Nocturnist offer

[lookingforajobwithgoodpay]

Hi all,

Need some advice about a recent Nocturnist job offer.

Nocturnist shift
10pm-8am
7 on/7 off
15 shifts a month
170$/hr
No RVU bonus
Sign in bonus up to 20-30k
Malpractice/medical insurance
401k etc

My role is to cover the 19 bed ICU; doing icu admissions, procedures (all lines, and intubations).

Will cover the ICU overnight and supervise the IM Residents for all non-ICU admissions to their ward service. Generally, the number of total admissions for the Nocturnist has averaged is 5.5 nightly (0-2 ICU admits and 2-3 ward admits). The Nocturnist does not need to respond to RRT’s unless specifically asked (though these requests are generally for ICU transfer). The Nocturnist does respond to all Code Blues

Pay comes out to around 306k/year. Location is in CA, large city.

Appreciate any and all advice. I feel comfortable with the job; including doing intubations and procedures. I just want to know if pay is fair for the work.

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[CCM-MD]

Damn that’s a great deal… for the hospital. They get an intensivist and a hospitalist, buy one get one free. At the same time, you get tons of liability so its also a great deal for plaintiff lawyers as well. Great find.

 

[rokshana]

agree with ccm-md..that is a crap deal but a sweet one for the facility.
run...run away.

 

[lookingforajobwithgoodpay]

agree with ccm-md..that is a crap deal but a sweet one for the facility.
run...run away.

What is the expected salary for the job I described; considering the location I mentioned?

 

[Prehealth1011]

My role is to cover the 19 bed ICU; doing icu admissions, procedures (all lines, and intubations).

Is this kinda stuff typical for hospitalist jobs these days?

 

[chromaticscale]

Hi all,

Need some advice about a recent Nocturnist job offer.

Nocturnist shift
10pm-8am
7 on/7 off
15 shifts a month
170$/hr
No RVU bonus
Sign in bonus up to 20-30k
Malpractice/medical insurance
401k etc

My role is to cover the 19 bed ICU; doing icu admissions, procedures (all lines, and intubations).

Will cover the ICU overnight and supervise the IM Residents for all non-ICU admissions to their ward service. Generally, the number of total admissions for the Nocturnist has averaged is 5.5 nightly (0-2 ICU admits and 2-3 ward admits). The Nocturnist does not need to respond to RRT’s unless specifically asked (though these requests are generally for ICU transfer). The Nocturnist does respond to all Code Blues

Pay comes out to around 306k/year. Location is in CA, large city.

Appreciate any and all advice. I feel comfortable with the job; including doing intubations and procedures. I just want to know if pay is fair for the work.

I'm confused here. This seems more like an intensivists' job than for a nocturnist/hospitalist. Have you ever done intubations without an attending during residency? Intensivists should be doing these procedures, not general IM folk. If I were a patient here and found out about this role description, I would avoid this hospital at all costs.

 

[Ubba]

Even if I were totally comfortable with lines and intubations, I wouldn't take a penny less than 300/hr.

 

[chessknt]

What is the expected salary for the job I described; considering the location I mentioned?

You arent going to be paid well in a large CA city assuming you mean it is actually a desirable one. If money is the sole objective (assuming based on your username and the fact that you are looking at an intensivist job without the training) but you HAVE to live in the second worst place in America for doctors then I would recommend you just do nocturnist locums for nearly double that rate but with 2/3 the time commitment and a fraction of the liability.

 

[sloh]

306k with no RVU bonus? I live in Cali. That is not enough money.

 

[PulmCrit]

306k with no RVU bonus? I live in Cali. That is not enough money.

how much do you get paid at your shop? is it nocturnist shifts? what would be an ideal pay for the work i mentioned in your opinion?

 

[collegestud2013]

Hi all,

Need some advice about a recent Nocturnist job offer.

Nocturnist shift
10pm-8am
7 on/7 off
15 shifts a month
170$/hr
No RVU bonus
Sign in bonus up to 20-30k
Malpractice/medical insurance
401k etc

My role is to cover the 19 bed ICU; doing icu admissions, procedures (all lines, and intubations).

Will cover the ICU overnight and supervise the IM Residents for all non-ICU admissions to their ward service. Generally, the number of total admissions for the Nocturnist has averaged is 5.5 nightly (0-2 ICU admits and 2-3 ward admits). The Nocturnist does not need to respond to RRT’s unless specifically asked (though these requests are generally for ICU transfer). The Nocturnist does respond to all Code Blues

Pay comes out to around 306k/year. Location is in CA, large city.

