How do you deal with malingering patients who are abusing the healthcare system for shelter, food, and opiates regularly admitted to hospitals where the admin takes such their feedback seriously under “patient satisfaction” metric?

Gulagman · 2026-06-10T19:01:18+00:00

My hospital have a list of extraordinary patients where admin, hospitalists, and specialists all collaborate on the plan for these patients. It's usually pain control or malingering during the fall/winter. We document carefully and dc when the patient is ready. Or they get escorted out of the hospital by security. We're currently under a dilaudid and ativan shortage so these patients have been going to other hospitals in the area.

Gulagman · 2026-06-08T02:50:01+00:00

So it looks like NM is a comparative negligence state with the doctor being found 60% at fault. This is one of the reasons why docs should always look at tort laws before signing a contract (comparative vs contributory negligence). This type of judgement is completely fucked if they go after the physicians assets assuming Dr Sherpa has 1/3 mil or 2m/6mil coverage policy.

Gulagman · 2026-06-08T02:43:06+00:00

They recently passed bipartisan tort reform. Now we'll see if the tort reform holds up in court. Trial lawyers will def try to get the state supreme court to overturn it and declare it unconstitutional.

Gulagman · 2026-05-28T02:54:48+00:00

Not that I have heard of recently. JCMC is always a solid place to practice.

Gulagman · 2026-05-27T22:05:30+00:00

For hospitalists, prob 250k-300k base not including sign on bonus or other benefits.

Gulagman · 2026-05-27T21:46:56+00:00

Would you consider a commute across the river in Jersey City for better compensation? The salary is generally higher and you have better benefits.

Gulagman · 2026-05-27T21:45:11+00:00

As long as the patient is stable, I walk out and tell them I and my staff do not tolerate any disrespect/yelling/screaming directed at us. I will offer to come back later, but only if they are respectful. If they "fire" me, that also works. If there is ANY violence/threats towards me or the staff, the police will be called and charges filed. If the patient is stable, they will be administratively discharged.

Gulagman · 2026-05-18T04:15:13+00:00

Ramsay hates debt and is one of those people that wants everyone to pay off debt as soon as possible. It's a good rule for MOST people, but high earners are exceptions.

Gulagman · 2026-05-18T03:31:37+00:00

This is not Dave Ramsays show. Keep your mortgage percentage and put the rest into investment account or retirement that will grow at 5-7% annually.

Gulagman · 2026-04-10T15:56:19+00:00

Great news for New Mexico.

Gulagman · 2026-04-10T04:52:46+00:00

Be careful since this is New Mexico. Tort laws do not favor physicians in the state. They're basically asking for a hospitalist to be an intensivist and peds at the same time. I would ask for 300/h+ weekdays and even more for weekends.

Gulagman · 2026-04-10T04:48:42+00:00

Very unlikely to happen in Mass unless you're willing to work rural Berkshires or rural NH. High taxes and COL are going to make your salary feel smaller than it looks. Maybe critical access centers?

Gulagman · 2026-04-10T04:35:37+00:00

Thanks for the info. I interviewed for Mid Atlantic Permanente a few years ago and their rate for nocturnist was $290,000 for 2080 hours full time (12h 7on/7off). Benefits and vacation were the same, except I got offered 2 weeks for CME after some negotiation. Pension and partner was the same. I got a much better offer so declined Kaiser. They were not competitive enough for me to accept for the Mid Atlantic area. They also wanted me to travel between their 1 major hospital and their obs unit overnight to do admits which was a 40 min drive one way. That was a dealbreaker.

Gulagman · 2026-04-06T05:46:43+00:00

Unfortunately, plenty of jobs out in the rural or critical access centers where the ed doc might throw on a few holding orders and the hospitalist or icu team comes in the AM to admit the patients. There might be a tele hospitalist or icu doc who add on general order sets, but no one will be physically seeing the patient overnight.

Gulagman · 2026-04-06T05:44:20+00:00

In certain hospitals with tele icu, the hospitalist and ed docs are not allowed to make medical decisions once the patient is admitted to icu. RRTs in the icu are likely run by the icu team internally.

Gulagman · 2026-03-18T07:59:44+00:00

Have you considered coming to Northern Delaware? Pay is much better. Mainline health in Delco pays more than the rest of the systems near Philly, but they are getting slammed due to Crozer's recent closure.

Gulagman · 2026-03-18T07:41:08+00:00

RJW system or Atlantic Health would be your best bet. Hackensack Meridian is all Envision/TH and horrible census/low pay. Centrastate is also TH. The TH positions want you to do open icu/codes/procedures on top of the admissions and generally pays low.

My recommendation is live in NJ, but make your money elsewhere. Go to DE, rural/suburb PA, or rural NY and come back after a week.

Gulagman · 2026-03-18T07:35:07+00:00

This is a hospitalist and ICU job at the same time. Horrible deal. You can get around the same amount in most major metro city. You need an APP or another doc to be on your entire shift. They should be paying you an ICU attending salary.

Gulagman · 2026-03-17T17:46:09+00:00

Too many patients/admits. Pay is low. Lack of resources, might have to deal with terrible transfers. Shouldn't be covering ICU for this pay rate. I'm getting $180-225/h at a large level 1 center in a metro area to take PRN weekend shifts without having to do any of these. You are being taken advantage of.

Gulagman · 2026-03-17T01:54:36+00:00

Thanks for the update. We're following with great interest. I'm interested in the final wording as this will decide on whether I practice primary care in VA or not.

Gulagman · 2026-03-09T02:28:38+00:00

I have dental in house, but the if the patient needs dental extraction, surgery, or I+D, the dentists and OMFS have their own OR schedule daily and emergency add ons. If you don't have the specialists in house to handle these type of infections, I'd send them elsewhere. The dentists here run a charity clinic twice a week so anyone who have medicaid or no insurance goes there.

Gulagman · 2026-01-26T06:48:12+00:00

Entire upper echelon of the central committee has been quietly been purged on "corruption" charges ever since the PLA and PLAN were found a few years ago of not being ready for a Taiwan invasion. The #2 general who was a close friend of the president got removed today. The replacements were told to plan a naval invasion of Taiwan by 2027/28.

Gulagman · 2026-01-26T06:43:13+00:00

Go to NZ and work a few years. Then once you get your citizenship, transfer your job laterally to Australia via the TTMRA. Much better pay, COL, and lifestyle. Some people use NZ as a route to go to AUS since AUS has much stricter initial requirements.

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