On the job hunt - is this normal?

[eefen]

I'm in my last year of CCM fellowship and looking for jobs. One place I'm strongly considering is a job close to family (important for my wife/kids), pays well, in an area we'd love to live. It's a 7 on/off set up, resident during day with home call and NP in house overnight, 14 bed mixed ICU though census is closer to 8 currently but will be increasing pending some hospital logistics to higher capacity over the next year. Smaller teaching community hospital.

They've been pretty flexible/reasonable with most negotiation points. The only thing is that the contract is for 26 weeks/year, so no built in vacation. The week off every other week is considered to count for that.

I've definitely seen 7 on/off arrangements with at least 2 weeks of vacation.

Is that standard in all of your experience? This is really one of the only potential sticking points for me, but I otherwise really like the place and general offer. Not sure if this is ridiculous or one of those "in a good compromise, both parties are a little disappointed" situation.

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[deleted999033]

I'm in my last year of CCM fellowship and looking for jobs. One place I'm strongly considering is a job close to family (important for my wife/kids), pays well, in an area we'd love to live. It's a 7 on/off set up, resident during day with home call and NP in house overnight, 14 bed mixed ICU though census is closer to 8 currently but will be increasing pending some hospital logistics to higher capacity over the next year. Smaller teaching community hospital.

They've been pretty flexible/reasonable with most negotiation points. The only thing is that the contract is for 26 weeks/year, so no built in vacation. The week off every other week is considered to count for that.

I've definitely seen 7 on/off arrangements with at least 2 weeks of vacation.

Is that standard in all of your experience? This is really one of the only potential sticking points for me, but I otherwise really like the place and general offer. Not sure if this is ridiculous or one of those "in a good compromise, both parties are a little disappointed" situation.

Can you disclose the pay in the ballpark? Just curious

 

[eefen]

Comes out to about $460k base, pretty decent signing bonus, relocation, some loan repayment, stipend while in fellowship.

 

[DrMetal]

I'm in my last year of CCM fellowship and looking for jobs. One place I'm strongly considering is a job close to family (important for my wife/kids), pays well, in an area we'd love to live. It's a 7 on/off set up, resident during day with home call and NP in house overnight, 14 bed mixed ICU though census is closer to 8 currently but will be increasing pending some hospital logistics to higher capacity over the next year. Smaller teaching community hospital.

They've been pretty flexible/reasonable with most negotiation points. The only thing is that the contract is for 26 weeks/year, so no built in vacation. The week off every other week is considered to count for that.

I've definitely seen 7 on/off arrangements with at least 2 weeks of vacation.

Is that standard in all of your experience? This is really one of the only potential sticking points for me, but I otherwise really like the place and general offer. Not sure if this is ridiculous or one of those "in a good compromise, both parties are a little disappointed" situation.

I notice this a lot in hospitalist contracts as well. That's a little concerning, I would want some built in vacation (weddings/funerals/golf tournaments, you never know). I think 14 days would be reasonable.

Do you guys ever consider just working part time for a system? Just picking up random shifts, doing random coverage? [pro is you can essentially make your own schedule, take as much vacation as you want: I worked 20 shifts one month, then only 6 the next. Con is you don't get any benefits, and you're not guaranteed any certain number of shifts.]

 

[CCM-MD]

I'm in my last year of CCM fellowship and looking for jobs. One place I'm strongly considering is a job close to family (important for my wife/kids), pays well, in an area we'd love to live. It's a 7 on/off set up, resident during day with home call and NP in house overnight, 14 bed mixed ICU though census is closer to 8 currently but will be increasing pending some hospital logistics to higher capacity over the next year. Smaller teaching community hospital.

They've been pretty flexible/reasonable with most negotiation points. The only thing is that the contract is for 26 weeks/year, so no built in vacation. The week off every other week is considered to count for that.

I've definitely seen 7 on/off arrangements with at least 2 weeks of vacation.

Is that standard in all of your experience? This is really one of the only potential sticking points for me, but I otherwise really like the place and general offer. Not sure if this is ridiculous or one of those "in a good compromise, both parties are a little disappointed" situation.

Unfortunately, the lack of PTO is pretty standard. You could try to negotiate 2 weeks of PTO as additional cash pay instead: ~$30-35k based on annual $460k. Overall not a bad gig for the amount of work and lack of in house nights, though "home call" can also be a nightmare depending on the set up.

 

[ryanjmy]

Smaller teaching community hospital.