Appreciate any and all advice. I feel comfortable with the job; including doing intubations and procedures. I just want to know if pay is fair for the work.

The job would be decent if it were closed ICU nocturnist and admitting volume at night was reasonable. 10-hour shifts also makes it more reasonable for night schedule. As others mentioned having to to do ICU level work is the dealbreaker for this type of pay. Might be competitive for large CA city but my guess is the physician market is saturated there. However, nocturnists are still much harder to recruit than daytime so you may have some negotiating power.

I'm also assuming you're responsible for cross-covering the inpatients at night as well (or supervising the residents to do it). The hospital probably just doesn't want to pay a full time critical care nocturnist at night (which is is common at many smaller hospitals that don't have that may ICU beds). Even if you are comfortable with ICU level work (which is less common to have among those who are only IM trained and didn't do a critical care fellowship), would expect more pay per hour for this type of job (at least $200/hr for full time W2 pay). Also I'm not a big fan of a straight up salary structure with no RVU pay since if the workload got busier for some reason down the line (eg the hospital decides to open more beds) you wouldn't get compensated any more for your extra work.

 

[Splenda88]

This is probably the worst nocturnist offer that I have seen here.

Are people in leadership at this hospital really serious?

 

[dozitgetchahi]

I'm confused here. This seems more like an intensivists' job than for a nocturnist/hospitalist. Have you ever done intubations without an attending during residency? Intensivists should be doing these procedures, not general IM folk. If I were a patient here and found out about this role description, I would avoid this hospital at all costs.

This reminds me of a hospitalist moonlighting job I encountered during fellowship…I got as far as doing the credentialing paperwork when I realized that they had written into the paperwork and contract that I was going to be credentialed for intubations. The subsequent conversation went like this:

Me: why am I being credentialed for intubations? I don’t feel comfortable doing that.

Them: oh don’t worry, there’s always an anesthesiologist there who does all the intubations for floor patients.

Me: ok, so why am I being credentialed to do this if I’m never going to do it?

We went around in circles like this for weeks until their recruiter came back and proposed that they send me to a weekend course for airways “if that would make me feel more comfortable”. I said that it wouldn’t, and that either I wasn’t going to be credentialed to do intubations at all or I wasn’t going to sign the paperwork (and a weekend airway course wouldn’t change that). They got pissed and the contract negotiations never went any further than that.

 

[chromaticscale]

This reminds me of a hospitalist moonlighting job I encountered during fellowship…I got as far as doing the credentialing paperwork when I realized that they had written into the paperwork and contract that I was going to be credentialed for intubations. The subsequent conversation went like this:

Me: why am I being credentialed for intubations? I don’t feel comfortable doing that.

Them: oh don’t worry, there’s always an anesthesiologist there who does all the intubations for floor patients.

Me: ok, so why am I being credentialed to do this if I’m never going to do it?

We went around in circles like this for weeks until their recruiter came back and proposed that they send me to a weekend course for airways “if that would make me feel more comfortable”. I said that it wouldn’t, and that either I wasn’t going to be credentialed to do intubations at all or I wasn’t going to sign the paperwork (and a weekend airway course wouldn’t change that). They got pissed and the contract negotiations never went any further than that.

So the recruiter doesn't understand the medical training and quality required for safe intubations. Maybe in other countries you can do it as an internist but in the US I wouldn't feel safe if a non-anesthesiologist or non-intensivist is doing these. Imagine the liabilities and malpractice.

 

[chessknt]

This reminds me of a hospitalist moonlighting job I encountered during fellowship…I got as far as doing the credentialing paperwork when I realized that they had written into the paperwork and contract that I was going to be credentialed for intubations. The subsequent conversation went like this:

Me: why am I being credentialed for intubations? I don’t feel comfortable doing that.

Them: oh don’t worry, there’s always an anesthesiologist there who does all the intubations for floor patients.

Me: ok, so why am I being credentialed to do this if I’m never going to do it?

We went around in circles like this for weeks until their recruiter came back and proposed that they send me to a weekend course for airways “if that would make me feel more comfortable”. I said that it wouldn’t, and that either I wasn’t going to be credentialed to do intubations at all or I wasn’t going to sign the paperwork (and a weekend airway course wouldn’t change that). They got pissed and the contract negotiations never went any further than that.

Yea a weekend course and youll be all set. Hopefully you can practice on the recruiter.

 

[Splenda88]

Is this kinda stuff typical for hospitalist jobs these days?

No... That is a crapy job.

