Advice for a newly minted neurohospitalist…

[Hockeyfan23]

Happy new year all! Hoping to seek some advice from everyone out there.

In my first gig outside of residency and so far it has generally been a good experience. (It’s the a private group who contracts with the hospital). I like the people I work with and surprisingly see a nice variety of pathology. I have one year left on my initial contract. However, the schedule right now is essentially 12 on 2 off. I’m doing fine now but am worried about burnout in the future. In addition we are in the process of starting a family and my wife is hoping to get back to work by the end of the year. When I first joined I was under the impression this would eventually be a 7on/7off gig but doesn’t seem like that will happen. I truly value time spent at home with my family and feel I will ultimately have to make a change to be at home more for my wife and kids. I’m considering other gigs that are 7 on 7 off or telemed (given non compete).

Had anyone been in a similar situation? What is the best way to handle this? If I do leave how much lead time is fair/appropriate? Does it look bad to move companies after first contract? Any advice or kind words would be appreciated. Thanks!

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[Neurogeneral]

Many employers will intentionally be vague/non-specific in regards to scheduling and coverage just to get you to sign the contract. Always try to get very concrete details and answers. Try to get it in writing in your contract as well if possible.

Now, 12 on/2 off seems a bit much for neuro-hospitalist. That is unless your volume/census is low and you dont get called much overnight by the ER…..

I have been in a similar position where fresh out of training. I was told that “call” would be 1 week out of 5 but it turned out to be 1 in 2. I planned on sticking around for 1-2 years max and then bolting. But I am still here. Why? Well, it is true that I only get 4 days off per month but my overall volume is lower than other neurologists for the total compensation they give me. But most importantly, I am limited geographically to this area cause my wife’s family lives here and it is helpful for us (she is also a physician and we have kids) to have them close by. I also don’t want to keep switching jobs to something I know will be temporary. My plan is to complete my five year contract and then leave the job.

Most younger physicians do change jobs within the first few years. So it won’t look bad IMO. If you are not happy, I would start looking for other opportunities but I wouldn’t just switch jobs right away unless you find something that clearly is much more compatible with your desired lifestyle and needs.

And just be careful with telemedicine. Many of the shifts are overnight or on weekends. The amount of hospitals you have to get credentialed for can be in the hundreds which is very time consuming. You are typically expected to keep doing all that paperwork on your off days. And then if you want to switch jobs, hospitals will expect you to declare and obtain documentation of good standing from each and every hospital where you have been credentialed……..

 

[xenotype]

Happy new year all! Hoping to seek some advice from everyone out there.

In my first gig outside of residency and so far it has generally been a good experience. (It’s the a private group who contracts with the hospital). I like the people I work with and surprisingly see a nice variety of pathology. I have one year left on my initial contract. However, the schedule right now is essentially 12 on 2 off. I’m doing fine now but am worried about burnout in the future. In addition we are in the process of starting a family and my wife is hoping to get back to work by the end of the year. When I first joined I was under the impression this would eventually be a 7on/7off gig but doesn’t seem like that will happen. I truly value time spent at home with my family and feel I will ultimately have to make a change to be at home more for my wife and kids. I’m considering other gigs that are 7 on 7 off or telemed (given non compete).

Had anyone been in a similar situation? What is the best way to handle this? If I do leave how much lead time is fair/appropriate? Does it look bad to move companies after first contract? Any advice or kind words would be appreciated. Thanks!

Hope you are very low volume like <10 encounters a day and no more than 1-2 phone calls a night with above market pay otherwise that schedule is hideous and completely unfair.

Many employers will intentionally be vague/non-specific in regards to scheduling and coverage just to get you to sign the contract. Always try to get very concrete details and answers. Try to get it in writing in your contract as well if possible.

Now, 12 on/2 off seems a bit much for neuro-hospitalist. That is unless your volume/census is low and you dont get called much overnight by the ER…..

I have been in a similar position where fresh out of training. I was told that “call” would be 1 week out of 5 but it turned out to be 1 in 2. I planned on sticking around for 1-2 years max and then bolting. But I am still here. Why? Well, it is true that I only get 4 days off per month but my overall volume is lower than other neurologists for the total compensation they give me. But most importantly, I am limited geographically to this area cause my wife’s family lives here and it is helpful for us (she is also a physician and we have kids) to have them close by. I also don’t want to keep switching jobs to something I know will be temporary. My plan is to complete my five year contract and then leave the job.

Most younger physicians do change jobs within the first few years. So it won’t look bad IMO. If you are not happy, I would start looking for other opportunities but I wouldn’t just switch jobs right away unless you find something that clearly is much more compatible with your desired lifestyle and needs.

