What do I need to become a nocturnist/hospitalist?

[JustPass]

Hello all
I plan on becoming a nocturnist after IM residency and I was wondering what I need to do now to be a good candidate.
I don't have much to show for on my CV/resume at this point as a PGY-2 and I don't particularly want to research or whatever else those who are wanting to go into fellowship are doing. Hopefully I can get a few case report in and stuff but my CV is pretty much blank at this point. I'm not looking to work at some top notch program either. Some suburban hospital will be fine.

Any insight will be appreciated.

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[bobow98]

1) Graduate from residency with competent medical knowledge and triage skills.
2) Be able to stay awake overnight and fall asleep during the day, consistently.
3) ?
4) Profit

 

[Sr_Miguelon]

Your username answers your question

 

[thumbz]

Steps to becoming a nocturnist:

1) Finish at least 1 year of residency
2) Have a pulse
3) Be willing to work nights
4) Get board certified/be board eligible
5a) If (4) is achieved, work/live anywhere
5b) If (4) not achieved, work in any town with a hospital and <1,000,000 population

 

[rokshana]

Steps to becoming a nocturnist:

1) Finish at least 1 year of residency
2) Have a pulse
3) Be willing to work nights
4) Get board certified/be board eligible
5a) If (4) is achieved, work/live anywhere
5b) If (4) not achieved, work in any town with a hospital and <1,000,000 population

uh, you can't be 4 if all you have done is 1

and while its not difficult to become a nocturnist/hosptialist, i seriously doubt there are a lot of places that will hire someone with only an intern year as a hospitalist...that is piss poor advice.

 

[thumbz]

uh, you can't be 4 if all you have done is 1

and while its not difficult to become a nocturnist/hosptialist, i seriously doubt there are a lot of places that will hire someone with only an intern year as a hospitalist...that is piss poor advice.

 

[Gastrapathy]

Good life and disability insurance

 

[rokshana]

View attachment 324003

if you have to explain it...it was a fail.

 

[tantacles]

if you have to explain it...it was a fail.

Agree. It was not sarcasm. Just dumb advice .

 

[blue.jay]

Hello all
I plan on becoming a nocturnist after IM residency and I was wondering what I need to do now to be a good candidate.
I don't have much to show for on my CV/resume at this point as a PGY-2 and I don't particularly want to research or whatever else those who are wanting to go into fellowship are doing. Hopefully I can get a few case report in and stuff but my CV is pretty much blank at this point. I'm not looking to work at some top notch program either. Some suburban hospital will be fine.

Any insight will be appreciated.

Just completing your residency and getting your medical license is a good enough requirement. Career Nocturnists are a rare breed. Most ppl who start night job soon realize it is not sustainable for a healthy living. I am willing to take a pay cut to give away my nights or find a job which is pure days. For this reason it is hard to find Nocturnists unless they are incentivized with less hours or higher pay or both.

The large academic health system I work for is planning to replace us with midlevels for the night role, because they think midlevels can put in admit ordersets and get the patient tucked in for the night and let the day team can take over the rest. If these hospitals think midlevels are good enough I would say even asking us for ABIM boards is bull****.

 

[JustPass]

Thanks for the replies.
But it can't be that easy can it?

 

[gutonc]

Thanks for the replies.
But it can't be that easy can it?

Why not? Most people don't want to work all nights. Many are willing to take a bit of a pay cut to pay someone else a little more to do all the nights.

It really is that easy in many situations.

I mean, don't be a sociopathic a****le either, but that should go without saying (although it actually needs to be said more often than I'd like).

 

[blue.jay]

Thanks for the replies.
But it can't be that easy can it?

Probably not that easy if it is a good employer with reasonable work load and shifts who wants to keep their nocturnist happy.

There are so many jobs with very high turnover that the admissions and cross cover gets overwhelming. If something goes wrong you are the one who gets sued and hence people leave such bad jobs. Much more easier to get very bad nocturnist jobs where the work you like a pig and pay pennies. You are probably naive right now, when you know your worth you probably won't consider offers from bad places.

