LocumLife - March 2009 - (Page 20) Internist to hospitalist TESTING THE WATERS Caroline Miles, MD, an internal medical specialist with 3½ years of experience, was curious to know whether hospital medicine was right for her. “I was working with 12 other internal medicine “I really enjoy the physicians in a clinic that complexity of hospital was part of a large HMO,” she recalls. “After my patient care, and I feel husband and I returned like I am making more f rom spend i ng some time abroad, I decided to of an impact.” make a switch to hospital medicine. I thought locum —Caroline Miles, MD tenens would be a good way to test out the hospitalist role before signing a contract.” So, Dr. Miles enlisted the services of Salt Lake City, Utah-based VISTA Staffing Solutions, and in October of 2008, she began a 5-week contract at an Indian Health Service (IHS) hospital in the Great Plains. “The facility was very remote and did not have any specialists or ICU capabilities, so most of the very sick patients were flown to a larger hospital. The lack of resources honed my critical thinking and assessment skills; it was a great way to get back into hospital practice.” Continues Dr. Miles, “Patient load was somewhere between 6 to 12 and almost every one of them was memorable because the severity of illness was so high. I treated a patient with a sodium level of 97, which is incredibly low, and a patient with cellulitis like I had never seen before in the U.S. I became quite good at caring for people with liver cirrhosis and diabetic ketoacidosis. It was very eye-opening.” Afterward, she began her second locum tenens opportunity—a 3-month engagement at a city hospital in the West. “I covered 8-hour shifts and my daily patient load was about 10 to 13 patients, which was perfect. I treated adults 18 and older, and I saw a lot of pneumonia, strokes, heart attacks, and diverticulitis.” Dr. Miles enjoyed her time there so much that she just signed on as a full-time staff member. “I love it here, and I have decided to stay. I really enjoy the complexity of hospital patient care, and I feel like I am making more of an impact. I also appreciate the shift-oriented schedule; in the clinic, I felt like I never finished.” What other observations can she share, now that she has experienced both types of settings? “Internal medicine and hospital medicine are similar in that you see patient after patient, but hospitalists operate more on their own schedule instead of having timed visits,” explains Dr. Miles. “In addition, hospitalists see a higher acuity of illness. I like being able to spend plenty of time with a very sick patient and know that I am not putting others off their schedule. And most hospitalist programs are structured so that you hand your pager off at the end of your shift and that is it.” Dr. Miles has a few words of wisdom for those interested in practicing hospital medicine as locum tenens physicians. “It is important to request a very thorough orientation so you can get to know the hospital,” she offers. “You may also want to ask if you can follow another physician for a day. Furthermore, be open-minded about what type of conditions to expect and be flexible if you are without the same level of resources to which you are accustomed.” And, if it has been a while since training, Dr. Miles advises not to dismiss this line of practice. “After having been out of residency a few years, I had some reservations regarding whether I would remember a lot about hospital medicine, but I found a couple of good texts to help refresh my memory, and it all came back pretty quickly. Plus, the need is so great that staff will be patient with you while you re-acclimate.” Anyone considering a move to hospital medicine will be at no loss to find a great match, she says. “There are so many opportunities right now that you have your choice of where you want to go. People are realizing that the hospitalist system really works. It is safer for patients and makes both doctors and nurses happier. The staff at my two contracts was very appreciative for the help.” Looking back on her locum tenens experiences, Dr. Miles has nothing but positive remarks—and www.LocumLife.com WORDS TO THE WISE Be realistic about your abilities Consider a refresher course or observing a colleague to update your inpatient skills Assess whether you are adaptable and can handle a faster pace Request a thorough orientation Assimilate seamlessly into the facility Be open-minded and flexible, especially with limited resources 20 LocumLife MARCH 2009 http://www.LocumLife.com
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