And just be careful with telemedicine. Many of the shifts are overnight or on weekends. The amount of hospitals you have to get credentialed for can be in the hundreds which is very time consuming. You are typically expected to keep doing all that paperwork on your off days. And then if you want to switch jobs, hospitals will expect you to declare and obtain documentation of good standing from each and every hospital where you have been credentialed……..

Completely agree on all points. I would add that most NH jobs you are trading 24hr call the 7 days you are on (getting woken up at night, can't relax etc) for shift work with telemed- but 1/3 to 1/2 of that shift work will absolutely be nights and weekends. Outpatient you can avoid the call in exchange for the inbox and treadmill. Locums you can get rid of almost all the hassles at high pay, choose when you want to work, but not where- travel away from family, hotels/long drives etc. Locums and telemed will both generate the long papertrail that will make future jobs a hassle credentialing wise, as will any lawsuits from any job. Have to pick your poison. Greatest demand/need is outpatient. Money for all of these in busy practices/competitive contracts will be similar with higher amounts for higher patient volume- except locums which is more money and variable volume.

 

[Splenda88]

That is exploitation unless they are paying you 700k+/yr...

If I work this schedule as a hospital medicine doc, my salary will be 600k+

 

[Hockeyfan23]

That is exploitation unless they are paying you 700k+/yr...

If I work this schedule as a hospital medicine doc, my salary will be 600k+

Yea def not making that much. The census is anywhere from 12 to >20 pts between two hospitals. Night call taken at home essentially every other week. They are now adding a third hospital into the mix so it’s likely the weekends will get tougher…

 

[Splenda88]

Yea def not making that much. The census is anywhere from 12 to >20 pts between two hospitals. Night call taken at home essentially every other week. They are now adding a third hospital into the mix so it’s likely the weekends will get tougher…

I am sorry that you are being taken advantage of... People in SDN should not be shy in calling out these egregious BS.

It's ridiculous! And If I were you, I would get out of that contract ASAP.

 

[xenotype]

Yea def not making that much. The census is anywhere from 12 to >20 pts between two hospitals. Night call taken at home essentially every other week. They are now adding a third hospital into the mix so it’s likely the weekends will get tougher…

I am sorry that you are being taken advantage of... People in SDN should not be shy in calling out these egregious BS.

It's ridiculous! And If I were you, I would got out of that contract ASA.

Yes. Exit ASAP. Look at your contract/talk to lawyer for any way out. 15-20 patient encounters/day is already average census for NH job. Sorry but for the benefit of everyone seeking jobs here the benchmark is about $300-325k for 15-20pt/day 7on 7off- make sure things like schedule, call etc are written into the actual contract. You are working more than a PGY2 resident...

 

[Hockeyfan23]

Yea not sure if it is possible to get out of this contract before next year. It is up January 2023. I also have a non compete and live in a major metro so that would make the job search tougher hence why I was considering telemed for a while. I’m essentially on par to make around $400k this year which still seems low based on above posts and my schedule

 

[Postictal Raiden]

Yea not sure if it is possible to get out of this contract before next year. It is up January 2023. I also have a non compete and live in a major metro so that would make the job search tougher hence why I was considering telemed for a while. I’m essentially on par to make around $400k this year which still seems low based on above posts and my schedule

Too little for the work you do.

I just endured the job hunt process and I can tell you that, like xenotype said, most 7/7 jobs pay in the neighborhood of 350k. Some pay that without having to take night calls either. The jobs I interviewed for were in very desirable markets and the pay was 320-370 for 7/7 plus potential collection bonus.

I encountered some jobs in the midwest and the south that pay higher.

Your rate should be around 2K/day. So if you're doing 12 days on 2 off, year round, you should be making 600K+

Give your 3 months notice and start looking for other jobs STAT

 

[Aldertonghen]

Too little for the work you do.

I just endured the job hunt process and I can tell you that, like xenotype said, most 7/7 jobs pay in the neighborhood of 350k. Some pay that without having to take night calls either. The jobs I interviewed for were in very desirable markets and the pay was 320-370 for 7/7 plus potential collection bonus.

I encountered some jobs in the midwest and the south that pay higher.

Your rate should be around 2K/day. So if you're doing 12 days on 2 off, year round, you should be making 600K+

Give your 3 months notice and start looking for other jobs STAT

7 on 7 off 12 hour shifts with no night call for $300-350k in a decent location? Is that possible?

