Good Nocturnist offer?

[bbos]

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-7 on 14 off
-8 to 10 admission, no caps
-10 hr shift
-120 pts cross coverage
-responsible for codes
-no rapids, no procedures, closed icu with 24/7 Icu intensivist
-just one nocturnist on at night
-350k base + RVU, $3000 per extra shift

I’m fresh out of residency where night shifts were 60cross coverage with 4 admission cap and a closed ICU. I’m not sure if I can handle the demands of this job offer.

 

[Splenda88]

Hard no unless they at least have an NP/PA with you for cross coverage

 

[bbos]

No NP/PA, just solo nocturnist.
24/7 ICU attending available, however there might be a wait time for the patient to be transferred to the ICU at the main campus.
so during the wait time, I'd be responsible for the vent and the drips.

specialties available at night- Cardiology, general surgery, trauma, EM, ob/gyn, critical care


On-call over phone and will come in for emergencies:
Neurology, urology, GI, neurosurgery, ortho, ID, heme/onc, ENT, ophthalmology, colorectal, gyn onc, ID, pulmonology, IR, vascular surgery, thoracic surgery

 

[Splenda88]

No NP/PA, just solo nocturnist.
24/7 ICU attending available, however there might be a wait time for the patient to be transferred to the ICU at the main campus.
so during the wait time, I'd be responsible for the vent and the drips.

specialties available at night- Cardiology, general surgery, trauma, EM, ob/gyn, critical care


On-call over phone and will come in for emergencies:
Neurology, urology, GI, neurosurgery, ortho, ID, heme/onc, ENT, ophthalmology, colorectal, gyn onc, ID, pulmonology, IR, vascular surgery, thoracic surgery

Do NOT take that job.

 

[dozitgetchahi]

-7 on 14 off
-8 to 10 admission, no caps
-10 hr shift
-120 pts cross coverage
-responsible for codes
-no rapids, no procedures, closed icu with 24/7 Icu intensivist
-just one nocturnist on at night
-350k base + RVU, $3000 per extra shift

I’m fresh out of residency where night shifts were 60cross coverage with 4 admission cap and a closed ICU. I’m not sure if I can handle the demands of this job offer.

Sounds pretty bad.

Reminds me of the huge 800 bed community hospital I spent some time at as a resident - about 550 of these beds were general medicine. Night coverage for those 550 beds consisted of one hospitalist and two NPs. It was apparently a total ****show at night - you didn’t even sign out to the night coverage because there was no way they could keep up with any of it. Everyone was told to “tuck in your patients real good” because all they did at night was put out fires.

 

[bobow98]

Looked amazing until you said 120 pts cross coverage as the only in house attending for IM. That is crazy.
Run.

Otherwise, if no cross coverage, looks like an amazing job.

 

[Cornfed101]

What would be the cross cover cap to make this job worth it?

 

[Splenda88]

What would be the cross cover cap to make this job worth it?

If you are admitting 8-10 people (it will be more since these people lie most of the time) in a 12 hrs shift, you should not have to worry about getting calls from nurses.

That job OP posted should be the job for 1 doc and 1 mid level.

It would not be a good job even if it was 20 patients cross coverage.

The salary is probably above average. They actually can get away by paying 300k for that job and use the 50k to pay a mid level 120-130k for cross coverage.

We have about 200 medical/ICU beds in our hospital. I was told average night admit is 16 (let's say 20). There are 2 physicians, and 1 midlevel to mainly do cross coverage. Lately, they are talking about hiring another midlevel to help with the cross coverage (~100 each for each midlevel). The only thing is that our docs work 1 wk on/off, and they only make 405k/yr.

 

[DrMetal]

-7 on 14 off
-8 to 10 admission, no caps
-10 hr shift
-120 pts cross coverage
-responsible for codes
-no rapids, no procedures, closed icu with 24/7 Icu intensivist
-just one nocturnist on at night
-350k base + RVU, $3000 per extra shift

I’m fresh out of residency where night shifts were 60cross coverage with 4 admission cap and a closed ICU. I’m not sure if I can handle the demands of this job offer.

