does a hospitalist or gastroenterologist get payed better?

[wjs010]

One can make a lot of $ as Hospitalist , with probably more time to use it than GI. Smaller gap if academic GI. But GI usually makes more (400s at least) but they are on call a lot

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[Gastrapathy]

What do you think about the other important question posed in this silly thread: Golf, who has a better aptitude for it? The GI who makes more money but maybe has less time, or the Hospitalist who makes less money and maybe has more time?

Well the internist I know who is a legit scratch golfer quit clinical practice and works for BC/BS.

 

[TwistedTea]

Not necessarily. The other option for a hospitalist is to see more patients per shift. For example, if one saw 30 patients per shift, at the current Medicare reimbursement rate of of approximately $54 per wRVU and a typical average of 1.8 rRVU per patient, that would equal to $530k a year doing the standard 7-on 7 off (which comes out a182 shifts a year) and assuming you're working at a place that pays you in line with the RVUs you generate. This is on the higher end for most hospitalists these days, but then again 30 patients per shift is higher than what most hospitalists are comfortable seeing and covering independently, but of course you can get a midlevel or residents (if at a teaching service) to help with coverage if one attending is covering that many patients.

So if I see 120 patients per shift ill make 2 mil a year?

Thats game stonk territory

 

[TwistedTea]

Well, there's no doubt in my mind that advanced HF/transplant should require more training. What I wonder/question is, do we need a different fellowship for it? Same question can be posed for a lot of different things. Can't it be done during the 3rd year of a regular Cards fellowship? Or what about the general cardiologist who's already practicing and develops the interest; can't she find a way to get trained up in HF/transplant in the form of an apprenticeship/OJT (call it what you will)? Does she really need to leave her practice, forfeit her income, change her geography, reapply for another GME cycle for a 1-year fellowship?

If we want to save our profession, we need to stop glorifying every subject with its own fellowship/BC. We need to find a way to train on the job, and we need to enter the workforce sooner. We spend too much time in education and training. If med school were only 3 years (could totally be done), and IM residency only 2 (for the strong resident, and the one we know is going into fellowship), and Cards is 3 years (including any sup-specialty topic) = 8 years (instead of 11). That delta of 3 years = $1 million bucks in salary (nice for you), and that's 3 years sooner we can get you practicing.

We need this paradigm shift in medicine or we're dead in the water.

I agree I think most people from decent programs are ready to be a hospitalist by the end of second year.

Also agree its dumb one needs to finish all three years of IM to do a fellowship, 2 is enough


What do you think about what peds is doing? another three year just to be a peds hospitalist after doing three years of basically peds wards?
I would say what I think about it but im already on probation here lol.

 

[InternistDO]

What do you think about what peds is doing? another three year just to be a peds hospitalist after doing three years of basically peds wards?
I would say what I think about it but im already on probation here lol.

I've always assumed the reason peds can get away with that is that pediatrics is already pretty oversaturated (how many truly sick kids are there, compared to adults?), so they can make you jump through whatever hoops you want. Even outpatient peds is saturated in big cities, and it's still almost all well-child or minor illness visits that would be handled by a GP/FM in other countries, as opposed to complex sick kids.

 

[DrMetal]

What do you think about what peds is doing? another three year just to be a peds hospitalist after doing three years of basically peds wards?

Say what?! Do you have to do a gen peds residency (3 years), then another 3 years (total 6 years of training), to be a general peds hospitalist?!

Wow. That's reason # 2543 why I didn't go into Peds!

That's pretty ridiculous. You know who loves this? (that we physicians stay in training so long, not entering the workforce any time soon): the mid-level community. The NPs are having a field day filling up the holes that we can't fill, b/c we insist on training/and BCing for everything.

 

[TwistedTea]

I've always assumed the reason peds can get away with that is that pediatrics is already pretty oversaturated (how many truly sick kids are there, compared to adults?), so they can make you jump through whatever hoops you want. Even outpatient peds is saturated in big cities, and it's still almost all well-child or minor illness visits that would be handled by a GP/FM in other countries, as opposed to complex sick kids.

Chasing a passion can be expensive. I sure wouldn’t do peds. Honestly last thing I’d ever go into with all the googlemoms out there.

 

[disorder]

Well, there's no doubt in my mind that advanced HF/transplant should require more training. What I wonder/question is, do we need a different fellowship for it? Same question can be posed for a lot of different things. Can't it be done during the 3rd year of a regular Cards fellowship? Or what about the general cardiologist who's already practicing and develops the interest; can't she find a way to get trained up in HF/transplant in the form of an apprenticeship/OJT (call it what you will)? Does she really need to leave her practice, forfeit her income, change her geography, reapply for another GME cycle for a 1-year fellowship?

