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[littlecow]

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[Hernandez]

Most family practice docs don't work many weekends. Shift work still tends to be longer shifts. How many FP work more than 10 hour shifts 5 days a week? Just because 7 on 7 off is less days, I find I tend to do 2 weeks worth of work in that 7 days. Which makes sense. 7 12 hour shifts is 84 hours. Then factor in the national shortage for pulm and cc docs, and then figure all of or pts are sicker than am out patient Physicians are and it's not hard to see why longer hours occur.

My family is accustomed to not seeing me when I'm working. YMMV

 

[CCM-MD]

What’s the source?

1 FTE for a CCM is ~42 hours a week based on 14-15 x 12 hour shifts. I don’t know how accurate that data is. It has CCM working more than cardiologists and neurosurgeons. Maybe they have very hard working CCM physicians in their sample. That data is not generalizable.

 

[Hernandez]

What’s the source?

1 FTE for a CCM is ~42 hours a week based on 14-15 x 12 hour shifts. I don’t know how accurate that data is. It has CCM working more than cardiologists and neurosurgeons. Maybe they have very hard working CCM physicians in their sample. That data is not generalizable.

How many locations have Physician might coverage outside of academic areas? I don't, so I end up staying late when someone is too sick for a mid-level of Hospitalist, which is not uncommon. Even at my old job where will was primarily out pt I often had to go back to the hospital to tiddy up the sick ones before heading home, if not spend a few hours working on notes.

There are not enough of us and most places are short staffed to provide true shift work.

1 FTE assumes ideal situations. I work more than 84 hours on my on weeks as a Hospital only PCCM.

A big problem with any data on our specialty is there is way too many ways to set up a practice and way to many variations, so charts rarely are generalizable, but thay chart easily fits with Pulmonologists local to me

 

[CCM-MD]

My co-fellows and various others in CCM I have come in contact with in my training/work - everyone who does shift based intensivist work typically doesn’t work more than 14-15 shifts a month, unless it is by choice for extra $. More and more places seem to have in house intensivists at night in the community from what I have seen. Most of those ICC set ups have nights in house.

But I get where you are coming from, my gig right now is 2 weeks a month with q2h night call from home during my service weeks. So if I there’s a sick patient or I’m called in at night to do something that’s all extra. I am not called much at night but I guess I am probably working more than I had thought.

How many locations have Physician might coverage outside of academic areas? I don't, so I end up staying late when someone is too sick for a mid-level of Hospitalist, which is not uncommon. Even at my old job where will was primarily out pt I often had to go back to the hospital to tiddy up the sick ones before heading home, if not spend a few hours working on notes.

There are not enough of us and most places are short staffed to provide true shift work.

1 FTE assumes ideal situations. I work more than 84 hours on my on weeks as a Hospital only PCCM.

A big problem with any data on our specialty is there is way too many ways to set up a practice and way to many variations, so charts rarely are generalizable, but thay chart easily fits with Pulmonologists local to me

 

[CCM-MD]

Source is JAMA 2011 article by Leigh et al

What's the point of working more hours than Ortho and making half of what they make?

Avg ortho makes 800-900k these days? I doubt that. I definitely make more than half that.

But you should do ortho. Seems like your priorities are clear. CCM is probably not for you.

 

[spacegun]

Source is JAMA 2011 article by Leigh et al

What's the point of working more hours than Ortho and making half of what they make?

I think the point is some people just enjoy doing critical care medicine.

It's not always about making more money for as little hours as possible. Otherwise something like derm is probably a better deal than ortho if we're trying to maximize income and minimize hours.

I see a lot of pediatricians who get paid a lot less than most others but they love their work. What's the point of doing pediatrics? I think they just really enjoy taking care of sick kids and they're okay with the hours and pay, though I'm sure they wouldn't pass up more pay, but they do it for reasons other than pay and hours.

I'm not saying it's okay to work ridiculous hours or it's okay to make nothing. And I'm not saying be naive and pick a specialty just because your heart tells you to pick it. I'm saying, even after everything is considered (money, hours, etc.), some people (like me) just really like critical care medicine and want to do it someday.

 

[Hernandez]

My co-fellows and various others in CCM I have come in contact with in my training/work - everyone who does shift based intensivist work typically doesn’t work more than 14-15 shifts a month, unless it is by choice for extra $. More and more places seem to have in house intensivists at night in the community from what I have seen. Most of those ICC set ups have nights in house.

But I get where you are coming from, my gig right now is 2 weeks a month with q2h night call from home during my service weeks. So if I there’s a sick patient or I’m called in at night to do something that’s all extra. I am not called much at night but I guess I am probably working more than I had thought.