What part of the country, a metro area? What you mean no caps? So if there's 15 admissions during your 10-hour shift, you have to admit all of them?

If you can negotiate, I would ask for:
- Cap at 8 admissions
- No codes

Otherwise pretty crappy deal.

 

[bbos]

What part of the country, a metro area? What you mean no caps? So if there's 15 admissions during your 10-hour shift, you have to admit all of them?

If you can negotiate, I would ask for:
- Cap at 8 admissions
- No codes

Otherwise pretty crappy deal.

the nocturnist i talked to said he had all time high of 13 admits, and he left as many as 4 admits for the day team.

mid sized city in the mid west

 

[DrMetal]

the nocturnist i talked to said he had all time high of 13 admits, and he left as many as 4 admits for the day team.

mid sized city in the mid west

So if you're leaving admits for the day team, sounds like there's a cap. That cap # should be stated clearly in your contract. How are you supposed to be admitting that many and running codes at the same time? No way. Ask them for $500K if they want all of the above.

 

[end stage fibro]

thanks for posting this. usually, all the jobs i see on SDN make me green with envy. I am glad i can finally say "no, this is a crap job."

edit: to add some real world data, a recent nocturnist posting in my area:
250ish base
probably 20-30k in quality bonus
Another 160k-ish in production bonus
183 shifts
12 hr shift
600 stipend per night. extra shift 1500 bucks (plus stipend)
no procedures
yes rapids
codes get paged out but usually ED handles it. you should still show up though
crosscover starts after midnight. there is a dedicated coverage person for that prior to midnight. after midnight, crosscover gets distributed among 4 docs. ratio is roughly 1 doc to 125 beds
12+ admits is typical, average 14-15. you will hit 18+ some nights. you can dump as much as you want on day team.
you admit ICU patients, but there is teleicu overnight. they take over everything....you do initial orders and H/P
all specialties available all the time

sounds good? too late, it is already filled.

 

[dozitgetchahi]

thanks for posting this. usually, all the jobs i see on SDN make me green with envy. I am glad i can finally say "no, this is a crap job."

edit: to add some real world data, a recent nocturnist posting in my area:
250ish base
probably 20-30k in quality bonus
Another 160k-ish in production bonus
183 shifts
12 hr shift
600 stipend per night. extra shift 1500 bucks (plus stipend)
no procedures
yes rapids
codes get paged out but usually ED handles it. you should still show up though
crosscover starts after midnight. there is a dedicated coverage person for that prior to midnight. after midnight, crosscover gets distributed among 4 docs. ratio is roughly 1 doc to 125 beds
12+ admits is typical, average 14-15. you will hit 18+ some nights. you can dump as much as you want on day team.
you admit ICU patients, but there is teleicu overnight. they take over everything....you do initial orders and H/P
all specialties available all the time

sounds good? too late, it is already filled.

Lmfao, cross covering 125 beds and 12+ admits?

The money is good, but how long until you kill somebody (or all your hair turns grey)? Who the hell signs up for this stuff?

 

[end stage fibro]

Lmfao, cross covering 125 beds and 12+ admits?

The money is good, but how long until you kill somebody (or all your hair turns grey)? Who the hell signs up for this stuff?

this is probably one of the more cush jobs where i live 😢. Most of the private groups have 1 or 2 people on overnight. You might be cross covering 250+ sick individuals and seeing 30 admits. orders are usually fine but the notes belong in the Fiction section, not Biographical. day team needs to do chart review on every overnight patient.

 

[DrMetal]

but how long until you kill somebody

We don't kill our patients. We help them die.

 

[tantacles]

Yeah, much like Gypsy Rose, I wouldn't touch that with a 10 foot pole.

 

[Splenda88]

If you are admitting 8-10 people (it will be more since these people lie most of the time) in a 12 hrs shift, you should not have to worry about getting calls from nurses.

That job OP posted should be the job for 1 doc and 1 mid level.

It would not be a good job even if it was 20 patients cross coverage.

The salary is probably above average. They actually can get away by paying 300k for that job and use the 50k to pay a mid level 120-130k for cross coverage.

