fullmetal

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This offer puzzles me.

It is for a Nocturnist. 7pm - 7am.
Small hospital (100 patients) but great location (suburbs 45 minutes outside a major city)
Has to be an average of 15 shifts per month, flexible (shifts are shared between you and a second nocturist)
2-3 admissions per night + 1-2 admissions for other services (ex. ortho) average
"You are a pseudo-intensivist" - you are responsible for intubations and central lines overnight but this is usually no more than two of each and usually its zero
You also respond to any rapids/codes (you are the only hospitalist there overnight)
Pays 1800 per shift (150/hr) -- total of 324,000k per year

As a resident I admit about 7 patients per night on average and run codes on a 250 bed hospital and I don't find it stressful at all.. but then again I am not responsible for intubations and central line placements.

It pays well and its a good location. The employer repeatedly states it is a stressful job and not for someone who is looking for easy money... am I missing something here?
 

chessknt

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This offer puzzles me.

It is for a Nocturnist. 7pm - 7am.
Small hospital (100 patients) but great location (suburbs 45 minutes outside a major city)
Has to be an average of 15 shifts per month, flexible (shifts are shared between you and a second nocturist)
2-3 admissions per night + 1-2 admissions for other services (ex. ortho) average
"You are a pseudo-intensivist" - you are responsible for intubations and central lines overnight but this is usually no more than two of each and usually its zero
You also respond to any rapids/codes (you are the only hospitalist there overnight)
Pays 1800 per shift (150/hr) -- total of 324,000k per year

As a resident I admit about 7 patients per night on average and run codes on a 250 bed hospital and I don't find it stressful at all.. but then again I am not responsible for intubations and central line placements.

It pays well and its a good location. The employer repeatedly states it is a stressful job and not for someone who is looking for easy money... am I missing something here?

The lack of airway coverage should be a hard stop. It may not happen often but you can kill people and get sued if you can't get an airway. A crna sleeping in the hospital would cost them 1-2k per night and they get in for free from whoever is covering this job. If the er was required to respond to airways immediately that would be much better.


Also have you tried running a code while doing an airway?
 
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lulu09

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I fully agree. You would be crazy to take this job unless you are essentially CCM trained. The risk of something bad happening is simply too high (also I'm kind of appalled that this hospital is going to these lengths to cut cost). Doing procedures while trying to run a code is no joke. Also who is cross-covering? Are you ALSO the cross-coverage?!

There's no such thing as a free lunch...
 
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rokshana

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This offer puzzles me.

It is for a Nocturnist. 7pm - 7am.
Small hospital (100 patients) but great location (suburbs 45 minutes outside a major city)
Has to be an average of 15 shifts per month, flexible (shifts are shared between you and a second nocturist)
2-3 admissions per night + 1-2 admissions for other services (ex. ortho) average
"You are a pseudo-intensivist" - you are responsible for intubations and central lines overnight but this is usually no more than two of each and usually its zero
You also respond to any rapids/codes (you are the only hospitalist there overnight)
Pays 1800 per shift (150/hr) -- total of 324,000k per year

As a resident I admit about 7 patients per night on average and run codes on a 250 bed hospital and I don't find it stressful at all.. but then again I am not responsible for intubations and central line placements.

It pays well and its a good location. The employer repeatedly states it is a stressful job and not for someone who is looking for easy money... am I missing something here?
That is an intensivist job... it should pay like one and the applicant should be one... as someone who works nocturnist ... no way
 
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throwaway1000000

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for the amount of work you will be doing, you are probably better off getting a normal job and doing locums. Probably more the mental side of it, like others said. Are you experienced in doing airways?
 

Splenda88

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That is a 500k+/yr intensivist job...
 
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wamcp

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This offer puzzles me.

It is for a Nocturnist. 7pm - 7am.
Small hospital (100 patients) but great location (suburbs 45 minutes outside a major city)
Has to be an average of 15 shifts per month, flexible (shifts are shared between you and a second nocturist)
2-3 admissions per night + 1-2 admissions for other services (ex. ortho) average
"You are a pseudo-intensivist" - you are responsible for intubations and central lines overnight but this is usually no more than two of each and usually its zero
You also respond to any rapids/codes (you are the only hospitalist there overnight)
Pays 1800 per shift (150/hr) -- total of 324,000k per year

As a resident I admit about 7 patients per night on average and run codes on a 250 bed hospital and I don't find it stressful at all.. but then again I am not responsible for intubations and central line placements.

