Any nocturnists on here?

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Planes2Doc

I enjoy the nightlife
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I'm currently on nights this month. It's a nice dynamic compared to days. I was thinking about doing this when I grow up.

I was wondering if anyone here works as a nocturnist? I was curious about the work schedules, job responsibilities, and pay. Currently my responsibilities are admissions, floor call, and codes. I was wondering if a nocturnist would be doing those same things?

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It’s nice for a while. Until you have no one to socialize overnight. When you’re younger, maybe not bad, since you can bounce back easily. But after a while, it can get a little lonely. Some people like it, and can get either 7 on/7 off or 5 on/5 off schedule and may tolerate that better. Pay usually a little higher than your counter part.

Last thing that people don’t talk about is, when you don’t show your face for a long time..... people may easily forget about you. Also when you have a family and kids, you may not see them much.
 
Not a nocturnist. But I have friends who have done this for a year or two. All quit and either subspecialized or went to days because they hated it. Combination of difficulty with family, friends, exhaustion with switching between days and nights, difficulty coordinating things etc.

That being said there are folks who have done it for years and love it. Test it out, see if it fits with your lifestyle and go for it. Pay is usually better for sure. You also don’t have to round, there’s less paperwork, more just medicine and stabilizing patients etc.
 
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I'm currently on nights this month. It's a nice dynamic compared to days. I was thinking about doing this when I grow up.

I was wondering if anyone here works as a nocturnist? I was curious about the work schedules, job responsibilities, and pay. Currently my responsibilities are admissions, floor call, and codes. I was wondering if a nocturnist would be doing those same things?

I'm 3 months in to a mostly-nocturnist job while taking a gap year before fellowship. I actually loved nights when I was a resident because I like the quiet and being able to really think about the admissions. Day jobs tend to be too consumed with social work issues and correct clinical documentation. I enjoy following up on consults, but I don't have to be the one calling them. Also, if you do direct care where you are first call, it is literally like being an intern again. I am lucky as I have NP/PA/housestaff so all I have to worry about is H&Ps at night.

When I was in residency I spoke to a CCM nocturnist who has been doing it for 5+ years - he is a fantastic doctor but he chose to be a nocturnists for primarily the same reasons that I outlined. His kids apparently are pretty young so they go to sleep at 7-8 PM anyway when he leaves for work and he takes them to school in the morning and picks them up in the afternoon.

I think the major pros are 1) no rounding and excessive documentation, 2) being primarily responsible for "acute" issues that arise which is all medical reasoning/more CCM type stuff, 3) higher pay than day staff for IMO less "grunt" work. The major cons are 1) a lot less continuity (it's up to you to follow-up on the patients you saw if you want to learn from what eventually happened to them), 2) the day hospitalists often dump stuff on you to do overnight, 3) slightly longer hours compared to the day staff (this may vary, my job is 7-7 but the day staff usually come in an hour or two after me and leave an hour or two early).

I work mostly stretches of 7 nights followed by 7 off (although this varies, as I'm only about 75% nights). Also, it's not purely 1 week on 1 week off so I average less than 14 days a month (closer to 12). You get into the rhythm after 3 nights but I do start missing the sunlight after 5 nights. It takes me about a day and a half to adjust back to days. I get paid a flat salary + some year-end bonuses without any RVU-billing like the day staff. I primarily oversee NPs, PAs, and housestaff that do the admissions, but also do some admissions on my own depending on service. I don't cover codes (the overnight intensivist does). I do attend to all "sick patients" overnight that are not actively coding and manage it with CCM if I have questions or if they need to be transferred to a higher level of care. Obviously the scope of your work varies greatly depending on what job you interview for. Some will require you do all admissions solo, others will require you to attend codes and do everything up to intubation and/or lines before calling CCM. Some will have you be first call at night which absolutely terrible (remember intern night float?!) and is a Bad Idea.

I'm in a major urban center and I would say that it's very easy to find a job as a nocturnist as turnover is high (a lot of people like me doing it for 1-3 years). It's definitely more of a buyer's market than academic track day hospitalists. However, I would urge you to find a model that works for you. I knew I couldn't do a pure 100% nocturnist job due to lack of sunlight (I have a very high threshold than most, but still can't work completely in the dark lol), so I worked out a hybrid model which allows me to do ~25% day shifts. Usually you can work something out with the hospital as a lot of night shifts in academic centers are covered by moonlighters and it actually saves the hospital money to hire a full-time nocturnist. Since you are in demand, try to work out a schedule that works for you. You'll just have finished residency so you'll have a good sense of how many patients you can comfortably admit, how many patients you can oversee, the acuity of patients you can comfortably manage overnight vs. the acuity of the hospital's patients, how comfortable you are with sick patients before calling CCM vs. what the overnight CCM support is...etc.
 
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I'm 3 months in to a mostly-nocturnist job while taking a gap year before fellowship. I actually loved nights when I was a resident because I like the quiet and being able to really think about the admissions. Day jobs tend to be too consumed with social work issues and correct clinical documentation. I enjoy following up on consults, but I don't have to be the one calling them. Also, if you do direct care where you are first call, it is literally like being an intern again. I am lucky as I have NP/PA/housestaff so all I have to worry about is H&Ps at night.

