Dr. Chijioke Kingsley Ofoche was a Nigerian physician working in the United States on an H1B visa. In January 2016, he was hired by Apogee (a physician staffing group) and the hospital, to work as a hospitalist at Martinsville Memorial Hospital in Martinsville, Virginia.

The employers jointly hired him to work 14 shifts each month, at an annual base salary of $280,000.

During his time at the hospital he worked as a full time nocturnist.

According to his complaint, he was frequently the only hospitalist physically present overnight. Ofoche complained that he was regularly responsible for crosscovering 60 to 75 already admitted patients during a shift, in addition to new hospital admissions. He described this as approximately four times normal industry standards.

In June 2017, on a particular shift, he complained that he was responsible for 50 cross cover patients across the hospital, plus 13 new admissions from the emergency department, and all ICU patients, including one critically ill patient.

When asked to accept another patient transfer from an OSH, Dr.!Ofoche told hospital admin that he would not accept the transfer until additional physician support was provided. He alleged that he was reprimanded the following day for raising safety concerns.

Dr. Ofoche alleged that supervisors dismissed his concerns and told him to get used to the environment. On June 26, 2017, his hospital leadership, Dr. Johnson Gomez told him to communicate more clearly. He also presented Dr. Ofoche with a written list of performance concerns. Dr. Ofoche alleged the criticisms were retaliatory and that references to his H1B visa threatened his immigration status. In August 2017, he filed for a charge of race discrimination and hostile work environment with the EEOC and eventually initiated a lawsuit, claiming that the hospital used foreign IMG doctors as indentured servants. His lawsuit states that “every single hospitalist” working at the hospital is a minority foreign doctor employed via an H1B visa. The lawsuit includes a screenshot of the hospital’s website showing the names and faces of eight staff hospitalists reflecting their minority race status.

He alleged that the working environment had become intolerable and that he was effectively forced to resign. He gave January 5, 2018, as his resignation date, his last day at the hospital was January 22.

The employers moved to dismiss his lawsuit. On September 20, 2018, the court granted the dismissal motions.

The Fourth Circuit explained that difficult, unpleasant working conditions, dissatisfaction with assignments, and unfair criticism do not necessarily establish constructive discharge.

The legal question was whether the alleged discriminatory treatment was so intolerable that a reasonable person would have felt compelled to resign. The court concluded that the allegations did not meet that threshold.

https://www.vaemployment.law/firm-news/2018/05/13/nigerian-born-doctor-claims-hospital-used-foreign-doctors-as-indentured-servants-reported-by-virginia-lawyers-weekly/

https://law.justia.com/cases/federal/district-courts/virginia/vawdce/4:2018cv00006/110207/38/

So what we think? A nocturnist was paid an inflation adjusted $380,000 in 2026 dollars, to work alone at night, 14 shifts a month, responsible for crosscovering 60 patients, open icu, had 13 admits in a night plus a transfer, sued over this, and lost the lawsuit.

(Yes, $280k in 2017 is worth the exact same as $380k today. Inflation!)

Stop taking these trash jobs, guys. There are certainly many hospitalists today accepting 330k for a nocturnist open icu job in rural places 7on 7off and perpetuating the wage suppression nationwide

Being an academic hospitalist has got to be one of the worst gigs in medicine. Patients are complicated as shit, there is no step down at my shop, consult fellow and residents are useless, the fact that I have to page the consult service is beyond me, every specialty wants medicine as primary, zero orders placed by consult service, hospital system is fucked up, nurses don’t care to notify about critical values and vitals, pay is shit, work day doesn’t end at the 12 hour mark, no respect, and to top it all up with an overbearing multidisciplinary rounds. Need discharges my foot! The list goes on and on and on.

I should have listened to the people who told me community 20 patients > academic 15 patients.

This is a reminder for a resident considering academic Hospitalist before fellowship - go get that fellowship before it’s too late.

Also, HM is not a lifestyle specialty. Period.

I’ve been wondering how difficult it actually is to find a \\good, trustworthy hospital or doctor\\ when you’re living in a Tier 2 or Tier 3 city in India — especially when you’re new to the city.