It pays well and its a good location. The employer repeatedly states it is a stressful job and not for someone who is looking for easy money... am I missing something here?

If you take this position you need to paid fairly. You should be paid like an intensivist and a nocturnist combined plus a premium for it. So no less than 700k a year.
 
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chessknt

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People saying 500-700k a year are smoking crack. This job sounds like it might bill in the department of 200-300 per year so that would be a huge stipend to require coverage, especially in current circumstances with hospitals starting to go under there is no way you are going to get 2.5x you're earnings in salary.
 
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CCM-MD

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People saying 500-700k a year are smoking crack. This job sounds like it might bill in the department of 200-300 per year so that would be a huge stipend to require coverage, especially in current circumstances with hospitals starting to go under there is no way you are going to get 2.5x you're earnings in salary.

What do you expect. This is SDN. Everyone has a 260 on step 1 and every hospitalist on here makes 500k and works only 10 days a month.
 
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wamcp

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People saying 500-700k a year are smoking crack. This job sounds like it might bill in the department of 200-300 per year so that would be a huge stipend to require coverage, especially in current circumstances with hospitals starting to go under there is no way you are going to get 2.5x you're earnings in salary.

that’s the whole point of saying 700k...they won’t pay that sum and neither should you accept the job otherwise, because you are literally being used and abused
 
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chessknt

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that’s the whole point of saying 700k...they won’t pay that sum and neither should you accept the job otherwise, because you are literally being used and abused

That's like a contractor asking for 10k to replace a lock because the job is too small
It is insulting and a waste of time on both sides. Just move on.
 
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CCM-MD

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that’s the whole point of saying 700k...they won’t pay that sum and neither should you accept the job otherwise, because you are literally being used and abused

Its a ****ty job but there are people out there doing these types of jobs - and not for 700k.
 
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CopaceticOne

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On the surface it looks like a cush job... until the airway / code coverage part. Then it is a diaper full of poo, unless there is more information. I agree with people saying the pay should be significantly more if you are also responsible for critical procedures in unstable patients.

Here's my reasoning:
Sure in straight forward airways most people can get the tube in using a videoscope. But... What happens if you (personally) can't get that tube in? What happens for the unstable upper GI bleeder that will transfer to the big house in the city, but needs to be stablized prior to transfer? What about that patient who is now vomiting and altered and needs to be intubated for airway protection? What about the patient with anaphylaxis? What about the patient with the known difficult airway? How comfortable are you with performing cricothyroidotomies?

Do you have the personal expertise to deal with these (and other similar) scenerios? Because they happen, even on patients who have been sitting stable on the floor for weeks. Intensivists & anesthesiologists are trained to deal with these situations (and they have also been trained to recognize situations they may need help). Who is the person on call for the hospital to be your backup (ENT / anesthesiologist / general surgeon)?

Because guess what - that anoxic brain injury is now your fault, that corneal abrasion is now your fault, that increase in morbidity is now your fault, heck an aggressive malpractice lawyer may even say the death is your fault. Even if you did everything perfectly, folks will want to blame someone and you have MD/DO after your name and have malpractice insurance.

Is all of that worth $1800 a night?
 
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bobow98

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On the surface it looks like a cush job... until the airway / code coverage part. Then it is a diaper full of poo, unless there is more information. I agree with people saying the pay should be significantly more if you are also responsible for critical procedures in unstable patients.

Here's my reasoning:
Sure in straight forward airways most people can get the tube in using a videoscope. But... What happens if you (personally) can't get that tube in? What happens for the unstable upper GI bleeder that will transfer to the big house in the city, but needs to be stablized prior to transfer? What about that patient who is now vomiting and altered and needs to be intubated for airway protection? What about the patient with anaphylaxis? What about the patient with the known difficult airway? How comfortable are you with performing cricothyroidotomies?

Do you have the personal expertise to deal with these (and other similar) scenerios? Because they happen, even on patients who have been sitting stable on the floor for weeks. Intensivists & anesthesiologists are trained to deal with these situations (and they have also been trained to recognize situations they may need help). Who is the person on call for the hospital to be your backup (ENT / anesthesiologist / general surgeon)?

Because guess what - that anoxic brain injury is now your fault, that corneal abrasion is now your fault, that increase in morbidity is now your fault, heck an aggressive malpractice lawyer may even say the death is your fault. Even if you did everything perfectly, folks will want to blame someone and you have MD/DO after your name and have malpractice insurance.

