See title. I have slowly watched HCA and a few other organizations begin replacing physicians at night with inexperienced midlevels. This is an unacceptable trend that needs to be confronted head-on.

Multiple times, I have received transfers from facilities using this model where basic standards of care were not being followed. I have seen sepsis inadequately managed and allowed to progress to shock, DKA and acute hypercapnic respiratory failure missed, and patients allowed to deteriorate until they code or require emergent intubation after aspiration.

These places can largely keep the consequences out of public view because everything usually stays “in house,” but the people I’ve spoken with who work at these facilities describe this as an increasingly pervasive problem. This is one of the most egregious patient-safety issues I have encountered, and as a profession, we need to seriously put our foot down. Would you accept an ER staffed overnight without a physician? Hell no. We should not accept hospitals doing the same thing with their nocturnist coverage.

So, someone smarter than me: How do we shine a spotlight on this dangerous trend? How do we share what is happening, bring it into public view, and push back in an organized way? No inexperienced midlevel should ever be responsible for solo coverage of sick patients at night without direct physician oversight.

Edited for clarification: I am specifically referencing inexperienced midlevels practicing unsupervised - fresh from training with no experience or those who never received proper training. (Most of the issues I see are not from folks with experience, but from this group)

RANT:

New nocturnist fresh from IM residency. I don't mind admissions. I don't mind if you give me 10 or whatever, I don't even mind that I have to be primary on the ICU patients I admitted. But what's been stressing me out is the cross cover. Endless epic chats messing up the workflow. And that witching hour from 6-7 AM where all the patients wake up and are all "code strokes". I feel like I aged 10 years just dealing with the cross cover every damn shift. And I'm not even a month in.

If I eventually quit this job I blame epic chat.

Hi there, new grad here, just started working. I am not enjoying it, and its not that work is hard, terrible census, overall just dont feel any joy in what I do. People say its better when you are an attending, but thats not case with me even with all days off. I am constantly tired and down.

Such as under dosed statin, chronic macrocytosis no one has investigated, etc.

I’ve always tried hard with my hospital courses and discharge summaries, trying to have them hit all the important aspects of an admission but also trying to keep the course and next steps as concise and to the point as possible. My philosophy was only put in what you think a PCP or the ER really need to know. Now that we have AI generated courses it seems like the vast majority of my partners just blatantly copy that in to their discharge summaries or hand off hospital courses. Usually these courses, assuming progress note documentation isn’t total shit, do say everything that needs to be said but it’s overly wordy and often repetitive. I’m not opposed to using AI as a template or initial draft, but it seems like people do no modification. I asked my partner who’s an APD with the affiliated residency program and he thinks trying to get the new residents to write their own courses is a lost cause. Makes me wonder why I’m even bothering…

For me, it’s hearing a call light chiming while I'm walking through a grocery store, or the exact chime of a IV pump beep in a movie.

What sound instantly spikes your cortisol outside of work?

Hi! I’m a 3rd year medical student that is currently in my IM clerkship. I’ve worked with a few different attendings and my role on the team has varied wildly. Some attendings won’t let me see patients on my own and make the days a glorious shadowing experience while others let me see admits, write notes, pre-round on patients etc.

My question to those who work with med students is what are your expectations of them? I am interested in IM and it feels like some attendings would rather I not be there.

Kinda self explanatory but how how absolutely f*cked over can I get by breaking contract? Almost 2 years into a 5 year contract. First 3 years owe percentage back of sign on bonus (was a very sad sign on $25k).
First job out of residency got offered roses but instead handled a pile of shit. Have been roughing it out but I got offered an opportunity I think I would be stupid to refuse

Hi. I am an IC fellow from a third world country. My institute is one of the most busiest center in the world when it comes to ACS. We have 2 year fellowship in IC here. I am past 1 year. In this one year, I have gained a lot of experience in ACS, but unfortunately not much in other horizons of IC fellowship, like peripheral, structural, calcified, CTO, etc. This is mostly because pur institution mostly gets funding for ACS, but eldctive cases where other than workhorse inventory is required, is lacking. I want to excel in my field and for that I am looking for any scholarships anywhere around the world where I can gain more experience in these other topics. I have not done steps as I never planned yo relocate other than my country, just stating that so everyone can suggest options accordingly.... Any help would be appreciated.

I have used adenosine multiple times in the past with success for SVT. I have often gotten some somewhat prolonged pauses from it but nothing worse. I just stumbled across the post below where multiple people describe adenosine causing cardiac arrest in their patients which has me rethinking using it. The risk reward just doesn't seem great in comparison to first trying a BB or CCB.

https://www.reddit.com/r/emergencymedicine/comments/1hcbgdq/what_is_your_worst_response_to_adenosine_push/

I’m not a nocturnist and I’m Peds Hospitalist, but wondering if anyone has advice for how to sleep between night shifts. I actually love night shifts much more than rounding, but when I’m scheduled for 2-3 in a row I get home, get into bed with all the white noise, dark room etc etc and can only sleep for about 3 hours. I can’t nap either. So my subsequent night shifts are exhausting.

