Hospitalist opportunity comparison

[dsk89]

Hi all, wanted to run these 3 opportunities by you and see what you guys think.
Location: all 3 are on West Coast, HCOL area in highly saturated market/metropolitan area or just on the outskirts of it

Job A:
7 on 7 off schedule (usually 1 in 4 shifts is 12 hrs in house, the others are 10 hrs in house), usually 1-4 nights a month (avg 2), 260K base for 189 shifts in a year, plus RVU (avg hospitalist in group makes 310-320K after RVU), 60K signing bonus as long as you stay 3 years, shareholding opportunity after 2 years. Commute 30-40 minutes. Open ICU, no procedures. Primarily rounder, take admits from 5-7 pm on your full 12 hr shift days. Large health system, all the subspeciality support.

Job B:
Shifts are typically 8 hrs long, and you'll work 20 days in the month. Base pay $280K, usually a couple nights a month at least. Don't think there is extra productivity/RVU. Slew of good benefits in a big health system, but lot of oversight and less autonomy.

Job C:
Nocturnist/Swing Shift, 12 shifts a month (10 hrs each shift)- 12 shifts minimum per month can be satisfied by night or swing shifts (usually about ~8 nights + 4 swings a month). Closed ICU, no procedures, minimal cross cover, no rapids/codes. Anywhere from 0 admits to 7 admits in a night. Pay scale is given by shift, varies based on which day of week youre working and swing/night. Lowest paid shift is around 1450 for a weekday swing, to as high as 1700 for a nighttime weekend. Plus an additional ~250 per shift for RVU. 10K profit sharing additional per year. Shareholding opportunity after 2 years. Large health system, all the subspeciality support.

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[chessknt]

Hi all, wanted to run these 3 opportunities by you and see what you guys think.
Location: all 3 are on West Coast, HCOL area in highly saturated market/metropolitan area or just on the outskirts of it

Job A:
7 on 7 off schedule (usually 1 in 4 shifts is 12 hrs in house, the others are 10 hrs in house), usually 1-4 nights a month (avg 2), 260K base for 189 shifts in a year, plus RVU (avg hospitalist in group makes 310-320K after RVU), 60K signing bonus as long as you stay 3 years, shareholding opportunity after 2 years. Commute 30-40 minutes. Open ICU, no procedures. Primarily rounder, take admits from 5-7 pm on your full 12 hr shift days. Large health system, all the subspeciality support.

Job B:
Shifts are typically 8 hrs long, and you'll work 20 days in the month. Base pay $280K, usually a couple nights a month at least. Don't think there is extra productivity/RVU. Slew of good benefits in a big health system, but lot of oversight and less autonomy.

Job C:
Nocturnist/Swing Shift, 12 shifts a month (10 hrs each shift)- 12 shifts minimum per month can be satisfied by night or swing shifts (usually about ~8 nights + 4 swings a month). Closed ICU, no procedures, minimal cross cover, no rapids/codes. Anywhere from 0 admits to 7 admits in a night. Pay scale is given by shift, varies based on which day of week youre working and swing/night. Lowest paid shift is around 1450 for a weekday swing, to as high as 1700 for a nighttime weekend. Plus an additional ~250 per shift for RVU. 10K profit sharing additional per year. Shareholding opportunity after 2 years. Large health system, all the subspeciality support.

I don't see avg census for A or B?

Job A-Open ICU where you have to routinely round in it shouldn't exist if this is a large health system. 15.75 shifts/month based on hours you describe is approx 2000 hours/yr, 155/hr pretax ignore signing bonus cant really tell if shareholder thing is worth anything at this juncture.

Job B-146/hr pretax, more days worked but better hours, probably a worse deal but again depends on census.

Job C-Different animal because it is night work. hard to tell exactly but hourly pay looks to be the same as the above which is a crap deal for nights.