When I was in residency I spoke to a CCM nocturnist who has been doing it for 5+ years - he is a fantastic doctor but he chose to be a nocturnists for primarily the same reasons that I outlined. His kids apparently are pretty young so they go to sleep at 7-8 PM anyway when he leaves for work and he takes them to school in the morning and picks them up in the afternoon.

I think the major pros are 1) no rounding and excessive documentation, 2) being primarily responsible for "acute" issues that arise which is all medical reasoning/more CCM type stuff, 3) higher pay than day staff for IMO less "grunt" work. The major cons are 1) a lot less continuity (it's up to you to follow-up on the patients you saw if you want to learn from what eventually happened to them), 2) the day hospitalists often dump stuff on you to do overnight, 3) slightly longer hours compared to the day staff (this may vary, my job is 7-7 but the day staff usually come in an hour or two after me and leave an hour or two early).

I work mostly stretches of 7 nights followed by 7 off (although this varies, as I'm only about 75% nights). Also, it's not purely 1 week on 1 week off so I average less than 14 days a month (closer to 12). You get into the rhythm after 3 nights but I do start missing the sunlight after 5 nights. It takes me about a day and a half to adjust back to days. I get paid a flat salary + some year-end bonuses without any RVU-billing like the day staff. I primarily oversee NPs, PAs, and housestaff that do the admissions, but also do some admissions on my own depending on service. I don't cover codes (the overnight intensivist does). I do attend to all "sick patients" overnight that are not actively coding and manage it with CCM if I have questions or if they need to be transferred to a higher level of care. Obviously the scope of your work varies greatly depending on what job you interview for. Some will require you do all admissions solo, others will require you to attend codes and do everything up to intubation and/or lines before calling CCM. Some will have you be first call at night which absolutely terrible (remember intern night float?!) and is a Bad Idea.

I'm in a major urban center and I would say that it's very easy to find a job as a nocturnist as turnover is high (a lot of people like me doing it for 1-3 years). It's definitely more of a buyer's market than academic track day hospitalists. However, I would urge you to find a model that works for you. I knew I couldn't do a pure 100% nocturnist job due to lack of sunlight (I have a very high threshold than most, but still can't work completely in the dark lol), so I worked out a hybrid model which allows me to do ~25% day shifts. Usually you can work something out with the hospital as a lot of night shifts in academic centers are covered by moonlighters and it actually saves the hospital money to hire a full-time nocturnist. Since you are in demand, try to work out a schedule that works for you. You'll just have finished residency so you'll have a good sense of how many patients you can comfortably admit, how many patients you can oversee, the acuity of patients you can comfortably manage overnight vs. the acuity of the hospital's patients, how comfortable you are with sick patients before calling CCM vs. what the overnight CCM support is...etc.

Wow! This is very helpful! Thank you for taking the time to write this out! 🙂
 
Wow! This is very helpful! Thank you for taking the time to write this out! 🙂

I have worked as a Nocturnist for the last 2 yrs. Love it! 6-8 admits per night (in the winter can be as high as 13-14), run codes and rapid responses. No procedures. Open ICU. No discharge summaries, progress notes, dealing with social work/case managers. Work 18 shifts per month, grossed 405K last year.
 
I have worked as a Nocturnist for the last 2 yrs. Love it! 6-8 admits per night (in the winter can be as high as 13-14), run codes and rapid responses. No procedures. Open ICU. No discharge summaries, progress notes, dealing with social work/case managers. Work 18 shifts per month, grossed 405K last year.

Now that's what I'm talking about! What region are you in?
 
Now that's what I'm talking about! What region are you in?

Midwest. But these types of deals are in many places. I spoke with a medical director recently in a large Rocky Mountain region city with very similar setup and pay structure. Nocturnists are in demand. The day people are not going to fight you to work nights. If you want to work extra shifts, they're available. Honestly I feel nights are much easier than days. But you have to be comfortable working on your own for the most part.
 
Midwest. But these types of deals are in many places. I spoke with a medical director recently in a large Rocky Mountain region city with very similar setup and pay structure. Nocturnists are in demand. The day people are not going to fight you to work nights. If you want to work extra shifts, they're available. Honestly I feel nights are much easier than days. But you have to be comfortable working on your own for the most part.

Yeah I absolutely love the dynamics versus days. I'm a total pushover in real-life, and can imagine some difficulties with some social situations. I'm one of those people that would say yes if a patient said "just one more day." It's nice to deal with acute aspects of medicine, without having to worry about the social situations. Being an over-paid babysitter isn't fun. I'll be looking in the Chicago suburbs once I move back, and possibly one hospital I loved rotating in as a medical school on the Indiana-Illinois border.
 
I have worked as a Nocturnist for the last 2 yrs. Love it! 6-8 admits per night (in the winter can be as high as 13-14), run codes and rapid responses. No procedures. Open ICU. No discharge summaries, progress notes, dealing with social work/case managers. Work 18 shifts per month, grossed 405K last year.

