7 On/7 Off Intensivist?

[sylvanthus]

Hey all, question for you. I am a graduating EM/IM/CC fellow and am looking to find a job that will allow me to qualify for PSLF and still make a decent salary in case PSLF gets gutted. Bear with me as I explain my situation.....I have done 6 years of IBR and would only need 4 more. I have a crapton of loans (500k now with interest), so working straight EM, even with higher pain per hour, is not really an option to pay off loans.

I am thinking about doing a 7 on/7 off position, potentially anywhere in the US, to qualify for PSLF and make a decent salary if PSLF goes away. I will be living in Washington State, and I cannot find anything decent around my area.

Any thoughts? Anyone do this? Where in the world do I look? Id have to be employed directly by the hospital to qualify and cannot do locums or work for a "for -profit" group.

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[tartesos]

are you limited to Washington state only?



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[deleted547339]

Hey all, question for you. I am a graduating EM/IM/CC fellow and am looking to find a job that will allow me to qualify for PSLF and still make a decent salary in case PSLF gets gutted. Bear with me as I explain my situation.....I have done 6 years of IBR and would only need 4 more. I have a crapton of loans (500k now with interest), so working straight EM, even with higher pain per hour, is not really an option to pay off loans.

I am thinking about doing a 7 on/7 off position, potentially anywhere in the US, to qualify for PSLF and make a decent salary if PSLF goes away. I will be living in Washington State, and I cannot find anything decent around my area.

Any thoughts? Anyone do this? Where in the world do I look? Id have to be employed directly by the hospital to qualify and cannot do locums or work for a "for -profit" group.

What do you consider decent?

 

[sylvanthus]

Not limited by area, have even started looking at flying out to north dakota or something for a week, then coming home for a week. Rinse and repeat. Would get old after awhile I am sure, but definitely wouldn't do it more than 4 years. Decent being 300-350k ish, figure that's possible if location isn't an issue and I'd even do pure nights if need be.

 

[BigRedBeta]

Given the stats on PSLF coming through the news, you'd be better off forgetting that program ever existed and just looking for what's going to pay you the most and try to negotiate some loan forgiveness money into your contract.

Having done locums here and there for a while, it mainly comes down to what you are leaving at home. Family and kids? Yeah that will get super old, super quick, for everyone. Just an Significant Other? Probably can make that last for some time, especially if you pull some 14 on/14 off with a nice vacation stretches. On your own? Very doable, but it might kill your love life if you're looking for that sort of thing. Before kids, with just a fiancee, it was super easy, and then I would be home for longer stretches. Now? I feel like crap after 4 days.

 

[sylvanthus]

Aye am alittle worried about PSLF, but then again if you look at the data alittle more it shows that people took out the wrong type of loans back then so did not qualify. I have the right type of loans, serviced by fedloan servicing, and have already made 6 years out of 10 year of payment. I also submit that verification nonsense every year so I have documentation of my qualifying payments.

Figure I can risk it by doing IBR for 4 more years and saving money on the side. If PSLF gets destroyed, then I take that extra money and pay down the loans with it ASAP. I figure that plan lets me bank on PSLF without getting hosed if the program gets dropped.

 

[chocomorsel]

You can make over 400k in PP critical care. Especially in the boonies. However I know nothing of PSLF.

 

[spacegun]

You can make over 400k in PP critical care. Especially in the boonies. However I know nothing of PSLF.

I know a guy working in a small town in the Southeast who makes >$500K doing PP critical care (7 on/7off). He told me other critical care doctors where he is make about the same or even more if they work more.

But I heard EM and anesthesia can make just as much in rural or small towns. Probably anesthesia can make more but in a bigger city.

 

[chocomorsel]

I know a guy working in a small town in the Southeast who makes >$500K doing PP critical care (7 on/7off). He told me other critical care doctors where he is make about the same or even more if they work more.

But I heard EM and anesthesia can make just as much in rural or small towns. Probably anesthesia can make more but in a bigger city.

I am in the SE. Hook a sister up. Are they hiring?

 

[spacegun]

I am in the SE. Hook a sister up. Are they hiring?