I think pay is close between them but C is a different entity than A/B since it is less shifts but night work which many people cannot or will not do. B might be better quality of life given shorter shifts but also fewer days off per month so hard to say. Depending on if this is in OR or CA you are going to be earning less on an hourly basis than a nurse practitioner does in the midwest who also has a lower COL. 150/hr minus ~40/hr to fed tax (depending on if married) minus ~15/hr (cali tax) and you're under 100/hr.

 

[rokshana]

Hi all, wanted to run these 3 opportunities by you and see what you guys think.
Location: all 3 are on West Coast, HCOL area in highly saturated market/metropolitan area or just on the outskirts of it

Job A:
7 on 7 off schedule (usually 1 in 4 shifts is 12 hrs in house, the others are 10 hrs in house), usually 1-4 nights a month (avg 2), 260K base for 189 shifts in a year, plus RVU (avg hospitalist in group makes 310-320K after RVU), 60K signing bonus as long as you stay 3 years, shareholding opportunity after 2 years. Commute 30-40 minutes. Open ICU, no procedures. Primarily rounder, take admits from 5-7 pm on your full 12 hr shift days. Large health system, all the subspeciality support.

Job B:
Shifts are typically 8 hrs long, and you'll work 20 days in the month. Base pay $280K, usually a couple nights a month at least. Don't think there is extra productivity/RVU. Slew of good benefits in a big health system, but lot of oversight and less autonomy.

Job C:
Nocturnist/Swing Shift, 12 shifts a month (10 hrs each shift)- 12 shifts minimum per month can be satisfied by night or swing shifts (usually about ~8 nights + 4 swings a month). Closed ICU, no procedures, minimal cross cover, no rapids/codes. Anywhere from 0 admits to 7 admits in a night. Pay scale is given by shift, varies based on which day of week youre working and swing/night. Lowest paid shift is around 1450 for a weekday swing, to as high as 1700 for a nighttime weekend. Plus an additional ~250 per shift for RVU. 10K profit sharing additional per year. Shareholding opportunity after 2 years. Large health system, all the subspeciality support.

Is B with a closed icu?
C is not a bad option, but takes a special person to do nocturnist ( I do nocturnist when I do hospitalist work) and more so to do swing!

 

[Splenda88]

C seems to be a better offer.

I would do C if it was only nocturnist shifts (I Just don't like swing shift). ~270k/yr ($1550x150 shifts+ $250x150) for 12 shifts/month.

I am assuming that you will get paid $1550/shift on average

 

[Osteoth]

C seems to be a better offer.

I would do C if it was only nocturnist shifts (I Just don't like swing shift). ~270k/yr ($1550x150 shifts+ $250x150) for 12 shifts/month.

I am assuming that you will get paid $1550/shift on average

What are swing shift hours normally?

 

[Splenda88]

What are swing shift hours normally?

Not uniform everywhere

something like:
12 noon to midnight
1 pm to 1 am
2pm to 2am

 

[wamcp]

Not uniform everywhere

something like:
12 noon to midnight
1 pm to 1 am
2pm to 2am

Didn’t you say they are ten hours long shift?
Is swing shift admissions only or include crosscover?
Open icu?
Expected patient Volume?

 

[Splenda88]

Didn’t you say they are ten hours long shift?
Is swing shift admissions only or include crosscover?
Open icu?
Expected patient Volume?

I don't have a job yet... these are the swing shifts I have seen. They are usually admitting shifts and some can be 10 hrs.

 

[Splenda88]

Sorry for hijacking your thread OP.

What do you guys/gals think of these two hospitalist offers?

Job 1
7 days on/off (182 shifts/yr)
Location: Major city in the southeast
Patient load: 20-22
Compensation: 260-270k, 401k, 5k CME, 20k sign-on bonus, medical insurance etc..
Vacation: None


Job2
16 shifts per month (192 shifts/yr)
Location: 1hr15mins away from a major city in the southeast
Patient load: 20-25
Compensation: 305k, 10k/yr for student loan, 20k sign-on, 401k, medical insurance, no CME $$$
Vacation: None


Both jobs are closed ICU, require no procedures, and I won't answer to codes.