Do you have the option of taking less shifts if you wanted to? I've also read on here that some nocturnists work 7 on and 14 off. Are these jobs common?
 
Our nocturnists work 1 on 2 off. It's a bigger hospital with 3 docs and like 4 or so PA's. 1 in 3 nights they take the pager from ED and outside transfers, which is a crummy job. Otherwise, not too bad. We have quite a few day docs that do anywhere from 0.1 to 0.5 FTE nights in addition to their day work. One of our nocturnists is even 2.0 FTE (2 on, 1 off)
 
Do you have the option of taking less shifts if you wanted to? I've also read on here that some nocturnists work 7 on and 14 off. Are these jobs common?

I am contracted for 14 shifts per month. I volunteer for the rest. 4 extra shifts per month boosts my yearly gross by another 70K
 
I am contracted for 14 shifts per month. I volunteer for the rest. 4 extra shifts per month boosts my yearly gross by another 70K

Doesn’t fit. In your prior post you said you made $405k.

$70k extra annually for 4 extra shifts a month (48 shifts a year) means $1458 a shift.

So, going by that, 18 shifts a month without vacation is 216 shifts a year. $1458 x 216 is $315k.
 
Doesn’t fit. In your prior post you said you made $405k.

$70k extra annually for 4 extra shifts a month (48 shifts a year) means $1458 a shift.

So, going by that, 18 shifts a month without vacation is 216 shifts a year. $1458 x 216 is $315k.

Oops. Math is not their strong suit.....
 
Doesn’t fit. In your prior post you said you made $405k.

$70k extra annually for 4 extra shifts a month (48 shifts a year) means $1458 a shift.

So, going by that, 18 shifts a month without vacation is 216 shifts a year. $1458 x 216 is $315k.
but his contract may be for a higher base than what you calculated (ie the 14 shifts a month have a set yearly amount) and the extra shifts a different amount.
 
Extra shifts are always higher than base.

Just to chime in (again, I work in a hybrid model with some days mixed in) but my contract states I need to fulfill 150 shifts a year, divided up to 12 months -- comes out to about 12 shifts a month give and take a few. I don't want to mention specifics of the salary but I'm in a major urban area on the coast so the pay is nowhere as good as the Midwest. You need to fulfill the 150 shifts, but beyond that you can pick up as many additional shifts as you like (people calling out, shifts unfilled by regulars needing moonlighters...etc.). It is super easy to moonlight and essentially you can work unlimited amounts should you wish. Additional shifts are paid at a 20-40% premium hourly rate compared to my base salary when divided by the number of hours I work in a year (150*12).
 
Doesn’t fit. In your prior post you said you made $405k.

$70k extra annually for 4 extra shifts a month (48 shifts a year) means $1458 a shift.

So, going by that, 18 shifts a month without vacation is 216 shifts a year. $1458 x 216 is $315k.

OK genius here you go:

Contract 15.2 shifts per month @ $1825/shift = 332880
What I work is 18.5 shifts per month @ $1825/shift = 405150

So I rounded the numbers. So much for your smell test.
 
Didn't mean to offend. See crazy things on SDN from time to time - have to question it. Looks like $150/h, which is believable. Thanks for sharing.

I would never be able to work that much, especially nights. Loved nights in training but can't do it now - my other boss (wife) won't allow it.
 
I'm currently on nights this month. It's a nice dynamic compared to days. I was thinking about doing this when I grow up.

I was wondering if anyone here works as a nocturnist? I was curious about the work schedules, job responsibilities, and pay. Currently my responsibilities are admissions, floor call, and codes. I was wondering if a nocturnist would be doing those same things?

I've been a nocturnist in a community hospital a few miles outside a major northeast metro for the last 3 years. I enjoy every aspect of it! For me, it's the most distilled form of medicine. The admission process is 90% of the medicine, getting to think about the presentation, analyzing the data and making the right diagnosis is the most stimulating aspect for me, it's the reason I went into medicine. I don't have to deal with rounding, discharge planning, family meetings, whether or not the patient moved their bowels etc. I actually like not having to interact with the patient again, I wake up excited every evening to follow up on my patients from prior days and find out I set them on the right course. When I'm not admitting, I also enjoy the excitement of codes and rapid responses. I enjoy the camaraderie of nights, as you get to know the night crew and rely on them much more. More so, I enjoy working alone and the autonomy of nights. No consultant is telling me how to manage my patients, but I have all the subspecialties a phone call away if I feel I need them. I enjoy focusing on one patient at a time, and working at my own pace unlike my daytime colleagues who are given a census of 15+ patients each morning. I fell in love with the work while moonlighting in residency and never looked back.

I've made just under 550K per year for the last 3 years. I will say I'm a bit of a workaholic and usually pick up several extra shifts a month. That figure is definitely representative of my desire to bank as much while I'm young and still dont have kids, but I will say none of the nocturnists in my group make less than 300k and the average is around 350-400K which is very comfortable to achieve. Some of my colleagues do have kids.

Happy to answer any other questions you may have...
 
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