The Nocturnist Guide You Never Wanted But Are Getting Anyway. Also, like, AMA? I guess? If you really feel like it? Compliment compliment question?

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Splenda88 said:
Agree that you can save that much in 2 yrs unless you are a neuro/spine surgeon.

One can definitely live on 1M with a paid off home

You put half of it in AT&T stock... You will make 40k/yr in dividend. The other half in an S&P500 index and pull out 4%(20k)/yr. That is a total of ~60k/yr.

Buy health insurance in the insurance exchange website for $200-300/month
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New to the stock market eh? ATT too big to fail right? Going to keep paying a 8% dividend for the rest of your life guaranteed? Why not just put the whole thing in ATT then and get 80k guaranteed?

Hardcore FIRE people who live on a razor thin margin with no expenses can make **** like that work because they are willing to literally eat garbage and live on the streets to save money--you willing to do that too?. The 4% rule only works when you dont have your entire life ahead of you. In late 20s expecting to live off 4% a year until death is beyond unrealistic and downright absurd.
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chessknt said:
New to the stock market eh? ATT too big to fail right? Going to keep paying a 8% dividend for the rest of your life guaranteed? Why not just put the whole thing in ATT then and get 80k guaranteed?

Hardcore FIRE people who live on a razor thin margin with no expenses can make **** like that work because they are willing to literally eat garbage and live on the streets to save money--you willing to do that too?. The 4% rule only works when you dont have your entire life ahead of you. In late 20s expecting to live off 4% a year until death is beyond unrealistic and downright absurd.
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That's why I said half of it in an S&P500. I would not risk it all. At least that's what I would do.

You think living on 5k/month when you don't even have to pay for rent is hard! Our family of 4 is living on 5.5k/month (rent of $1600 included) and we are doing ok.

It is not surprising that the average American are saying most rich people are out of touch.

Do you understand the median household income in the US is ~69k?

By the way, my cousin with his son have been doing that for ~14 yrs now. He got up whenever he wants. Go to the gym daily. And even travel a 1-2 times a year. House paid off and live on ~3.3k/month from his other 2 paid off homes. The guy retired in his early 40s, and his net worth has more than doubled due to the explosion in home price in south FL. I am pretty sure that people told him that he could not retire with a 400k net worth in 2008-2009.
 
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Splenda88 said:
That's why I said half of it in an S&P500. I would not risk it all. At least that's what I would do.

You think living on 5k/month when you don't even have to pay for rent is hard! Our family of 4 is living on 5.5k/month (rent of $1600 included) and we are doing ok.

It is not surprising that the average American are saying most rich people are out of touch.

Do you understand the median household income in the US is ~69k?

By the way, my cousin with his son have been doing that for ~14 yrs now. He got up whenever he wants. Go to the gym daily. And even travel a 1-2 times a year. House paid off and live on ~3.3k/month from his other 2 paid off homes. The guy retired in his early 40s, and his net worth has more than doubled due to the explosion in home price in south FL. I am pretty sure that people told him that he could not retire with a 400k net worth in 2008-2009.
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This is detailing the thread so I’ll just end with I am not rich or out of touch. Everyone has their own financial risk tolerance but retiring in your 20s or 30s takes either very high capital or very high risk tolerance. And don’t conflate being a landlord with being retired.
 
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chessknt said:
This is detailing the thread so I’ll just end with I am not rich or out of touch. Everyone has their own financial risk tolerance but retiring in your 20s or 30s takes either very high capital or very high risk tolerance. And don’t conflate being a landlord with being retired.
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If you are a physician, you are RICH.
 
rokshana said:
Then do something non clinical or another aspect on medicine… you can teach, go into informatics, research, etc and frankly resident life and attending life are different…you can have a lot more autonomy once you are out in The real world.

I work locums, choose to work 2 weeks a month and make more than enough to meet my financial needs and get plenty of free time to do what I want.
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Honestly . . . I'm hoping my youtube channel picks up and I can just do that. It'll satisfy my medical itch.
 
Splenda88 said:
Agree that you can save that much in 2 yrs unless you are a neuro/spine surgeon.

One can definitely live on 1M with a paid off home

You put half of it in AT&T stock... You will make 40k/yr in dividend. The other half in an S&P500 index and pull out 4%(20k)/yr. That is a total of ~60k/yr.

Buy health insurance in the insurance exchange website for $200-300/month
Click to expand...
Except ATT is cutting their dividend in half.
 
