Nocturnist compensation

[throaway12345]

Hello everyone.



I am a new graduate with a IM nocturnist job offer and would love to get a 2nd opinion on it.

It’s a unique nocturnist job opportunity, where most of my(a general internist) responsibilities are admitting and caring for icu and step down units. I’ll be dropping lines, doing simple procedures, running the code and Ed doc will do the airway. Currently just 15icu beds and 10 step down units, but they have plans to double the icu beds in the next few years.

I will be working a 9hour shift, 122shifts per year. Base pay is 238k + 20k quality parameters. I’m taken aback b/c the daytime hospitalist at the same hospital gets 283k base pay… I thought nocturnists make more money than their day shift counterparts so I’m extremely disappointed. This is in an area with a very high cost of living so I need the money to buy a decent 3br home, which is easily above a million..

That being said, I have also noticed that my hours are much shorter than an average nocturnist. When I calculate the hourly pay it’s $216/hr, not bad compared to my daytime counterpart who gets $129/hr. Also currently (before the expansion) I heard the job is pretty slow and not much work to be done.

What do you think? Is this a fair price? Or should I pass on the offer? I’m not the biggest fan of working at night but I do love the icu medicine and sees it as an opportunity to get my fix without going through a pulmcrit fellowship. Also, the hours being quite cush, I expect to have lots of extra time with my family, which is long overdue. If I need an extra income, I could always pick up extra shifts and make an easy $1.6-2k per night..

Alternatively, I’m thinking of doing primary care. I think I can easily make that money doing primary care and not doing nights. But I will have much less free time..

Take it or leave it? It’s at a semi-academic institution.

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[DrMetal]

Hello everyone.



I am a new graduate with a IM nocturnist job offer and would love to get a 2nd opinion on it.

It’s a unique nocturnist job opportunity, where most of my(a general internist) responsibilities are admitting and caring for icu and step down units. I’ll be dropping lines, doing simple procedures, running the code and Ed doc will do the airway. Currently just 15icu beds and 10 step down units, but they have plans to double the icu beds in the next few years.

I will be working a 9hour shift, 122shifts per year. Base pay is 238k + 20k quality parameters. I’m taken aback b/c the daytime hospitalist at the same hospital gets 283k base pay… I thought nocturnists make more money than their day shift counterparts so I’m extremely disappointed. This is in an area with a very high cost of living so I need the money to buy a decent 3br home, which is easily above a million..

That being said, I have also noticed that my hours are much shorter than an average nocturnist. When I calculate the hourly pay it’s $216/hr, not bad compared to my daytime counterpart who gets $129/hr. Also currently (before the expansion) I heard the job is pretty slow and not much work to be done.

What do you think? Is this a fair price? Or should I pass on the offer? I’m not the biggest fan of working at night but I do love the icu medicine and sees it as an opportunity to get my fix without going through a pulmcrit fellowship. Also, the hours being quite cush, I expect to have lots of extra time with my family, which is long overdue. If I need an extra income, I could always pick up extra shifts and make an easy $1.6-2k per night..

Alternatively, I’m thinking of doing primary care. I think I can easily make that money doing primary care and not doing nights. But I will have much less free time..

Take it or leave it? It’s at a semi-academic institution.

Jesus, what are they doing to us? $240K for a nocturnist job? In the words of Iron Maiden, "Run to the Hills".

They're trying to employ you as an intensivist, b/c they don't want to hire one and pay her twice your salary. What you're describing above should warrant at least a $300K salary, or at least it did in 2015.

Go to law school. At least lawyers are honest about screwing each other.

 

[throaway12345]

Jesus, what are they doing to us? $240K for a nocturnist job? In the words of Iron Maiden, "Run to the Hills".

They're trying to employ you as an intensivist, b/c they don't want to hire one and pay her twice your salary. What you're describing above should warrant at least a $300K salary, or at least it did in 2015.

Go to law school. At least lawyers are honest about screwing each other.

I felt the kind of anger you described when I was first told about the compensation. But when I calculated the hourly rate, it became competitive.

The schedule is pretty sweet as it will allow me to have a relaxing dinner and hang out with my family before the shift, then make it home in time for breakfast. Even when I am working nights, I won’t be missing from my family. Not to mention only working 1/3 of the year.. I don’t think I will burn out.

