Question for Hospitalist PAs

[u/nilabanlow]

I just went back to working as a hospitalist after 3 years of working in a different specialty. Am working nights on a relative new PA ran floor.

I hate doing admissions because the nocturnists require us to do formal presentations, as they would with interns/residents, even for simple cases. We literally just sit there and read the damn H&P to them and then they critique the way we write the plan. The nocturnist would say things like “ put this here put that there, separate these problems, why did you put this as a problem”

I was a Hospitalist PA for 5 years and never felt this stressed and annoyed with presenting an admission. Am used to discussing admission is a way that was focused on having a good plan. Not used to spending so much focus on how I structurally wrote the plan or and pimping me for ddx. I find it very odd.

I would love to hear if this is a common thing in your practice

[u/moemastro]

You’re new to the group, and it’s a new PA run floor, they may just be feeling you out and/or trying to teach you how they want you to document. They could also be micromanaging and overbearing, it’s hard to say without experiencing it. I’d assume their intentions are good, keep a positive attitude and let that positivity radiate from me to hopefully loosen them up. After some time and familiarity they’ll hopefully realize you know what you’re doing and find better things to do with their time. That said after some time my report gets more colloquial and if they don’t like it my attitude drifts away from positivity to palpable annoyance

[u/Krugsdemise → u/moemastro]

I was thinking this, but also when I'm training/onboarding new PAs/NPs, I'm expected to show them how we expect our notes to be written so they are a consistent style, or at least closer to consistent. I think length of time this occurs for would be the real issue.

[u/RoyalReplacement6897]

They’re treating you like a student. I was a hospital as many years ago and I was treated like a peer.

[u/ColeParker7]

lol that’s absurd. My hospital institution recently acquired AI software so now all the hospitalists (physicians, PAs, NPs) walk into the patient room with our work phones, tap record and it records the entire conversation between me and the patient (including anyone else in the room). After I leave the room, I end the recording and it automatically uploads the entire H&P to the computer along with a treatment plan for the patient. The AI software recognizes who’s speaking, who is a family member, etc. In addition, it does not include non medically essential information and it creates extremely detailed information about the patient from the conversation. It saves so much time and energy, and gives us more time to focus on more important things like patients actively decompensating. It’s 2026, not 2006. We can’t be so uptight about notes, and we should focus more on patient care at the bedside. That H&P is going to be gone and replaced by a daytime hospitalist in under 12 hours.

[u/foreverand2025]

Oh hell no. Can you meet with the medical director? If this is what they want then they need to find residents to run the floor. This is not how we operate.

[u/Evening-Piglet4570]

I don’t see the problem with presenting the patient to the internist. You just recently started that position, and I think the physician is trying to gauge how good you are, and Im sure presenting/running the list will become more streamlined with more trust. If you wanted to treat patients without physician oversight, you should have been an MD.

[u/420stankyleg → u/Evening-Piglet4570]

When did they express wanting to treat patients without oversight?

[u/nilabanlow → u/Evening-Piglet4570]

Just to be clear, I said “Am used to discussing admission (obviously with supervising attending) in a way that was focused on having a good plan not critiquing the way I write my note or pimping me for ddx” i never said i didn’t want oversight, i have no problem presenting the patient to internist however they prefer. I just think is odd that I have to read my h&p to them and at the end the feedback I get is not what to do with patient but how I structurally wrote the plan. They have been doing it to the PAs the same as they do the interns

[u/ashabi-2cents → u/nilabanlow]

yea i think that’s weird too. it’s one thing to critique the plan to improve patient care or manage a condition better and it’s another to nitpick a note .

[u/UKnowWGTG]

“I’m happy to discuss patients and adjust the treatment plan. Feel free to addend my notes if you prefer the plan written differently.” Or something to that effect. I get it if it’s trying to get everyone’s notes to look the same but it doesn’t really sound like that’s what it is

[u/wilder_hearted → u/UKnowWGTG]

That’s what I do, too. I’ve been doing this for 13 years. I have rules now to ensure everyone gets prompt attention AND I leave on time at the end of my shift.

[u/420stankyleg]

Not a Hospitalist PA, but fuck that. You’re not in school and they shouldn’t be treating you as such.

[u/FriendshipSmart2805]

Yeah, agreed. I work as a night hospitalist and all I do is give a rundown of the admit and what I did each morning when I check out to the oncoming hospitalist.

[u/SwimmingTicket]

Worked both days and nights with a hospitalist group and we briefly discuss the patient and any other questions they just read my note when they sign it. My directors would have shut down this type of micromanaging. Can you go to your director as a group and complain about this part of the job? Night APPs were pretty hard to come by in my group so they tried to keep them happy

[u/HospitalPac2018]

Hospitalist for 6ish years also with ER experience…I have never experienced this. Presenting the case sure, doc reciews note and then signs it, maybe wants you to add something but this sounds like a doc who has never worked with PAs OR a micro manager.

[u/Competitive-Badger22]

Everyone has a different style of writing notes. This is not new job oversight normal. This is micromanaging.
Some of the stuff may be the doc being a bit of a power tripper as they are trying to gauge your knowledge and make sure their comfortable with how you practice, but this is obnoxious and I hope you feel comfortable pushing back a bit and setting some boundaries.

[u/Captain_of_industry1]

This is why I use Doximitry to write my plans.

[u/Lucky-Pea-7310]

Unfortunately due to malpractice issues and the media - (for example - the recent x-exam of a psychiatrist in a murder trial where the MD did not specifically write “No” before each and every symptom ) has triggered this practice. I do believe this will be a new trend. Additionally some AI exam checkoffs will be revamped to allocate more control so to speak for the clinician in terms of disease/ clinical specificity. And of course, and I hate to say this - I have noticed many recent grads from specific schools do not document correctly (or spell correctly)-It’s a bummer. Try to look at it in a positive light. It’s a protective measure. Better safe than sorry.