 

[Postictal Raiden]

Job 1 pays 9% less per shift than job 2 (post tax the gab is a little less). However it is in a much better location, I would assume.

Personally, I’d take Job 1. The difference in pay isn’t enough to offset the “inconvenience “ of living 1.25hrs away from a major city.

 

[rokshana]

Keep looking

 

[wamcp]

Sorry for hijacking your thread OP.

What do you guys/gals think of these two hospitalist offers?

Job 1
7 days on/off (182 shifts/yr)
Location: Major city in the southeast
Patient load: 20-22
Compensation: 260-270k, 401k, 5k CME, 20k sign-on bonus, medical insurance etc..
Vacation: None


Job2
16 shifts per month (192 shifts/yr)
Location: 1hr15mins away from a major city in the southeast
Patient load: 20-25
Compensation: 305k, 10k/yr for student loan, 20k sign-on, 401k, medical insurance, no CME $$$
Vacation: None


Both jobs are closed ICU, require no procedures, and I won't answer to codes.

For job 1: 1400/shift with that encounter load, even with closed icu? Yuck. Negotiate higher or find other jobs

job 1>job 2 for the presumably desirable location

 

[CCM-MD]

Sorry for hijacking your thread OP.

What do you guys/gals think of these two hospitalist offers?

Job 1
7 days on/off (182 shifts/yr)
Location: Major city in the southeast
Patient load: 20-22
Compensation: 260-270k, 401k, 5k CME, 20k sign-on bonus, medical insurance etc..
Vacation: None


Job2
16 shifts per month (192 shifts/yr)
Location: 1hr15mins away from a major city in the southeast
Patient load: 20-25
Compensation: 305k, 10k/yr for student loan, 20k sign-on, 401k, medical insurance, no CME $$$
Vacation: None


Both jobs are closed ICU, require no procedures, and I won't answer to codes.

I think job 1 is good. Try to negotiate up if you can. I would take it and run if it’s a location you like. It’s not easy to land a good hospitalist job these days, especially in big cities.

 

[Splenda88]

@wamcp and @CCM-MD

I was leaning toward job 2 because of the salary and help with the student loan repayment even though location was not ideal. I am negotiating with with them right now and they agree to pay 2.5k/yr for CME and increase the student loan repayment to 12k/yr. I think I can get another 10-15k added to the salary. This company is a physician own company.

The other things is that job1 is 1h15 mins from where i already own a house that is in a good school district. No sure how feasible that commute will be for 7 days in a row. Job 1 is with envision and the recruiter told me there is no room for negotiation.

What do you guys/gals think?

 

[CCM-MD]

@wamcp and @CCM-MD

I was leaning toward job 2 because of the salary and help with the student loan repayment even though location was not ideal. I am negotiating with with them right now and they agree to pay 2.5k/yr for CME and increase the student loan repayment to 12k/yr. I think I can get another 10-15k added to the salary. This company is a physician own company.

The other things is that job1 is 1h15 mins from where i already own a house that is in a good school district. No sure how feasible that commute will be for 7 days in a row. Job 1 is with envision and the recruiter told me there is no room for negotiation.

What do you guys/gals think?

I think that sounds like a good plan!

 

[Splenda88]

Job 3 offer today
7 days on/off (182 shifts/yr)
Location: Small town. 2.5 hrs from where I used to live
Average census: 20-22
Compensation: 255k (Incentive 45-55k/yr), 401k, 3k CME, 20k sign-on bonus, medical insurance etc...
Vacation: None
No procedures, no codes

 

[chessknt]

You need to soul search and decide if hourly comp, total comp, census, or location is most important. These are all profoundly different jobs. I would say do not underestimate a commute. Anything over 20 minutes will start to drain your soul and over 40 is not long term sustainable.

 

[wamcp]

@wamcp and @CCM-MD

I was leaning toward job 2 because of the salary and help with the student loan repayment even though location was not ideal. I am negotiating with with them right now and they agree to pay 2.5k/yr for CME and increase the student loan repayment to 12k/yr. I think I can get another 10-15k added to the salary. This company is a physician own company.