We have about 200 medical/ICU beds in our hospital. I was told average night admit is 16 (let's say 20). There are 2 physicians, and 1 midlevel to mainly do cross coverage. Lately, they are talking about hiring another midlevel to help with the cross coverage (~100 each for each midlevel). The only thing is that our docs work 1 wk on/off, and they only make 405k/yr.

By the way, they have a new pay incentive for nocturnists at my shop as of yesterday.

Any admission above 9, the nocturnist got paid the hourly rate ($185/hr) per additional admission. For instance, If the nocturnist admits 14 patients in a particular night, he/she will get an additional of $925 = [ 5x ($185)] that night.

By the way, norcturnists base rate is $2,220/night at my shop.

 

[gutonc]

By the way, they have a new pay incentive for nocturnists at my shop as of yesterday.

Any admission above 9, the nocturnist got paid the hourly rate ($185/hr) per additional admission. For instance, If the nocturnist admits 14 patients in a particular night, he/she will get an additional of $925 = [ 5x ($185)] that night.

By the way, norcturnists base rate is $2,220/night at my shop.

This is actually a good way to incentivize hard work without punishing people who choose to work less hard. Don't want to admit that 10th or 11th patient? Cool. Want to hustle?, here's another $300-1000.

In my last job, I came up with an incentive for seeing new patients in clinic vs follow ups. New patients are a lot more work but a level 5 new only pays about 25% more than a level 5 follow up. And if you can see 3 or 4 level 5 follow ups in the time it takes you to see 1 level 5 new patient, why wouldn't you fill your schedule full of follow ups and limit the number of new patients you saw a day? So we tried to add a 20% wRVU multiplier for docs who saw more than the median number of new patients a day (averaged over a year) seen by the group as a whole (it was 2-ish at the time). And this multiplier didn't just apply to your new patient wRVUs, but every single wRVU you generated. Admin was on board (we were losing new referrals due to delays in scheduling). The docs vetoed it because "we're being punished if we don't see enough new patients". I sat down one-on-one with every single doc, looking at a spreadsheet showing how their comp would stay exactly the same if they didn't see more new patients, and how it would go up by 20% if they saw literally one more patient a year over the median and they all still believed they were being punished. So we scrapped that comp plan.

 

[DrMetal]

By the way, they have a new pay incentive for nocturnists at my shop as of yesterday.

Any admission above 9, the nocturnist got paid the hourly rate ($185/hr) per additional admission. For instance, If the nocturnist admits 14 patients in a particular night, he/she will get an additional of $925 = [ 5x ($185)] that night.

By the way, norcturnists base rate is $2,220/night at my shop.

That's pretty good. Let's enjoy it while it lasts. In 10 years, it'll be done at half the cost, by a NP with an iPad powered by chatGPT.

 

[NewYorkDoctors]

That's pretty good. Let's enjoy it while it lasts. In 10 years, it'll be done at half the cost, by a NP with an iPad powered by chatGPT.

not to mention AI will have algorithms altered so it will give misinformation about certain diagnoses that will prolong length of stay or do not fit the hospital administrator's chosen narratives or pad those non MD bureaucrats bottom line....

AI is not meant to enlighten. It is meant to control those who cannot think for themselves due to lack of formal training and education.

am I talking about something else besides independent midlevels taking over hospitalist role? most definitely yes. lol

 

[DrMetal]

not to mention AI will have algorithms altered so it will give misinformation about certain diagnoses that will prolong length of stay or do not fit the hospital administrator's chosen narratives or pad those non MD bureaucrats bottom line....

AI is not meant to enlighten. It is meant to control those who cannot think for themselves due to lack of formal training and education.

am I talking about something else besides independent midlevels taking over hospitalist role? most definitely yes. lol

All true, but nobody really cares. If it saves $$$, they'll go with it.

 

[Splenda88]

That's pretty good. Let's enjoy it while it lasts. In 10 years, it'll be done at half the cost, by a NP with an iPad powered by chatGPT.

Agree. Gotta find a way to be financially independent in 10 yrs.