When I signed my gig 50/50 hybrid which is 1 week days and 5-6 nights a month, I thought it was cool to work only 13 days a month. Now I realize why ED docs are so burnt out.

Working nights is not physiological and affects your health. Within 6 months of starting my hospitalists job I started getting GERD, sleep disturbance, weight gain and hopelessness. Heck I was much more happier and healthier during residency days. I used to workout and play sports almost daily in residency. Though I've so many days off, I am just fatigued with bone/muscle pain most of the time. If I get another chance I would never work nights and never more than 12 hr shift.

 

[end stage fibro]

the nocturnist triad:
general misanthropy
masochist tendencies
resolute constitution (not cus the emergencies, but the endless number of pages you’ll get)

you think it’s called the graveyard shift because it’s good for you? see blue jays eloquent post above

rebuttals:
i like that i focus on medicine only,
no social issues. ❌ hint: bs admissions are more BSy at night

better money/fewer shifts ✅sure, but how sustainable is this? i do admit i have worked with some nocturnists that do a consistently good job and have for years

if you can put your nose to the grindstone for a few years can be worth it for sure

 

[collegestud2013]

Hello all
I plan on becoming a nocturnist after IM residency and I was wondering what I need to do now to be a good candidate.
I don't have much to show for on my CV/resume at this point as a PGY-2 and I don't particularly want to research or whatever else those who are wanting to go into fellowship are doing. Hopefully I can get a few case report in and stuff but my CV is pretty much blank at this point. I'm not looking to work at some top notch program either. Some suburban hospital will be fine.

Any insight will be appreciated.

Make sure wherever you work isn't severely understaffed at night. It's not uncommon to find positions where one nocturnist is doing 10+ admissions in 12-hour shift and cross-covering 100+ patients at night.

Outside of teaching programs (where residents/fellows are essentially free labor), non-teaching services will often staff the night shift especially thinly to save money since cross-coverage work does not generate any RVUs (since one specialty can only bill once per patient per calendar date so nocturnists do not typically write progress notes or discharge summaries and hence their RVUs mostly come from new admissions and new consults).

Some places might staff a PA/NP to help with the cross coverage and admissions which make things more manageable, but keep in mind they're doing more as a necessary expense to run the hospital and reduce the nocturnist turnover rate (which probably has higher turnover rates rather than doing so since it will directly bring more revenue and midlevels typically cost 1/3 to 1/2 of an attending salary per hour.

The pay differential for nocturnist is higher not because they usually generally more RVUs, but because most places expect the RVUs generated by the day hospitalists to partially subsidize the work of the nocturnist.

Personally I would expect a shift differential of at least 30% per hour for nocturnist but this the national average is closer to 15%.

 

[tantacles]

Make sure wherever you work isn't severely understaffed at night. It's not uncommon to find positions where one nocturnist is doing 10+ admissions in 12-hour shift and cross-covering 100+ patients at night.

Outside of teaching programs (where residents/fellows are essentially free labor), non-teaching services will often staff the night shift especially thinly to save money since cross-coverage work does not generate any RVUs (since one specialty can only bill once per patient per calendar date so nocturnists do not typically write progress notes or discharge summaries and hence their RVUs mostly come from new admissions and new consults).

Some places might staff a PA/NP to help with the cross coverage and admissions which make things more manageable, but keep in mind they're doing more as a necessary expense to run the hospital and reduce the nocturnist turnover rate (which probably has higher turnover rates rather than doing so since it will directly bring more revenue and midlevels typically cost 1/3 to 1/2 of an attending salary per hour.

The pay differential for nocturnist is higher not because they usually generally more RVUs, but because most places expect the RVUs generated by the day hospitalists to partially subsidize the work of the nocturnist.

Personally I would expect a shift differential of at least 30% per hour for nocturnist but this the national average is closer to 15%.

One exception to the cross cover RVU rule - critical care. Remember that a patient can have critical care billed as many times as you fulfill the requirement - 45 minutes (the threshhold for 1 hour of critical care) of critical care that you must bill for if you want to receive credit. Management of conditions like sepsis, hypoxemic respiratory failure, and other acute life threatening conditions can still generate some RVU's, so while that's not what this post is about, if you're a hospitalist, don't forget to bill for them!

