Salary for night intensivist

[cavitarynodule]

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If I want to spend a year or two doing night ICU coverage shifts in a metropolitan area, what kind of general setups have people seen (shifts/month) and expected salary. On a locums basis what is a reasonable per night payment?

 

[jdh71]

Probably week on/week off (with some weeks off for vacation in the year) for ~385,000 +/- 40,000 depending on how desperate they might be for the coverage, how actually busy the ICU is, and what you might personally mean or expect by “metropolitan area”. $180-200/hour.

I think I’d prefer myself a short term employment contract to locums work. But I’ve never actually done locums work - so take that with as much salt as you need - but I prefer not to bounce around much and I suspect you have more negotiating power individually.

I hate working nights. I know my group would LOVE a noctutnist. If you end up like that kind of work and want a steady night work job send me a PM.

 

[Hamhock]

If you end up like that kind of work and want a steady night work job send me a PM.

Yeah, send me a PM too!

HH

 

[CCM-MD]

Depends on the location. Get ~425k for days only where I am. ICU telemedicine night time is paying $250/hr to sit at a computer. I’m sure nights only “boots on the ground” coverage would pay more than telemedicine does.

MGMA median is ~$400k. I wouldn’t accept anything less than that for full time nights even in a major city.

 

[NDcienporciento100]

Depends on the location. Get ~425k for days only where I am. ICU telemedicine night time is paying $250/hr to sit at a computer. I’m sure nights only “boots on the ground” coverage would pay more than telemedicine does.

MGMA median is ~$400k. I wouldn’t accept anything less than that for full time nights even in a major city.

Wait so you take care of the patient without actually being there?

 

[RemyMcswain]

Wait so you take care of the patient without actually being there?

I have done tele ICU work. It is tough. The only way I would consider doing those nights again would be for 300+ and hour.

 

[chocomorsel]

I have done tele ICU work. It is tough. The only way I would consider doing those nights again would be for 300+ and hour.

Please elaborate. What makes it tough? Actually not being there to assess the situation yourself? Too many hospitals and patients? What?

 

[sylvanthus]

As a new grad im doing .5 nights (1 week a month) at 195k. I think its reasonable. I avg a couple admissions per night and cover about 10-12 icu pt as primary. I moonlight in the ED on the side.

 

[POW16]

As a new grad im doing .5 nights (1 week a month) at 195k. I think its reasonable. I avg a couple admissions per night and cover about 10-12 icu pt as primary. I moonlight in the ED on the side.

What part of the country ?

 

[sylvanthus]

What part of the country ?

Washington state

 

[Tipsy McStagger]

As a new grad im doing .5 nights (1 week a month) at 195k. I think its reasonable. I avg a couple admissions per night and cover about 10-12 icu pt as primary. I moonlight in the ED on the side.

Do you mean you work 1 week a month and those are all nights, or you are 1 week on 1 week off per month with half being nights? Because 195k sounds low for a full time intensivist?


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[jdh71]

Do you mean you work 1 week a month and those are all nights, or you are 1 week on 1 week off per month with half being nights? Because 195k sounds low for a full time intensivist?


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he said .5 FTE nights

 

[bigdan]

A good buddy from training is getting $3,000/night for SICU cover.
14h (6p-8a)
16 beds, ave census 8-12
Not a trauma hospital
No code, airway, or RR cover outside of the ICU

 

[jw3600]

As a new grad im doing .5 nights (1 week a month) at 195k. I think its reasonable. I avg a couple admissions per night and cover about 10-12 icu pt as primary. I moonlight in the ED on the side.

As in 7 nights in a row (12-14 hours ish)/ every 4 weeks? For 195k?
Good deal.

 

[sylvanthus]

Aye 12 hour night shift, 7 shifts in a row. One stretch per month.

 

[sylvanthus]

Best plan imo is a combo of a W2 salaried position for the benefits and 401k match and then moonlighting as an independent contractor on the side for the tax perks (20% passthrough and claiming travel books etc as business expenses) and extra solo 401k account.

If you live in a community property state can also form an llc, have your wife, if your married, put in 500 hours a year into the business (scheduling, finances, cleaning home office, whatever) and then can elect to do a qualified joint venture and she can also have a solo 401k.

 

[chocomorsel]

A good buddy from training is getting $3,000/night for SICU cover.
14h (6p-8a)
16 beds, ave census 8-12
Not a trauma hospital
No code, airway, or RR cover outside of the ICU

That’s 215 an hour. So not great...

 

[bigdan]

That’s 215 an hour. So not great...

Meh.

I'd do it. He's not getting killed.

 

[BoolaHI]

My W and D are both intensivists and typically have made between 2300-2500 per night.

If I want to spend a year or two doing night ICU coverage shifts in a metropolitan area, what kind of general setups have people seen (shifts/month) and expected salary. On a locums basis what is a reasonable per night payment?