Most other hospitalist jobs look so grinding and nocturnist jobs start way too early to allow for evening leisure so I won’t take them.

I feel really mixed as I don’t want to contribute to mistreatment of physicians if that’s what this job means. Thats why I created a throwaway account just to ask this question …

 

[IMGASMD]

I haven’t done nocturnist in a while. I was getting 160-175/hr 1099. So you’re already ahead on hourly basis.

If you look into some of the older threads. Nocturnist work usually works well, until it doesn’t.

Good luck. Happy New Year

 

[DrMetal]

I felt the kind of anger you described when I was first told about the compensation. But when I calculated the hourly rate, it became competitive.

The schedule is pretty sweet as it will allow me to have a relaxing dinner and hang out with my family before the shift, then make it home in time for breakfast. Even when I am working nights, I won’t be missing from my family. Not to mention only working 1/3 of the year.. I don’t think I will burn out.

Most other hospitalist jobs look so grinding and nocturnist jobs start way too early to allow for evening leisure so I won’t take them.

I feel really mixed as I don’t want to contribute to mistreatment of physicians if that’s what this job means. Thats why I created a throwaway account just to ask this question …

Go for it then. Just a have a good exit strategy.

 

[tantacles]

On my first look at this, not a terrible job. Honestly, having fewer required shifts and a lower salary (with a good hourly rate) is preferable to just getting a pay bump compared to the daytime docs. and 9 hour shifts with about 10 per month is definitely good. I think as others have mentioned, the fact that this is essentially an intensivist position is troubling. What kind of backup will you have if an intensive care issue comes up that you simply aren't trained for?

I don't think this is a bad offer. I just don't know that I would want an only ICU job as an internal medicine physician.

 

[chessknt]

It sounds like you are working 8 hour shifts then and you are ok with that even though your entire schedule is going to be inverted but missing 1/3 of the hours you would normally be working.

I think it is a screaming deal for the hospital to pay for only coverage in the middle of the night for someone who isn’t trained to do the job. Have you managed vents are your own? Have you ever managed one that was difficult like bad ards or bad asthma? How many sedation complications have you run in to? Can you fix a pneumothorax? Managed a refractory status epilepticus? Can you bronch a mucus plug out?

So many other potential issues you would have no backup for… why do you want to do an icu job with minimal training for it?

 

[anonperson]

Hello everyone.



I am a new graduate with a IM nocturnist job offer and would love to get a 2nd opinion on it.

It’s a unique nocturnist job opportunity, where most of my(a general internist) responsibilities are admitting and caring for icu and step down units. I’ll be dropping lines, doing simple procedures, running the code and Ed doc will do the airway. Currently just 15icu beds and 10 step down units, but they have plans to double the icu beds in the next few years.

I will be working a 9hour shift, 122shifts per year. Base pay is 238k + 20k quality parameters. I’m taken aback b/c the daytime hospitalist at the same hospital gets 283k base pay… I thought nocturnists make more money than their day shift counterparts so I’m extremely disappointed. This is in an area with a very high cost of living so I need the money to buy a decent 3br home, which is easily above a million..

That being said, I have also noticed that my hours are much shorter than an average nocturnist. When I calculate the hourly pay it’s $216/hr, not bad compared to my daytime counterpart who gets $129/hr. Also currently (before the expansion) I heard the job is pretty slow and not much work to be done.

What do you think? Is this a fair price? Or should I pass on the offer? I’m not the biggest fan of working at night but I do love the icu medicine and sees it as an opportunity to get my fix without going through a pulmcrit fellowship. Also, the hours being quite cush, I expect to have lots of extra time with my family, which is long overdue. If I need an extra income, I could always pick up extra shifts and make an easy $1.6-2k per night..

Alternatively, I’m thinking of doing primary care. I think I can easily make that money doing primary care and not doing nights. But I will have much less free time..

Take it or leave it? It’s at a semi-academic institution.

Night shift work is associated increased risk of diabetes, heart attack, stroke and possibly some cancers.

You're covering the ICU and step down unit and basically functioning like an intensivist without the requisite training. You will be held to the standard of care of a fellowship trained intensivist when things go wrong.

