What are your thoughts about this Nocturnist offer!

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EASM

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I have been offered a nocturnist job that I would like to explore your thoughts about especially those who worked/are working as a nocturnist. It is a J-1 waiver job. It is also a new program so if I accepted, I will be the first nocturnist working there, currently, the nights are managed by 2 NPs along with a day hospitalist (from home). They have an open ICU with no intensivist at all. ER runs the codes and do procedures. I am expected to cross cover 70-80 patients in addition to admissions, up to 18 admission/night along with one NP. Day hospitalist census is 20 patients. Not every night has 18 admissions but +12 admissions happened at least half of the days. 7 on and 7 off, No paid time off, they offered a little below 300K annually. I am still a resident (IM) and Kind of geographically restricted but I do not have to accept it so feel free to share any concerns or thoughts.

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I have been offered a nocturnist job that I would like to explore your thoughts about especially those who worked/are working as a nocturnist. It is a J-1 waiver job. It is also a new program so if I accepted, I will be the first nocturnist working there, currently, the nights are managed by 2 NPs along with a day hospitalist (from home). They have an open ICU with no intensivist at all. ER runs the codes and do procedures. I am expected to cross cover 70-80 patients in addition to admissions, up to 18 admission/night along with one NP. Day hospitalist census is 20 patients. Not every night has 18 admissions but +12 admissions happened at least half of the days. 7 on and 7 off, No paid time off, they offered a little below 300K annually. I am still a resident (IM) and Kind of geographically restricted but I do not have to accept it so feel free to share any concerns or thoughts.

Just 300k for 18 admissions per night? Absolutely not. 400k is completely appropriate for this kind of job. And 7 on 7 off? That schedule needs a serious revamp with fewer nights. They want you to do more work than the daytime hospitalists in a shift they hate for similar pay. No way.

Does not matter if they have an NP. You’re still responsible for those patients the NP admits and you have to review their documentation.
 
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SDN standard for this job would be around 1.6 MM per year or $550/hr whichever is higher.

Take what you read here regarding the job market with a huge grain of salt but TBH that job sounds bad. Open ICU + a lot of admits makes the job much tougher than a typical night job and the pay is really about average IMO. If pay was closer to mid-3s it would seem appropriate.

Disagree with the above--the NP will help immensely assuming you arent also having to train them. Documentation is a huge part of the job and being able to simply attest and add your own brief blurb while all the bloated billing bull**** is taken care of by someone else (eg ROS, 8 point HPI, 14 point PEx, 4+ problems addressed etc) so you can focus on the real problem in a simple note really cuts time down significantly.
 
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This job sounds miserable. I agree with other posters that this position should be 400k plus. Granted, you did not mention if there was wRVU bonus. No way that I would consider this unless there was paid time off plus wRVU bonus. If base is 300k with a reasonable RVU bonus, you will make good money but will be worked to the bone. Check on specialty support in the hospital as well. Good luck and keep on the job search.
 
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I have been offered a nocturnist job that I would like to explore your thoughts about especially those who worked/are working as a nocturnist. It is a J-1 waiver job. It is also a new program so if I accepted, I will be the first nocturnist working there, currently, the nights are managed by 2 NPs along with a day hospitalist (from home). They have an open ICU with no intensivist at all. ER runs the codes and do procedures. I am expected to cross cover 70-80 patients in addition to admissions, up to 18 admission/night along with one NP. Day hospitalist census is 20 patients. Not every night has 18 admissions but +12 admissions happened at least half of the days. 7 on and 7 off, No paid time off, they offered a little below 300K annually. I am still a resident (IM) and Kind of geographically restricted but I do not have to accept it so feel free to share any concerns or thoughts.
Nope...and nope.
Worked as nocturnist and prefer nights over day ( no discharge summaries!!), but would run away from that!
 
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This job sounds miserable. I agree with other posters that this position should be 400k plus. Granted, you did not mention if there was wRVU bonus. No way that I would consider this unless there was paid time off plus wRVU bonus. If base is 300k with a reasonable RVU bonus, you will make good money but will be worked to the bone. Check on specialty support in the hospital as well. Good luck and keep on the job search.
No RVU, no PTO nor Unpaid Time off, I also forgot to mention that I have to drive one hour back and forth!
 
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Nope...and nope.
Worked as nocturnist and prefer nights over day ( no discharge summaries!!), but would run away from that!
I feel it is not doable but they have been trying to convince that if it is currently done by 2 NP alone it should not be an issue for a nocturnist! I never wanted to be a nocturnist to start with but due to family ties, geographically restricted and started very late to look for waiver job due to the same reason.
 
