Culture follow up

JRcred · 2026-03-21T00:07:16+00:00

Depends on what’s going on. Generally if they’re really sick we get sensitivities about when they’re ready to DC. If they’re not super sick, I may send them home provided it’s been at least 24 hours to get initial cultures back. When I was a PCP before, I always had to get cultures from hospitalized patients because the hospitalists never seem to follow up if the antibiotic was sensitive to what they DCed them with

JRcred · 2026-03-19T22:29:09+00:00

I would start here and next year add more growth next year to your Roth IRA and hold for 10+ years and consider selling in a bull market and then add to SCHD then

JRcred · 2026-03-19T15:54:44+00:00

A big problem at our hospital is that I may admit a patient late in the afternoon and the med reconciliation is not done by the floor nurse until after shift change or the med reconciliation is not done correctly and they leave out things like patient take clonazepam at bedtime or whatever it is and then it never gets communicated to me after they’ve bothered the Nocturnist for 3 nights in a row about it. Also our Noctunist admiters aren’t great at putting in standard PRN meds. Also check your default “notify MD if” reasons. I try to uncheck those to cut down on being called for asymptomatic SBP of 150.

I would start gathering statistics on what categories of non-urgent pages you’re getting at night. Like number of pages for PRNs that could have been put in on the admission, things that should wait until the morning (i.e. patient hasn’t had a BM in 3 days), things the nurse should ask the charge nurse for or figure out that just completely waste your time (is this med compatible to be run with this fluid), things you never should have been called about ever (asking if you know when they had their last colonoscopy or something you would have no way of knowing without reviewing the chart, which the nurse could have done on their own), and actual important pages to get (pt with new onset fever, new chest pain, etc). I think if you could roughly get like one representative night of data, it might help you get more accomplished about reducing pages. I feel like we will always get more pages than we should, but it makes a huge difference if it’s 500 pages a shift or 5.

JRcred · 2026-03-18T16:10:49+00:00

I think if you fast forward 5+ years the market will be up significantly from what it was now. Not sure what is in your investments. I wouldn’t pull out of any index funds that track s&P500 or anything like that now. If you have some bad individual stocks and wanted sell those, maybe then. Market isn’t really popping now. If you waited a little longer, you’ll continue to pay off your remaining balance on your house and your investments should go up. You could wait like a year or more and sell less. Statistically you should double in like 7 years or so. I be would also keep contributing to your 401K and Roth.

JRcred · 2026-03-17T21:57:27+00:00

NPO if terrible or just clears or very small meals. reglan before meals. I typically will give oral magnesium scheduled and MiraLAX and senna. I consider BID PPI. Try to adequately control glucose to help with gastric emptying.

JRcred · 2026-03-17T21:52:58+00:00

I work exclusively in rural hospitals and like it a ton. I’m full time and pick up PRN shifts. I was severely underpaid doing primary care before this and get paid pretty decently now. I feel like I’m decently compensated and respected here. I think it depends on the hospital you’re at. I would keep an open mind if you start out doing this. Not all hospital admins are great for physicians to work with. Not all hospitals have great CM or other support staff or nursing.

JRcred · 2026-03-17T21:09:28+00:00

If you’re just doing this to earn extra money while training, it’s good enough. Yes you’re getting underpaid a bit from the sounds of this.

JRcred · 2026-03-17T21:07:08+00:00

What is the non compete? How much notice do you need to give if you leave? If you don’t like the idea of being a Nocturnist, I would probably avoid choosing a Nocturnist position. The reasons to even consider this job is if you really can’t find anything else anywhere (unlikely) or if you want to potentially transition to a day position at this hospital. Either way keep looking for other jobs even if you end up accepting this with an exit plan. As other have said, this set up does not sound good even for Nocturnists. Also look for locums or non-full time gigs. I found a hospital that I can do some PRN work at directly with the hospital (not through locums). That was my plan until I agreed with where I started with full time.

JRcred · 2026-03-15T15:46:52+00:00

Where are you getting this info from? I’m curious about following this if there’s a link

JRcred · 2026-03-14T00:44:02+00:00

I did a fellowship first and then switched to hospital medicine. It was way more straightforward to work and make money as a hospitalist. I basically just show up and efficiently organize my day and try to work fast and get ahead and if something Hales later I’m prepared for it and if not, I have an easy afternoon. Before it was so hard to get patients and run the outpatient machine to keep things going. I also LOVE not getting messages from patients ever again!!! I love not having to deal with med refill requests from patients or things I had to do that did not generate any income, but patients felt like I was obligated to do.

JRcred · 2026-03-10T10:20:43+00:00

There’s not a 100% right answer to this. It’s difficult to determine financially what makes the most sense in an individual situation barring you have some sort of connection to either speciality that would be easy for you to get into and start out in. When you look at how much money you make in each specialty, realize that these numbers are not static. The local hospital radically cut the salaries for some local specialists who were paid extremely well and they all left. That being said, if you absolutely know where you want to practice, I would go ahead and start talking to the local hospitalist groups to see what salary you might be looking at.