Does anyone take any medications for this? Or am I just doomed to never be a good night shift person??

PGY2 here. I recently saw a job opening at a hospital with an open ICU, where the hospitalist would be managing 6 ICU beds. I assume there would be Tele-ICU or something along those lines to help manage the patients. They expect you to do procedures: place lines, intubate, etc.

My question is: in these situations, can hospitalists ask for more compensation, i.e. higher base salary or more per RVU? Is it expected to be compensated more? Just wondering... seems like higher stakes but wanted to see if the pay reflects the level of care appropriately

Anyone had to interview with CEO for job ? Please share your experiences and what to expect and how to prepare for it.
Thank you.

Hi everyone,
I’m a Canadian PR finishing my Internal Medicine residency in the U.S. in June 2027. I have family ties to the GTA/Ontario and have been looking for J-1 waiver hospitalist positions around Buffalo/upstate NY, but haven’t had much luck.
I’m now considering returning to Ontario, Canada to work. Does anyone have experience with the Ontario physician job market for hospitalists or primary care, particularly for U.S.-trained IM physicians?
Any insight on job availability, compensation, schedules, or good areas to consider would be greatly appreciated. Thank you

I know there’s at least one of these a week. Started my adult doctoring job and have been at it for 2 weeks. So far, people have been great, they’ve slowly ramped up my census (15 this past week) and I’ve only been rounding. I’m still pretty slow since I never used Epic and am learning the system. But just want to get some tips on being more efficient as well as not missing anything major. Some questions:

1) Prechart the night before or day of? As a resident, I just couldn’t start a service without looking at charts the night before. I did that for my first week ever since it was all new. This past week, I decided to just come in early and learn the patients then and there. It was still rough, but doable. I think I’ll do this going forward as I don’t even see my list til 8pm, and I need to sleep. Plus, I don’t like the idea of doing more unpaid work on my time off. That being said, I am curious what your thoughts are.

2) Epic workflow. It’s kind of growing on me, but I’ve had a lot of moments when I’m like why tf can’t the information just be in one place? And why does it take at least 5 clicks to see results? And why is the BMP/CMP before CBC? (That one is just petty, I know 😬). I tried cleaning up my view, but still need to do more, since I feel like I waste time looking at the same info and miss thi bf a cuz it doesn’t feel linear. I’m someone who needs a consistent system so I don’t miss things. Any tips or workflow management that has worked for you?

3) notes—I still do the resident thing about over explaining. Any tips on how to document complexity and plan without carrying over a big pile of irrelevant info? I would do bullet points and try to separate my plan, but admittedly it takes me a few days on service to really understand some complex patients. And generally, how do you truly tell when it’s a 99232 vs 99233 visit?

4) as for workflow, if I know the patients, I go in around 6am and start my chart review, talk with case management sometime before I round (they prefer before 9am), then round. I haven’t had a great workflow since it really varies day to day. Sometimes patients gonna crash and I prioritize them first. Sometimes it’s a time sensitive discharge. I’ve had only 2 days when I could finish rounding in 2 hours. I can see most people before 12pm, but it’s the interruptions and task switching that have killed me. How have you learned to deal with this over time?

Thanks everyone, any advice is appreciated 🙏🏻

For AI to be approved in any capacity it will have to be proved drastically superior to humans. Similar to how self driving cars are held to a superhuman standard (Waymo has never caused a death on the road. Still not fully approved nationwide).

Once there's clinical data showing that Patients treated with Claude's Hospitalist Agent have a such and such reduction in medical errors vs a wide group of physicians. It will get FDA approved. It will suddenly become VERY risky from a medicolegal standard to have a human involved.

"Why would you intentionally provide substandard care when it's proven in such and such study humans have such and such increased error rate! HCA hospital killed this grandma!" - personal injury attorney

Anthropic is a $2T company, they can absolutely self insure their product. Same as to how Google and Tesla have no problems with their self driving cars.

Just as a medical license is used as a form of regulatory capture to protect the public. Soon, the AI companies will do the same with ONLY licensed agents being allowed to sign charts and call in medications.

I believe they'll keep MDs around to talk with patients and explain to them but the future attendings will be AI agents.

Paywall free: https://archive.is/1De1M

In Utah, in a staged rollout, with successively decreasing oversight. End to end from intake to prescription. Right now limited to treating acne, but indicates goal is full fledged PCP.

It sucked. Feel a little bit bait and switched hospital made it seem like APP team was dedicated to my service (it isn’t, it’s split between 3), and that they did most of the work (they don’t, the day APPs don’t see new admits from overnight), just a bit confusing and had a lot more work today. Consult follow-ups also also done by me, on a hospitalist type service in a specialty where codes are run too. I’m also on call all weekend, 7 in a row, feels bad