If we want to save our profession, we need to stop glorifying every subject with its own fellowship/BC. We need to find a way to train on the job, and we need to enter the workforce sooner. We spend too much time in education and training. If med school were only 3 years (could totally be done), and IM residency only 2 (for the strong resident, and the one we know is going into fellowship), and Cards is 3 years (including any sup-specialty topic) = 8 years (instead of 11). That delta of 3 years = $1 million bucks in salary (nice for you), and that's 3 years sooner we can get you practicing.

We need this paradigm shift in medicine or we're dead in the water.

I think this is a very difficult question to answer.

You need the volume to be competent in advanced heart failure and not every institution can do this. I also do think this takes a dedicated year.
Can it be done during general fellowship? I think so but it would have to be an accelerated program as in I think you'd need to come in as a combined fellowship. It wouldn't leave much room for "scholarly" activities if your plan was to do research/stay academic.

 

[PrimaryCareDOToBe]

I agree I think most people from decent programs are ready to be a hospitalist by the end of second year.

Also agree its dumb one needs to finish all three years of IM to do a fellowship, 2 is enough


What do you think about what peds is doing? another three year just to be a peds hospitalist after doing three years of basically peds wards?
I would say what I think about it but im already on probation here lol.

In theory, one could do a fellowship but go on to work as a PCP or Hospitalist. I think for this reason, because technically they can (although why would you?) you should have to complete all 3 IM years. Also, heaven forbid you get into a fellowship and "Drop out" now you only completed 2 years of IM and 1 Year of Cards and now you can do neither.

 

[Nocturnist]

Obviously the love of medicine and helping people are the motives but having said that and family, loans, work and all the other complexities life throws at you....does hospitalist or GI pay best? (private practice, not academic medicine)

I think it's an interesting question. I've also wondered the same about cards.

I think if you're comparing day time hospitalist- there's probably little question GI pays more- in the medium to long run. As others have pointed out, you have to factor in the 3 year opportunity cost. I made 1.6M my first 3 years out of residency (my coresidents who went on to fellowship made maybe 60k a year and got 3 weeks vacation). I was maxing out 2 retirement accounts, putting thousands aside a month in my investment account, still saved a down-payment for my well over 1m house I now own, and bought a 6 figure luxury car. I became a millionaire a little under 4 years out of residency, and had the resources and freedom/flexibility to travel abroad each month. I dont say this to brag, just to point out the very real opportunity cost of pursuing fellowship, and that you don't necessarily have to do fellowship to enjoy that lifestyle. Will the GIs from my class catch up? Probably, but financially it could take them another 10-15 years. They may never catch up to the travel I've been able to do until retirement.

I do think the question becomes a little more interesting when you're talking GI vs a nocturnist. With a typical nocturnist contract of, lets say 300k for 12 nights a month- after productivity and quality incentives and a couple extra shifts a month- its incredibly easy to be well into the 400K a year (as is nearly every nocturnist in my program). A nocturnist that really wants to crush it by working 18-22 shifts a month (and I know several) can easily be in the 500-600k range.

Now I'm sure there are some GIs on SDN that rake in over a million a year, but according to most surveys my salary gets me comfortably in the neighborhood of all top specialties- including ortho, GI, cards, plastics, derm, gas etc... 3 years post med school. And like others have mentioned when you get to the top income bracket you're really talking diminishing returns (600k vs 750k is really not a huge difference when around 50% is taxed). I have no admins or social BS or family talks to worry about. Most nights I easily exceed my productivity goals and still get one or two Netflix movies in. The work itself is stimulating-i feel like 90% of what i do is real medicine. For those that don't mind nights, it's a great way to go.

 

[Osteoth]

I think it's an interesting question. I've also wondered the same about cards.

I think if you're comparing day time hospitalist- there's probably little question GI pays more- in the medium to long run. As others have pointed out, you have to factor in the 3 year opportunity cost. I made 1.6M my first 3 years out of residency (my coresidents who went on to fellowship made maybe 60k a year and got 3 weeks vacation). I was maxing out 2 retirement accounts, putting thousands aside a month in my investment account, still saved a down-payment for my well over 1m house I now own, and bought a 6 figure luxury car. I became a millionaire a little under 4 years out of residency, and had the resources and freedom/flexibility to travel abroad each month. I dont say this to brag, just to point out the very real opportunity cost of pursuing fellowship, and that you don't necessarily have to do fellowship to enjoy that lifestyle. Will the GIs from my class catch up? Probably, but financially it could take them another 10-15 years. They may never catch up to the travel I've been able to do until retirement.

