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On being and nothingness; on being a hospitalist

June 23, 2010

Oh, I always found it so hard to read Sartre. But now, as I think I might have figured out what to do with the next bit of my life, I’m beginning to wonder if I really chose it or if I was born to do it. Though I don’t believe in determinism in the traditional sense, I do believe that our genetics and all the experiences in our life guide us to make the choices that we do. Even though decisions feel like choices, I don’t know if they are really ‘free choices’ if everything we do is based on what came before it. Perhaps all the experiences feed into our brains, but something internal makes the final call.

On the other hand, could a human in a vacuum do anything?  Without influence (like sensory input), I guess we wouldn’t have anything to calculate, nothing to make a decision about. Whatever balancing in our head, whatever wavering we think we are doing, could our actions be predicted? I don’t feel like a glorified calculating machine, but maybe that’s it.

Fortunately, for whatever reason, I’ve found a kind of medicine that will keep me happy at and away from work. Maybe it chose me.

I think I left my sense of humour in my other pants today, so here’s a simple post about what – to me – has been realization a long-time-coming.

I’m going to be a Hospitalist.

I think. I mean, it seems like a good idea. Doesn’t it?

A hospitalist is a doctor who looks after patients admitted to the hospital who a) don’t have a family doctor or b) whose doctor doesn’t have/want hospital privileges and so will be unable to look after them while they are an inpatient.

People in big cities are not used to having their regular doc look after them anyway; at big academic hospitals, they are often admitted to the Internal Medicine service or whatever other specialty their illness relates to. In smaller hospitals, all but the most specialized/complicated cases wind up admitted under the specialist; usually, people are admitted under their GP and a consultant is called for their assessment if necessary.

The bits I like are:

– shift work, don’t have to take work home or be on call
– no overhead or worries about staff or running a clinic
– can travel/work overseas and not worry about leaving behind a practice
– get to work in a team environment, and with more senior physicians, and I seem to have a personality which fits nicely with other hospitalists
– interesting medicine with sick patients
– none of the kinds of medicine that I don’t enjoy as much
– not the only person who will be responsible for a person’s care, have consultants and allied care close at hand

But there are definitely drawbacks:

– less flexibility to run things the way I want to, have to work under the hospital’s system, protocols, EMR
–> but I do love the politics and pushing for change

– lots of geriatrics can mean lots of tricky conversations – end-of-life, lack of comprehension in demented patients
–> but I revel in the challenge of ethical conundrums

– may make it hard to work in other places; some countries mainly have Internal Medicine grads working in the Hospitalist role, small towns may not have hospitalists and I might lose my ‘full-service GP’ types of skills
–> these things may change, or I may be able to work in some other capacity if I want to work in another country/or small Canadian town

– can’t set one’s own hours, if you work faster/harder you don’t earn more
–> can swap shifts with others and stability might be a good thing!

– we need family doctors in the community practising good chronic and preventative medicine
–> but we also need people to look after their patients when they are admitted!

I have another year, and there’s still so much to learn. I’m still lacking a lot before I’m ready for this kind of job. Apparently in some hospitals, hospitalists need to have ICU-level skills. I don’t. And I’m not sure if I can get the procedures down in my FP program. I know that palliative care, methadone management, and global health would be great additions to a Hospitalist career and definitely want to find a way to incorporate them into my practice. More training needed. After my second year of residency, I might feel competent and confident in any of this province’s hospitalist programs. “Might.”

The question is now, do I do a fellowship or “special competency” (3rd year) to pursue my interests? Most of the better programs (established in the late 90s when Hospital Medicine was getting its foothold) are in the US. This would give me some adventure but might also be a nightmare to arrange the licencing and I really don’t know anything about the US healthcare system except that its complexity, litigiousness, and two-tier status is utterly intimidating.

So, I’m going to a hospitalist. But I don’t know how, or where, yet. And I might change my mind, if Sartre allows for it.

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3 Comments leave one →
  1. June 27, 2010 11:19 pm

    Congratulations on making that decision!

    It must not have been an easy one.

    • June 27, 2010 11:42 pm

      true dat!

      thanks Jenn – hopefully I’m on the right track.

  2. Greg permalink
    July 9, 2010 5:39 pm

    Good choice: If you’re interest in medicine is to be as much of as total a physician as possible, then hospitalist is as close as you can get, unless you never forget anything and master everything the first time around (then you can be a family practitioner). I’m an FP and hospitalist was not an option years ago. I liked FP to be able to practice all of medicine but dilution of diagnoses and patient steeling leads to less and less exposure to the complex and interesting cases. Ever lower compensation causes specialists often to refer the patients they get from FP’s to their own PA’s or NP’s to keep them busy. And patients often go to the specialists as first line so the FP sees too much of the simple stuff and less and less the more complex that makes it easy for those skills to fade, unless the fp is in the boondocks and all on his own.

    The con’s you listed are not all that significant, from my perspective. Good Luck.

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