I was 200% sure of eventually going academic but after reading all these posts I’m not so sure lol

 

[Postictal Raiden]

7 on 7 off 12 hour shifts with no night call for $300-350k in a decent location? Is that possible?

I was 200% sure of eventually going academic but after reading all these posts I’m not so sure lol

Yes. Not in a coastal city tho

The ones on coastal metros all required night coverage. Which is ok I guess.

 

[Aldertonghen]

Yes. Not in a coastal city tho

The ones on coastal metros all required night coverage. Which is ok I guess.

Yeah I’m fine with living in a medium large Midwest city..

 

[Hockeyfan23]

I guess the issue becomes my contract termination date and the non compete which is pretty significant. Not sure how well those hold up in a court situation anyways. Like I said, at this time my primary concern is family and will need to make something change for their sake. Life is too short.

 

[NEApplicant]

Not an attending so please excuse me if this is a silly question but:
If the shifts aren't clearly spelled out in the contract, is there something stopping you from asking for it to be 7 on 7 off? Or say 12 days on 1 week off? Do you just have to work whatever shifts you're assigned?

 

[Splenda88]

Not an attending so please excuse me if this is a silly question but:
If the shifts aren't clearly spelled out in the contract, is there something stopping you from asking for it to be 7 on 7 off? Or say 12 days on 1 week off? Do you just have to work whatever shifts you're assigned?

It has to be spelled out. My contract clearly says 7 on/off (straight from Tuesday to Monday) from 7a-7p. They weren't clear about night shift and my lawyer made sure everything was spelled out clearly.

 

[Hockeyfan23]

So I work for a private group that contracts with hospitals. The initial contract was M-F with one weekend a month. The contract was addended to two weekends a month with extra pay. So that basically comes out to 12 days on 2 off. I have asked to go 7 on 7 off due to multiple reasons I have mentioned but doesn’t seem in the cards at this time.

 

[xenotype]

So I work for a private group that contracts with hospitals. The initial contract was M-F with one weekend a month. The contract was addended to two weekends a month with extra pay. So that basically comes out to 12 days on 2 off. I have asked to go 7 on 7 off due to multiple reasons I have mentioned but doesn’t seem in the cards at this time.

Stop asking. Talk to a lawyer and there is probably a more creative way out of your contract than you are foreseeing (or perhaps you don't accurately understand what the penalties to breaching the contract are). Once you have that creative way make a plan to exit and deal with the non-compete based on advice from lawyer, and either threaten to cause them pain or just leave. Then 7 on 7 off will either be 'in the cards' then or it just won't matter. If you didn't talk to a lawyer when you signed the contract you really made a mistake. If there is anyone else in the 'group' in a similar situation reach out to them and coordinate contract non-renewal which would really get their attention.

 

[Postictal Raiden]

FWIW, I heard from a couple IM hospitalists that the non-compete clause doesn't hold water in court since you are not necessarily going to be competing with the former practice by taking away their patients. You're merely providing service to whoever walks through the hospital door. However, you need to double check with a lawyer

 

[Hockeyfan23]

I did have an attorney look at initial contract. They were a group familiar with Medical contracts and did not have much issue with it at the time. The non compete is pretty well established but I did also hear that they rarely hold up in court for hospitalists for the same reason. The issue with terminating early is also giving back all of the signing bonus which was quite substantial. At this point I’m just considering putting up with the year and giving them an advanced heads up. I have no personal issues with the management. Unfortunately I’m the only true hospitalist in the group so nobody else is really in my position.

 

[xenotype]

I did have an attorney look at initial contract. They were a group familiar with Medical contracts and did not have much issue with it at the time. The non compete is pretty well established but I did also hear that they rarely hold up in court for hospitalists for the same reason. The issue with terminating early is also giving back all of the signing bonus which was quite substantial. At this point I’m just considering putting up with the year and giving them an advanced heads up. I have no personal issues with the management. Unfortunately I’m the only true hospitalist in the group so nobody else is really in my position.

Well, if they have a big signing bonus to hold over you then you have to do the math on how much your misery is worth. A year wouldn't be worth the usual $25k but 50-100 starts to get quite painful. Another tactic is to tell them now you won't be renewing unless they take away one of those weekends but with a year of advance notice they probably won't care. You should have never signed that addendum to the contract on the extra weekend and should have walked then.

 

[Hockeyfan23]

At the time coming from residency, the extra weekend didnt sound like a bad idea, but now it is kind of sh***y. As I said, my primary reasons for changing now are starting a young family and my wife going back to work. Thanks for everyone's help and advice

 

[neurochica]

That’s just crazy! There is always a way out for non compete-there is precedent to bust out and a good lawyer can do it.

