Going from inpatient to outpatient for a 45k pay increase

I’m currently working as a hospitalist APC in a HCOL area at an academic medical center. A few weeks ago, after a stretch of burnout (lots of moonlighting + several high-acuity patients), I applied somewhat impulsively to an outpatient primary care role within my system.

The clinic serves patients with high ED/hospital utilization—many are unhoused or have substance use disorders, with complex comorbidities similar to what I see inpatient. They offer therapy, groups for substance use, case management, and primary care all under one roof. The setup is very different: 1-hour visits, about 4–6 patients per day, 9–5 Monday–Thursday, every other Friday off, and a half day the alternate Fridays.

I shadowed for a day and honestly felt a little unsure. It’s much slower-paced than what I’m used to, and I wasn’t sure if it would fully scratch the “high-acuity” itch I’ve grown used to.

That said, I just received an offer: $165k, which is a >$45k increase from my $120k base (about $134k with night differential). With moonlighting, I’ll probably make around $150k this year in my current role.

My hesitation is that I’ve built an identity in high-acuity care. I genuinely enjoy the hospital environment and taking care of very sick patients—the pace, the challenge, even the adrenaline.

But the outpatient role is very appealing:

• No nights, weekends, or holidays
• Significant pay increase
• Predictable schedule (which would help with sleep, workouts, and overall routine)

On the flip side, my current job offers a lot of flexibility:

• ~168 working days/year
• Block scheduling (5–7 shifts on, then long stretches off) making it easy to travel without PTO
• Ability to moonlight at ~$100/hr
• Option to reduce FTE in the future (e.g., ~10 shifts/month and still make six figures), which feels valuable as I think about having kids

At the same time, hospital medicine is tough, burnout is real, and I know nights aren’t sustainable long term for my health.

I’d love to hear from anyone who has made a similar switch from inpatient to outpatient (especially in higher-acuity populations). Do you miss the hospital? Was the lifestyle trade-off worth it? What would you do in my position, and what factors should I be weighing more heavily?