I heard not hiring unfortunately

 

[tartesos]

I am in the SE. Hook a sister up. Are they hiring?

417k north fl 7o7off last i heard. It's with icc.
If you are into money.... can easily make 500+ with a few extra days of work.


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[CCM-MD]

417k north fl 7o7off last i heard. It's with icc.
If you are into money.... can easily make 500+ with a few extra days of work.


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There's a lot of these similarly paying ICC/HCA gigs throughout Florida. Half the shifts are nights though... and from what I hear, it can suck to work for them...

 

[tartesos]

There's a lot of these similarly paying ICC/HCA gigs throughout Florida. Half the shifts are nights though... and from what I hear, it can suck to work for them...

It does suck, but if what op wants it's , theirs is as green as it comes.


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[psychbender]

There's a lot of these similarly paying ICC/HCA gigs throughout Florida. Half the shifts are nights though... and from what I hear, it can suck to work for them...

There are several HCA hospitals back home, that I consider as a backup plan at times. What sucks about working for ICC? Large number of patients to see? Lots of APP supervision? Poor benefits?

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[CCM-MD]

There are several HCA hospitals back home, that I consider as a backup plan at times. What sucks about working for ICC? Large number of patients to see? Lots of APP supervision? Poor benefits?

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I know their EMR usually sucks - many of their hospitals still use meditech. Patient volume can be high but it is probably augmented by the intensivist not being "primary" - their set up is usually open ICU with a required CCM consult. I have heard admin sometimes pushes you to withdraw care on patients. Equipment like ultrasound/video laryngoscope can be ****ty - and don't bother asking for new things because you probably won't get it. Pay seems ok until you account for the number of patients you are seeing - then it doesn't sound that good anymore - plus you are doing half nights.

Someone else might have more insight because I have never actually worked for them. This is just bits of what I have heard from a friend.

 

[tartesos]

I know their EMR usually sucks - many of their hospitals still use meditech. Patient volume can be high but it is probably augmented by the intensivist not being "primary" - their set up is usually open ICU with a required CCM consult. I have heard admin sometimes pushes you to withdraw care on patients. Equipment like ultrasound/video laryngoscope can be ****ty - and don't bother asking for new things because you probably won't get it. Pay seems ok until you account for the number of patients you are seeing - then it doesn't sound that good anymore - plus you are doing half nights.

Someone else might have more insight because I have never actually worked for them. This is just bits of what I have heard from a friend.

And they constantly "audit you" and recommend to bill higher than you did.


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[chocomorsel]

And they constantly "audit you" and recommend to bill higher than you did.


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Well then I shall tip my hat to them and decline. Seems like going rate around here in the SE is min 400. I am in.
And I can eat, and drink and poop without having to ask someone to cover me.

 

[spacegun]

Well then I shall tip my hat to them and decline. Seems like going rate around here in the SE is min 400. I am in.
And I can eat, and drink and poop without having to ask someone to cover me.

I'm assuming you mean as an anesthesiologist, but people got to cover the ICU also, right? I think anesthesiologists have a very cool job though. But I guess in the (closed) MICU you're more of the boss in charge vs. running the show together with the surgeon in the OR.

 

[tartesos]

Well then I shall tip my hat to them and decline. Seems like going rate around here in the SE is min 400. I am in.
And I can eat, and drink and poop without having to ask someone to cover me.

Maybe it works for you, don't write it off until you try. They have employees so it must work for some. In some markets they are the only choice so you don't want to be limited unless you know for sure.


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[chocomorsel]

Maybe it works for you, don't write it off until you try. They have employees so it must work for some. In some markets they are the only choice so you don't want to be limited unless you know for sure.


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Spoken to recruiter already but haven’t pursued it further mainly because of their DOS computer system and because I have heard horror stories of working for HCA when it comes to them pushing for the bottom line.
So it’s on my radar, but farther down the list.

 

[chocomorsel]

I'm assuming you mean as an anesthesiologist, but people got to cover the ICU also, right? I think anesthesiologists have a very cool job though. But I guess in the (closed) MICU you're more of the boss in charge vs. running the show together with the surgeon in the OR.

