I would like to get some outside feedback on whether or not my current position is good or if it is time to move on... First job out of residency, but 4 years out now.
Location: Medium sized midwestern city (1M + metro area). Not generally considered a "desirable" location otherwise
Current contract: 156 shifts/year. M-F 10p-7a. Sat-Sun 7-7. Base salary 273k + 30k possible additional compensation/year based on quality metrics. No RVUs. Can pick up additional shifts as desired for $1500-2000.
We have several hospitals we staff throughout the city. Main hospital is a teaching hospital with closed ICU, full subspecialty support (whatever that means on nights). I generally provide cross coverage here on about 150 patients while trying to do as many ER and transfer admits as possible (I personally will see around 5-7 per night). I have 1 NP to help with admits that I have to staff with them. We alternate holding the pager. The pager is pretty crippling. We have a RR and code team, but RN's will usually call me to bedside before even thinking about calling a RR. Day rounders are RVU based, so its considered acceptable if I leave 1new H&P per rounder in the morning. The general consensus is that they don't like for me to bill after midnight so they can collect RVUs. They usually have 15-18 pts per day.
Second hospital is a busy suburban hospital. Here I cross cover up to 200 patients at times with 1-2 NPs. Open ICU, but Intensivist in house (recent addition after years of fighting admin) does ICU admits at night now. Not uncommon for this hospital to get 30+ admits overnight. Again, I don't have to see all these as the cross coverage becomes crippling. But I do have to "tuck in" these patients without seeing them and I am liable for these not seen patients until AM should anything happen. Other hospitals are smaller with cross coverage of only 50-60, no NP, and about 5-10 admits per night. We have tele critical care support on ICU patients overnight at the smaller locations.
Pre-pandemic, these numbers were more manageable and acuity was less. Obviously during the pandemic we have been stretched thin with increased census, managing higher acuity patients in non-ICU settings. Admin has countered this by increasing day rounders to keep day rounder census manageable, but nights have not seen much increased staffing. Their go-to solution seems to be adding more and more NPs at nights (fresh grads with no experience) that I still have to supervise. Again we don't get RVUs on nights, so not getting compensated more for the increased census like my day counterparts. The other troubling aspect of this contract is that salary has not been adjusted for inflation, COL in many years. Also, after RVUs, my day counterparts are making 330-350k (some RVU hungry up to 400K) for working 18-20 shifts per month. Can leave by 2pm during they week if they're done rounding and only have to stay a full 12 hour shift one day each weekend.
Locums have been in/out of our hospital and rave how good of a job this is, which makes me second guess my wandering eye. I know in the midwest, especially the more rural states, we can be spoiled in terms of census compared to the coasts and mountain regions. But the trade off is having to live in the midwest. COL in my city has increased pretty significantly over the past few years, and salary has not increased to match that.
I am a rare breed that actually enjoys working nights and not dealing with the social aspects of working days. I could see myself as a career nocturnist. I would prefer to stay on nights, but also want to be compensated for this as I know for a fact that most of the day rounders despise nights. I work 20% less shifts, but they are longer shifts that I have to stay in house for the entire time. I expect that I should be at least making the same amount as the day providers (if not more). I've also been scouring job listings and see that it's not uncommon for nocturnists to be pulling 350-400K. I do have the option to potentially switch to a day contract and make RVUs.
Thoughts?
Location: Medium sized midwestern city (1M + metro area). Not generally considered a "desirable" location otherwise
Current contract: 156 shifts/year. M-F 10p-7a. Sat-Sun 7-7. Base salary 273k + 30k possible additional compensation/year based on quality metrics. No RVUs. Can pick up additional shifts as desired for $1500-2000.
We have several hospitals we staff throughout the city. Main hospital is a teaching hospital with closed ICU, full subspecialty support (whatever that means on nights). I generally provide cross coverage here on about 150 patients while trying to do as many ER and transfer admits as possible (I personally will see around 5-7 per night). I have 1 NP to help with admits that I have to staff with them. We alternate holding the pager. The pager is pretty crippling. We have a RR and code team, but RN's will usually call me to bedside before even thinking about calling a RR. Day rounders are RVU based, so its considered acceptable if I leave 1new H&P per rounder in the morning. The general consensus is that they don't like for me to bill after midnight so they can collect RVUs. They usually have 15-18 pts per day.
Second hospital is a busy suburban hospital. Here I cross cover up to 200 patients at times with 1-2 NPs. Open ICU, but Intensivist in house (recent addition after years of fighting admin) does ICU admits at night now. Not uncommon for this hospital to get 30+ admits overnight. Again, I don't have to see all these as the cross coverage becomes crippling. But I do have to "tuck in" these patients without seeing them and I am liable for these not seen patients until AM should anything happen. Other hospitals are smaller with cross coverage of only 50-60, no NP, and about 5-10 admits per night. We have tele critical care support on ICU patients overnight at the smaller locations.
Pre-pandemic, these numbers were more manageable and acuity was less. Obviously during the pandemic we have been stretched thin with increased census, managing higher acuity patients in non-ICU settings. Admin has countered this by increasing day rounders to keep day rounder census manageable, but nights have not seen much increased staffing. Their go-to solution seems to be adding more and more NPs at nights (fresh grads with no experience) that I still have to supervise. Again we don't get RVUs on nights, so not getting compensated more for the increased census like my day counterparts. The other troubling aspect of this contract is that salary has not been adjusted for inflation, COL in many years. Also, after RVUs, my day counterparts are making 330-350k (some RVU hungry up to 400K) for working 18-20 shifts per month. Can leave by 2pm during they week if they're done rounding and only have to stay a full 12 hour shift one day each weekend.
Locums have been in/out of our hospital and rave how good of a job this is, which makes me second guess my wandering eye. I know in the midwest, especially the more rural states, we can be spoiled in terms of census compared to the coasts and mountain regions. But the trade off is having to live in the midwest. COL in my city has increased pretty significantly over the past few years, and salary has not increased to match that.
I am a rare breed that actually enjoys working nights and not dealing with the social aspects of working days. I could see myself as a career nocturnist. I would prefer to stay on nights, but also want to be compensated for this as I know for a fact that most of the day rounders despise nights. I work 20% less shifts, but they are longer shifts that I have to stay in house for the entire time. I expect that I should be at least making the same amount as the day providers (if not more). I've also been scouring job listings and see that it's not uncommon for nocturnists to be pulling 350-400K. I do have the option to potentially switch to a day contract and make RVUs.
Thoughts?