 

[Hockeyfan23]

Once again wanted to thank everyone for the advice and support. There have been some recent developments. We are adding another hospital to our coverage and there is a high likelihood of being able to go 7on/7off. The kicker is I will be covering 3 smaller hospitals (cover 2 small ones now) and also taking night call for those hospitals I am covering which is generally not too busy. The census between all 3 seems like it could run 20-30 patients or so. The 7 days on will definitely be long and exhausting if I do decide to stick it out. At this point, my initial contract is null and void so I believe I have some bargaining power. What is a reasonable salary to expect for the above volume and coverage? Thanks!

 

[Postictal Raiden]

1k per night to hold the pager
100 per patient you see during day so let’s say 2500 on average

So 600k

 

[curiousneuro]

Once again wanted to thank everyone for the advice and support. There have been some recent developments. We are adding another hospital to our coverage and there is a high likelihood of being able to go 7on/7off. The kicker is I will be covering 3 smaller hospitals (cover 2 small ones now) and also taking night call for those hospitals I am covering which is generally not too busy. The census between all 3 seems like it could run 20-30 patients or so. The 7 days on will definitely be long and exhausting if I do decide to stick it out. At this point, my initial contract is null and void so I believe I have some bargaining power. What is a reasonable salary to expect for the above volume and coverage? Thanks!

Wow this sounds like a quick way to burn out...that's going to be really difficult. Agree wouldn't do this for less than 600k, if not more

 

[xenotype]

Once again wanted to thank everyone for the advice and support. There have been some recent developments. We are adding another hospital to our coverage and there is a high likelihood of being able to go 7on/7off. The kicker is I will be covering 3 smaller hospitals (cover 2 small ones now) and also taking night call for those hospitals I am covering which is generally not too busy. The census between all 3 seems like it could run 20-30 patients or so. The 7 days on will definitely be long and exhausting if I do decide to stick it out. At this point, my initial contract is null and void so I believe I have some bargaining power. What is a reasonable salary to expect for the above volume and coverage? Thanks!

30 patients a day is miserable. If the initial contract is void then just walk away. I love being told a hospital is 'small' and the list has 18 on it, half of them new.

 

[Splenda88]

There must be something about that company or that place that makes OP really want to stay there because every single person is telling you that they are exploiting you.

You are not only hurting yourself. You also are hurting your colleagues.

 

[Phantom Spike]

Will there be NPs/PAs to assist?
With regard to large patient census, does everyone see every patient on their list every day even if they're stable and just awaiting a test or placement or some such? Personally it is rather unusual for me to see a patient even once in follow up; most consults are unnecessary anyway (clearly cardiogenic syncope, breakthrough seizure in a patient noncompliant with medication, patient with known Parkinson's disease and an established outpatient neurologist admitted for something different entirely, completely resolved TIA with completed workup, AMS in 80-year old dementia patients with UTIs etc.). I just say, "no further neurological work up needed", or "if brain MRI, CTA and EEG are unrevealing, cleared from Neurology standpoint with XYZ recommendations", etc. A patient would have to have really acute neurological illness (massive stroke, status epilepticus, GBS, etc.) for me to keep seeing them. Especially if one is salaried and not being paid based on volume. Yet some of my colleagues just can't seem to bring themselves to sign off. I notice that certain other specialties, cardiology and ID for example, keep seeing patients every single day till they are discharged even if they are not doing anything active. But they always have a midlevel provider doing the notes.

 

[Hockeyfan23]

No I will not have midlevels with me. At this point I am essentially working on an exit strategy. However. The job hunt, interview/contract process, and credentialing process means I wouldn’t be able to start the next chapter for at least 4-6 months. In the mean time I need to try and negotiate for what I believe is fair.

 

[Phantom Spike]

No I will not have midlevels with me. At this point I am essentially working on an exit strategy. However. The job hunt, interview/contract process, and credentialing process means I wouldn’t be able to start the next chapter for at least 4-6 months. In the mean time I need to try and negotiate for what I believe is fair.

If your previous contract is null and void, are you immediately free, or do you still have to work for them for a time? If the latter, I'm not sure this is a situation where you can bargain necessarily. You mentioned earlier that you were considering teleneurology. Now that you are out of your prior contract, why don't you pursue that? It seems as if it would solve all your issues (no need to relocate, flexible schedules, no non-compete issues, etc.).