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Planes2Doc said:
Sooooo... Technically it is 10 hour shifts. 9 to 7. I come in earlier though since I'm commuting for work and we get RVUs. I have nothing better to do with my time since I only have one friend that lives there.
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Being a hospitalist/nocturnist is arguably one of the most flexible jobs in medicine...

I am new to this, but I dont know how many jobs in medicine you can work 8 days/month, make ~200k, have all the benefits and kind of dictate your schedule. These "part timers" at my shop twist and turn their schedule and availability however they want and the PD finds a way to work with them.
 
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Planes2Doc said:
Yeah I definitely hit the jackpot! It's in a large midwestern city. I don't actually live there. I commute from around 5 hours away and stay in a cheap apartment about 5 minutes away.
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i know someone who does this and i thought it was literally one of the smartest things id ever heard. seems like it can open up a ton of employment opportunities. plus you can REALLY leave work at work if you're literally *a flight* away from your shop, when you're off.
 
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How is this nocturnist offer I got?
Top 5 US metro area, 1000 bed hospital/Level 1 center
Full time employee with benefits
7on/7off schedule, 182 shifts/year 11pm-8am
2 Docs per night
8-9 admits per night per doc (expected to to 1 H&P/hr), no trauma or OBGYN admits.
closed ICU, ICU doc does ICU admits
No procedures, No codes
Cross-cover done by 2 APRNs
some nights there will be a 3rd APRN to help with admits that you will co-sign and those count towards your 8-9/night.
Comp: 315K flat. No RVU or other bonus. Can pick up extra night shifts or swing shifts for $1500/shift. Can come early to shift and do extra admits for 150/admit before your shift starts.
20K sign bonus
 
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drumass said:
How is this nocturnist offer I got?
Top 5 US metro area, 1000 bed hospital/Level 1 center
7on/7off schedule, 182 shifts/year 11pm-8am
2 Docs per night
8-9 admits per night per doc (expected to to 1 H&P/hr), no trauma or OBGYN admits.
closed ICU, ICU doc does ICU admits
No procedures, No codes
Cross-cover done by 2 APRNs
some nights there will be a 3rd APRN to help with admits that you will co-sign and those count towards your 8-9/night.
Comp: 315K flat. No RVU or other bonus. Can pick up extra night shifts or swing shifts for $1500/shift. Can come early to shift and do extra admits for 150/admit before your shift starts.
20K sign bonus
Click to expand...
Is this 1099? Any other benefits? Who is responsible for RRTs? Is that a hard cap at 9 admits (e.g., . if you get 9 admits by 3 am you are done)? Why are extra shifts paid less than regular shifts?
 
ReviewOfSystems said:
Is this 1099? Any other benefits? Who is responsible for RRTs? Is that a hard cap at 9 admits (e.g., . if you get 9 admits by 3 am you are done)? Why are extra shifts paid less than regular shifts?
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employed, including full benefits. ICU runs RRTs. And I think that the rate for swing shift is. 4 pm -12. The docs I talked to said that when they hit 9 they stop seeing patients and work on their notes but I don't think that is official in the contract
 
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drumass said:
How is this nocturnist offer I got?
Top 5 US metro area, 1000 bed hospital/Level 1 center
7on/7off schedule, 182 shifts/year 11pm-8am
2 Docs per night
8-9 admits per night per doc (expected to to 1 H&P/hr), no trauma or OBGYN admits.
closed ICU, ICU doc does ICU admits
No procedures, No codes
Cross-cover done by 2 APRNs
some nights there will be a 3rd APRN to help with admits that you will co-sign and those count towards your 8-9/night.
Comp: 315K flat. No RVU or other bonus. Can pick up extra night shifts or swing shifts for $1500/shift. Can come early to shift and do extra admits for 150/admit before your shift starts.
20K sign bonus
Click to expand...
$192/hr without cross coverage or icu/procedures is seemingly a great base until you realize they're cramming 12-14 hours worth of work into 9 hours.

1 admit per hour is objectively ALOT- The gold standard is 90 minutes per admission. And that's without having other responsibilities.
Who is handling rapid responses? If those don't count towards your cap or productivity, you could have some very difficult nights.

9 chest pain rule outs, kindey stones, or diverticulitis? All day every day. But it doesn't take more than a couple super sick chronically ill train recs with impossible med recs or family situations to suck your soul and time. I do 6-8 admits per 12 hour shift and I find that's the real sweet spot to avoid burnout. Every night I do 9-10 I really feel exhausted the next couple days.
I'm honestly not sure I could do have been a nocturnist this long if I had to be doing 9 admits each and every night for 7 on/7 off.
Big question to ask here, are there med rec techs at night? Give me perfectly reconciled med recs and I can bang out admits in 30-45 minutes easy. If I'm having to call facilities or pharmacies, forget about it.
Also ask other docs, are they actually going home on time at 8am or they staying up to finish their notes? A 10 hour night drops your rate to $173, a 12 hour night takes it down to $144...which without a bonus, are really no longer attractive rates.