Leapfrog no longer requires in house intensivists, and frankly for most places I don't see how it financially makes sense as it also would hurt the daytime teams productivity. CCT billing is getting more and more scrutiny so you can't expect to get by with that. Procedures don't pay crap when you figure how much time they take.

It all depends on where you are, most guys I trained with also did the same, but that's not universal unless you're looking coastal or larger cities (usually cities w/ fellowships)

But yeah, ideally we'd average 42 hour weeks, but critical care doesn't happen during business hours sadly.

 

[Hernandez]

Source is JAMA 2011 article by Leigh et al

What's the point of working more hours than Ortho and making half of what they make?

Why are there such huge disparities between specialties period? The lack of billable easy procedures hurts many specialties that we desperately need. Rheum, Endo, ID, and out patient pulm among others. Without incintive these will be always short staffed. My current job essentially has no out pt pulm at all. Admin keeps pushing for it but I'm not working office on my office weeks for a corporate run (poorly) clinic for rvus per encounter. I'd rather have the time off to recoup, which I don't know about y'all but Covid is really kicking our short staffed asses.

 

[Hernandez]

I think the point is some people just enjoy doing critical care medicine.

It's not always about making more money for as little hours as possible. Otherwise something like derm is probably a better deal than ortho if we're trying to maximize income and minimize hours.

I see a lot of pediatricians who get paid a lot less than most others but they love their work. What's the point of doing pediatrics? I think they just really enjoy taking care of sick kids and they're okay with the hours and pay, though I'm sure they wouldn't pass up more pay, but they do it for reasons other than pay and hours.

I'm not saying it's okay to work ridiculous hours or it's okay to make nothing. And I'm not saying be naive and pick a specialty just because your heart tells you to pick it. I'm saying, even after everything is considered (money, hours, etc.), some people (like me) just really like critical care medicine and want to do it someday.

Alot of this, if you don't love what you do. Life will suck.

 

[CCM-MD]

Leapfrog no longer requires in house intensivists, and frankly for most places I don't see how it financially makes sense as it also would hurt the daytime teams productivity. CCT billing is getting more and more scrutiny so you can't expect to get by with that. Procedures don't pay crap when you figure how much time they take.

It all depends on where you are, most guys I trained with also did the same, but that's not universal unless you're looking coastal or larger cities (usually cities w/ fellowships)

But yeah, ideally we'd average 42 hour weeks, but critical care doesn't happen during business hours sadly.

Leapfrog or not, my personal experience is that many larger hospitals are moving to in house intensivists at night. Smaller hospitals are getting ICU telemedicine set ups for nights. None of that makes financial sense on the surface but I still see more and more of it. Out of the ccm docs I know, those taking home call are a minority.

 

[chessknt]

Home call where I am. Hospital would like an in house intensivist but can't find anyone to take the job.

Surgeons will always make more because the rvu/hr made in the or has no parallel. Cognitive work has almost no value under the current cpt system that can't differentiate managing a routine PE from working through a complex fever case other than to count minutes and value them at approximately 1/50th of a surgeon's time so thank the ama for that system by paying their fees and dues.

 

[chocomorsel]

What’s the source?

1 FTE for a CCM is ~42 hours a week based on 14-15 x 12 hour shifts. I don’t know how accurate that data is. It has CCM working more than cardiologists and neurosurgeons. Maybe they have very hard working CCM physicians in their sample. That data is not generalizable.

Maybe other specialties actually take real vacation weeks. Which factors in for a better overall yearly schedule.
Not the 7 on 7 off BS that counts as vacation that is really not vacation.

 

[CCM-MD]

Maybe other specialties actually take real vacation weeks. Which factors in for a better overall yearly schedule.
Not the 7 on 7 off BS that counts as vacation that is really not vacation.

Agree. The no vacation thing is BS. The logistics of incorporating vacation into the schedule is challenging for critical care. We have 4.5 intensivists at my current gig, if someone takes vacation then someone has to work extra. Or admin needs to get a locum, which we know is not gonna happen. What some places do is pay you for an additional 14 shifts as vacation time that you didn't take off. We just switched to wRVU where I am and my deal just became real sweet with our high patient volumes, so at least we aren't working that invisible vacation time for free and are getting paid excellently for it. There are bigger groups out there that give vacation time but you are right, majority don't.

 

[chocomorsel]

The logistics of incorporating vacation into the schedule is challenging for critical care. We have 4.5 intensivists at my current gig, if someone takes vacation then someone has to work extra. Or admin needs to get a locum, which we know is not gonna happen.