The typical job: 280-320k, 7 on/off, no ICU, no procedures, no codes or RRT for a census of 16-20 patients

 

[collegestud2013]

So the recruiter doesn't understand the medical training and quality required for safe intubations. Maybe in other countries you can do it as an internist but in the US I wouldn't feel safe if a non-anesthesiologist or non-intensivist is doing these. Imagine the liabilities and malpractice.

Not uncommon for IM or FM trained physicians (who haven't done a critical care fellowship, or an anesthesiology or EM residency) to do intubations and vent management at hospitalist jobs that are open ICU. They are typically found in more rural hospitalist jobs or nocturnist jobs where there there is no intensivist on staff at all or not at night (or maybe the ICU census is too small to justify hiring a full time intensivist, especially at night). But anyone should have to be credentialed properly to do it if they don't have the formal residency/fellowship training (usually involves having history of certain number of logged intubation procedures in the past 1-2 years). Medicolegally you're generally only be held to the standard of care of your formal training (so if something goes wrong and there is a malpractice lawsuit, you're only held to the standard of care of an IM or FM trained physician and not an intensivist or anesthesiologist or EM physician).

 

[dozitgetchahi]

Not uncommon for IM or FM trained physicians (who haven't done a critical care fellowship, or an anesthesiology or EM residency) to do intubations and vent management at hospitalist jobs that are open ICU. They are typically found in more rural hospitalist jobs or nocturnist jobs where there there is no intensivist on staff at all or not at night (or maybe the ICU census is too small to justify hiring a full time intensivist, especially at night). But anyone should have to be credentialed properly to do it if they don't have the formal residency/fellowship training (usually involves having history of certain number of logged intubation procedures in the past 1-2 years). Medicolegally you're generally only be held to the standard of care of your formal training (so if something goes wrong and there is a malpractice lawsuit, you're only held to the standard of care of an IM or FM trained physician and not an intensivist or anesthesiologist or EM physician).

I’ve lived and worked as a physician in both urban and rural parts of America (the latter of which being where I live now). I’ll just say that what passes for “healthcare” in rural America can get pretty horrific, and the patient outcomes show it. There are all sorts of crazy things that get done in rural areas by doctors that aren’t really qualified to do them, and the excuse that always gets used is “well, that’s all we’ve got” etc. Sometimes the care is godawful enough that you’d think you weren’t in the USA anymore.

Regardless of whatever liability standards one might or might not be held to as a rural internist doing intubations, we should all aspire to avoid situations where we’re placing patients in danger by doing something we’re probably not able to do safely.

 

[chessknt]

I’ve lived and worked as a physician in both urban and rural parts of America (the latter of which being where I live now). I’ll just say that what passes for “healthcare” in rural America can get pretty horrific, and the patient outcomes show it. There are all sorts of crazy things that get done in rural areas by doctors that aren’t really qualified to do them, and the excuse that always gets used is “well, that’s all we’ve got” etc. Sometimes the care is godawful enough that you’d think you weren’t in the USA anymore.

Regardless of whatever liability standards one might or might not be held to as a rural internist doing intubations, we should all aspire to avoid situations where we’re placing patients in danger by doing something we’re probably not able to do safely.

To be fair that isn't an excuse, that is reality. Not every condition can wait for a 6 figure air transport to be taken to the nearest academic center whenever they may happen to have a bed. We had a patient come in from a very rural area with a very poorly done crich but you know what? That family med doc saved his life. This is different from the alcoholic cardiologist who failed at cathing some guy and dissected his LAD who could have easily come 20 minutes down the road to get an IC boarded physician to work on him for his NSTEMI.

 

[dozitgetchahi]

To be fair that isn't an excuse, that is reality. Not every condition can wait for a 6 figure air transport to be taken to the nearest academic center whenever they may happen to have a bed. We had a patient come in from a very rural area with a very poorly done crich but you know what? That family med doc saved his life. This is different from the alcoholic cardiologist who failed at cathing some guy and dissected his LAD who could have easily come 20 minutes down the road to get an IC boarded physician to work on him for his NSTEMI.

I see both sides of it, again having lived in both types of places. But again…while I appreciate that these types of places have to do what they can with what they have where they are (and I currently work in this type of place), the question remains: how many people would I have to kill as an internist before I got good at intubations?