 

[sloh]

This is actually a good way to incentivize hard work without punishing people who choose to work less hard. Don't want to admit that 10th or 11th patient? Cool. Want to hustle?, here's another $300-1000.

In my last job, I came up with an incentive for seeing new patients in clinic vs follow ups. New patients are a lot more work but a level 5 new only pays about 25% more than a level 5 follow up. And if you can see 3 or 4 level 5 follow ups in the time it takes you to see 1 level 5 new patient, why wouldn't you fill your schedule full of follow ups and limit the number of new patients you saw a day? So we tried to add a 20% wRVU multiplier for docs who saw more than the median number of new patients a day (averaged over a year) seen by the group as a whole (it was 2-ish at the time). And this multiplier didn't just apply to your new patient wRVUs, but every single wRVU you generated. Admin was on board (we were losing new referrals due to delays in scheduling). The docs vetoed it because "we're being punished if we don't see enough new patients". I sat down one-on-one with every single doc, looking at a spreadsheet showing how their comp would stay exactly the same if they didn't see more new patients, and how it would go up by 20% if they saw literally one more patient a year over the median and they all still believed they were being punished. So we scrapped that comp plan.

Wow physicians can be bad at math haha

 

[gutonc]

Wow physicians can be bad at math haha

I worked with some phenomenally financially stupid people.

 

[dozitgetchahi]

not to mention AI will have algorithms altered so it will give misinformation about certain diagnoses that will prolong length of stay or do not fit the hospital administrator's chosen narratives or pad those non MD bureaucrats bottom line....

AI is not meant to enlighten. It is meant to control those who cannot think for themselves due to lack of formal training and education.

am I talking about something else besides independent midlevels taking over hospitalist role? most definitely yes. lol

After messing around with ChatGPT recently…let’s just say that I’m less concerned about it than I was. It’s really not that great, and IMHO is much more hype than substance. It whiffs badly on even basic rheumatology scenarios. It’s basically a glorified Googler with a bull**** engine.

I get that the technology will continue to get better, but the only people who should currently be concerned about ChatGPT are those whose jobs consist of spinning corporate bull**** and doing corporate busywork (and granted, a LOT of jobs in the US fit that description).

 

[chessknt]

After messing around with ChatGPT recently…let’s just say that I’m less concerned about it than I was. It’s really not that great, and IMHO is much more hype than substance. It whiffs badly on even basic rheumatology scenarios. It’s basically a glorified Googler with a bull**** engine.

I get that the technology will continue to get better, but the only people who should currently be concerned about ChatGPT are those whose jobs consist of spinning corporate bull**** and doing corporate busywork (and granted, a LOT of jobs in the US fit that description).

Try OpenEvidence with your tests then see what you think.

 

[DrMetal]

It whiffs badly on even basic rheumatology scenarios.

What does it tell you do, throw steroids at everyone?! Chee I wonder where it got that idea.

but the only people who should currently be concerned about ChatGPT are those whose jobs consist of spinning corporate bull**** and doing corporate busywork (and granted, a LOT of jobs in the US fit that description).

Well don't look now, but that's where medicine is heading (into corporate hell), or it's already there.

Here's the bottom line: healthcare is too expensive. What makes it so expensive? The people involved (doctors, nurses, techs, etc) and now corporate interests. If you can find a way to replace said people (chatBots, AI, robotics) while maintaining the standard of care (which is definition that can be changed), then the corporate machine will find a way to do that. (We've seen this done time and time again in several other industries).

We used to think medicine was different, that it was somehow immune to corporate pressures. We're fools.

In < 20 years, you'll have a chatbot taking your intake History at a GI clinic, with a robot then performing your colonoscopy.

 

[Splenda88]

That's pretty good. Let's enjoy it while it lasts. In 10 years, it'll be done at half the cost, by a NP with an iPad powered by chatGPT.

The stock market this week is not helping my 10-yr plan.

 

[dozitgetchahi]

What does it tell you do, throw steroids at everyone?! Chee I wonder where it got that idea.



Well don't look now, but that's where medicine is heading (into corporate hell), or it's already there.