If the ED physician is busy dealing with their own crashing patient and you have an airway emergency, what then?

This place is shameful for this lowball offer while accepting a huge amount of liability and responsibility.

They should be paying a fellowship trained intensivist for this position but some c-suite doofus thinks all physicians are interchangeable and thinks they can save a couple of bucks.

 

[CCM-MD]

The $/h is pretty good. We have hospitalists covering >40 ICU beds in house at night, we (intensivists) are available by phone and come in when needed. This set up is far from ideal but it can be done.

 

[rokshana]

Hello everyone.



I am a new graduate with a IM nocturnist job offer and would love to get a 2nd opinion on it.

It’s a unique nocturnist job opportunity, where most of my(a general internist) responsibilities are admitting and caring for icu and step down units. I’ll be dropping lines, doing simple procedures, running the code and Ed doc will do the airway. Currently just 15icu beds and 10 step down units, but they have plans to double the icu beds in the next few years.

I will be working a 9hour shift, 122shifts per year. Base pay is 238k + 20k quality parameters. I’m taken aback b/c the daytime hospitalist at the same hospital gets 283k base pay… I thought nocturnists make more money than their day shift counterparts so I’m extremely disappointed. This is in an area with a very high cost of living so I need the money to buy a decent 3br home, which is easily above a million..

That being said, I have also noticed that my hours are much shorter than an average nocturnist. When I calculate the hourly pay it’s $216/hr, not bad compared to my daytime counterpart who gets $129/hr. Also currently (before the expansion) I heard the job is pretty slow and not much work to be done.

What do you think? Is this a fair price? Or should I pass on the offer? I’m not the biggest fan of working at night but I do love the icu medicine and sees it as an opportunity to get my fix without going through a pulmcrit fellowship. Also, the hours being quite cush, I expect to have lots of extra time with my family, which is long overdue. If I need an extra income, I could always pick up extra shifts and make an easy $1.6-2k per night..

Alternatively, I’m thinking of doing primary care. I think I can easily make that money doing primary care and not doing nights. But I will have much less free time..

Take it or leave it? It’s at a semi-academic institution.

Run away… this is an icu job and not suitable for a freshly minted IM resident…yes a new grad has probably more experience with the icu setting… but there is so much that you don’t know that you don’t know that will get you into trouble…one crashing Pt in the icu and you are admitter? That has fubar written all over it…and when it hits the fan… admin is not going to back you up that you are not critical med trained.

Want to do intensivist level work? Go do the fellowship and they work.

 

[bingbongbink]

Night shift work is associated increased risk of diabetes, heart attack, stroke and possibly some cancers.

You're covering the ICU and step down unit and basically functioning like an intensivist without the requisite training. You will be held to the standard of care of a fellowship trained intensivist when things go wrong.

If the ED physician is busy dealing with their own crashing patient and you have an airway emergency, what then?

This place is shameful for this lowball offer while accepting a huge amount of liability and responsibility.

They should be paying a fellowship trained intensivist for this position but some c-suite doofus thinks all physicians are interchangeable and thinks they can save a couple of bucks.

Agree this post.

Side question: what do you think about night home call coverage for the ICU? Same effects / dependent on volume of calls and how much you have to go back in I would assume

 

[throaway12345]

Op here. I deeply appreciate all of your thoughts and will think about them over and over again befor making my final decision

Go for it then. Just a have a good exit strategy.

I do have the exit in sight. Primary care if I hate this. May also bite the bullet and go for fellowship if I really can’t get enough, but depends on family situation.

I think it is a screaming deal for the hospital to pay for only coverage in the middle of the night for someone who isn’t trained to do the job. Have you managed vents are your own? Have you ever managed one that was difficult like bad ards or bad asthma? How many sedation complications have you run in to? Can you fix a pneumothorax? Managed a refractory status epilepticus? Can you bronch a mucus plug out?

So many other potential issues you would have no backup for… why do you want to do an icu job with minimal training for it?

Not to tout anything but I am really good w/ pulmcrit. People constantly tell me to do the fellowship, but I can’t because of my family situation. I also constantly listen to pulmcrit education materials on a daily basis so my knowledge level in field is definitely much higher than all of my peers, and at least comparable to a first year fellow. That being said although my brain may know what to do on some of the cases you describe, you are absolutely right that I don’t have the procedural skills. We have an icu attending on call all the time to come in for procedures or accessible via phone if I need their knowledge.