The other things is that job1 is 1h15 mins from where i already own a house that is in a good school district. No sure how feasible that commute will be for 7 days in a row. Job 1 is with envision and the recruiter told me there is no room for negotiation.

What do you guys/gals think?

Add 2.5 hours of commute to your shift. Assuming 12 hour shifts and that you don’t get to leave early. And at 317K pay (including the loan repayment). This would be equal to $113.86/hr at 192 shifts x 14.5 hr each

Is this acceptable to you?

edit: just realized you said job 1 is 1 hr plus away so nevermind

 

[wamcp]

Job 3 offer today
7 days on/off (182 shifts/yr)
Location: Small town. 2.5 hrs from where I used to live
Average census: 20-22
Compensation: 255k (Incentive 45-55k/yr), 401k, 3k CME, 20k sign-on bonus, medical insurance etc...
Vacation: None
No procedures, no codes

I suppose with current job market this might be ok deal at ~140/hr assuming easy achievable incentives and closed icu

 

[CCM-MD]

@Splenda88

To me it seems the compensation is pretty comparable and it is consistent with what I have personally seen/heard about recently. I think you should make your decision based on location, work environment etc. Go to the place you get good vibes from and like the location. Don’t compromise on any of that just for a little bit more compensation.

 

[Splenda88]

Add 2.5 hours of commute to your shift. Assuming 12 hour shifts and that you don’t get to leave early. And at 317K pay (including the loan repayment). This would be equal to $113.86/hr at 192 shifts x 14.5 hr each

Is this acceptable to you?

No it's not acceptable but I can cut down the commute time to 1h40mins. The average commuting time to go to work in the US is ~1 hr. My commute won't be great but it won't be horrible either. Also, I will only work 16 days/month when most people work 21 days/month.

 

[Splenda88]

I suppose with current job market this might be ok deal at ~140/hr assuming easy achievable incentives and closed icu

Was the job market better 2 yrs ago(before covid)? Hospitalists in SDN make 300-325k/yr with all benefits workin 7 days on/off, close ICU, no code/procedures, and average census 16-18, but it seems like the reality out there is different.

Will co-manage ICU patients with intensivist.

 

[thumbz]

Was the job market better 2 yrs ago(before covid)? Hospitalists in SDN make 300-325k/yr with all benefits workin 7 days on/off, close ICU, no code/procedures, and average census 16-18, but it seems like the reality out there is different.

Will co-manage ICU patients with intensivist.

I think there is a decent amount of reporter bias on SDN. People making $205k/yr working 180 days aren't coming on here talking about their job.

I have a unicorn job, what you're finding is more normal.

From what I have heard - the general hospitalist job market is less awesome than it was two years ago, but in certain spots you can get a "covidist" job (yep, saw that new term on a recruitment email the other day). And these covidist jobs tend to be much higher compensating.

In April 2020 I took a 10% "temporary pay cut" that just turned into a permanent pay cut.

 

[gutonc]

@Splenda88

To me it seems the compensation is pretty comparable and it is consistent with what I have personally seen/heard about recently. I think you should make your decision based on location, work environment etc. Go to the place you get good vibes from and like the location. Don’t compromise on any of that just for a little bit more compensation.

Agree with this 100%. I know that when you're starting at $60-70K, $30-50K is a big difference. But trust me when I tell you that the difference between $250K and $300K is essentially nothing. So choose the job that feels best to you, the money will sort itself out.

 

[Splenda88]

I think there is a decent amount of reporter bias on SDN. People making $205k/yr working 180 days aren't coming on here talking about their job.

I have a unicorn job, what you're finding is more normal.

From what I have heard - the general hospitalist job market is less awesome than it was two years ago, but in certain spots you can get a "covidist" job (yep, saw that new term on a recruitment email the other day). And these covidist jobs tend to be much higher compensating.

In April 2020 I took a 10% "temporary pay cut" that just turned into a permanent pay cut.

You definitely have a unicorn job.