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It sounded like quite a bit for that pay. Open ICU. Lot of admissions. Having an NP is a double edged sword. Relatively low pay. Nail in the coffin is losing 2 hours just driving.

I have never done hospital medicine, but based on what I have seen here, a nocturnist job that only pays 300K without anything beyond that sounds like something that should be a relatively chill gig.
 
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TBH, not sure how j-1 works. But if you need a sponsorship, you may not have a whole lot of choices. Stick it out for however the requirement is for the green card then a more permanent job.

For comparison, 7 years ago, I worked at a place very similar to what you’re describing as locum. It was 150/hr. Cross-cover 70-100 patients, 12 admissions. With two physicians on, no mid-levels. ICU wasn’t open, but certainly don’t have greatest overnight coverage.

Three years ago, I worked at a more rural area. 160/hr as locum. 1-3 admissions, usually 15 patients in house. Covering psych unit for medical emergencies. Codes, ICU, basically all comers.

When you get your more permanent status, you will have more selections.... without, you get whatever that will help you make your next step.

Summary: beggars can’t be choosers.
 
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I have been offered a nocturnist job that I would like to explore your thoughts about especially those who worked/are working as a nocturnist. It is a J-1 waiver job. It is also a new program so if I accepted, I will be the first nocturnist working there, currently, the nights are managed by 2 NPs along with a day hospitalist (from home). They have an open ICU with no intensivist at all. ER runs the codes and do procedures. I am expected to cross cover 70-80 patients in addition to admissions, up to 18 admission/night along with one NP. Day hospitalist census is 20 patients. Not every night has 18 admissions but +12 admissions happened at least half of the days. 7 on and 7 off, No paid time off, they offered a little below 300K annually. I am still a resident (IM) and Kind of geographically restricted but I do not have to accept it so feel free to share any concerns or thoughts.
I had a similar side gig at a small community hospital a few miles out of town. I only worked there 2-3 nights a month. Just myself and an NP overnight with a closed ICU. 3 medical floors, around 70-80 inpatients. I cross covered the 2 more acute floors and she'd cover the third. I was responsible for all rapids and cross covers on my floors in addition to doing all the triaging, consults, psych evals, and rare OSH transfers. We'd get about 15-20 admits a night, I'd try to do 6-7 a night and give her 5-6, leaving the rest to the day team. I did not evaluate the NPs patients or cosign her note. we briefly discussed the plan when I triaged the pt to her and that was it. It paid $150/hr. Long story short, it was an awfully stressful gig and a sure recipe for burnout. I quit after a year, found another side gig with reasonable conditions and never looked back. 300k for 15 shifts a month works out to 139/hr- objectively that is very low. I do not believe nocturnists should consider anything less than $150/hr, and depending on geography and responsibilities- 175-190/hr is not unreasonable. Especially given an open ICU, all the responsibilities you mentioned, and the 15 shift commitment- this should be a 350-380k gig.

Is the amount of work you're doing worth 500k or more? Definitely, and you will feel it when you wear out a few months out. But no hospital is going to pay you $250+ an hour for doing 2 or 3 people's jobs. They're just going to recognize they need to hire 2 nocturnists when they analyze their turnover rate. You're probably better off looking for another job that won't burn you out and pays appropriately. Trust me they are definitely out there.

How do you find them? First question you need to ask is how long their nocturnists have been on board. That gig I mentioned? The longest serving nocturnist there was 4 months out of residency and the rest were locums. At my full time job- all have been working 5 to as long as 20 years.
 
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Ask for $400K and 2 weeks off per year. They will say yes. Then turn them down. 70+ cross cover patients? ICU? 12+ admits?
No $ worth the grief!
 
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Your post, OP, made me want to vomit. There was nothing good about that job offer. Open ICU with no intensivist? The liability alone is ridiculous. I'd have laughed that offer off.
 
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Thanks guys, you have helped me to realise how awful that offer was.
 
I have been offered a nocturnist job that I would like to explore your thoughts about especially those who worked/are working as a nocturnist. It is a J-1 waiver job. It is also a new program so if I accepted, I will be the first nocturnist working there, currently, the nights are managed by 2 NPs along with a day hospitalist (from home). They have an open ICU with no intensivist at all. ER runs the codes and do procedures. I am expected to cross cover 70-80 patients in addition to admissions, up to 18 admission/night along with one NP. Day hospitalist census is 20 patients. Not every night has 18 admissions but +12 admissions happened at least half of the days. 7 on and 7 off, No paid time off, they offered a little below 300K annually. I am still a resident (IM) and Kind of geographically restricted but I do not have to accept it so feel free to share any concerns or thoughts.
Yikes.
Run away.
 
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