Can I find this unique hospitalist schedule?

[Osteoth]

So I'm an intern in medicine in southern California, and am determining whether it makes financial sense to do fellowship, or if I could work an equivalent amount of time as a hospitalist and make the same amount.

In residency we work 6 days a week with one day off, so I wondered if I could find a hospitalist job that is 6 days on, with every Saturday off, round and go, cover your patients till 7. Closed ICU, subspecialty support, no procedures.

Per my calculations, $225/14 days=$16,000 per day worked every month. Expand that to 25/31 days a month comes out to ~$400,000. Of course burn out would be an issue, but I like wards and don't feel like a round and go situation is that bad right now (our residency allows us to take calls from home if we are not admitting).

My question would be how hard it would be to find a schedule like this out in the community. I know alot of jobs people have taken are 7 on/7 off 12-hour in house. I would be willing to relocate, but train in SoCal where I assume it would be harder to find a good job like this.

Thanks,

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[tantacles]

If your goal is to make $400k/year, just work nights, man. You'll get there in under 20 shifts per month. The schedule you've put forth sounds awful.

 

[Osteoth]

If your goal is to make $400k/year, just work nights, man. You'll get there in under 20 shifts per month. The schedule you've put forth sounds awful.

Just finished a month on night float and honestly can’t do nights.

Felt physically sick the entire time and my days off weren’t fun being awake when everyone else is asleep.

I wish I liked it because it really is the easy answer though.

 

[tantacles]

Doing nights as a resident is very different than doing it as an attending. You work 12 nights in 14 days. I work 10 nights in a month. That's full time.

 

[Osteoth]

Doing nights as a resident is very different than doing it as an attending. You work 12 nights in 14 days. I work 10 nights in a month. That's full time.

To hit around 400 I’d need to work about 17 nights per month.

It’s not the 25 I worked when I was on float but it’s not nothing. Add on 1-2 days to transition to or from the schedule and you’re close the same number of total working days as just working day shift.

In addition as I referred to above on nights days off aren’t as fun, so even though maybe I’d be able to work 5 fewer days I wouldn’t enjoy those days off as much unfortunately

 

[chessknt]

Doing nights as a resident is very different than doing it as an attending. You work 12 nights in 14 days. I work 10 nights in a month. That's full time.

That isnt full time anywhere I have seen--completely YMMV. From a hospital's perspective they would have to hire 3 people for a hard to fill job and unless those 3 people are the price of 2 then you are eating it in the face on benefits/medmal/scheduling issues etc

 

[tantacles]

That isnt full time anywhere I have seen--completely YMMV. From a hospital's perspective they would have to hire 3 people for a hard to fill job and unless those 3 people are the price of 2 then you are eating it in the face on benefits/medmal/scheduling issues etc

My comment about my job wasn’t to say that you will find the same arrangement. Every place does things differently. Some just pay more for nights, and you could go 8/10 time if you wanted.

The reason my job does it this way is it makes it easier to fill the spot, alleviating the stress of retention as our nocturnists are likely to stay.

 

[tantacles]

To hit around 400 I’d need to work about 17 nights per month.

It’s not the 25 I worked when I was on float but it’s not nothing. Add on 1-2 days to transition to or from the schedule and you’re close the same number of total working days as just working day shift.

In addition as I referred to above on nights days off aren’t as fun, so even though maybe I’d be able to work 5 fewer days I wouldn’t enjoy those days off as much unfortunately

I’m not saying you’re definitely wrong. I’m just saying your perspective as a resident leaves out pieces of the whole picture. You could do your scheduled night shifts, for example, and make up the extra with more day shifts, for example. The point is that with appropriate days off, nights can actually be great. When you have 1 night in 7 off, it’s not sustainable, but things are different in attending land.

 

[Osteoth]

I’m not saying you’re definitely wrong. I’m just saying your perspective as a resident leaves out pieces of the whole picture. You could do your scheduled night shifts, for example, and make up the extra with more day shifts, for example. The point is that with appropriate days off, nights can actually be great. When you have 1 night in 7 off, it’s not sustainable, but things are different in attending land.

Yeah I definitely agree, and thats why I make posts like this, to learn.

I also feel, based on my experience, that I would rather work a few extra days than do nights. Personal preference.

Based on your experience, do you think it is likely for me to find the schedule I described out in the world? And if possible in SoCal?

 

[tantacles]

Yeah I definitely agree, and thats why I make posts like this, to learn.

I also feel, based on my experience, that I would rather work a few extra days than do nights. Personal preference.