 

[curiousneuro]

If your previous contract is null and void, are you immediately free, or do you still have to work for them for a time? If the latter, I'm not sure this is a situation where you can bargain necessarily. You mentioned earlier that you were considering teleneurology. Now that you are out of your prior contract, why don't you pursue that? It seems as if it would solve all your issues (no need to relocate, flexible schedules, no non-compete issues, etc.).

+1 on the teleneuro although I may be a little biased

However there's usually at least a 4-6 month lead time needed for licensing, credentialing.

 

[deathmerchant]

Once again wanted to thank everyone for the advice and support. There have been some recent developments. We are adding another hospital to our coverage and there is a high likelihood of being able to go 7on/7off. The kicker is I will be covering 3 smaller hospitals (cover 2 small ones now) and also taking night call for those hospitals I am covering which is generally not too busy. The census between all 3 seems like it could run 20-30 patients or so. The 7 days on will definitely be long and exhausting if I do decide to stick it out. At this point, my initial contract is null and void so I believe I have some bargaining power. What is a reasonable salary to expect for the above volume and coverage? Thanks!

20 patients a day covering 3 hospitals with overnight call is tough but doable with the right salary. OTOH, 30 patients a day in 3 hospitals With call is a recipe for disaster. You need Hazard pay for that! This is not Nephrology or cardiology where you can easily run through 30 patients.
Expect >500K-600k for this

 

[Neurogeneral]

Will there be NPs/PAs to assist?
With regard to large patient census, does everyone see every patient on their list every day even if they're stable and just awaiting a test or placement or some such? Personally it is rather unusual for me to see a patient even once in follow up; most consults are unnecessary anyway (clearly cardiogenic syncope, breakthrough seizure in a patient noncompliant with medication, patient with known Parkinson's disease and an established outpatient neurologist admitted for something different entirely, completely resolved TIA with completed workup, AMS in 80-year old dementia patients with UTIs etc.). I just say, "no further neurological work up needed", or "if brain MRI, CTA and EEG are unrevealing, cleared from Neurology standpoint with XYZ recommendations", etc. A patient would have to have really acute neurological illness (massive stroke, status epilepticus, GBS, etc.) for me to keep seeing them. Especially if one is salaried and not being paid based on volume. Yet some of my colleagues just can't seem to bring themselves to sign off. I notice that certain other specialties, cardiology and ID for example, keep seeing patients every single day till they are discharged even if they are not doing anything active. But they always have a midlevel provider doing the notes.

I usually see the patient a couple of times for the typical AMS case but once the workup is done or the patient has improved I am done. I notice though the other neurologists will continue to follow the patient for the entirety of the admission with the same old assessment over and over again “Encephalopathy due to underlying medical condition. We will continue to follow.”

 

[Phantom Spike]

I usually see the patient a couple of times for the typical AMS case but once the workup is done or the patient has improved I am done. I notice though the other neurologists will continue to follow the patient for the entirety of the admission with the same old assessment over and over again “Encephalopathy due to underlying medical condition. We will continue to follow.”

I notice this as well. If you're volume-based or if you have NPs/PAs who will do the note for you and all you have to do is walk into the patient room with them for a minute and then sign their assessment, it might make sense. Otherwise, to me, a census of 30 patients is oftentimes really just a census of 10 new patients and 1-2 really sick follow-ups.

As I mentioned following a patient throughout the admission seems to be standard practice for some specialties. For neurology, it seems physician-specific.

 

[cerebral edema]

Happy new year all! Hoping to seek some advice from everyone out there.

In my first gig outside of residency and so far it has generally been a good experience. (It’s the a private group who contracts with the hospital). I like the people I work with and surprisingly see a nice variety of pathology. I have one year left on my initial contract. However, the schedule right now is essentially 12 on 2 off. I’m doing fine now but am worried about burnout in the future. In addition we are in the process of starting a family and my wife is hoping to get back to work by the end of the year. When I first joined I was under the impression this would eventually be a 7on/7off gig but doesn’t seem like that will happen. I truly value time spent at home with my family and feel I will ultimately have to make a change to be at home more for my wife and kids. I’m considering other gigs that are 7 on 7 off or telemed (given non compete).

Had anyone been in a similar situation? What is the best way to handle this? If I do leave how much lead time is fair/appropriate? Does it look bad to move companies after first contract? Any advice or kind words would be appreciated. Thanks!

I was in this exact situation when I graduated residency and I already had 3 kids by then. It was miserable and I left. I am much happier now. The hospital I left is still looking for someone to fill my position (left >4 years ago). They have no intention on changing their model to retain physicians. 🤷‍♂️