7 on 7 off (12 hour shifts), but NO call neurocritical care jobs available?

[glioneuroxytoma]

In my institute the attending takes call and is pretty much 24*7 when he’s on. I, on the other hand, would very much like a hospitalist-like 7 on 7 off job with no call, but was wondering if neuroICU could provide the same (but with higher salary). I don’t mind higher workload/tougher patients/handling family when I’m on, but I want to be off when I’m off. I’m a shift duty person.

I know there’s always a couple of unicorn jobs in every field that can offer this, but in general, can neuro ICU (in the US) provide this? If not, is there any other subspecialty that does (stroke? Interventional? Epilepsy? That doesn’t seem likely)? What about telestroke? If not, and hospitalist is my only route, then which fellowship would be best to complement a hospitalist job?

Also, are similar jobs (7 on 7 off and no call, with off time devoted to research or training) available in academia? Or do I have to stick to private practice?

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[xenotype]

This is the main problem with neurohospitalist jobs- they all expect you to take call the week you are on. Many smaller places aren't that busy and many of these jobs now will send acute stroke to tele overnight so you may only get woken up once or twice a night but you'll still have to remain available. I don't do NCC but I imagine the overnight call is potentially worse. NCC in general does not seem to pay much more than neurohospitalist, and obtaining a true NCC job may limit your location much more. 7/7 jobs in academia are quite rare and most expect traditional call, but most academic jobs are 90+% outpatient and more M-F with heavy clinics so you wouldn't be on call very often unless it is a very small place.

Tele jobs you'll be truly off when you are off and probably what you are looking for. Specialties that mesh well with tele are epilepsy, stroke, and NCC. The downside is that scheduling is rarely 7/7 with these and more random days/nights, and you'll be expected to do night shifts for most outfits. You'll have to spend some off time each week managing state licenses and hospital onboarding. Tele will not handle any visa issues, and fellowship is really expected for most tele jobs unless you already have extensive neurohospitalist experience. Neurohospitalist you don't need fellowship but I recommend it (except I do not recommend neurohospitalist 'fellowships').

If you want substantial research beyond a few small papers you really need an academic job set up for it with a beefy grant or industry funding. This isn't conducive to 7 on 7 off mentality at all and has a lot of administrative overhead to handle.

 

[glioneuroxytoma]

This is the main problem with neurohospitalist jobs- they all expect you to take call the week you are on. Many smaller places aren't that busy and many of these jobs now will send acute stroke to tele overnight so you may only get woken up once or twice a night but you'll still have to remain available. I don't do NCC but I imagine the overnight call is potentially worse. NCC in general does not seem to pay much more than neurohospitalist, and obtaining a true NCC job may limit your location much more. 7/7 jobs in academia are quite rare and most expect traditional call, but most academic jobs are 90+% outpatient and more M-F with heavy clinics so you wouldn't be on call very often unless it is a very small place.

Tele jobs you'll be truly off when you are off and probably what you are looking for. Specialties that mesh well with tele are epilepsy, stroke, and NCC. The downside is that scheduling is rarely 7/7 with these and more random days/nights, and you'll be expected to do night shifts for most outfits. You'll have to spend some off time each week managing state licenses and hospital onboarding. Tele will not handle any visa issues, and fellowship is really expected for most tele jobs unless you already have extensive neurohospitalist experience. Neurohospitalist you don't need fellowship but I recommend it (except I do not recommend neurohospitalist 'fellowships').

If you want substantial research beyond a few small papers you really need an academic job set up for it with a beefy grant or industry funding. This isn't conducive to 7 on 7 off mentality at all and has a lot of administrative overhead to handle.

Tele sounds very interesting then. The other day I talked to a stroke guy who does Tele in 3 states only- Georgia, SC and NC. He said that those 3 states were enough for him to have a full time job, and 3-5 state licenses sounds manageable honestly.