Is all of that worth $1800 a night?


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throwaway1000000

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On the surface it looks like a cush job... until the airway / code coverage part. Then it is a diaper full of poo, unless there is more information. I agree with people saying the pay should be significantly more if you are also responsible for critical procedures in unstable patients.

Here's my reasoning:
Sure in straight forward airways most people can get the tube in using a videoscope. But... What happens if you (personally) can't get that tube in? What happens for the unstable upper GI bleeder that will transfer to the big house in the city, but needs to be stablized prior to transfer? What about that patient who is now vomiting and altered and needs to be intubated for airway protection? What about the patient with anaphylaxis? What about the patient with the known difficult airway? How comfortable are you with performing cricothyroidotomies?

Do you have the personal expertise to deal with these (and other similar) scenerios? Because they happen, even on patients who have been sitting stable on the floor for weeks. Intensivists & anesthesiologists are trained to deal with these situations (and they have also been trained to recognize situations they may need help). Who is the person on call for the hospital to be your backup (ENT / anesthesiologist / general surgeon)?

Because guess what - that anoxic brain injury is now your fault, that corneal abrasion is now your fault, that increase in morbidity is now your fault, heck an aggressive malpractice lawyer may even say the death is your fault. Even if you did everything perfectly, folks will want to blame someone and you have MD/DO after your name and have malpractice insurance.

Is all of that worth $1800 a night?
Honestly depends on your training. What OP is saying is pretty much what EM folks do. They are not experts in airways or anything but they get by.
Most IM residents don't have much experience in airways, etc but if the OP trained at such a place and are willing to take a risk then 330k is not a bad gig. It will by no means be an easy job and it's different from what typical IM trained folks do.
I agree with the above poster 600-700k is too much to ask for this sort of job. Most intensivists are not making that much.
You can probably find an EM person who would feel comfortable with this job and even do it for around 300-400k.
 
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CopaceticOne

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Honestly depends on your training. What OP is saying is pretty much what EM folks do. They are not experts in airways or anything but they get by.
Most IM residents don't have much experience in airways, etc but if the OP trained at such a place and are willing to take a risk then 330k is not a bad gig. It will by no means be an easy job and it's different from what typical IM trained folks do.
I agree with the above poster 600-700k is too much to ask for this sort of job. Most intensivists are not making that much.
You can probably find an EM person who would feel comfortable with this job and even do it for around 300-400k.
I view EM folks as not typically working on the inpatient side of things. I agree that EM folks wouldn't be too risk adverse for the scenarios I mentioned because that is what can come into an ED. However the job mentioned is for a nocturnist, which typically means an IM person. Plus, I doubt an EM doc would want to be a nocturnist; and, they really aren't trained for managing the minutia of an admitted patient.
 
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tantacles

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Its a ****ty job but there are people out there doing these types of jobs - and not for 700k.

It's true. I certainly wouldn't take it, but a friend is doing essentially this job for $285,000/year. Now, granted, she wants to go into critical care, so when she gets to intubate, she gets hugely turned on. But I think the circumstance is very different for her.
 
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rokshana

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Point me in the right direction for this. You guys make it sound like these 500k intensivist jobs are plenty and easy to find.
I would love some help with this.
eh, they are probably not as hard as you think to find...have a friend who is a peds intensivist, and makes ~450K after 4 years of practice...not just hospital shifts of course...has a clinic he started and now medical director...but if peds can make that much, i would imagine adult medicine, which typically pays more, would offer up the same possiblities.
 

chocomorsel

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eh, they are probably not as hard as you think to find...have a friend who is a peds intensivist, and makes ~450K after 4 years of practice...not just hospital shifts of course...has a clinic he started and now medical director...but if peds can make that much, i would imagine adult medicine, which typically pays more, would offer up the same possiblities.
Well, I think it’s more like imagination and not actual reality. My friends and I looked and found that 500K is hard to come by. Now maybe a pulmonologist can easily make that.
Or maybe I am not that lucky. There is a 500k job advertised but it’s out of state. And with Covid, travel is not what it used to be.
 

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500k ICU jobs are out there for sure, my days only job is not too far from that and I’m getting paid a bit above the most recent MGMA mean. I bet nights only is higher. But it won’t be a sleeper job in a chill unit at a 100 bed hospital like the one OP described. Probably gonna be twerking all night long for that 500k.
 
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