NPs, inpatient vs outpatient, which one do you like better?

[treeye]

I am hoping that I have made a good decision switching to inpatient consult service from an outpatient clinic in the same health system. I did not really have a choice because my boss is awful. Could you share your thoughts on the pro and cons of outpatient vs. inpatient consulting service? 

Since I only had one job in the past 4 years in the outpatient clinic, I'll start with outpatient clinic (in a large academic center)

Pro: I enjoyed the flexibility (admin time) and the easy schedule (30 min per patient and sometimes half of the patients do not show up ? 

Cons: most diseases are chronic and there are no cures, so you are always patching things up. There will be endless patient messages.

[CuriousConundrum]

treeye said:

I am hoping that I have made a good decision switching to inpatient consult service from an outpatient clinic in the same health system. I did not really have a choice because my boss is awful. Could you share your thoughts on the pro and cons of outpatient vs. inpatient consulting service? 

Since I only had one job in the past 4 years in the outpatient clinic, I'll start with outpatient clinic (in a large academic center)

Pro: I enjoyed the flexibility (admin time) and the easy schedule (30 min per patient and sometimes half of the patients do not show up ? 

Cons: most diseases are chronic and there are no cures, so you are always patching things up. There will be endless patient messages.

•  
•  
•  
•  
•  

Outpatient for me.  My specialty is psych, and I really don't enjoy de-escalation or attempting interviews on people manic, tweaking on meth, etc.  I say that having been working an every other weekend inpatient Zoom gig for about 5 years in parallel to my 10 years of outpatient practice.    

Outpatient is relaxed, I'm in my environment, and there's usually no implicit need for immediate action. Prior to psych, I worked in everything chaos and immediate, and I got very burned out on that (to the point if I feel rushed I really do get defensively angry).  In outpatient, you know many things could be improved with addressing lifestyle factors that most patient's won't address or commit to.  That part is frustrating, but I do enjoy what limited continuity and temporal improvement I see in psych patients...those patients that do make improvements.

Since we're at a desk, in a fixed and usually comfortable office, and have no images and very few labs to review, many of the plagues of primary care don't haunt us the same.  The year before covid I began working at home and continue to do so.  I actually can't envision functioning in life without working from home now, but I know most everyone else does it.   I communicate only through nursing staff and haven't personally talked with a patient, insurance company or pharmacist in many years.  I work a lot of hours, in a lot of places, and by having glaring boundaries I'm able to do this without getting overly stressed. 

[JBMmom, MSN, NP]

My outpatient experience is limited only to my clinical rotations where I realized that, for me, outpatient is NOT a good fit. I found myself frustrated with patients coming in for their specialty visit (nephrology and pulmonology) that are not demonstrating an interest in improving or even maintaining their health. The nephrology patients that have uncontrolled hypertension, uncontrolled diabetes, didn't get the labs drawn prior to the visit, etc. far outnumbered the patients that were trying to follow the doctor's recommendations. The number of pulmonology patients I interviewed that were actively smoking and not interested in quitting. I was genuinely confused as to why these people paid the co-pay to see a doctor when they weren't doing ANY of the things recommended. I would find myself extremely unsatisfied with that type of job. And a patient shouldn't be seeing a provider that isn't able to provide the best care.

Granted, many of the patients I see in the ICU are there as a consequence of lifestyle issues. But, I am there as part of the team to address this acute issue and then we will both move on. I am able to remove judgment from my thinking and focus on the issues I can address. 

I'm thankful that there are people for whom outpatient is a good fit because we need those providers. But I'm not one of them. Good luck with your new position!

[treeye]

thanks all for your replies. 

I have worked in-patient for two weeks and would like to give some input and hopefully will get this thread going.

In my opinion, inpatient is definitely more fast pace and stimulating comparing to outpatient. I am learning a ton every day. I like the fact that there are always layers of support/supervision. I like having all my notes signed by an attending and discussing plans of care as a group. I like coming across many talented ppl in other specialities. I also like the fact that after you are done with your shifts, you are done. I feel that in outpatient settings, I am always patching things up and there are no endings to that. Let's face that, most chronic illnesses have no cure.

My perceptions of drawbacks of inpatient world are unpredictable work flow. You can get no consult or 8 consults. Your schedule is somewhat tied to the attending's schedule. If they round late, you'd likely not going home early that day. Additionally, inpatient is higher acuity and in translation, higher risks. Sometimes I am thinking is it worth the risks without additional pay?

 

[djmatte, ADN, MSN, RN, NP]

Whether you *like* one vs the other shouldn't matter. You should be working in an area commensurate with the training you've received. FNP should be working in family health and or out patient/urgent care. If I didn't like it, I would be inclined to get my acute care or ENP.  Sadly the only reason is a question is there's a sizable amount of NPs working outside their field of expertise.