greenmood

Alternating two weeks working, two weeks furlough.

One week furloughs seem burdensome, but some areas of my hospital are doing rolling two weeks furloughs. It seems to be going ok.

I love it. I doubt they will have info on longer term use or a permanent option until we are all done with the pilot. It’s great though.

Yes. You will always owe now unless you adjust your withholding. Even with dependents (I have two), a mortgage, etc I still owed every year until last year when I finally got it evened out. One year, we had to pay a fine to the IRS because they essentially said we should have known we needed to withhold more. My employer withholds extra now.

My employer has guaranteed jobs/pay through the end of April regardless of work status. Many of us have been called off because hospital volume is at 30%. We have hundreds of empty beds. They aren’t making us use PTO and the pension remains funded, but I don’t know how long this can last. As a Hospitalist I’m not super worried about my job. I’m too useful right now, and if they furlough or fire us they won’t have the ability to react to COVID surges or to recover quickly once more normal volumes of non COVID patients return. But I’m worried they will take the benefits that made this job attractive, and more worried that this will drag on so long that the benefits won’t be reinstated at the end.

Volumes way down. Admissions WAY down. We have closed several of our hospital medicine services, literally 50% patient census. And this after all elective surgeries have been cancelled. The calm before the shit storm.

A family member of mine works in the ED and has been given a single N95 mask to reuse... indefinitely.

Short answer is that yes, you have to read everything in the chart. You do. My first day is usually a mess because I have to learn 5-7 patients who've been here for X number of days, and the hospital course is often extremely complicated. I start by reading what's in the hospital course so far. We keep a running document that each provider updates daily. Ideally, it has the reasons the patient presented and was admitted, along with key points in their hospital stay and remarkable diagnostic testing. I start a stub progress note and organize the patient's problem list. That gives me a really good review of their chronic medical conditions and current issues. Then I comb through their order list and make sure every medication correlates to something in their chart. I compare it to their home med list to make sure I know what they were on prior to admission. I look at their labs and lab trends throughout the hospital stay. I look at any micro results. I look at all of their imaging. I look at their most recent vitals and trends for the last several days. I check I&Os and weights. TBH, it does not take very long for most patients, but I've been doing this for a while. When I first started, I routinely arrived two hours before rounds started so that I could do it effectively.

Well, as hospitalists we deal with the dramatic fall-out from patients who don't listen to their outpatient family medicine providers, so this would likely not be an improvement for you. Tired of arguing about A1C? Now the patient's in with HHS and you still get to argue about that full sugar soda and fries. You still get to argue about insulin. If you're straight hospitalist you probably won't deal with many children, so that might be a step up for you. I also spend much more than 15 minutes with my patients. Sometimes hours. Antibiotic arguments happen everywhere. In the hospital, we often get patients who've been started on something empirically in the ED and we have to take it away. What's worse than refusing to give antibiotics? Trying to take them away once "that other doctor said I had an infection!" I LOVE my job. You should just know that the things you hate about outpatient family medicine are still big problems in hospitalized populations. Have you considered a specialty?

I never use benzodiazepines. Makes the situation worse the next day. I typically use Seroquel in low doses. 25 mg, sometimes 12.5 with a repeat dose if they are not sleeping in an hour. Have a lot of room to go up on that. I also use melatonin. I know many folks believe this doesn't work, but I've seen it effective. Haldol IM is my last resort, if the patient doesn't have LBD and is trying to hurt himself or someone else. We're lucky though, we have a lot of resources including a behavior response team that can spend the time talking the patients down and often helps us avoid medicating them entirely.

Depending on patient acuity, 6-7 admissions in those 10 hours might be a lot. I work 10 hour admitter shifts and my cap is 5 (they are usually very high acuity). I have no other responsibilities beyond those patients I admit - are they expecting you to do other floor work or cover pagers? The no PTO/sick time is rotten. Would the new place offer you PTO?

We do the second option you listed, although we have a very large group (~50) and some of us do 7/7 by choice. PTO is based on years with the hospital, but for most of us is 10.15 hours per 2-week pay period. They call it “33 days” but that’s 8 hour days. So it’s really 22 days of our 12 hour shifts. Were you asking about other bennies or just PTO?

Young mom with aggressive cancer. Came for surgery, found unresectable intraop. No family that we knew about aside from the elementary aged child. She had a panic attack when we told her the news, because there was NO ONE else to take care of the boy. No family, no friends, no neighbors, no church. He was going to end up in the foster care system if she didn’t spend the last precious months of her life desperately searching for someone trustworthy. It was agonizing.

I use it a lot as a hospitalist and I'm currently working towards my certification from SHM. For me, it's been most helpful for a quick glance at the IVC and lungs when I'm on the fence about additional diuresis. I've also saved patients a trip down to radiology for cellulitis to rule out abscess. I'm pretty careful in my documentation to never pin my medical decision making solely on POCUS. I'll probably be less anxious about that once I have the certification so that I can have something to say about my credentials if I'm ever pressed.

Minnesota is great.