The $/h is pretty good. We have hospitalists covering >40 ICU beds in house at night, we (intensivists) are available by phone and come in when needed. This set up is far from ideal but it can be done.

I am very happy to hear from a pulmcrit attending and hope to hear more of your thoughts on the issue. I am training at an institution where we have an icu attending all the time, although I get to fly solo when they are busy.
However I know that many other hospital’s icu’s are not that way. Most resident ICU’s are covered by a fellow at night at an educational institution. Many non-resident icu’s just have mid level coverage with icu attending backup, is that correct? If I think about that, I don’t feel like the setup I am offered is completely unreasonable.

This hospital is not of the highest acuity and currently there’s only one hospitalist covering the entire hospital(medicine admit, icu admit, crosscover everything) 2am-7am and I was told it works out most of the time. So adding 3 icu-dedicated hospitalist is a big addition. They said they decided to add a hospitalist instead of icu attending because there just isn’t that much icu work currently at night and want me to help out with regular admits when I have nothing to do.
Again we have Intensivist backup, Ed for airway, and also have an anesthesiologist in the building all the time for difficult airway.

I am aware of my shortcoming and had requested for the following dedicated time for education with the icu attending: debriefing with icu attending every morning, twice monthly educational session for case discussions. I also plan on asking for access to institution’s pulmcrit fellowship education material although I wonder how that’ll work out. I almost see it as an opportunity for growth, and a semi-fellowship without going through a fellowship. Lots of growth to do, have gaping holes, but if I carefully accept what I can’t do or don’t know, and know when to call for backup, I feel like it can be done. A huge challenge, but I plan on working hard to be the best I can.

Run away… this is an icu job and not suitable for a freshly minted IM resident…yes a new grad has probably more experience with the icu setting… but there is so much that you don’t know that you don’t know that will get you into trouble…one crashing Pt in the icu and you are admitter? That has fubar written all over it…and when it hits the fan… admin is not going to back you up that you are not critical med trained.

Want to do intensivist level work? Go do the fellowship and they work.

Thank you for your thoughts.

 

[CCM-MD]

Op here. I deeply appreciate all of your thoughts and will think about them over and over again befor making my final decision

I do have the exit in sight. Primary care if I hate this. May also bite the bullet and go for fellowship if I really can’t get enough, but depends on family situation.


Not to tout anything but I am really good w/ pulmcrit. People constantly tell me to do the fellowship, but I can’t because of my family situation. I also constantly listen to pulmcrit education materials on a daily basis so my knowledge level in field is definitely much higher than all of my peers, and at least comparable to a first year fellow. That being said although my brain may know what to do on some of the cases you describe, you are absolutely right that I don’t have the procedural skills. We have an icu attending on call all the time to come in for procedures or accessible via phone if I need their knowledge.


I am very happy to hear from a pulmcrit attending and hope to hear more of your thoughts on the issue. I am training at an institution where we have an icu attending all the time, although I get to fly solo when they are busy.
However I know that many other hospital’s icu’s are not that way. Most resident ICU’s are covered by a fellow at night at an educational institution. Many non-resident icu’s just have mid level coverage with icu attending backup, is that correct? If I think about that, I don’t feel like the setup I am offered is completely unreasonable.

This hospital is not of the highest acuity and currently there’s only one hospitalist covering the entire hospital(medicine admit, icu admit, crosscover everything) 2am-7am and I was told it works out most of the time. So adding 3 icu-dedicated hospitalist is a big addition. They said they decided to add a hospitalist instead of icu attending because there just isn’t that much icu work currently at night and want me to help out with regular admits when I have nothing to do.
Again we have Intensivist backup, Ed for airway, and also have an anesthesiologist in the building all the time for difficult airway.

I am aware of my shortcoming and had requested for the following dedicated time for education with the icu attending: debriefing with icu attending every morning, twice monthly educational session for case discussions. I also plan on asking for access to institution’s pulmcrit fellowship education material although I wonder how that’ll work out. I almost see it as an opportunity for growth, and a semi-fellowship without going through a fellowship. Lots of growth to do, have gaping holes, but if I carefully accept what I can’t do or don’t know, and know when to call for backup, I feel like it can be done. A huge challenge, but I plan on working hard to be the best I can.