In my time in the rural south and Midwest, I’ve encountered the following debacles:

- Grossly incompetent FPs doing c-scopes and EGDs and either missing important things completely, or perfing bowel, or (in the worst case) making a bleeding varix much worse to the point that the patient bled out and died;

- In my own specialty (rheumatology) I’ve seen FPs opting to start methotrexate without folic acid in patients who never had hepatitis screenings or a CBC, one of whom was febrile 2/2 an ongoing surgical site infection (and in patients who didn’t even have RA anyway once I evaluated them);

- FPs dabbling in psych, starting stimulants and benzos and atypical antipsychotics and SNRIs and opioids and lithium all at once in people who probably never actually needed any of these drugs to begin with;

And on and on and on. Stuff like this was seen every single day in my office. Alabama was just horrific when it came to this stuff, and for whatever reason every other doctor in town would just dump any and all patients they didn’t know what to do with anymore on rheumatology. So I ended up cleaning up a LOT of ugly, unnecessary medical messes that never ever should have happened in the first place, and trying to triage these poor patients to the places they should have gone to begin with. I saw a lot more PCPs (and midlevels, don’t forget) doing poorly thought out and downright stupid things than I ever want to have to deal with again. There’s the point where a “Jack of all trades” doctor can step in and do some good, and then there’s the point where said doctor needs to know that this situation is way beyond his skill set and safety level - and to call for help, whether this is a referral, the ER, airlift, whatever.

 

[Meerkatology]

I see both sides of it, again having lived in both types of places. But again…while I appreciate that these types of places have to do what they can with what they have where they are (and I currently work in this type of place), the question remains: how many people would I have to kill as an internist before I got good at intubations?

In my time in the rural south and Midwest, I’ve encountered the following debacles:

- Grossly incompetent FPs doing c-scopes and EGDs and either missing important things completely, or perfing bowel, or (in the worst case) making a bleeding varix much worse to the point that the patient bled out and died;

- In my own specialty (rheumatology) I’ve seen FPs opting to start methotrexate without folic acid in patients who never had hepatitis screenings or a CBC, one of whom was febrile 2/2 an ongoing surgical site infection (and in patients who didn’t even have RA anyway once I evaluated them);

- FPs dabbling in psych, starting stimulants and benzos and atypical antipsychotics and SNRIs and opioids and lithium all at once in people who probably never actually needed any of these drugs to begin with;

And on and on and on. Stuff like this was seen every single day in my office. Alabama was just horrific when it came to this stuff, and for whatever reason every other doctor in town would just dump any and all patients they didn’t know what to do with anymore on rheumatology. So I ended up cleaning up a LOT of ugly, unnecessary medical messes that never ever should have happened in the first place, and trying to triage these poor patients to the places they should have gone to begin with. I saw a lot more PCPs (and midlevels, don’t forget) doing poorly thought out and downright stupid things than I ever want to have to deal with again. There’s the point where a “Jack of all trades” doctor can step in and do some good, and then there’s the point where said doctor needs to know that this situation is way beyond his skill set and safety level - and to call for help, whether this is a referral, the ER, airlift, whatever.

ya i'd be concerned about liability on that op's offer.

as an exclusive nocturnist, neither me nor any one in my group have done a procedure or a code blue. we admit to the icu but do not do procedures or vent mngt, there are oncall intensivists/er for that. they are trained for it and do it all the time.

i dont get why fps/im's want more responsiblity, if u only do a procedure once a month u arent gonna be good enough at it and its an liability issue. there is enough we need to know in our own field already, more than enough.

even if the OP is comfortable with vent management and being the exclusive provider on a intubated icu patient, isnt that legally outside the scope of a internist's practice?

 

[chessknt]

even if the OP is comfortable with vent management and being the exclusive provider on a intubated icu patient, isnt that legally outside the scope of a internist's practice?

There is no legality to scope, only civil liability. As a doctor you can inject fillers, do boob jobs or brain surgery if you want and none of it would be illegal.

 

[Suprep]

Hi all,

Need some advice about a recent Nocturnist job offer.

Nocturnist shift
10pm-8am
7 on/7 off
15 shifts a month
170$/hr
No RVU bonus
Sign in bonus up to 20-30k
Malpractice/medical insurance
401k etc

My role is to cover the 19 bed ICU; doing icu admissions, procedures (all lines, and intubations).

Will cover the ICU overnight and supervise the IM Residents for all non-ICU admissions to their ward service. Generally, the number of total admissions for the Nocturnist has averaged is 5.5 nightly (0-2 ICU admits and 2-3 ward admits). The Nocturnist does not need to respond to RRT’s unless specifically asked (though these requests are generally for ICU transfer). The Nocturnist does respond to all Code Blues

Pay comes out to around 306k/year. Location is in CA, large city.

Appreciate any and all advice. I feel comfortable with the job; including doing intubations and procedures. I just want to know if pay is fair for the work.

lol, Run. for CA, you should be making 400k for that work. also always ask for rvu bonus that is fair and straight forward. dont take $15 per RVU over 4000 or something. it should be at least median conversion factor, like 55 or 60$ after the threshold