 

[RemyMcswain]

Please elaborate. What makes it tough? Actually not being there to assess the situation yourself? Too many hospitals and patients? What?

1. Relying on other peoples skill set: You want a patient to get a central line with CVP monitoring and venous blood gas. "Oh, ED doc is busy and NP cant do CVLs. Is there something else you'd like." No, this septic patient with a history of cardiomyopathy needs a central line.

2. You dont know the staff the same way you know staff at your home institution. In this sense, they can be abusive. (Nurse)"Patient needs a fluid bolus." "Um, hi, this is Dr. Remy, why do you think this patient who i know absolutely nothing about needs a 'fluid bolus.'"

3. You are constantly witnessing and party to some less than average care. I have watched many many horrible intubations where my a$$hole was puckered from 1000 miles away. I have come on service to find patients on 10cc/kg TV + no PEEP.

4. In some instances, you do not get sign out. I have been alerted to many cases where there was a plan put in place by the daytime intensivist/hospitalist that, upon reviewing the chart, I did not agree with. Im not a genius nor the worlds smartest doctor. If i missed something, thats cool. But I would atleast like the opportunity to discuss the issue with the daytime provider.

5. Can have a set up where you are putting in trash orders all night. "Doc, can you reorder PO metoprolol, order fell off." I really dont enjoy doing that at 245am. Dont know about you guys

6. I have been put in situations where I have to have a goals of care discussion with patients families, again, from 1000 miles away. That feels icky. I dont like it.

7. This is just an aside, but I have seen a few instances where I camera into the room and the nurses are doing chest compressions. "Hi, this is Dr. Remy, how long have you been doing this, is there a doctor in the room?" "No, patient literally just came up from the ED." How in the F*ck do you send a patient from the ED so unstable that they literally code when they get into the ICU room. Thats unacceptable.

I think the idea of a central doc assisting in care is great. I think it would work for a particular health network where you know the staff. Not a situation where you are seeing patients from random hospitals across the country

OH, did I mention the EMRs. The E M Rs. the Log on passwords, tech support. It was never ending.

Very tough gig

 

[chocomorsel]

Thank you so much @RemyMcswain for that detailed explanation. This was something I was possibly considering doing the future but now probably won’t.

 

[jw3600]

1. Relying on other peoples skill set: You want a patient to get a central line with CVP monitoring and venous blood gas. "Oh, ED doc is busy and NP cant do CVLs. Is there something else you'd like." No, this septic patient with a history of cardiomyopathy needs a central line.

2. You dont know the staff the same way you know staff at your home institution. In this sense, they can be abusive. (Nurse)"Patient needs a fluid bolus." "Um, hi, this is Dr. Remy, why do you think this patient who i know absolutely nothing about needs a 'fluid bolus.'"

3. You are constantly witnessing and party to some less than average care. I have watched many many horrible intubations where my a$$hole was puckered from 1000 miles away. I have come on service to find patients on 10cc/kg TV + no PEEP.

4. In some instances, you do not get sign out. I have been alerted to many cases where there was a plan put in place by the daytime intensivist/hospitalist that, upon reviewing the chart, I did not agree with. Im not a genius nor the worlds smartest doctor. If i missed something, thats cool. But I would atleast like the opportunity to discuss the issue with the daytime provider.

5. Can have a set up where you are putting in trash orders all night. "Doc, can you reorder PO metoprolol, order fell off." I really dont enjoy doing that at 245am. Dont know about you guys

6. I have been put in situations where I have to have a goals of care discussion with patients families, again, from 1000 miles away. That feels icky. I dont like it.

7. This is just an aside, but I have seen a few instances where I camera into the room and the nurses are doing chest compressions. "Hi, this is Dr. Remy, how long have you been doing this, is there a doctor in the room?" "No, patient literally just came up from the ED." How in the F*ck do you send a patient from the ED so unstable that they literally code when they get into the ICU room. Thats unacceptable.

I think the idea of a central doc assisting in care is great. I think it would work for a particular health network where you know the staff. Not a situation where you are seeing patients from random hospitals across the country

OH, did I mention the EMRs. The E M Rs. the Log on passwords, tech support. It was never ending.

Very tough gig

I would not want a friend or family member to be anywhere near this hospital.

 

[YCAGA]

1. Relying on other peoples skill set: You want a patient to get a central line with CVP monitoring and venous blood gas. "Oh, ED doc is busy and NP cant do CVLs. Is there something else you'd like." No, this septic patient with a history of cardiomyopathy needs a central line.

2. You dont know the staff the same way you know staff at your home institution. In this sense, they can be abusive. (Nurse)"Patient needs a fluid bolus." "Um, hi, this is Dr. Remy, why do you think this patient who i know absolutely nothing about needs a 'fluid bolus.'"

3. You are constantly witnessing and party to some less than average care. I have watched many many horrible intubations where my a$$hole was puckered from 1000 miles away. I have come on service to find patients on 10cc/kg TV + no PEEP.

