount on a daily basis for seeing an X amount of patients and then if I see more patients because the hospital is busy or whatever then there's a percentage split between my company and me and that percentage changes over the time and the years that you work with the hospital so again that number varies but I would say it's safe to assume there's definitely going to be somebody in the comments that say I know someone who's in a big city who's making like $500,000 of the hospitals good for them that's awesome there's going to be somebody who says that I know somebody who is working in the middle of nowhere that makes absolutely nothing it's going to be situational it doesn't really make sense but that range is basically where my salary will fall in after this year that's where a majority of my colleagues and most people will be working a few days a week where you're not doing something so that will also depend in my personal experience I likely will take on more shifts starting the next few months as I have things figured out and I have more free time on my end now hopefully that got you excited about the life as a hospitalist but I know there's going to be more questions so make sure you drop in the comment section down below if you're watching on YouTube and while you're down there's going to be tons of free resources around exactly how I studied that's also free now if you enjoyed today's episode and you want to do well on your medical journey to essentially get any job any position that you want and I'll talk about that later in future episodes then go ahead and watch this episode right here on how I got a 3.9 GPA in medical school and all the study strategies I used as well as this strategy that here using Anki and all the advanced strategies that I used with it to essentially make med school so much easier as always my friends hopefully I was a little