Yes, I am trying to leave the OR. I am not needed every minute in the ICU like in the OR. I am looking to work in a closed unit, but in the community hospitals, the surgeons typically don’t micromanage the SICUs. Unless they are CV/CT people I hear so not doing that full time for sure.

 

[wamcp]

417k north fl 7o7off last i heard. It's with icc.
If you are into money.... can easily make 500+ with a few extra days of work.


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So that is 190/hr?
A nocturnist working full time in >1million pop city area (20 miles out from downtown) makes 175-180/hr...have seen night shift moonlighting rates up to 250-300/hr at times...so is doing crit care worth the extra 2-3 yr of training if the pay differential is so low?

 

[tartesos]

So that is 190/hr?
A nocturnist working full time in >1million pop city area (20 miles out from downtown) makes 175-180/hr...have seen night shift moonlighting rates up to 250-300/hr at times...so is doing crit care worth the extra 2-3 yr of training if the pay differential is so low?

That's an easy question to answer: if you like ccm it's worth it, if you do it for the money only( may suck but it's still worth it ).


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[CCM-MD]

So that is 190/hr?
A nocturnist working full time in >1million pop city area (20 miles out from downtown) makes 175-180/hr...have seen night shift moonlighting rates up to 250-300/hr at times...so is doing crit care worth the extra 2-3 yr of training if the pay differential is so low?

Probably not worth picking anything in medicine for money alone. Especially a field like CCM. Burnout is high, fellowship won’t be a walk in the park, and job afterwards is not going to be easy by any means.

With regards to $ - you also shouldn't compare a very high paying hospitalist gig to an average paying CCM job.

Nocturnist-Hospitalist medians 2017 - AMGA 293k; MGMA 284k
CCM medians in 2017 - AMGA 400k; MGMA 381k

That being said, 250-300/h for night time coverage as a hospitalist is ridiculously high - 180/h is more believable but no one is getting that in my area. But if you are going to use that to compare, you have to compare it to some of the ridiculously high locums $/h in CCM (they are out there).

 

[spacegun]

As @CCM2017 notes, IM hospitalist averages about $300K, CCM averages about $400K for a 7 on/7 off schedule. Assuming these average numbers:

IM Hospitalist
PGY1 $50K
PGY2 $55K
PGY3 $60K
PGY4 $300K
PGY5 $300K
PGY6 $300K
PGY7 $300K
PGY8 $300K
PGY9 $300K
Total $1,965,000

CCM Only (No Pulm, etc.)
PGY1 $50K
PGY2 $55K
PGY3 $60K
PGY4 $65K
PGY5 $70K
PGY6 $400K
PGY7 $400K
PGY8 $400K
PGY9 $400K
Total $1,900,000

If someone likes both jobs equally, and only cares about money, then it seems like PGY9 is when it starts to equal out.

Starting PGY10 and beyond, CCM will make a lot more. So I guess as long as you are in it for 10 years (5 years post-fellowship), then CCM will be better financially.

I know this is just the average. Both can make more if each picks up extra shifts. Maybe nocturnists can make more, too. I'm also not including extra things like benefits and bonuses.

And I have no clue but generally-speaking, don't most people say you can probably make more (in either specialty) if you are in a private group in a nice suburb not on the coasts with a good payor mix than if you are employed by a hospital? I know not everyone wants to live in a suburb, but if it's about the money, then maybe they will.

 

[chocomorsel]

I am an anesthesiologist. However, I take care of plenty of patients from the hospitalist service. As an intensivist, you see a lot of patients in the Unit due to iatrogenic problems. I suspect because hospitalists are responsible for a large number of patients and are probably running around like chickens with their heads cut off and are missing important stuff on patients who just keep getting worse. I could be wrong though. And the social work alone that's required as a hospitalist is what completely turned me of from an IM residency. It just seems to blow.

 

[CCM-MD]

As @CCM2017 notes, IM hospitalist averages about $300K, CCM averages about $400K for a 7 on/7 off schedule. Assuming these average numbers:

IM Hospitalist
PGY1 $50K
PGY2 $55K
PGY3 $60K
PGY4 $300K
PGY5 $300K
PGY6 $300K
PGY7 $300K
PGY8 $300K
PGY9 $300K
Total $1,965,000

CCM Only (No Pulm, etc.)
PGY1 $50K
PGY2 $55K
PGY3 $60K
PGY4 $65K
PGY5 $70K
PGY6 $400K
PGY7 $400K
PGY8 $400K
PGY9 $400K
Total $1,900,000

If someone likes both jobs equally, and only cares about money, then it seems like PGY9 is when it starts to equal out.