I do think the question becomes a little more interesting when you're talking GI vs a nocturnist. With a typical nocturnist contract of, lets say 300k for 12 nights a month- after productivity and quality incentives and a couple extra shifts a month- its incredibly easy to be well into the 400K a year (as is nearly every nocturnist in my program). A nocturnist that really wants to crush it by working 18-22 shifts a month (and I know several) can easily be in the 500-600k range.

Now I'm sure there are some GIs on SDN that rake in over a million a year, but according to most surveys my salary gets me comfortably in the neighborhood of all top specialties- including ortho, GI, cards, plastics, derm, gas etc... 3 years post med school. And like others have mentioned when you get to the top income bracket you're really talking diminishing returns (600k vs 750k is really not a huge difference when around 50% is taxed). I have no admins or social BS or family talks to worry about. Most nights I easily exceed my productivity goals and still get one or two Netflix movies in. The work itself is stimulating-i feel like 90% of what i do is real medicine. For those that don't mind nights, it's a great way to go.

What part of the country are you in, how far from a metro?

Procedures? Open ICU?

 

[Nocturnist]

What part of the country are you in, how far from a metro?

Procedures? Open ICU?

Northeast, closed icu, I can see the city from the top floor.

 

[aafisahar]

Northeast, closed icu, I can see the city from the top floor.

like actual buildings?

 

[CCM-MD]

I think it's an interesting question. I've also wondered the same about cards.

I think if you're comparing day time hospitalist- there's probably little question GI pays more- in the medium to long run. As others have pointed out, you have to factor in the 3 year opportunity cost. I made 1.6M my first 3 years out of residency (my coresidents who went on to fellowship made maybe 60k a year and got 3 weeks vacation). I was maxing out 2 retirement accounts, putting thousands aside a month in my investment account, still saved a down-payment for my well over 1m house I now own, and bought a 6 figure luxury car. I became a millionaire a little under 4 years out of residency, and had the resources and freedom/flexibility to travel abroad each month. I dont say this to brag, just to point out the very real opportunity cost of pursuing fellowship, and that you don't necessarily have to do fellowship to enjoy that lifestyle. Will the GIs from my class catch up? Probably, but financially it could take them another 10-15 years. They may never catch up to the travel I've been able to do until retirement.

I do think the question becomes a little more interesting when you're talking GI vs a nocturnist. With a typical nocturnist contract of, lets say 300k for 12 nights a month- after productivity and quality incentives and a couple extra shifts a month- its incredibly easy to be well into the 400K a year (as is nearly every nocturnist in my program). A nocturnist that really wants to crush it by working 18-22 shifts a month (and I know several) can easily be in the 500-600k range.

Now I'm sure there are some GIs on SDN that rake in over a million a year, but according to most surveys my salary gets me comfortably in the neighborhood of all top specialties- including ortho, GI, cards, plastics, derm, gas etc... 3 years post med school. And like others have mentioned when you get to the top income bracket you're really talking diminishing returns (600k vs 750k is really not a huge difference when around 50% is taxed). I have no admins or social BS or family talks to worry about. Most nights I easily exceed my productivity goals and still get one or two Netflix movies in. The work itself is stimulating-i feel like 90% of what i do is real medicine. For those that don't mind nights, it's a great way to go.

Do you invest well in the stock market?

 

[Osteoth]

Northeast, closed icu, I can see the city from the top floor.

Dope job

 

[Nocturnist]

Do you invest well in the stock market?

I just cost average invest a few hundred dollars every day into my investment account's index funds and max out both retirement accounts every year. As opposed to all the reddit/GME gurus on here I've found that every time I try to time the market or invest into individual stocks- I've lost money. So I consider this strategy to be investing well. Whats good enough for Warren Buffett is good enough for me.

 

[CCM-MD]

I just cost average invest a few hundred dollars every day into my investment account and max out both retirement accounts every year. As opposed to all the reddit/GME gurus on here I've found that every time I try to time the market or invest into individual stocks- I've lost money. So I consider this strategy to be investing well. Whats good enough for Warren Buffett is good enough for me.

Funny you should say that. You fit the SDN hospitalist stereotype perfectly.

Most SDN hospitalists seem to make GI level income and are Warren Buffet type investors.