Based on your experience, do you think it is likely for me to find the schedule I described out in the world? And if possible in SoCal?

If not, all you have to do if you want to work 6 on 1 off is get credentialed at a bunch of different hospitals and get put on the schedule.

 

[chessknt]

To answer your question yes I am absolutely sure some place like this exists and that they would be willing to employ you at 2 FTE; as for it being in socal that is less likely and at 225/hr I am guessing not what you think of when you think socal (maybe the death valley area or something way out in the desert).

I guess the questions I have if you are going home when finished rounding every day are:
Who is responsible for responding to RRT calls on your patients when you are at home?
Who is doing the admitting?
How many patients do you think are reasonable to cover? How much do you think you should be paid per shift?
How do you think the admins view going home when you are 'on the clock'?

 

[Osteoth]

If not, all you have to do if you want to work 6 on 1 off is get credentialed at a bunch of different hospitals and get put on the schedule.

Problem is consistency of scheduling. Can't all of a sudden lose 4 shifts a month if you've got a mortgage. Also I might be interested in leadership at some point and it is easier to rise through the ranks in my mind if you can serve on multiple committees in the same hospital.

To answer your question yes I am absolutely sure some place like this exists and that they would be willing to employ you at 2 FTE; as for it being in socal that is less likely and at 225/hr I am guessing not what you think of when you think socal (maybe the death valley area or something way out in the desert).

I guess the questions I have if you are going home when finished rounding every day are:
Who is responsible for responding to RRT calls on your patients when you are at home?
Who is doing the admitting?
How many patients do you think are reasonable to cover? How much do you think you should be paid per shift?
How do you think the admins view going home when you are 'on the clock'?

$225k was just me extrapolating per day worked a month how much that day is worth. Aka $225k/14 days = $16k per day a month extrapolated over a year. I would expect more around $150-$175/hr.

Rapids and codes handled by ED & ICU, closed ICU only.

The model I prefer is one where the day team takes admits until like 4pm up to a cap of maybe 2-3 and then everyone takes a turn doing in house admissions maybe once every six weeks or however the division works until 7p for a week.

I think 15 average census is appropriate for FTE, with RVU bonus above this amount. $150x12=$1800/shift, with RVU bonus if seeing above 15.

If the group handles calls and admits patients appropriately I doubt admin would care. At my residency program the private docs do this and no one seems to care.

Thoughts?

 

[chessknt]

Problem is consistency of scheduling. Can't all of a sudden lose 4 shifts a month if you've got a mortgage. Also I might be interested in leadership at some point and it is easier to rise through the ranks in my mind if you can serve on multiple committees in the same hospital.



$225k was just me extrapolating per day worked a month how much that day is worth. Aka $225k/14 days = $16k per day a month extrapolated over a year. I would expect more around $150-$175/hr.

Rapids and codes handled by ED & ICU, closed ICU only.

The model I prefer is one where the day team takes admits until like 4pm up to a cap of maybe 2-3 and then everyone takes a turn doing in house admissions maybe once every six weeks or however the division works until 7p for a week.

I think 15 average census is appropriate for FTE, with RVU bonus above this amount. $150x12=$1800/shift, with RVU bonus if seeing above 15.

If the group handles calls and admits patients appropriately I doubt admin would care. At my residency program the private docs do this and no one seems to care.

Thoughts?

I think that hourly rate is probably a fair expectation but might not be achievable in some areas. The census of 15 seems on the lower end of what I have seen in community shops. Dont ever think that admin doesnt care if you are getting paid to sit at home--they do. All it takes is a few nurses to put up a fuss about how they couldnt reach you or a family complaint about how they didnt get to see you and, whether it is justified or not, you can watch that perk completely disappear and if you are employed you cant do anything about it. As an ICU doc I find it supremely annoying when I have to go learn about a patient on the floor from the nurse and the swing shift hospitalist at bedside doesnt know anything about the person and it is only 2PM because the primary MD has already gone home.

As an aside--losing a few shifts unexpectedly in one month should not spell financial ruin for a doctor, if it does you have major budgeting/spending problems.

 

[Osteoth]

I think that hourly rate is probably a fair expectation but might not be achievable in some areas. The census of 15 seems on the lower end of what I have seen in community shops. Dont ever think that admin doesnt care if you are getting paid to sit at home--they do. All it takes is a few nurses to put up a fuss about how they couldnt reach you or a family complaint about how they didnt get to see you and, whether it is justified or not, you can watch that perk completely disappear and if you are employed you cant do anything about it. As an ICU doc I find it supremely annoying when I have to go learn about a patient on the floor from the nurse and the swing shift hospitalist at bedside doesnt know anything about the person and it is only 2PM because the primary MD has already gone home.