I know how telestroke works (and it’s been discussed here on the forums too), but would you happen to know more about 0.75-1 FTE tele-epilepsy and teleneuro ICC? Stroke isn’t really my cup of tea, and epilepsy offers a lot in these lines- including IOM which seems pretty cush (or maybe there’s something I’m missing?). On the other hand, I like NCC because of the acuity. When I’m on my shift, I really dont mind a frantic pace. It’s just that I want to sleep peacefully/ be in the mountains at all other times.

Im mostly interested in research as a hobby. I don’t think I want a heavy academic job.

 

[elanmorin]

A lot of NCC is stroke (both ischemic and hemorrhagic), so if you don't enjoy that or aren't comfortable with it, you probably won't enjoy NCC that much. Tele-EEG/IOM is a pretty cush gig in most places. You won't be making the big bucks, but it's decent pay and you could even do it on some off weeks as it's typically not that high of a cognitive burden.

 

[glioneuroxytoma]

A lot of NCC is stroke (both ischemic and hemorrhagic), so if you don't enjoy that or aren't comfortable with it, you probably won't enjoy NCC that much. Tele-EEG/IOM is a pretty cush gig in most places. You won't be making the big bucks, but it's decent pay and you could even do it on some off weeks as it's typically not that high of a cognitive burden.

How are TeleEEG/IOM jobs? Is full time possible or is it something to do on the side?

 

[xenotype]

How are TeleEEG/IOM jobs? Is full time possible or is it something to do on the side?

There aren't a lot of them and EEG doesn't pay well anymore. Some people are getting paid 50$ for a 72hr ambulatory EEG that can take 2 hours to read with a bunch of video events. 50% of hospital neurology is stroke. If you aren't comfortable with it or don't enjoy it, then you may not find inpatient work fulfilling and jobs that completely write acute stroke out of them are less common especially outside of academics. For tele, most companies need people to take stroke call in addition to rounding/EEG/etc. You can find hospital jobs and tele jobs without acute stroke but it narrows your options. Most NCC jobs expect acute stroke call or telestroke call as well.

 

[glioneuroxytoma]

There aren't a lot of them and EEG doesn't pay well anymore. Some people are getting paid 50$ for a 72hr ambulatory EEG that can take 2 hours to read with a bunch of video events. 50% of hospital neurology is stroke. If you aren't comfortable with it or don't enjoy it, then you may not find inpatient work fulfilling and jobs that completely write acute stroke out of them are less common especially outside of academics. For tele, most companies need people to take stroke call in addition to rounding/EEG/etc. You can find hospital jobs and tele jobs without acute stroke but it narrows your options. Most NCC jobs expect acute stroke call or telestroke call as well.

I’m okay with doing a fair bit of acute stroke in teleNCC jobs as long as it’s not just stroke. How is teleNCC compared to teleneuro jobs in terms of compensation? I read a few discussions here which mentioned the pay being anywhere from 100-300 bucks an hour. Is this the range for teleNCC too or is it higher?

Can you schedule your shifts/calls according to your needs? I understand that for most tele jobs you have to sign on for a minimum number of shifts per month but I don’t know if it’s the case for NCC.

Thank you again!

 

[xenotype]

I’m okay with doing a fair bit of acute stroke in teleNCC jobs as long as it’s not just stroke. How is teleNCC compared to teleneuro jobs in terms of compensation? I read a few discussions here which mentioned the pay being anywhere from 100-300 bucks an hour. Is this the range for teleNCC too or is it higher?

Can you schedule your shifts/calls according to your needs? I understand that for most tele jobs you have to sign on for a minimum number of shifts per month but I don’t know if it’s the case for NCC.

Thank you again!

I don't know anything about teleNCC as I said before. 100-300 is essentially the typical rate anyways for most of clinical neurology, with the top end of that implying heavy volume or locums in an area they can't find anyone. Nothing is ever 'just stroke' as you'll always get stroke alerts for seizures, encephalopathy, even GBS just like residency- it is just the stat neuro consult catch all. There are a few crazy people that combine part time teleneurology with 7/7 NCC for crazy income but I don't know how they don't burn out. In general, you will not have much control over scheduling your shifts in larger groups and you will be expected to do some nights and a lot of weekends.