Other issue is the no productivity bonus. If you're billing 3.5 wRVUs for 9 admissions over 182 shifts it's 5700 rvus a year. That's 90th+ percentile for a hospitalist's productivity.
My productivity bonus structure would pay me around 100k a year bonus for that kind of productivity.

Overall, could be a good gig for someone young and efficient, or could be a real wolf in sheep's clothing.
 
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Nocturnist said:
$192/hr without cross coverage or icu/procedures is seemingly a great base until you realize they're cramming 12-14 hours worth of work into 9 hours.

1 admit per hour is objectively ALOT- The gold standard is 90 minutes per admission. And that's without having other responsibilities.
Who is handling rapid responses? If those don't count towards your cap or productivity, you could have some very difficult nights.

9 chest pain rule outs, kindey stones, or diverticulitis? All day every day. But it doesn't take more than a couple super sick chronically ill train recs with impossible med recs or family situations to suck your soul and time. I do 6-8 admits per 12 hour shift and I find that's the real sweet spot to avoid burnout. Every night I do 9-10 I really feel exhausted the next couple days.
I'm honestly not sure I could do have been a nocturnist this long if I had to be doing 9 admits each and every night for 7 on/7 off.
Big question to ask here, are there med rec techs at night? Give me perfectly reconciled med recs and I can bang out admits in 30-45 minutes easy. If I'm having to call facilities or pharmacies, forget about it.
Also ask other docs, are they actually going home on time at 8am or they staying up to finish their notes? A 10 hour night drops your rate to $173, a 12 hour night takes it down to $144...which without a bonus, are really no longer attractive rates.

Other issue is the no productivity bonus. If you're billing 3.5 wRVUs for 9 admissions over 182 shifts it's 5700 rvus a year. That's 90th+ percentile for a hospitalist's productivity.
My productivity bonus structure would pay me around 100k a year bonus for that kind of productivity.

Overall, could be a good gig for someone young and efficient, or could be a real wolf in sheep's clothing.
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I do not think there are med rec techs, did not even know that existed. how common is this? In my residency, we do our own med recs. The nocturnist doesn't have to deal with rapids, procedures, cross cover, or ICU patients. I am considering it cause its down the street from my apartment and would not have to move but the lack of productivity bonus and 7/7 are the to major factors i'm considering.
 
drumass said:
I do not think there are med rec techs, did not even know that existed. how common is this? In my residency, we do our own med recs. The nocturnist doesn't have to deal with rapids, procedures, cross cover, or ICU patients. I am considering it cause its down the street from my apartment and would not have to move but the lack of productivity bonus and 7/7 are the to major factors i'm considering.
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Yup, there are med rec techs and I'm blown away that not every hospital uses them 24/7. It only requires 3-4 months training and pays $20-30/hr. Why use the most skilled/highest paid personnel to waste time doing something you wouldn't even need a college degree for? While I do pick up a couple mistakes from them here and there, they generally do a phenomenal job; and imagine how smoothly any admission would be if you walked into it with a perfectly reconciled med rec?

Look any way you slice it it's not a bad gig. If you're truly able to sustain that pace and get out in 9 hours, its a great gig even without productivity. but if you're staying 2-3 hours past each shift to finish notes, that turns it into a very average gig. Try to tease that issue out from current nocturnists and also try to get a sense of the seniority there. If no one's last more than 5 years at this job, you're not going to either. We have nocturnists at my shop who have been there for 15-20+ years.
 
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drumass said:
How is this nocturnist offer I got?
Top 5 US metro area, 1000 bed hospital/Level 1 center
Full time employee with benefits
7on/7off schedule, 182 shifts/year 11pm-8am
2 Docs per night
8-9 admits per night per doc (expected to to 1 H&P/hr), no trauma or OBGYN admits.
closed ICU, ICU doc does ICU admits
No procedures, No codes
Cross-cover done by 2 APRNs
some nights there will be a 3rd APRN to help with admits that you will co-sign and those count towards your 8-9/night.
Comp: 315K flat. No RVU or other bonus. Can pick up extra night shifts or swing shifts for $1500/shift. Can come early to shift and do extra admits for 150/admit before your shift starts.
20K sign bonus
Click to expand...
Your $1500 rate for extra shift is less than your regular pay. You are getting paid ~$1730/night. The rate for extra shifts makes no sense. For instance, I got ~25% extra pay for extra shift as a hospitalist.