One of the offers said:

• $11.30 RVU bonus – actual earned - NO CAP

What does that even mean? How much would that RVU translate in actual $$$ if I see 22 patients on average daily?

 

[chessknt]

No it's not acceptable but I can cut down the commute time to 1h40mins. The average commuting time to go to work in the US is ~1 hr. My commute won't be great but it won't be horrible either. Also, I will only work 16 days/month when most people work 21 days/month.

Have you ever done a commute like this? I did 15-18 nights/month with a 1 hour commute and I can tell you it doesn't hit you the same way it hits someone doing a 9-5 job. Being in a hospital for 12 hrs is different and I cannot recommend strongly enough against a commute that long. You will be looking back in 6 months asking why in the world you agreed to it.

 

[Splenda88]

Have you ever done a commute like this? I did 15-18 nights/month with a 1 hour commute and I can tell you it doesn't hit you the same way it hits someone doing a 9-5 job. Being in a hospital for 12 hrs is different and I cannot recommend strongly enough against a commute that long. You will be looking back in 6 months asking why in the world you agreed to it.

Never had to commute more than 30 mins (1 hr total) for work/school. I understand 50 mins commute each way is not ideal, but none of the offers check all the boxes (Location > great job > salary) in that order. Therefore, I will have to make the less painful choice.

With this job, I can live in the metro area (3O mins from downtown, major airport), but the sacrifice will be commuting 50 minutes from home to work, vice versa.

 

[wamcp]

You definitely have a unicorn job.

One of the offers said:

• $11.30 RVU bonus – actual earned - NO CAP

What does that even mean? How much would that RVU translate in actual $$$ if I see 22 patients on average daily?

They pay you $11.30 per wRVU for the entire year as a bonus? No threshold that triggers it?

If so and you produce, say, 40 wRVU per day from 22 avg encounters then 182 days equal 82k bonus

 

[Splenda88]

They pay you $11.30 per wRVU for the entire year as a bonus? No threshold that triggers it?

If so and you produce, say, 40 wRVU per day from 22 avg encounters then 182 days equal 82k bonus

It seems like it based on the language.

Is it feasible to produce 40 wRVU per day seeing 22 patients if you not doing any procedure?

 

[thumbz]

Average hospitalist is around 4200 wRVU so probably not. I forget if that job was rounding only but it's also a lot harder if you aren't doing admission as daily rounding RVUs mediocre.

Edit: wow that's some savage grammar. I need coffee for this night shift

 

[Splenda88]

Average hospitalist is around 4200 wRVU so probably not. I forget if that job was rounding only but it's also a lot harder if you aren't doing admission as daily rounding RVUs mediocre.

Edit: wow that's some savage grammar. I need coffee for this night shift

it's rounding, but you admit 2-3 patients per day.

How feasible it is to make an additional 80k+ in RVU (with that 11.30 RVU bonus)? If not, I won't even consider that offer given that base is only ~165k/yr after 90 days when you are transitioned to base + RVU + incentive.

 

[chessknt]

Never had to commute more than 30 mins (1 hr total) for work/school. I understand 50 mins commute each way is not ideal, but none of the offers check all the boxes (Location > great job > salary) in that order. Therefore, I will have to make the less painful choice.

With this job, I can live in the metro area (3O mins from downtown, major airport), but the sacrifice will be commuting 50 minutes from home to work, vice versa.

Well if one job is a 20 minute commute you are adding 1 hour per day in commuting to this job. 182 shifts per year=182 hours=15.15 shifts per year x $1600/shift (avg with incentive)=24k pretax income loss + mileage to car. If you are set on this job it might be economically viable to get a condo or rent an apartment nearby away from your primary home and just work an extra shift a month to make up for it but gain a bunch of free time back. If you have a family/kids then that probably wont work.

 

[Splenda88]

Well if one job is a 20 minute commute you are adding 1 hour per day in commuting to this job. 182 shifts per year=182 hours=15.15 shifts per year x $1600/shift (avg with incentive)=24k pretax income loss + mileage to car. If you are set on this job it might be economically viable to get a condo or rent an apartment nearby away from your primary home and just work an extra shift a month to make up for it but gain a bunch of free time back. If you have a family/kids then that probably wont work.

