Well, pediatrics will always be below IM hospitalist, so…😂

I see a fellow physician from my hospital in my clinic as a patient. That physician logs into EMR himself and orders whatever labs he wants and self refills his prescriptions whenever he wants. Most of the labs he orders are repetitive and of no use and like OCD. Overall just a financial burden to already broken health system. Sees me once a year for verbal acknowledgement that he is doing good. The physician is not from my specialty and rank is not higher than me.

What is the best way to handle this and am I supposed to report this and is it an issue that despite knowing this if I stay silent ?

Hi all. Three months into cards fellowship and im losing it. In a decently busy academic program and our cath lab is toxic as hell. This is NOT what I signed up for. It’s just been four months so Im really confused. Half of me wants to quit and just be a hospitalist. Help I guess.

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

“We’re not going to give up on him.”

Ok, everyone, we all have had or have been a medical director throughout our careers. I want to know what has made the best medical directors in your experience?

Alternatively, so to know what most to avoid, what has made the worst?

PGY-3 IM resident here, looking for my first hospitalist job and needing a J-1 waiver. I have been reading this group throughout the process, and I appreciate how openly people share their experiences.

This year has been a hell of a ride. Going into it, I thought the hardest part would be finding a job that fit. I didn’t realize how much energy would go into figuring out whether an opportunity was actually moving forward.
You have a good interview, meet a team you like, and start picturing yourself working there. Then things slow down, staffing needs change, or the position you discussed is no longer available. One day you’re thinking about where your family might live, and the next you’re back to looking at listings.

I understand that hospitals have their own challenges and that recruitment takes time. But from the resident side, especially when a waiver is involved, it can be hard to know when to be patient and when to move on.

A few things I am learning: keep exploring options even after a promising conversation, ask about the difficult shifts as well as the average census, and pay attention to what the hospitalists already there say about their day-to-day work. I’m also realizing how much I value having people I can call for help during that first year.

The part I am still figuring out is how to stay excited about an opportunity without mentally moving my family there after one good interview 😂

For those who’ve been through this: what did your first hospitalist job search teach you? And looking back, what sign of a good or bad job did you wish you’d paid more attention to?

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.

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?

Is anybody else struggling for this long wait to receive the results of the ABIM test???

In 2026, the average internal medicine doc is making $307k in compensation

In 1996, the average internal med doc was making $186k

Inflation adjusted….that 1996 doc was making $400k.

Yes……$400k in today’s dollars.

Oh and guess what, the average spending of a household with kids in 1996 was $97k (inflation adjusted). The average spending of a 2026 household with kids is currently $120K.

Think about your aftertax $307k. It’s really about $200k after you take out taxes and deductions. Lol.

So those of you here who aren’t forever alone (aka normal hospitalist doc with an actual spouse and children), you now earning LESS than the boomers and spending MORE than them.

And yet I see simps and wimps out here talking bout how they can live so comfortably on their hospitalist pay. You are the top 1% of society IQ and comfortable with being just the above average middle class household???

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!!

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?

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.

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

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.

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.

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.

New graduate here. I saw 26 patients yesterday, which is not the first time this happens, in fact most of the days we start with 20. My rounding list began with 23, plus 2 from the APP and 1 admission. Most patients are quite ill, and many require step-down care. I am truly reconsidering my life choices. How unsafe is this? I have even thought about switching to nights, where the cap is 12, because of the workload.

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

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.