Thank you for your thoughts.

Like I said, the set up is similar to what we have where I am. We have almost triple the ICU beds and probably more high acuity (everything except transplant and ECMO). Nocturnists cover at night and we are available.

It’s not a great set up to be honest and I agree with the concerns everyone has mentioned. You’re taking on liability by not being formally trained in ccm. But it’s hard to recruit for critical care and not everywhere has the luxury of 24h in house coverage. I think >200/h for an employed gig is good for nocturnist, comes down to whether its worth it to you to take on the extra liability and feel comfortable.

 

[DrMetal]

Op here. I deeply appreciate all of your thoughts and will think about them over and over again befor making my final decision

I do have the exit in sight. Primary care if I hate this. May also bite the bullet and go for fellowship if I really can’t get enough, but depends on family situation.


Not to tout anything but I am really good w/ pulmcrit. People constantly tell me to do the fellowship, but I can’t because of my family situation. I also constantly listen to pulmcrit education materials on a daily basis so my knowledge level in field is definitely much higher than all of my peers, and at least comparable to a first year fellow. That being said although my brain may know what to do on some of the cases you describe, you are absolutely right that I don’t have the procedural skills. We have an icu attending on call all the time to come in for procedures or accessible via phone if I need their knowledge.


I am very happy to hear from a pulmcrit attending and hope to hear more of your thoughts on the issue. I am training at an institution where we have an icu attending all the time, although I get to fly solo when they are busy.
However I know that many other hospital’s icu’s are not that way. Most resident ICU’s are covered by a fellow at night at an educational institution. Many non-resident icu’s just have mid level coverage with icu attending backup, is that correct? If I think about that, I don’t feel like the setup I am offered is completely unreasonable.

This hospital is not of the highest acuity and currently there’s only one hospitalist covering the entire hospital(medicine admit, icu admit, crosscover everything) 2am-7am and I was told it works out most of the time. So adding 3 icu-dedicated hospitalist is a big addition. They said they decided to add a hospitalist instead of icu attending because there just isn’t that much icu work currently at night and want me to help out with regular admits when I have nothing to do.
Again we have Intensivist backup, Ed for airway, and also have an anesthesiologist in the building all the time for difficult airway.

I am aware of my shortcoming and had requested for the following dedicated time for education with the icu attending: debriefing with icu attending every morning, twice monthly educational session for case discussions. I also plan on asking for access to institution’s pulmcrit fellowship education material although I wonder how that’ll work out. I almost see it as an opportunity for growth, and a semi-fellowship without going through a fellowship. Lots of growth to do, have gaping holes, but if I carefully accept what I can’t do or don’t know, and know when to call for backup, I feel like it can be done. A huge challenge, but I plan on working hard to be the best I can.


Thank you for your thoughts.

Also be weary of the promised 9-hour shift and 122 shifts/year. Is this stated explicitly in your contract? I doubt it.

If you're running codes, having family meetings, and dropping lines, a 9-hour shift can very easily become a 10-, 11-, or 12-hour one.

Also, they may ask you very nicely to work more than 122 shifts/year. They may guilt---or as we say in the military, 'voluntold'---to do it. Although, you don't have to oblige, you may be viewed as a non-team player if you don't work extra, especially when needed. (it's BS, I know, but that how it goes sometimes)

All things said, if this is your first job, and you want experiment a little, take a little plunge, then go for it. If you're looking for your dream job, this probably isn't it.

 

[Bobblehead]

One of the things I would be cognizant of is that while you may develop the practical skills of an intensivist such as vent management or intubated bronchoscopy I'm not sure these are necessarily going to translate into portability or marketability if you were to go look for another job. That is unless you enter another open ICU situation where they're looking for in-house warm bodies with critical care backup elsewhere.

You should be ok with being a practicing intensivist but on paper only have IM credentials for your next gig. For example you may be unlikely to obtain bronchoscopy privileges and vent management may be limited to whatever ICU coverage model they already have established.