So that means they have contracted another MD to cover the other 26 weeks. I have a similar situation with 2 weeks on 1 off. From the hospital's perspective they don't care who is there as long as the work gets done. Assuming the other MD is reasonable you can usually swap days with that person if there are times you have to be off or need longer than 7 days for a big trip or whatever.

You could always reach out to the other person and see if are agreeable. Its a give and take.

 

[grt398]

I'm in my last year of CCM fellowship and looking for jobs. One place I'm strongly considering is a job close to family (important for my wife/kids), pays well, in an area we'd love to live. It's a 7 on/off set up, resident during day with home call and NP in house overnight, 14 bed mixed ICU though census is closer to 8 currently but will be increasing pending some hospital logistics to higher capacity over the next year. Smaller teaching community hospital.

They've been pretty flexible/reasonable with most negotiation points. The only thing is that the contract is for 26 weeks/year, so no built in vacation. The week off every other week is considered to count for that.

I've definitely seen 7 on/off arrangements with at least 2 weeks of vacation.

Is that standard in all of your experience? This is really one of the only potential sticking points for me, but I otherwise really like the place and general offer. Not sure if this is ridiculous or one of those "in a good compromise, both parties are a little disappointed" situation.

One place I'm currently looking at has a similar schedule in terms of weeks of service (26 weeks total with no time off) and similar pay, but wants 1/3 nights and the census per person is supposedly 16-20 so your setup is actually better. I found a second position that wanted an immediate hire but they did the 24 weeks of clinical time you're referring to. I've also come across positions that specify a number of shifts per month/per year, so it seems like there's a lot of variation.

 

[CCM-MD]

One place I'm currently looking at has a similar schedule in terms of weeks of service (26 weeks total with no time off) and similar pay, but wants 1/3 nights and the census per person is supposedly 16-20 so your setup is actually better. I found a second position that wanted an immediate hire but they did the 24 weeks of clinical time you're referring to. I've also come across positions that specify a number of shifts per month/per year, so it seems like there's a lot of variation.

My patient load approaches that currently but I do 0 in house nights and make quite a bit more due to a productivity bonus. I personally wouldn't see 16-20 for 460k, there are better opportunities out there.

 

[grt398]

My patient load approaches that currently but I do 0 in house nights and make quite a bit more due to a productivity bonus. I personally wouldn't see 16-20 for 460k, there are better opportunities out there

This is really helpful, thank you, because I've been wondering a little bit lately as I've been reviewing the contract since I'm getting emails with some regularity for locums coverage for $275-300+/hour for all days, no home call, and as a single person without ties to any region...it seemed like maybe locums would be better (meaning more money, more time off). If you're willing to discuss further please send me a PM as I'd appreciate any additional feedback on the contract and would be happy to anonymize stuff after for the benefit of the forum (it looks like your PM's are turned off).

 

[psychbender]

The full time guys here have, I think, 9 or 10 days of PTO in addition to the off weeks, for effectively 172 shifts per year. Roughly one fifth of their time is spent working nights (3 or 4 night blocks). Day shift typically only sees 8-12 patients per day in their units. The triage/admitting doc can see more, but also has one or two PA/NPs working with him (everyone else is solo). Pay for them is, I believe, about $200/hr plus benefits. The hospital is also hiring (Virginia) if interested.

 

[grt398]

Just want to sincerely thank everyone posting info about their jobs...it's really helpful to those of us in the market coming from a program where our attendings are not able to give us much info about work outside academics.

 

[DoctorMD1]

I'm in my last year of CCM fellowship and looking for jobs. One place I'm strongly considering is a job close to family (important for my wife/kids), pays well, in an area we'd love to live. It's a 7 on/off set up, resident during day with home call and NP in house overnight, 14 bed mixed ICU though census is closer to 8 currently but will be increasing pending some hospital logistics to higher capacity over the next year. Smaller teaching community hospital.

They've been pretty flexible/reasonable with most negotiation points. The only thing is that the contract is for 26 weeks/year, so no built in vacation. The week off every other week is considered to count for that.

I've definitely seen 7 on/off arrangements with at least 2 weeks of vacation.

Is that standard in all of your experience? This is really one of the only potential sticking points for me, but I otherwise really like the place and general offer. Not sure if this is ridiculous or one of those "in a good compromise, both parties are a little disappointed" situation.

How long is the shift if you don't mind me asking?

 

[eefen]

How long is the shift if you don't mind me asking?

Since you are "on" for the 24 hours, you can leave whenever things are quiet and come back if needed. Generally come in around 7 am and can leave anywhere from 3 pm to 6 pm depending on how busy it is. Talked to one person who would round, go home if the day was unusually quiet, and check back in the afternoon.