As an aside--losing a few shifts unexpectedly in one month should not spell financial ruin for a doctor, if it does you have major budgeting/spending problems.

So its my understanding that hospitals cannot employ hospitalists due to conflict of interest, and as a result most partner with groups to provide hospitalist services. As a result, unless they are willing to replace the whole group if a group has an understanding/contract then that is hard to change with a specific hospital. True or false?

 

[chessknt]

So its my understanding that hospitals cannot employ hospitalists due to conflict of interest, and as a result most partner with groups to provide hospitalist services. As a result, unless they are willing to replace the whole group if a group has an understanding/contract then that is hard to change with a specific hospital. True or false?

Totally false in any way that matters. Typically hospital owns the medical group that employs the hospitalists.

 

[tantacles]

Totally false in any way that matters. Typically hospital owns the medical group that employs the hospitalists.

Definitely state dependent. In my state the hospital has to go through huge hoops if they want to do this. The groups at the hospitals I work in are physician owned.

 

[blue.jay]

Totally false in any way that matters. Typically hospital owns the medical group that employs the hospitalists.

Not totally false. In few states (for eg, texas, california) hospitals are not allowed to directly employ hospitalists unless they are academic institution. Try looking for jobs in texas or california, majority of them are through staffing agencies similar to sound, team health,ipca, apogee etc

 

[Laradd]

Doing nights as a resident is very different than doing it as an attending. You work 12 nights in 14 days. I work 10 nights in a month. That's full time.

Is this at a major hospital or more rural because that seems hella chill?

 

[rokshana]

Is this at a major hospital or more rural because that seems hella chill?

No that’s a common full time nocturnist

 

[Prehealth1011]

No that’s a common full time nocturnist

Aren’t most nocturnist jobs 12-15 shifts a month? IM applicant here trying to learn.

 

[gutonc]

Aren’t most nocturnist jobs 12-15 shifts a month? IM applicant here trying to learn.

The super s****y ones are.

The good ones know you can't flog a nocturnist that hard and expect them to stay longer than a year or so.

 

[tantacles]

Is this at a major hospital or more rural because that seems hella chill?

Urban community hospital.

 

[tantacles]

Aren’t most nocturnist jobs 12-15 shifts a month? IM applicant here trying to learn.

I’ve seen both. However, the turnover is tremendous at places with 14-15 shifts per month (7 on 7 off). If you have someone who likes to work nights, you generally bend over backward to keep them, or at least that’s been my experience.

Some at the hospitals I work at have been offering me cash stacks to take their nights shifts, bringing my pay rate to 1.5 x its normal. That’s how much some people hate doing nights.

 

[Osteoth]

I’ve seen both. However, the turnover is tremendous at places with 14-15 shifts per month (7 on 7 off). If you have someone who likes to work nights, you generally bend over backward to keep them, or at least that’s been my experience.

Some at the hospitals I work at have been offering me cash stacks to take their nights shifts, bringing my pay rate to 1.5 x its normal. That’s how much some people hate doing nights.

So $225/hr with 10 shifts FTE, salary of $325,000?

 

[tantacles]

So $225/hr with 10 shifts FTE, salary of $325,000?

Nope. My base is around $250,000 with an approximate hourly of $165-$180 for my base shifts.

 

[Splenda88]

The hospitalist market is not as lucrative a s I thought... I haven't been able to find a 6 nights on and 8 nights off in a decent city in the south eastern part of the country that is paying 280k+/yr...

Wha't is going on? I am starting to be worried a little bit.

 

[chessknt]

The hospitalist market is not as lucrative a s I thought... I haven't been able to find a 6 nights on and 8 nights off in a decent city in the south eastern part of the country that is paying 280k+/yr...

Wha't is going on? I am starting to be worried a little bit.

Likely a combination of things:

1. Financial uncertainty with rising covid cases threatening the procedure money machine (which also incidentally exposes how flawed compensation is in this country that a hospital running at capacity doing what it was actually designed to do is losing money)

2. Financial pain from the first wave that have dried up subsidies for night work

3. More grads staying local/less willing to leave due to covid

 

[Kaustikos]

Some at the hospitals I work at have been offering me cash stacks to take their nights shifts, bringing my pay rate to 1.5 x its normal. That’s how much some people hate doing nights.

*raises hand*