Nocturnist Gig in a major city

[dman1234]

Folks, wanted to run this by you guys. Nocturnist 7/7, working 26 weeks a year. Cross covering 100 patients with another Nocturnist. Average admissions between both of us 16-18. We responds to RR. Salary $330K. They also offer wRVU's over 600 per quarter. What do you guys think?

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[Death and Taxes]

Codes and procedures too?

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[chessknt]

Bonus, benefits, icu coverage? Sounds pretty busy and might get exhausted after grinding away but for an urban area compensation seems good. 18 admit average means with variance that could go to 30 which will be horrible while crosscovering so many people. Shouldn't have issue hitting rvus if you bill correctly.

Subspecialty support overnight should make it a bit easier. How are admits split? If you get a complicated chf exacerbation with pna and aki and the other guy gets an acs rule out or a pop drop are you still up for the next hit?

 

[dman1234]

We responds to RR and Codes / ER comes up for lines and procedures and then we take over. ICU is open but intensivest on call. 30k bonus if I sign for 2 years. Benefits included. Not sure how admits are split, probably alternating, not sure though.

If we get over 600 RVUs, they are paying $15 per RVU.

Thanks for all the info!

 

[chessknt]

Er probably doesn't actually do procedures despite what they're telling you or will bitch you out if you force them on it. Rvu comp is a bit low but not unreasonable with that base. It's going to be like an 8-9/10 on work difficulty and doesn't seem long term viable to me but it all depends on what you like and can handle.

 

[NotAProgDirector]

If we get over 600 RVUs, they are paying $15 per RVU.

Are you certain you haven't misread/typed this number? $15/RVU is tiny. As an example, the median annual RVU's for hospitalists is somewhere around 3700. 3700 x $15 = $55,500.

Anyway, the point is that this will be a tiny amount of salary.

 

[end stage fibro]

I agree the RVU numbers are unusual. $15/rvu is a pittance, but your RVU threshold is quite low as well. You should be hitting 600 RVUs in just over a week.

Math:
Let's say you average 17 admissions a night, at 3.3 RVU per admission (conservative estimate) = 56.1 RVU per shift (including only admissions)
56.1 RVU per shift * (26 weeks * 7 shifts per week) = 10,210 RVUs.
600 RVU per quarter * 4 qtr = 2400 minimum
10,210 - 2400 = 7810 subject to bonus
7810 * 15 = 117,150 bonus
total comp, base + RVU = $447, 153

edit: whoops, thought you did 17 admissions personally. If you change the numbers to 9 admissions each, bonus is 45,000 --> comp 375k. decent for Chicagoland I think. Again, for comparison, in the southwest i'd be making 370K.

I think that's fair. The above scheme disincentivizes working harder for RVUs because 15/rvu is less than medicare. Is there extra shift incentive to sweeten the deal?

For comparison, my large tertiary care hospital in a top 10 population city in a would yield total comp in mid 400s. RVU bonus would work out to ~126k. Pretty comparable

edit: Also, I would try to talk to the existing nocturnists about ED's procedure accountability. There's a large difference between "OMFG this patient is dying in front of my eyes plz plz plz intubate/put 3 lines in to prevent a code" vs the ED guys automatically showing up when a order goes in.

Also is the caf open? Cold PBJ sandwiches only count as a delicacy for so long

 

[dman1234]

End stage fibro & aProgDirector thanks for the input!

It is $15 per RVU over 600 per quarter. But this is on top of my base salary of $330k. I think the potential is there to make over $350k. No extra shift incentives, however. They will pay $140 per hour even if I pick up extra shifts, not more than that.

$350k around Chicago land area, isn't that bad for a nocturnist, no?

 

[chessknt]

Are you certain you haven't misread/typed this number? $15/RVU is tiny. As an example, the median annual RVU's for hospitalists is somewhere around 3700. 3700 x $15 = $55,500.

Anyway, the point is that this will be a tiny amount of salary.

It isn't an uncommon bonus structure. If he's as busy as it looks with about 9 admits a night and maybe some CCM time that's say 6 level 3 admits, 2 level 2s, and one CCM block average=32.8 rvu per night x 45 nights per quarter is 1476 rvu and at 15 per rvu over 600 that is $13400 which brings his total annual comp somewhere around 380k. It's a busy job but pays well. Would be a lot easier to do with residents or a mid-level.

2400 rvu at good reimbursement if 60 per only covers about 40% of his base so it would be a huge loss for them to give him full rvu over 600. For them to do that they would need his target closer to 1400 before they would break even.

Also he isn't doing 18 admits he is splitting those.

 

[NotAProgDirector]

I agree the RVU numbers are unusual. $15/rvu is a pittance, but your RVU threshold is quite low as well. You should be hitting 600 RVUs in just over a week.

Math:
Let's say you average 17 admissions a night, at 3.3 RVU per admission (conservative estimate) = 56.1 RVU per shift (including only admissions)
56.1 RVU per shift * (26 weeks * 7 shifts per week) = 10,210 RVUs.
600 RVU per quarter * 4 qtr = 2400 minimum
10,210 - 2400 = 7810 subject to bonus
7810 * 15 = 117,150 bonus
total comp, base + RVU = $447, 153

edit: whoops, thought you did 17 admissions personally. If you change the numbers to 9 admissions each, bonus is 45,000 --> comp 375k. decent for Chicagoland I think. Again, for comparison, in the southwest i'd be making 370K.

I think that's fair. The above scheme disincentivizes working harder for RVUs because 15/rvu is less than medicare. Is there extra shift incentive to sweeten the deal?

For comparison, my large tertiary care hospital in a top 10 population city in a would yield total comp in mid 400s. RVU bonus would work out to ~126k. Pretty comparable

edit: Also, I would try to talk to the existing nocturnists about ED's procedure accountability. There's a large difference between "OMFG this patient is dying in front of my eyes plz plz plz intubate/put 3 lines in to prevent a code" vs the ED guys automatically showing up when a order goes in.

Also is the caf open? Cold PBJ sandwiches only count as a delicacy for so long

Thanks for this. I wasn't thinking about the minimum being so low, so what's happening here is he/she is making both fixed and variable salary on most of their work.

Also didn't think about the fact that a pure nocturnist gig will have many more RVU's than a standard hosp gig, since it's all admission codes. 10K RVU's for a hospitalist is enormous, at least in my world. But I'm working days, with most of my billing is progress notes and discharge codes.

 

[CDI]

Sounds painful. Hard pass.