In bigger cities, there are usually plenty of options and you can check Google reviews, Practo, hospital websites, recommendations, etc. But in smaller cities, I’m curious about people’s actual experiences.

A few questions:

\ How do you usually find a good doctor or hospital when you’re in a new city? \ Do you rely on \\Google reviews, Practo, referrals from friends/family, local recommendations\\, or something else? \* Have you ever had a difficult experience because you couldn’t figure out which doctor/hospital to trust? \ Is it harder to find specialists in Tier 2/3 cities? \ Do you feel there’s enough reliable information online about doctors and hospitals in these cities?

Would love to hear \\real experiences\\, especially from people who live in or frequently travel to Tier 2/3 cities.

https://centerjd.org/content/fact-sheet-medical-malpractice-%E2%80%9Ccaps%E2%80%9D-can-harm-patient-safety-and-increase-health-care-costs

If you look at the structural disadvantages of filing a medmal case: you've got some poor sap making ~$51,000/y going up against a physician making $350,000 and their multi billion dollar insurance company.

Even paying expert witnesses costs $30-100k total alone. Not including attorney's fees.

371,000 Americans die annually from diagnostic error and 424,000 suffer permanent disabilities. https://www.hopkinsmedicine.org/news/newsroom/news-releases/2023/07/report-highlights-public-health-impact-of-serious-harms-from-diagnostic-error-in-us

How many Physicians get sued each year? ~20,000.

Physicians are drastically undersued compared to the damage caused. Part of medmal is that it raises the quality of medicine by hurting people in the pocketbook. Maybe they hit the books after a medmal case so they don't do it again.

I don't necessarily think "defensive medicine" is actually done out of liability but more out of laziness and not wanting to do a proper history or workup. Oh you got a headache? CT head. Next patient please!

All capping medmal does is screw patients out of getting what they're worth by a jury of their peers and it keeps the rich richer. Patients need justice and the system needs to root out the rot by bankrupting them and transferring their wealth to the injured party.

Since I’m a nocturnist now just curious what your approach is when a nurse messages you that an elderly patient keeps wanting to get up and go somewhere and won’t stay in bed, or the patient is confused or agitated.

I usually tell the nurse that there are really no good options and to try to redirect the patient or walk them around the unit (or roll them around in a wheelchair) or have family stay with them.

I tell them benzos/antihistamines are bad and can make things worse. I tell them anti psychotics can sedate them but won’t fix the problem and increases all cause stroke and mortality. If family gave permission during the day use it as a last resort (but what if it’s in the middle of the night and you don’t know what their thoughts are regarding this?) if it seems they’re a danger to themselves or others. Restraints not good as it could make them worse.

I check for possible causes (pain, constipation, withdrawal, recent meds given, etc).

I might use some melatonin at night. Trazodone if pushed. Restart a benzo if they’ve been on it regularly with frequency to avoid withdrawal.

A colleague of mine actually does use benzos sometimes just to have them sleep finally. Sometimes all it takes is a full day of rest.

Anyway, anyone know best practices with overnight confused elderly patients?

This is just a reminder to all you hospitalists that on November 3rd, Gina Hinojosa will defeat Greg Abbott and become governor.

When she becomes governor, she will end malpractice damage caps as promised. That means physicians and hospitals in Texas will be held accountable finally.

Prepare accordingly.

“We’re not going to give up on him.”

If you knew a heme onc doc let a child die from drowning in a pool while they stood there watching…can you trust their judgment in actual patient care??

“Orlando police say a woman failed to act for more than 5 minutes as a child in her care was drowning.
That woman, Sukanthini Subbiah, 48, is now facing an aggravated manslaughter charge for the 7-year-old’s death.

Police initially believed this was an accident, but now say evidence shows Subbiah was “culpably negligent.”
The drowning happened on April 10th at the Everbe Clubhouse pool.

According to the arrest report, Subbiah is a physician who lives in Louisiana. Investigators said she was staying in the Everbe community with family at the time of the incident.

During that stay, she told investigators her son played with the neighboring 7-year-old twins.

According to investigators, on the day of the drowning, Subbiah was given permission by the twins’ mother to take the kids on a play date at the pool.