Starting PGY10 and beyond, CCM will make a lot more. So I guess as long as you are in it for 10 years (5 years post-fellowship), then CCM will be better financially.

I know this is just the average. Both can make more if each picks up extra shifts. Maybe nocturnists can make more, too. I'm also not including extra things like benefits and bonuses.

And I have no clue but generally-speaking, don't most people say you can probably make more (in either specialty) if you are in a private group in a nice suburb not on the coasts with a good payor mix than if you are employed by a hospital? I know not everyone wants to live in a suburb, but if it's about the money, then maybe they will.

Agree with you in general. The one thing your analysis doesn’t account for is the “time-value” of money. Money today is worth more than money tomorrow. Probably not a huge difference when talking about a 2 year fellowship but it adds up when you are comparing specialties with longer training paths.

Interesting discussion here: Should I pursue additional training?

 

[CCM-MD]

CCM isn’t all glory. It’s hard work, outcomes aren’t always good, families can be crazy, it is high stress, and it’s always ranked near the top in surveys about burnout. CCM has enough of its own versions of “social work” - end of life, futility of care type discussions for example. Expect to work in house nights, although there are lots of different models out there.

If one thinks they can be happy being a Hospitalist, better do that. Probably not worth doing CCM for the ~100k increase in pay alone. There’s some sweet Hospitalist gigs out there, pick up some extra shifts and the income differential probably won’t exist anymore. I could never be a Hospitalist for multiple reasons. If I wasn’t doing CCM I would probably much rather do any other IM subspecialty before deciding to work as a Hospitalist.

 

[Bostonredsox]

I was a 7/7 hospitalist for 2 years and have been a 14/14 critical care hospitalist for 3 years now, with lots of additional locum work in the NE and SE regions, cannot comment on the midwest or far west.

The gap is much wider than 100k from my experience. the major reason for this is the variability in hospitalist income regionally. in the SE you are talking 275-300k adding everything up, but 400-450 for CCM.

In the Northeast the hospitalist income is drastically lower, some places offering 5 years+ experience 220k starting base whereas the CCM pay is still higher 375-400 range.

Can be 1.4x the pay in some places but also can easily be double based on your location

 

[chocomorsel]

I was a 7/7 hospitalist for 2 years and have been a 14/14 critical care hospitalist for 3 years now, with lots of additional locum work in the NE and SE regions, cannot comment on the midwest or far west.

The gap is much wider than 100k from my experience. the major reason for this is the variability in hospitalist income regionally. in the SE you are talking 275-300k adding everything up, but 400-450 for CCM.

In the Northeast the hospitalist income is drastically lower, some places offering 5 years+ experience 220k starting base whereas the CCM pay is still higher 375-400 range.

Can be 1.4x the pay in some places but also can easily be double based on your location

What kind of hospitals does a critics care hospitalist, not formally trained through fellowship, work? How big are these places and units?

 

[Bostonredsox]

it is certainly not that common. Generally there are open ICUs with little pulm/cc coverage. there are situations with a closed unit that is run by a cc hospitalist such as mine. that said I am the only cc hospitalist in our grp, the other 2 are pulm/cc trained. Our shop is about 240 beds, 18 bed multidisciplinary ICU. 90% of the pts are standard MICU but we do have cardiothoracic surgery and 24/7 stemi so we do have a bunch of heart pts too. occasionally some trauma, have a GSW with an obliterated femoral artery as we speak. no neuro stuff outside of standard tpa/cva.

 

[chocomorsel]

What I don’t understand is why docs are so accepting of this schedule. It is the same thing as working 42 hours a week, 52 WEEKS a year an NO VACATION.
But most people I talk to seem soo excited about the 26 weeks “off” they fail to see that they are being taken advantage of.
I am thinking of just sticking to locums so I can take off when I want. Can’t seem to find any groups that give a real vacation.
No other field would be so excited about this schedule. Maybe they know better math than we.