Prior to the ICU having NPs overnight you would have to come back in for overnight admits but as long as they are fairly straightforward that isn't the case now. Will likely have to field occasional phone call but much less than before.

 

[CCM-MD]

Since you are "on" for the 24 hours, you can leave whenever things are quiet and come back if needed. Generally come in around 7 am and can leave anywhere from 3 pm to 6 pm depending on how busy it is. Talked to one person who would round, go home if the day was unusually quiet, and check back in the afternoon.

Prior to the ICU having NPs overnight you would have to come back in for overnight admits but as long as they are fairly straightforward that isn't the case now. Will likely have to field occasional phone call but much less than before.

This is a pretty sweet set up.

 

[Dr Meow]

OMS1 here,
Critical care interests me but also confuses me.

I see critical care in terms of Emergency Medicine, Neurology, Internal med, etc.

What is Critical care? Is it a residency like the others? Is it just a a fellowship? Is critical care by itself the same as a fellowship from emergency med or neurology?

Does critical care from emergency med get paid the same as critical care from neurology or internal med?

 

[psychbender]

OMS1 here,
Critical care interests me but also confuses me.

I see critical care in terms of Emergency Medicine, Neurology, Internal med, etc.

What is Critical care? Is it a residency like the others? Is it just a a fellowship? Is critical care by itself the same as a fellowship from emergency med or neurology?

Does critical care from emergency med get paid the same as critical care from neurology or internal med?

In the US, there are no critical care residencies, only fellowships sponsored by various specialty boards (ABIM, ABA, ACS, etc). Initial specialty training in IM, anesthesiology, general surgery, EM, or neurology is needed to enter a fellowship and obtain board certification via one of those sponsoring boards.

As for pay, the answer is mostly yes, if talking just critical care. If you throw in Trauma/Emergency General surgery work, pulmonary consult and clinic, Neuro consults, and anesthesiology on top of critical care, then the different pathways can have different incomes

 

[eefen]

Thanks for everyone's replies. I ended up signing the contract after a bit of back and forth. Hopefully everyone in a similar spot has some fellowship mentors they can run things by, but it's sometimes nice to get some outside input as well.

We'll see how this goes. 🤞

 

[CCM-MD]

Thanks for everyone's replies. I ended up signing the contract after a bit of back and forth. Hopefully everyone in a similar spot has some fellowship mentors they can run things by, but it's sometimes nice to get some outside input as well.

We'll see how this goes. 🤞

Congratulations. I think you got a decent gig lined up. That patient load and not being required to stay in-house for the entire 12 hours, makes it a pretty sweet deal.

 

[ICUislife]

Just wondering what location you're in? I'm a new attending (graduated June '21) making significantly less works out to $170/hr day and $190/hr night- for 15 12hr shifts/month average encounter 14-16/day. All in house coverage.

Looking for new opportunities elsewhere.

 

[CCM-MD]

Just wondering what location you're in? I'm a new attending (graduated June '21) making significantly less works out to $170/hr day and $190/hr night- for 15 12hr shifts/month average encounter 14-16/day. All in house coverage.

Looking for new opportunities elsewhere.

Where are you located?

 

[eefen]

Just wondering what location you're in? I'm a new attending (graduated June '21) making significantly less works out to $170/hr day and $190/hr night- for 15 12hr shifts/month average encounter 14-16/day. All in house coverage.

Looking for new opportunities elsewhere.

I'm in the pacific northwest.

 

[ICUislife]

NY/NJ area (not in the city)

Where are you located?

 

[CCM-MD]

MGMA mean in 2020 was 450k overall. Location plays a big role in compensation. MGMA mean in the midwest was 520k in 2020. Highly desirable/competitive locations are likely to compensate less competitively.

 

[robellis]

MGMA mean in 2020 was 450k overall. Location plays a big role in compensation. MGMA mean in the midwest was 520k in 2020. Highly desirable/competitive locations are likely to compensate less competitively.

Where do you find mgma numbers can you post them for all specialties?

 

[psychbender]

Just wondering what location you're in? I'm a new attending (graduated June '21) making significantly less works out to $170/hr day and $190/hr night- for 15 12hr shifts/month average encounter 14-16/day. All in house coverage.

Looking for new opportunities elsewhere.

At the two places I interviewed in Virginia a couple of years ago, $200/hr was the going rate for 12-hr shifts in the ICU. That was also the rate for places where I looked in Pennsylvania. Where you are now, what is the average number of patients seen per shift, and are you solo or working with residents or midlevels?