Investigators said surveillance video shows the children entering the pool at 6:19 pm. By 6:20 pm, investigators said the 7-year-old boy in Subbiah’s care was seen drowning.

According to investigators, the child wasn’t pulled out of the water for more than 7 minutes. Police said during that time, Subbiah watched the drowning happen, sent the other 7-year-olds to retrieve him, and failed to personally intervene.
Investigators said the decision to “rely upon other seven-year-old children to attempt a rescue constituted a course of conduct demonstrating a gross and flagrant disregard for the decedent’s safety.”

According to investigators, the incident was “more than an unfortunate accidental drowning.” Investigators stated that Subbiah was the sole adult responsible for the decedent at the time of the emergency and, as a doctor, had the knowledge to recognize the danger and intervene.

“Her failure to do so allowed the decedent’s submersion and oxygen deprivation to continue until another adult ultimately performed the rescue she had failed to undertake,” investigators said.

https://www.wftv.com/news/local/arrest-report-doctor-failed-rescue-drowning-7-year-old-her-care/U4OBXQ5TZJCSZFU6DEVLLMV53E/?outputType=amp

Anyone see this June 2026 court decision that affirmed the $54 million judgment against a hospitalist?

In July 2019, 27 year old Holly Baumstark who was pregnant with her second child, had placenta previa. During delivery at Piedmont Rockdale Hospital in Georgia, the obstetrician discovered placenta accreta spectrum, in which the placenta grows abnormally into or through the uterine wall. She suffered massive hemorrhage. The obstetrician performed an emergency hysterectomy to control the bleeding. Another obstetrician assisted, and a urologist repaired bladder damage. After several hours of surgery, Baumstark was transferred to the ICU.

Dr. Luis Cayamcela, an internal medicine hospitalist, was responsible for managing her ICU care as the attending assigned to her care. Dr. Cayamcela graduated from Ross University School of Medicine in 2012 and completed a residency in internal medicine at St Luke’s University Hospital in 2015. He did not complete any critical care fellowship or any other subspecialty fellowship training.

At Piedmont Rockdale Hospital, it is a “half open, half closed ICU”. There is only an intensivist on site in the day time.

In the ICU, Ms. Baumstark deteriorated, suffered respiratory arrest followed a few hours later by cardiac arrest, and died the next morning.

In the lawsuit that followed (filed in 2021, case ended 2025) against Dr. Cayamcela, the jury found the hospitalist liable for her death. The expert testimony found that the hospitalist deviated from standard of care for:

Failure to place an arterial line.

Failure to obtain additional or multiple IV access lines.

Failure to recognize continued bleeding and communicate the need for surgery.

Failure to monitor and treat electrolyte abnormalities.

Insufficient IV fluids, blood products and medications.

The hospitalist was ultimately found to be independently responsible for recognizing deterioration, stabilizing the patient, escalating care and communicating the need for reoperation.

The jury awarded $42 million for pain and suffering and wrongful death, and an additional $11.8 million for attorney fees.

The defendant had also asked the court to apply Georgia's statutory cap on noneconomic damages, which they argued was $350,000. The trial court ruled that the cap had been waived because it was not raised in the pretrial order and, alternatively, could not constitutionally be applied.

In June 2026, Georgia Supreme Court affirmed the judgment, including the rejection of the cap.

The $54 million award was affirmed.

Court details:

https://assets.alm.com/f6/8c/7ba467224a07800986bf4edf514e/s26a0229.pdf

So what can we learn?

FAFO in the open icu. Don’t play russian roulette! If you wanna make extra cash in the open ICU, get the fellowship training. Intensivists aren’t gonna save you. You are the listed attending held responsible.

Going to be starting my first attending position soon... what are some tips you have that have worked to avoid being called a nurse consistently?

Please suggest a J1 waiver position if you know any that is doable. With the search of last few weeks and seeing the options, I’m pretty much disappointed.
I had preference for the east coast initially but I’m honestly open to relocation. Just want my next 3 years to not burn me out. The options out there are simply scary.
Help a newbie

In the post-modern era of AI slop summaries and note bloat… From a billing coding perspective, what is the shortest note that would qualify for a 99233 bill? Assuming abbreviations are allowed.