 

[CCM-MD]

One of the things I would be cognizant of is that while you may develop the practical skills of an intensivist such as vent management or intubated bronchoscopy I'm not sure these are necessarily going to translate into portability or marketability if you were to go look for another job. That is unless you enter another open ICU situation where they're looking for in-house warm bodies with critical care backup elsewhere.

You should be ok with being a practicing intensivist but on paper only have IM credentials for your next gig. For example you may be unlikely to obtain bronchoscopy privileges and vent management may be limited to whatever ICU coverage model they already have established.

This model isn’t doesn’t usually involve the nocturnist doing bronchs, lines, tubes or jockeying anything complicated on the vent. We have anesthesia/ER doing airways and lines at night, and call to the intensivist for a bronch/chest tube/difficult vent.

 

[Osteoth]

Also be weary of the promised 9-hour shift and 122 shifts/year. Is this stated explicitly in your contract? I doubt it.

If you're running codes, having family meetings, and dropping lines, a 9-hour shift can very easily become a 10-, 11-, or 12-hour one.

Also, they may ask you very nicely to work more than 122 shifts/year. They may guilt---or as we say in the military, 'voluntold'---to do it. Although, you don't have to oblige, you may be viewed as a non-team player if you don't work extra, especially when needed. (it's BS, I know, but that how it goes sometimes)

All things said, if this is your first job, and you want experiment a little, take a little plunge, then go for it. If you're looking for your dream job, this probably isn't it.

I’m still in training but I never get the voluntold thing. Who cares about appearing to be a team player? Should I care or am I missing something?

I play for the team based on the contract I signed, no more no less.

 

[bingbongbink]

I’m still in training but I never get the voluntold thing. Who cares about appearing to be a team player? Should I care or am I missing something?

I play for the team based on the contract I signed, no more no less.

Thats why you don’t get it yet, but you will

 

[DrMetal]

Who cares about appearing to be a team player?

You might care, when the team you're playing for downsizes, decides to not renew your contract, and replaces you with an NP.

 

[Splenda88]

I would not even entertain a job like that. If you think you can do it, ask for 270k+ plus the 20k 'qualify parameters" (whatever that means). They have no choice because 95%+ of IM trained docs won't touch that job with a 20-foot pole.

As someone said above, 9 hrs will turn into 10-11 in most days.

 

[IMGASMD]

I would not even entertain a job like that. If you think you can do it, ask for 270k+ plus the 20k 'qualify parameters" (whatever that means). They have no choice because 95%+ of IM trained docs won't touch that job with a 20-foot pole.

As someone said above, 9 hrs will turn into 10-11 in most days.

I think in all reality, you may all be correct. It really depends on how the op’s contract is constructed. Also it seems like OP actually will “enjoy” staying a little late to get a little “education”.

All I can say is when I was on nights, if you want less from me during sign out the better. Also I was a 1099 contractor…. Sure I will give you a comprehensive sign out, for a price.

OP, at some point hopefully you will understand, you’re doing this as a “job”. There are many trade offs that you may or may not have encountered in your training. Proceed with caution. As always I recommend to have a lawyer to do a once over. One of my good friend told me, and I can vouch for - probably the best grand that we have spent.

 

[throaway12345]

It’s not a great set up to be honest and I agree with the concerns everyone has mentioned. You’re taking on liability by not being formally trained in ccm. But it’s hard to recruit for critical care and not everywhere has the luxury of 24h in house coverage. I think >200/h for an employed gig is good for nocturnist, comes down to whether its worth it to you to take on the extra liability and feel comfortable.

Thank you for your reply. Deeply appreciate your insight.

You should be ok with being a practicing intensivist but on paper only have IM credentials for your next gig. For example you may be unlikely to obtain bronchoscopy privileges and vent management may be limited to whatever ICU coverage model they already have established.

I understand this is pretty unique and probably not a skillset I can tout unless I decide to go for a pulmcrit fellowship. I came into medicine at later age because I am deeply curious about human beings, mind and body. So naturally I chose IM because I love how broad it is, and it's been difficult for me to choose a narrower scope after residency. If I can't last on this job, I'd probably do primary care since I love the relationship aspect of it. Maybe at least the insight and understanding of the human body i obtained through this job would somehow be used in my primary care endeavor.