4. In some instances, you do not get sign out. I have been alerted to many cases where there was a plan put in place by the daytime intensivist/hospitalist that, upon reviewing the chart, I did not agree with. Im not a genius nor the worlds smartest doctor. If i missed something, thats cool. But I would atleast like the opportunity to discuss the issue with the daytime provider.

5. Can have a set up where you are putting in trash orders all night. "Doc, can you reorder PO metoprolol, order fell off." I really dont enjoy doing that at 245am. Dont know about you guys

6. I have been put in situations where I have to have a goals of care discussion with patients families, again, from 1000 miles away. That feels icky. I dont like it.

7. This is just an aside, but I have seen a few instances where I camera into the room and the nurses are doing chest compressions. "Hi, this is Dr. Remy, how long have you been doing this, is there a doctor in the room?" "No, patient literally just came up from the ED." How in the F*ck do you send a patient from the ED so unstable that they literally code when they get into the ICU room. Thats unacceptable.

I think the idea of a central doc assisting in care is great. I think it would work for a particular health network where you know the staff. Not a situation where you are seeing patients from random hospitals across the country

OH, did I mention the EMRs. The E M Rs. the Log on passwords, tech support. It was never ending.

Very tough gig

Well that is terrifying. Who intubates/is at bedside in these hospitals?


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[RemyMcswain]

Well that is terrifying. Who intubates/is at bedside in these hospitals?


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Hospitalist, ED, NP/PA, Respiratory. I would see all sorts of stuff. A lot of hospitals the surgeon on call would come in from home to place a central line.

 

[deleted547339]

As in 7 nights in a row (12-14 hours ish)/ every 4 weeks? For 195k?
Good deal.

Have you done 7 12 hour night shifts in a row? It’s a fair deal, but I wouldn’t get excited about it.

 

[ShockIndex]

Well that is terrifying. Who intubates/is at bedside in these hospitals?


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I was an ED attending at an academic institution that had a small, community affiliate hospital with roughly 60 beds and a 10 bed “ICU.” The hospitalist group handled all admissions and relied heavily on a tele-ICU. The more complex cases were transferred up to the academic mothership. We had to pull a couple of shifts a month there and part of our responsibility was responding to floor codes to assist the hospitalist with intubation. Anesthesia was also available for non-crash airways, central lines, etc. if they were not in a case or tied up in OB.

 

[gulmohr]

Well that is terrifying. Who intubates/is at bedside in these hospitals?


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https://www.washingtonpost.com/nati...story.html#click=[URL]https://t.co/nGDjg62aX9

[/URL]

A passage from this article:

He watched on the monitor as a few more nurses and a physician assistant came into the hospital room to prepare for an emergency intubation. They needed to insert a tube down the patient’s throat to put her on a ventilator, but first that would require sedating and temporarily paralyzing her with medication, which meant she would no longer be capable of breathing on her own.

“Let’s get her down nice and hard,” Skow said, instructing the nurse to give the sedative first and then the paralytic. He zoomed in to check a bedside monitor that showed the patient’s oxygen level at 100 percent and then switched over to another camera adjacent to the breathing tube that allowed him to see down the inside of the patient’s throat.

“So there’s the epiglottis,” he said, directing the nurse as she tried to navigate the breathing tube past the tongue and into the windpipe. “There are your vocal cords. You’ve got a nice view right there. Do you see it?”

“There’s a lot of blood in the airway,” the nurse said.

 

[jw3600]

Have you done 7 12 hour night shifts in a row? It’s a fair deal, but I wouldn’t get excited about it.

I have. 7 ED 12s in a row. It’s not easy you’re totally right.
But if you can handle it 3 weeks a month off for 200k seems like a reasonable life.
Since he’s also EM. He can pick up 2-4 shifts per month as needed. And if his wife works at all that’s definitely a nice life.

 

[deleted547339]

I have. 7 ED 12s in a row. It’s not easy you’re totally right.
But if you can handle it 3 weeks a month off for 200k seems like a reasonable life.
Since he’s also EM. He can pick up 2-4 shifts per month as needed. And if his wife works at all that’s definitely a nice life.

Yea. I do mostly 8s, but will do a week of 12h night shifts 3-5 times a year. Brutal.

 

[sylvanthus]

Its not too bad. Fairly often ill have a few hours to sleep. Definitely easier than a 12 hr ED shift. Granted there are bad nights, but on average im not running my ass off as much as I do in the ED.

 

[chocomorsel]

Well that is terrifying. Who intubates/is at bedside in these hospitals?


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The ED doc or the Anesthesiologist coming in from home if the ED doc is unavailable. In my old hospital.
Been there done that. I remember saying, “it will take me 5-7 minutes to get there.” And they said that’s fine. Cuz the patient was already dead anyway.
Honestly, Intensivists are hard to come by. Intenisvists who intubate, even rarer. That ICU had pulmonary running it but didn’t incubate.
Oh well... what can you do.