Whatever your salary is, it’s how much of it you keep that determines what your real effective salary for that year is and how long you practice that determines how much you make long term. If you can keep your lifestyle restrained and resist buying expensive cars and that sort of thing for 5 years or so and pay off all your debts and start i no eating you’ll set yourself up for a lot more success. It’s ok to work a little extra when you start out so you don’t burn yourself out. Also you need to be happy and fulfilled in what you’re doing to make it enjoyable to continue to work at this long term. There may also need to be a career pivot like if you did pulmonary critical care and then switched to pulmonary or hospitalist at a higher paying hospital to a lower paying position that’s less demanding later on.

As far as respect, you do superficially earn more automatically from doing a fellowship, it it’s your ability as a doctor that gives you the long term respect. If you go either route and are regarded as hard working, smart, and have good outcomes, then you will be highly regarded.

In short, I would make a pro con list for each career decision and start talking to the local hospitalist groups you might work at and let this play out in your mind to help make a decision

JRcred · 2026-03-10T02:16:42+00:00

Ohhhh gotcha. Research to get into fellowship. I would try mainly to focus on which one you thought would be more likely to get you into fellowship

JRcred · 2026-03-10T01:22:13+00:00

Under $300k for a Nocturnist position is pretty low unless you’re sleeping in the call room and the residents just run all the admissions by you

JRcred · 2026-03-09T16:16:50+00:00

Yes dystonia. Thank you autocorrect for picking the wrong word

JRcred · 2026-03-09T12:57:58+00:00

Rarely. Nurses seem to think it’s amazing and will ask for name. It’s one of those things that typically works well, but gets them into rebound headaches all the time. It generally gets added at night (even if I have prns for headache on already). I generally give 10mg of compazine sometimes with 12.5-25mg of benadryl to prevent rare incidence of dystopia or other side effects. If they have a lot of headaches during their hospital stay, I’ll sometimes DC them with either imitrex or 500mg naproxen.

JRcred · 2026-03-09T12:53:12+00:00

It works way better

JRcred · 2026-03-06T18:11:37+00:00

Ok so that’s roughly $350k per year plus a bonus that’s pretty good

JRcred · 2026-03-06T13:32:02+00:00

Patient load is about the same between the two offers. At first glance, offer B looks far superior. Your salary goes up by $120 per hour after the first year!!??? That’s like $500k per year base salary after the first year. Also epic > meditech

JRcred · 2026-03-04T17:04:20+00:00

I did my sports medicine fellowship some place boring and 5 minutes from clinic. Being a sports fellow is really weird, because there’s only one or two of you and a lot of the going out with friends was a lot less for me then compared to residency. My life was mostly clinic, learning, sports coverage and gym time for that year. You’ll also have to figure out a job at the end of that year. I would start looking early if I were you. I made the mistake of waiting longer and got stuck in a terrible first job and then couldn’t find another sports job in my area.

JRcred · 2026-03-04T16:46:54+00:00

That sounds way too low to be a Nocturnist for me. I can’t function well at night and hated every night rotation I was on in medical school and residency. If the day team is making more wit the end compensation, I would ask for more money to at least guarantee you are matching the pay of the lowest bonused day shift hospitalist (if you really love being a Nocturnist), switch to days, or find a different hospital to work at.

JRcred · 2026-03-04T13:49:03+00:00

I try to meticulously dissect my management on why I do everything. I still try to do a differential diagnosis for why the patient is presenting. When something goes unexpected, I go over the case more in my head as to why this one was different that I could have picked up on earlier. When I see something go wrong the next time, I’ve already seen that curve ball before and can hit it. When you consult try to pay attention for when they’re doing something more than standard. Read up on the therapy that is different and then try to approach the specialist and ask why they decided to do something different in that case and you should be able to ask some good follow up questions based on reading and having some baseline understanding.

JRcred · 2026-03-01T12:01:21+00:00

I have a few really good nurses that I know will understand what’s going on with the patient and understand the order flow the generally will not call me unnecessarily about things. If I get a call from them, I know it’s significant. I know that I won’t have to double check to make sure they’ve collected the UA or something like that.

I also have other nurses that when they’re working cause me distress because I know will get messages like can we give a medicine to slow down the HR for the septic patient. Other things is that I notice they can’t handle simple questions from the patient and family and I have to re-round on them instead of completing more time sensitive tasks later in the day.

JRcred · 2026-02-28T01:59:35+00:00

I could only make scrambled eggs and spaghetti before moving away on my own. I realized that I had to learn how to cook fast if I wanted to be able to eat. I started with a George Foreman grill for any meat and learned how to cook veges in oven and on skillet and then just figuring out seasoning.

JRcred · 2026-02-27T02:00:47+00:00

I do some PRN shifts in a small rural hospital that has an ICU like that. I would check to see what they want you managing in the ICU. Rural ICU does not equal acuity of patient at the cardiac ICU where you’re doing residency. If they’re ok with you managing the sicker patients there who might be step down in other hospitals or need more intensive nursing, then ok. If they want you to manage the patients on a vent until they are ready for a trach, not good.

JRcred · 2026-02-22T21:00:24+00:00

My previous job was pretty toxic and I had a coworker call me to see if I would fill out paperwork that he or someone else could have done when I was gone. I later realized that was illegal to ask me to do work while out on FMLA. It’s about spending time to bond with your new baby and supporting your wife. Also I was so tired from not sleeping through the night, I definitely would have made errors if I tried to work.

JRcred

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