If you think you can do it, ask for 270k+ plus the 20k 'qualify parameters" (whatever that means). They have no choice because 95%+ of IM trained docs won't touch that job with a 20-foot pole.

As someone said above, 9 hrs will turn into 10-11 in most days.

Yes I will ask for increased wage, although I think chances are slim given it's an academic institute known for its lowballing. I will guard for 9 hours turning into more for sure.

OP, at some point hopefully you will understand, you’re doing this as a “job”. There are many trade offs that you may or may not have encountered in your training. Proceed with caution. As always I recommend to have a lawyer to do a once over. One of my good friend told me, and I can vouch for - probably the best grand that we have spent.

Thank you, thank you. I will definitely hire a contract lawyer. Appreciate you caring for me. Happy new year.

 

[NITRAS]

This model isn’t doesn’t usually involve the nocturnist doing bronchs, lines, tubes or jockeying anything complicated on the vent. We have anesthesia/ER doing airways and lines at night, and call to the intensivist for a bronch/chest tube/difficult vent.

Fresh out of residency, I was pretty comfortable doing basic vent, and management of most critical care things. I’d have been pretty comfortable managing this kind of job. I’d be more concerned with things like how much assistance you can get if you need it, how easy is it to transfer people out, and how much time after your shift ends are you really expected to stay. How many admits is really expected, and when does the day team stop accepting admissions to dump on you. What is going to happen to your compensation when your ICU load increases? I’d clarify what you mean by ”procedures”. Honestly, central lines can be a huge time sink.

I’m a bit more rusty now in my ICU care now, so I really wouldn’t take it, but there was a time. Some days I wish I would have went the CCM/PCCM route, but such is life.

 

[collegestud2013]

Hello everyone.



I am a new graduate with a IM nocturnist job offer and would love to get a 2nd opinion on it.

It’s a unique nocturnist job opportunity, where most of my(a general internist) responsibilities are admitting and caring for icu and step down units. I’ll be dropping lines, doing simple procedures, running the code and Ed doc will do the airway. Currently just 15icu beds and 10 step down units, but they have plans to double the icu beds in the next few years.

I will be working a 9hour shift, 122shifts per year. Base pay is 238k + 20k quality parameters. I’m taken aback b/c the daytime hospitalist at the same hospital gets 283k base pay… I thought nocturnists make more money than their day shift counterparts so I’m extremely disappointed. This is in an area with a very high cost of living so I need the money to buy a decent 3br home, which is easily above a million..

That being said, I have also noticed that my hours are much shorter than an average nocturnist. When I calculate the hourly pay it’s $216/hr, not bad compared to my daytime counterpart who gets $129/hr. Also currently (before the expansion) I heard the job is pretty slow and not much work to be done.

What do you think? Is this a fair price? Or should I pass on the offer? I’m not the biggest fan of working at night but I do love the icu medicine and sees it as an opportunity to get my fix without going through a pulmcrit fellowship. Also, the hours being quite cush, I expect to have lots of extra time with my family, which is long overdue. If I need an extra income, I could always pick up extra shifts and make an easy $1.6-2k per night..

Alternatively, I’m thinking of doing primary care. I think I can easily make that money doing primary care and not doing nights. But I will have much less free time..

Take it or leave it? It’s at a semi-academic institution.

Sounds like the hospital is trying to skimp on their night coverage by trying to hire an IM only trained nocturnist instead of paying a bit more for an actual critical care trained nocturnist to cover the ICU, and only paying for 9 hrs a night instead of the usual 12. Not too surprised about this since night coverage ends largely being an expense the hospital has to subsidize (remember that cross coverage at night generally not billable, so you would be billing only for new admissions/consults). As mentioned with ICU level patients 9 hrs can often turn into 10 or 11 on a busy night, especially if the volume picks up after they expand the number of beds,. Is there an RVU pay on top of the base salary, or overtime pay by the hour? If not I would be very careful in accepting the job since you could easily get squeezed into doing more work during your shifts without additional pay? Given that you'll be living in a high COL area ~$250k per year is probably just barely enough to get by these days, especially if you're a new grad with family and lots of student loans. You'll probably have to take on extra shifts in addition to the base 122 shifts to make a decent living which is definitely possible time-wise, but you also don't know how easily available they are at your new place and the extra shifts aren't guaranteed.