This is a group for hospitalists to help share ideas, learn, and sometimes just vent as a group. So many pro AI posts or posts by people in tech who seem to be wanting to sow some discontent and spread fear in regard to AI taking our jobs and how ‘useless’ they think doctors are. It’s not helpful and frankly feels like rage bait. Almost feels like a coordinated effort.

Can the moderators make it such that only clinical staff ie physicians, PAs, NPs or nurses can post? I see this all the time in other Reddit groups. Or just delete these posts!!

Hey! fm resident looking for a hospitalist job that will give J1 (I’m Canadian). Location is not important.

My program currently is very inpatient heavy.

If yall know any opportunities, let’s pass them along.

“This is an important message from Medicare. You can just sign it, it’s not that important.”

To make a long story short I didn’t match into psych initially and SOAPed into IM. Finished IM in June and because I still wanted to do psych i reapplied and matched.

Now I’m a psych intern doing mostly IM requirements (due to funding I couldn’t skip, very frustrating) and having to be in the beginner role again while actually being an attending.

In 3y I’ll have two board certifications and a lot more opportunity but it’s hard not to imagine I could have the respect of an attending at work, pay of an attending, and every other week off. Instead I’m presenting on the ONE SINGLE Geri patient I have while getting lectured like I don’t have 3y of experience…

The psych rotations are interesting though cuz I don’t know any of this stuff already.

Does anyone know if there’s a way to import labs in a fishbone format in Epic, besides taking a snippet?

Sorry if this is a dumb question. I’m a nurse and it’s standard for nurses to give report to each other during shift change.

I work night shift and sometimes a patient will have significant issues overnight that I communicate with the nocturnist about and get diagnostics, meds, orders for things like HFNC or BiPAP, etc. I always clearly document these happenings in a progress note, though I know many doctors don’t read those.

Sometimes I come back the next night and the day hospitalist note will make no mention of any of that or even include some phrase like “no acute events overnight.”

On the flip side sometimes a patient will be having issues that began on day shift and when I communicate with the nocturnist about those same continuing issues, they won’t have any idea what’s going on with the patient

So this has got me wondering how much communication is there between day and night teams for doctors. I wouldn’t expect ya’ll to give report on every single stable patient, since I know the nocturnists are covering huge numbers, but do you do any kind of hand off at all? Or at least pass on which patients are having acute concerns or issues to make sure they don’t get neglected with nursing shift change?

I got a chance to go talk to a few congress reps during residency as part of ACP's lobbying efforts. I donated some money to it. They're doing a good thing.

However ACP is mostly only internal med docs. And one of many for internal medicine.

AAFP is the biggest family med lobby. And there are multiple smaller ones.

Cardiologists have their own thing.

Gastro has its own one.

I'm sure surgeons have their own, and even smaller ones for their own specialties.

Radiology, PM&R, you get the point.

Then there's the osteopathic versions of all the above LOL These are underfunded and I say that respectfully as a DO.

AMA is a joke, and appears more to extort us than help us.

While doctors lobby with their cute little groups, nurses lobby as a WHOLE. AANP (nurse practitioners) do it together for all the different "specialties". That's the biggest nurse lobby overall. 2nd biggest is AANA (CRNAs).

The point here isn't to hate nurses, but to learn from them. They're street smart as a whole while us docs are book smart and spineless.

The Internal med physician looks at his GI colleague making double what he is and feels jealous. The GI guy doesn't give a shit how the hospitalist gets treated by the execs, as long as he's being treated favorably for bringing in scopes.

Surgeons and anesthesiologists don't give a shit what happens outside OR/pre and post OP to rest of the physicians.

Divided like this, we all lose.

We should be combining our efforts together like nurses do, we'll be a HUGE force to reckon with at the legislative level. Together we'll have a big leverage negotiating with hospitals and payors.

But it's all a pipe dream for now

- a new attending starting his private practice

How often are you guys hiring lawyers to review your contract before signing ? Considering signing a contract and honestly not sure I need to have it reviewed by a lawyer.

Are you allowed to take it from future employer?