division provide consistent teaching
for fellows and increase inpatient
billing. Prior to my arrival, attendings
who staffed the consult service were
expected to continue their research
and outpatient clinical workload
while finding time to come to the
hospital. Not surprisingly, attending
rounds was erratic. The fellows were
left to manage patients independently,
scrambled to run cases by whomever
happened to be around, or waited
until they could reach the attending
the next day. Unsurprisingly, billing by
attendings was sparse.
What is a typical day like in
your life as a GI hospitalist?
My day starts at 7: 30 a.m. with my
outpatient office hours, endoscopy
session, or GI Grand Rounds. Each
week, I have two morning outpatient
office sessions, one morning endoscopy session, and one morning session supervising fellows’ endoscopy.
At noon, I round with a team of GI
fellows, medical students, and house
staff rotators for 2 hours. After we
see the new consults, the remainder
of my afternoon is spent seeing the
follow-up patients. For two afternoons throughout the week, I have
outpatient endoscopy sessions. I typically conclude my day at 5 p.m.
For night coverage, I take emergency calls for my own patients, and
share general call duties with the
other members of my division. On
average, I take calls for 1 weekday a
month and 5 weekends per year.
Typically, GI hospitalists cover in-
patients only during the daytime. All
nights and weekends are covered by
partners and nonemergent overnight
consults are saved until the next day.
They have no office work.
What is the most challenging
part of being a GI hospitalist?
As the perpetual “GI Consult Attend-
ing,” there is the threat of burnout
when confronted with a high volume
of sick, complex patients. Many of
the patients have multiple comorbid-
ities and require a multidisciplinary
approach. On average, we have five
new consults a day, and the number
of active follow-up patients is 10.
Nonetheless, the nature of the inpatient service makes the volume of
work unpredictable. When the service is busy and the census swells,
the numbers of patients requiring
staffing and notes can become overwhelming.
While there is diversity in the
types of consults, one repeatedly
confronts common problems such
as GI bleeding, food impactions, unexplained abdominal pain, diarrhea,
dysphagia, nausea and vomiting,
iron-deficiency anemia, abnormal
liver tests, and PEG placements. Seeing the same consults over and over
again can get tiresome. Fortunately,
in a teaching hospital, this repetition
is somewhat mitigated when one’s
audience consists of new crops of
enthusiastic medical students, rotating housestaff, and fellows.
Importantly, for those without an
outpatient practice, one loses the
opportunity to develop longitudinal
relationships with patients. Additionally, one also loses the ability to
provide integrated, comprehensive
care for individual patients once they
leave the hospital.
How are you paid?
My compensation is based on a base
salary with an incentivized system
based on my RVUs and collections.
For the dedicated hospitalist for a
group practice, there is typically a
base salary and productivity-based
income. Additionally, there should
be a path to partnership. Lastly, in
balancing the ledger, the diminished
inpatient revenue stream is offset by
the lack of overhead.
What are the benefts of a
GI hospitalist system?
Our system benefits the workflow for
the GI fellows. Since I have started,
the GI consultation rounds start at a
MIKE POWELL / THINKSTOCK