6-7 admits is doable; 9 is pushing it IMO.
 
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drumass said:
I do not think there are med rec techs, did not even know that existed. how common is this? In my residency, we do our own med recs. The nocturnist doesn't have to deal with rapids, procedures, cross cover, or ICU patients. I am considering it cause its down the street from my apartment and would not have to move but the lack of productivity bonus and 7/7 are the to major factors i'm considering.
Click to expand...
Don't assume you won't have any cross cover responsibilities just because there are NPs/PAs there. They may get the pages first but you'll likely have to sign off their work (Eg orders or event notes they right), and depending on how good they are they may frequently ask for your help.

Having staffing to do med recs is very helpful and it's not uncommon, though may be less common at night. If there's no pharmacy tech available at night, at some hospitals an ED pharmacist can help out with some of time, or nursing is expected to do them (though the ones done by ED or floor nurses aren't always the most accurate..). If there's no one at night to do it, probably not the deal breaker if they allow you pass some of the med recs on to the day team to do.

9 admission per night would be reasonable for a 12-hour shift and if there's a NP/PA to help with some of them (and you just supervise and sign their notes) though cramming 9 admits into 9 hrs is pushing it (1 admission per hour is reasonable but it leaves no time to catch any breaks in between), especially if the NP/PA won't help on any. What happens if it gets busier and the ED admits a lot and you get more than 9 on some nights? At most places there's not much back-up support at night, so hard to imagine that 9 admits would be a hard cap. One possibility if your group allows is passing the later admissions to the next day team. Is there a cutoff time where you can stop taking admits and pass them to the day team? If so that would make it a bit more doable on the busier nights.

9 hr shifts is a plus for night shifts instead of the standard 12. While $192/hr seems solid for night shifts, it seems like this job is trying to squeeze a lot into 9 hrs and paying for just 9 hrs. And I strongly advise taking a job without an RVU portion to your pay, as you will have no incentive to do any extra work while your employer will have a lot of incentive to push extra work on you. Your nights could end up getting busier down the line (eg if the hospital is full during the winter, or if an NP/PA calls out sick and there's no back-up) but without any extra pay.
 
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How much room for negotiation do you get when bargaining with staffing agencies? If a nocturnist job advertises 7 - 7, can this be adjusted to 5 on 10 off. Can IM only positions accommodate FM? Does it need to be written into the contract
 
This is from the HM page in FB. This shows how good the market has become.


Full time Nocturnist opening
7/on 7 off 7pm-7a
12 hour shifts, 185/hour in
Los Angeles, California
Average 3-10 admissions/night, cross cover and rapid responses. Closed icu and icu runs codes.
Starts from May 21, 2023.




That is a 400k/yr job in LA
 
Splenda88 said:
This is from the HM page in FB. This shows how good the market has become.


Full time Nocturnist opening
7/on 7 off 7pm-7a
12 hour shifts, 185/hour in
Los Angeles, California
Average 3-10 admissions/night, cross cover and rapid responses. Closed icu and icu runs codes.
Starts from May 21, 2023.




That is a 400k/yr job in LA
Click to expand...
Ummm…how is this good?
 
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rokshana said:
Ummm…how is this good?
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One cardiologist from southern cal that does locum at place told me that is the median salary for general card in LA. Maybe some from LA can chime in.

Nocturnist at my place (small city of 60k in the southeast) make 385k/yr. I tend to believe 400k in a desirable city like LA is good
 
Splenda88 said:
One cardiologist from southern cal that does locum at place told me that is the median salary for general card in LA. Maybe some from LA can chime in.

Nocturnist at my place (small city of 60k in the southeast) make 385k/yr. I tend to believe 400k in a desirable city like LA is good
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400k in LA is pretty good, but this is a nocturnist gig :(
 
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sloh said:
400k in LA is pretty good, but this is a nocturnist gig :(
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Salary difference of hospitalist vs. nocturnist in most places is 30-40k/yr. Therefore, hospitalist at that same place might be making ~360k/yr, which is good IMO.
 
Splenda88 said:
Salary difference of hospitalist vs. nocturnist in most places is 30-40k/yr. Therefore, hospitalist at that same place might be making ~360k/yr, which is good IMO.
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Might be the general rule but wouldn't assume it's case without actually knowing. Some places who are desperate for a nocturnist might even pay a higher differential if they have no problem getting dayshift. Otherwise, the dayshift would have to rotate on nights.