 

[Bostonredsox]

i mean i'm getting almost half a mil for 14 on 14 off with benefits purely to run a closed icu. no clinic. no real call (phone only at nights as there is rarely anything I cannot manage over the phone at night). it doesn't get much better to me than that. i have a 2 week vacation for half of every month. locums would not improve my job satisfaction in any way, shape or form.

 

[CCM-MD]

I’ve seen gigs that give you “paid time off” - $ for a few weeks of vacation instead of actual vacation.

 

[psychbender]

I’ve seen gigs that give you “paid time off” - $ for a few weeks of vacation instead of actual vacation.

Not quite sure what you're getting at. The groups are providing pay for additional days in which you are not working (beside the usual post-ICU week)? How is this not vacation? Week on, week off with four weeks PTO is still working 22 weeks a year. Or, am I missing something glaring?

 

[chocomorsel]

Maybe he means they expect you to work instead of take vacation and therefore pay you extra money for that “vacation”.

 

[CCM-MD]

Not quite sure what you're getting at. The groups are providing pay for additional days in which you are not working (beside the usual post-ICU week)? How is this not vacation? Week on, week off with four weeks PTO is still working 22 weeks a year. Or, am I missing something glaring?

Maybe an example will help:

You work 26 weeks and get additional pay for 3 weeks. These 3 weeks are “vacation” weeks but you are not able to use those weeks as vacation time... don’t know if this is any clearer.

 

[psychbender]

Maybe an example will help:

You work 26 weeks and get paid for 3 weeks of “vacation”. You are not able to use those weeks as vacation.

So, you're really just working a standard week-on/week-off, 26 week/year job, but the salary is higher than average by three weeks pay? That seems rather disingenuous on the employer's part.

I'm Anesthesia-CC, so I will admit that I haven't looked at full-time CC jobs all that closely. From what I remember interviewing last year, some of the academic places had ICU-only options that were 22-24 weeks/yr, scheduled as week-on/week-off. I thought there were others like that in the private sector, too.

 

[CCM-MD]

So, you're really just working a standard week-on/week-off, 26 week/year job, but the salary is higher than average by three weeks pay? That seems rather disingenuous on the employer's part.

I'm Anesthesia-CC, so I will admit that I haven't looked at full-time CC jobs all that closely. From what I remember interviewing last year, some of the academic places had ICU-only options that were 22-24 weeks/yr, scheduled as week-on/week-off. I thought there were others like that in the private sector, too.

Exactly as you said. Standard week on/off but additional pay for the weeks of “vacation” not taken. I don’t think it’s disingenuous if both employer and employee have agreed beforehand that it’s not possible to actually take that time off.

I don’t know enough about academic gigs. The most common private/hospital employed models I see are either week on/off or scattered 12-15 shifts per month. Vacation time is very variable - but there are gigs out there that provide it. May be a good negotiation point.

 

[chocomorsel]

So, you're really just working a standard week-on/week-off, 26 week/year job, but the salary is higher than average by three weeks pay? That seems rather disingenuous on the employer's part.

I'm Anesthesia-CC, so I will admit that I haven't looked at full-time CC jobs all that closely. From what I remember interviewing last year, some of the academic places had ICU-only options that were 22-24 weeks/yr, scheduled as week-on/week-off. I thought there were others like that in the private sector, too.

I need one of these weeks in academia.
What part of the country? NE?
Know of any of these in the south?

 

[psychbender]

I need one of these weeks in academia.
What part of the country? NE?
Know of any of these in the south?

Midwest, unfortunately.

 

[Hamhock]

i mean i'm getting almost half a mil for 14 on 14 off with benefits purely to run a closed icu. no clinic. no real call (phone only at nights as there is rarely anything I cannot manage over the phone at night).