Here's the bottom line: healthcare is too expensive. What makes it so expensive? The people involved (doctors, nurses, techs, etc) and now corporate interests. If you can find a way to replace said people (chatBots, AI, robotics) while maintaining the standard of care (which is definition that can be changed), then the corporate machine will find a way to do that. (We've seen this done time and time again in several other industries).

We used to think medicine was different, that it was somehow immune to corporate pressures. We're fools.

In < 20 years, you'll have a chatbot taking your intake History at a GI clinic, with a robot then performing your colonoscopy.

While I don’t disagree with the “final destination” you suggest for medicine here, physician pay is not what makes medicine so expensive at this point. Corporate grifters in management are. This has been demonstrated time and time again in analyses.

I also think it will take longer than 20 years to get to the point you suggest. Much longer, in fact. The current state of AI is much more primitive than the Silicon Valley hype men want you to think.

(Also, for the record, “throw steroids at everyone” hasn’t been the dominant strategy for managing rheumatologic disease for some time now.)

 

[Splenda88]

While I don’t disagree with the “final destination” you suggest for medicine here, physician pay is not what makes medicine so expensive at this point. Corporate grifters in management are. This has been demonstrated time and time again in analyses.

I also think it will take longer than 20 years to get to the point you suggest. Much longer, in fact. The current state of AI is much more primitive than the Silicon Valley hype men want you to think.

(Also, for the record, “throw steroids at everyone” hasn’t been the dominant strategy for managing rheumatologic disease for some time now.)

It's not primarily physicians pay. I would say personnels pay is a huge contributing factor. It's hard to find anyone in the healthcare industry who is not making six figure these days.

 

[gutonc]

It's not primarily physicians pay. I would say personnels pay is a huge contributing factor. It's hard to find anyone in the healthcare industry who is not making six figure these days.

I've seen this posted in various discussions on SDN and figured it fit nicely here:

From here.

(NB: these data are 10 years old and the paper was published 6 years ago.)

 

[DrMetal]

physician pay is not what makes medicine so expensive at this point. Corporate grifters in management are.

True. But all healthcare workers combined (as noted in the above figure) is significant. If AI can be used to replace the front office, the back office, the coders, etc, we'll likely use it as such. The concept of replacing the provider wont be that far behind.

I also think it will take longer than 20 years to get to the point you suggest. Much longer, in fact. The current state of AI is much more primitive than the Silicon Valley hype men want you to think.

True. The CT scanner became trendy in the early 80s. It took about a decade for many to regard it as a legitimate modality of diagnosis (over the physical exam). Now we don't do anything without imaging.

The problem with AI is, we don't know the true rate of its expansion and influence, right now, at any given moment in time. It's still too new and unexplored. It may be hype, it may be real, only time will tell.

(Also, for the record, “throw steroids at everyone” hasn’t been the dominant strategy for managing rheumatologic disease for some time now.)

Also True. I prefer the urgent psych consult, to explore their psychosomatic symptoms, which is the real explanation for most patients' symptoms when they think they might have rheumatological problems (despite completely negative workups).

 

[collegestud2013]

-7 on 14 off
-8 to 10 admission, no caps
-10 hr shift
-120 pts cross coverage
-responsible for codes
-no rapids, no procedures, closed icu with 24/7 Icu intensivist
-just one nocturnist on at night
-350k base + RVU, $3000 per extra shift

I’m fresh out of residency where night shifts were 60cross coverage with 4 admission cap and a closed ICU. I’m not sure if I can handle the demands of this job offer.

Pay per hour seems good on paper, coming out to at least $289 per hour, which is high even for nocturnist (and possibly even higher depending on the RVU pay structure). But agreed that single night coverage for that kind of volume will both lead to very quick burnout significantly increase your liability. Would also doubt you could finish the shift in 10 hrs on most days, especially on nights with more than 10 admits and multiple emergencies on the floor. Would only consider that volume if they have a PA/NP with your at night to rotate in on some of the admissions and help with cross coverage (and if they have to lower the pay somewhat per hour to help pay for the PA/NP, would be more likely to consider that instead).