Also 400k per year is pretty good even for 182 nocturnist shifts, but is there a NP/PA to help with cross coverage and admissions or does 1 person have to doing all by themselves? If it's the latter that's not sustainable for very long.
 
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Wow. This thread really stayed alive.

So fun times. I quit both of my nocturnist gigs because I got tired of living in Northern California, was working too much, and had made enough to feel secure enough.

I took another non-clinical remote position for about 6 months.

And now, my partner and I live on the east coast, and I started doing locum tenens work. Max 5-7 shifts per month. Seriously . . . won't do any more than that because life is better when I don't. But still nocturnist. Nights are definitely better than days. Admins suck.
 
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tantacles said:
And now, my partner and I live on the east coast, and I started doing locum tenens work. Max 5-7 shifts per month. Seriously . . . won't do any more than that because life is better when I don't. But still nocturnist. Nights are definitely better than days. Admins suck.
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Sorry to revive this thread, but I am considering doing this same thing in the future. What's the salary like for doing only seven shifts per month, if you don't mind me asking? Also, do you have to do locums, or can you get a permanent nocturnist job at one hospital even if you're only doing seven shifts per month?
 
We all should working toward financial independence. We will be the first one on the chopping block when healthcare expenditure cross the 20% GDP. Everyone hates us.
 
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Splenda88 said:
We all should working toward financial independence. We will be the first one on the chopping block when healthcare expenditure cross the 20% GDP. Everyone hates us.
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Honestly primary care has it worse. More annoying patients and less pay.
 
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Osteoth said:
Honestly primary care has it worse. More annoying patients and less pay.
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Owning your patients can be a double edged sword. I am content seeing my 15-18 patients daily in the hospital.
 
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tantacles said:
Wow. This thread really stayed alive.

So fun times. I quit both of my nocturnist gigs because I got tired of living in Northern California, was working too much, and had made enough to feel secure enough.

I took another non-clinical remote position for about 6 months.

And now, my partner and I live on the east coast, and I started doing locum tenens work. Max 5-7 shifts per month. Seriously . . . won't do any more than that because life is better when I don't. But still nocturnist. Nights are definitely better than days. Admins suck.
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I reached this conclusion after 3 years of doing days.

Nights and max 10 shifts a month.

Enjoy life while young and strong.
 
Konigstiger said:
Sorry to revive this thread, but I am considering doing this same thing in the future. What's the salary like for doing only seven shifts per month, if you don't mind me asking? Also, do you have to do locums, or can you get a permanent nocturnist job at one hospital even if you're only doing seven shifts per month?
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He is doing locums. Pay is about 200-220 per hr., so for a 12 hr. shift. approx. 2600. Companies usually pay for lodging and travel. It will be hard to find a permanent job for 7 shift a month unless the hospital is desperate.
 
SOLID_SnAkE said:
He is doing locums. Pay is about 200-220 per hr., so for a 12 hr. shift. approx. 2600. Companies usually pay for lodging and travel. It will be hard to find a permanent job for 7 shift a month unless the hospital is desperate.
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There are 3 hospitalist where I work that are doing 7 days on and 21 days off. I don't know if it's extremely difficult to find.
 
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Splenda88 said:
There are 3 hospitalist where I work that are doing 7 days on and 21 days off. I don't know if it's extremely difficult to find.
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hmm. I might be wrong then. I have never come across such a job. a few years ago I was looking for such a position in the Midwest region but I couldn't find one.
 
BicepsTriceps said:
You can always ask any job to do 0.8 or 0.5 FTE. Worst they'll say is no then it's their loss.
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I tried that. At 0.5 they take away the benefits. no retirement plan, no health insurance. Its better to work 1099 but its difficult to find steady shifts, constantly need to find new work and I have developed a strong dislike for hotels.
 
SOLID_SnAkE said:
I tried that. At 0.5 they take away the benefits. no retirement plan, no health insurance. Its better to work 1099 but its difficult to find steady shifts, constantly need to find new work and I have developed a strong dislike for hotels.
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At 0.8 FTE you keep all benefits.

If 1.0 FTE is 160 shifts then 0.8 is 128 shifts which is almost one week on two weeks off + one week squeezed somewhere during the year.

If it's 182 shifts then 0.8 is ~ 144 shifts ~ 12 shifts a month which is reasonable work load.
 
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