That's the BS that administration feeds us. Yeah, I know there is a shortage of intensivists.
In my past life, I used to be an RN working 12 hour shifts. Vacation was never an issue.
Administration just doesn't want to pay for coverage for vacation or for a part timer who can cover vacation. That's all there is to it. Yet they have C--O for every damn thing imaginable that they want to add a title to.
And we doctor's are too stupid and/or get paid too well to see the need to fight for this vacation.
Personally, I chose to do locums, continue to do majority anesthesia instead of getting tied down to a rigid schedule that includes absolutely no vacation. You aren't gonna use me and abuse me and tell me I gotta pay back all my vacation in advance or after the fact. No thank you.

 

[CCM-MD]

That's the BS that administration feeds us. Yeah, I know there is a shortage of intensivists.
In my past life, I used to be an RN working 12 hour shifts. Vacation was never an issue.
Administration just doesn't want to pay for coverage for vacation or for a part timer who can cover vacation. That's all there is to it. Yet they have C--O for every damn thing imaginable that they want to add a title to.
And we doctor's are too stupid and/or get paid too well to see the need to fight for this vacation.
Personally, I chose to do locums, continue to do majority anesthesia instead of getting tied down to a rigid schedule that includes absolutely no vacation. You aren't gonna use me and abuse me and tell me I gotta pay back all my vacation in advance or after the fact. No thank you.

I dislike hospital admin too and corporate groups more. If additional vacation time is something one values, it might be a challenge in this specialty. But to be fair, there are all kinds of models out there for CCM, probably is one out there that incorporates some vacation time. I personally don't mind it, especially if I'm getting paid extra for the work I'm doing. I work less than the non-invasive cardiologists at my hospital, have more block time off and get paid close to the same. If I could travel, I would do locums too. There have been some really good opportunities recently.

 

[FunnyDocMan1234]

I dislike hospital admin too and corporate groups more. If additional vacation time is something one values, it might be a challenge in this specialty. But to be fair, there are all kinds of models out there for CCM, probably is one out there that incorporates some vacation time. I personally don't mind it, especially if I'm getting paid extra for the work I'm doing. I work less than the non-invasive cardiologists at my hospital, have more block time off and get paid close to the same. If I could travel, I would do locums too. There have been some really good opportunities recently.

So most MICU jobs don't allow for vacation? say you wanted to take a 2 week block off for a trip that would be hard to arrange?

 

[CCM-MD]

So most MICU jobs don't allow for vacation? say you wanted to take a 2 week block off for a trip that would be hard to arrange?

Easy to arrange. Would involve one of your partners working an extra week for you and you loosing pay for that, or making an even switch that would result in you working 2 weeks in a row followed by 2 weeks off. There are various models out there, so if vacation time is a priority, you can probably look for a gig that has that. I personally know of 2 gigs in the Midwest that have vacation time. Most jobs probably don’t.

Also, keep in mind there is typically no “MICU job” in the community, you see everything with the largest group of patients being medical patients.

 

[FunnyDocMan1234]

Easy to arrange. Would involve one of your partners working an extra week for you and you loosing pay for that, or making an even switch that would result in you working 2 weeks in a row followed by 2 weeks off. There are various models out there, so if vacation time is a priority, you can probably look for a gig that has that. I personally know of 2 gigs in the Midwest that have vacation time. Most jobs probably don’t.

Also, keep in mind there is typically no “MICU job” in the community, you see everything with the largest group of patients being medical patients.

Do you mean mixed MICU/SICU/Neuro ICU/CCU is common in most places? Or some seperation of these? Seems like this would be true only in rural low acuity ICUs but idk.

 

[CCM-MD]

Do you mean mixed MICU/SICU/Neuro ICU/CCU is common in most places? Or some seperation of these? Seems like this would be true only in rural low acuity ICUs but idk.

They may be separate but you will be consulted to manage these patients. This is why it is very beneficial to go to a multidisciplinary fellowship that allows you the opportunity to manage a diverse group of critically ill patients.

 

[FunnyDocMan1234]

They may be separate but you will be consulted to manage these patients. This is why it is very beneficial to go to a multidisciplinary fellowship that allows you the opportunity to manage a diverse group of critically ill patients.

So basically open ICUs with intensivist 'consults' are the norm in the community?

 

[CCM-MD]

So basically open ICUs with intensivist 'consults' are the norm in the community?

From what I have seen that is the more common type of set up but I am basing this largely off my personal experience from the places I have worked at or interviewed and what my colleagues have told me. ICC is a large group that has 300+ physicians, multiple states, their model in almost all their hospitals is open ICU with intensivist consult. There are definitely closed units out there too, if thats what you are looking for.