Are you saying you are "available" for 24h when "on"?
If so, how many beds? Are there fellows and residents?
14-on solo in any unit with acuity and more than 8 beds seems brutal. Even 14-on with a day-doc--night-doc setup is tough.
...but to each ?his own.
HH

 

[jw3600]

i mean i'm getting almost half a mil for 14 on 14 off with benefits purely to run a closed icu. no clinic. no real call (phone only at nights as there is rarely anything I cannot manage over the phone at night). it doesn't get much better to me than that. i have a 2 week vacation for half of every month. locums would not improve my job satisfaction in any way, shape or form.

I think I remember when you were a med student. Damn time flies.

 

[bigdan]

What I don’t understand is why docs are so accepting of this schedule. It is the same thing as working 42 hours a week, 52 WEEKS a year an NO VACATION.
But most people I talk to seem soo excited about the 26 weeks “off” they fail to see that they are being taken advantage of.
I am thinking of just sticking to locums so I can take off when I want. Can’t seem to find any groups that give a real vacation.
No other field would be so excited about this schedule. Maybe they know better math than we.

Choco -

Your point about the amount of hours is mathematically sound, but in practice - at least for me - the time off is exactly that: time off.

I do anesthesiology/CC, and do 1 week on for 7 days (and take calls all night from home; go back in if required), and then get 7 days off. While the amount of hours on service can be excessive, the following week off is MY week off, and that is worth it's weight in gold to me. Maybe my glasses are too rose-colored, but if I work working "the usual" anesthesiology gig in the ORs, I would come in and leave as scheduled - some days earlier, some later, but I don't get to bop out of town for a few days, or stay up too late. I would have to wait for vacation for that. As I have it now, the ICU week on can be laborious, but then I get 7 days where I decide when I wake up (figuratively speaking; I have little kids), when I go to bed, where I go, etc. AND I get vacation and CME time.

I like the work I do, which helps my perspective. Although I have never worked locums, I can see your point about having total control over your schedule. But from my point of view, the 7 on/7 off ICU thingy is working out pretty well.

 

[chocomorsel]

Choco -

Your point about the amount of hours is mathematically sound, but in practice - at least for me - the time off is exactly that: time off.

I do anesthesiology/CC, and do 1 week on for 7 days (and take calls all night from home; go back in if required), and then get 7 days off. While the amount of hours on service can be excessive, the following week off is MY week off, and that is worth it's weight in gold to me. Maybe my glasses are too rose-colored, but if I work working "the usual" anesthesiology gig in the ORs, I would come in and leave as scheduled - some days earlier, some later, but I don't get to bop out of town for a few days, or stay up too late. I would have to wait for vacation for that. As I have it now, the ICU week on can be laborious, but then I get 7 days where I decide when I wake up (figuratively speaking; I have little kids), when I go to bed, where I go, etc. AND I get vacation and CME time.

I like the work I do, which helps my perspective. Although I have never worked locums, I can see your point about having total control over your schedule. But from my point of view, the 7 on/7 off ICU thingy is working out pretty well.

Yes. Your eyes are rose colored because if you are working 100 hours a week, well heck you more than deserve that week.
The difference is, you actually get vacation time. Real vacation time.
I have been in this game for a minute on both ends. Nursing and medicine. Nurses are smarter than us as they would most likely not accept this as “woohoo! I got my 26 weeks””
I am not asking for a lot. Just two weeks or so.

 

[stillers]

Hey all, question for you. I am a graduating EM/IM/CC fellow and am looking to find a job that will allow me to qualify for PSLF and still make a decent salary in case PSLF gets gutted. Bear with me as I explain my situation.....I have done 6 years of IBR and would only need 4 more. I have a crapton of loans (500k now with interest), so working straight EM, even with higher pain per hour, is not really an option to pay off loans.

I am thinking about doing a 7 on/7 off position, potentially anywhere in the US, to qualify for PSLF and make a decent salary if PSLF goes away. I will be living in Washington State, and I cannot find anything decent around my area.

Any thoughts? Anyone do this? Where in the world do I look? Id have to be employed directly by the hospital to qualify and cannot do locums or work for a "for -profit" group.

I've gotten many emails about jobs in the Midwest fitting this description. SSM, Mercy, Essentia Health, Prevea, Aurora, and Sanford Health are a few of the employers that I recall. Sound Critical Care also has these types of jobs but you wouldn't be directly employed by the hospital.