I do have family/kids.

 

[chessknt]

I do have family/kids.

Have you ever done an 8 day stretch of 14.5 hour days with them? Depending on kids age that may mean no good morning or good night and not seeing them outside Skype for that entire time period. That hour of commute sometimes makes a big difference there.
Again this is all my personal experience, ymmv

 

[gutonc]

You definitely have a unicorn job.

One of the offers said:

• $11.30 RVU bonus – actual earned - NO CAP

What does that even mean? How much would that RVU translate in actual $$$ if I see 22 patients on average daily?

The math isn’t really that hard.

Assume all of your patients are Level 2 follow ups (99232 =1.39 wRVU) and go from there. You’ll definitely be underestimating, but that’s what you should be doing.

Works out to ~$63K this way. Which, once everyone else gets their cut, is probably $35k in your pocket. Not chump change for sure. Not FU money, but definitely the kind of money you can actually do something with.

 

[wamcp]

I'm bored as usual at work and browsed some jobs.

Hospitalist Physician job in

Hospitalist Physician job in

www.practicelink.com

Nocturnist job is in Connecticut, so presumably a 'desirable' non-rural area could be lived in:

• 7 on and 7 off block schedule
• No procedures or ICU coverage needed
• $300K base salary with $30K in performance
• 2 weeks of PTO offered
  You will also be offered medical/dental/vision for the physician and eligible dependents, life insurance/disability, relocation assistance, a sign-on bonus, CME, a retirement plan, 2 weeks of PTO, and malpractice with tail coverage.

Good deal on paper. Closed ICU, in a 'saturated' state/northeast region, 148/hr base (if you count the 2 weeks PTO) pay.

I feel this is the kind of base pay you should be comparing nocturnist jobs with. If you're in a less desriable region, you should look for a job that pays higher than the above.
For example, I'm assuming "coastal" Alabama is a less desirable place than CT. And so this job ( Hospitalist Physician at CompHealth ) is offering $165 base pay for nocturnists.

 

[Splenda88]

They pay you $11.30 per wRVU for the entire year as a bonus? No threshold that triggers it?

If so and you produce, say, 40 wRVU per day from 22 avg encounters then 182 days equal 82k bonus

Is that a realistic RVU that one can produce seeing that number of patients per day?

 

[wamcp]

Is that a realistic RVU that one can produce seeing that number of patients per day?

As a nocturnist i’m really only billing for admissions and critical care during rapids that meet the criteria. At my full time place I generate 30-40 wRVU per night (8 admits on average). Closed ICU job.

40 wRVU for 22 encounters as a day hospitalist is possible, particularly if you are working open ICU and your group lets you take admissions in the day rather than “rounding only”.

You can do the math for hypothetical scenarios, mix and match with a calculator

RVU Calculator - AAPC Relative Value Units

CPT® RVU calculator provides a quick analysis of the work relative value units associated with a certain volume of CPT or HCPCS codes.

www.aapc.com

Medical Coding and Billing for Hospitalists - Key Points

A professional medical coding company can provide error-free coding for hospitalists and ensure proper claim submission and reimbursement.

www.outsourcestrategies.com

 

[Meerkatology]

I'm bored as usual at work and browsed some jobs.

Hospitalist Physician job in

Hospitalist Physician job in

www.practicelink.com

Nocturnist job is in Connecticut, so presumably a 'desirable' non-rural area could be lived in:

Good deal on paper. Closed ICU, in a 'saturated' state/northeast region, 148/hr base (if you count the 2 weeks PTO) pay.

I feel this is the kind of base pay you should be comparing nocturnist jobs with. If you're in a less desriable region, you should look for a job that pays higher than the above.
For example, I'm assuming "coastal" Alabama is a less desirable place than CT. And so this job ( Hospitalist Physician at CompHealth ) is offering $165 base pay for nocturnists.

theses things never mention the most important part of a nocturnist job description - how many admits per shift?