 

[FUBAR2020]

Hello all
I plan on becoming a nocturnist after IM residency and I was wondering what I need to do now to be a good candidate.
I don't have much to show for on my CV/resume at this point as a PGY-2 and I don't particularly want to research or whatever else those who are wanting to go into fellowship are doing. Hopefully I can get a few case report in and stuff but my CV is pretty much blank at this point. I'm not looking to work at some top notch program either. Some suburban hospital will be fine.

Any insight will be appreciated.

I was a nocturnist. The gig is great as you don't have to round, typically don't deal with families and case managers. In order to make it sustainable you first and foremost need your significant other be OK with it. You will be out of sync with "normal" peoples daily schedules. Second you need to be disciplined. Sleep when your shift ends. Wake up early and workout. Eat clean. Don't snack at night. And the most important thing... find a GOOD program. I practiced at a place where I had 6-8 admits per night, managed ICU patients and had to respond to codes and RRTs. It was rural and paid well. That was doable. I have been at a place where you have 17-25 admits a night, with great specialty support, no codes, no ICU or RRT's. Paid a bit less but was also doable. I was also at a place that had 25 admits per night, no specialty support, ran codes and RRT's paid GREAT (made 530K), but always felt that my license was on the line, was always stressed and hated my job. This was not doable. Being a Nocturnist can be great, but you need to check out what you are actually responsible for and how much support you have. Not many people want to be nocturnists. Be up front with what you want, stand your ground. It's a buyers market.

 

[stanfordpa2005]

Hello all
I plan on becoming a nocturnist after IM residency and I was wondering what I need to do now to be a good candidate.
I don't have much to show for on my CV/resume at this point as a PGY-2 and I don't particularly want to research or whatever else those who are wanting to go into fellowship are doing. Hopefully I can get a few case report in and stuff but my CV is pretty much blank at this point. I'm not looking to work at some top notch program either. Some suburban hospital will be fine.

Any insight will be appreciated.

Hello JustPass. I am an academic Nocturnist at UCSF and am happy to share my experiences. You may message me privately if you wish. One recommendation I can give is to try to manage patients on your own as much as you can during your last remaining months of your residency. It's ok to have fear, but when you are presenting a case to your attending, tell them all your plans in details and why you are doing what you are doing. Imagine yourself as attending. Don't worry about what's on your CV and what's not. It's something you will build on and more importantly, it's what's you're willing to do and achieve.

 

[stanfordpa2005]

I was a nocturnist. The gig is great as you don't have to round, typically don't deal with families and case managers. In order to make it sustainable you first and foremost need your significant other be OK with it. You will be out of sync with "normal" peoples daily schedules. Second you need to be disciplined. Sleep when your shift ends. Wake up early and workout. Eat clean. Don't snack at night. And the most important thing... find a GOOD program. I practiced at a place where I had 6-8 admits per night, managed ICU patients and had to respond to codes and RRTs. It was rural and paid well. That was doable. I have been at a place where you have 17-25 admits a night, with great specialty support, no codes, no ICU or RRT's. Paid a bit less but was also doable. I was also at a place that had 25 admits per night, no specialty support, ran codes and RRT's paid GREAT (made 530K), but always felt that my license was on the line, was always stressed and hated my job. This was not doable. Being a Nocturnist can be great, but you need to check out what you are actually responsible for and how much support you have. Not many people want to be nocturnists. Be up front with what you want, stand your ground. It's a buyers market.

Completely agree with this!

 

[wjs010]

Wow I’m sure that will go over well

Just completing your residency and getting your medical license is a good enough requirement. Career Nocturnists are a rare breed. Most ppl who start night job soon realize it is not sustainable for a healthy living. I am willing to take a pay cut to give away my nights or find a job which is pure days. For this reason it is hard to find Nocturnists unless they are incentivized with less hours or higher pay or both.

The large academic health system I work for is planning to replace us with midlevels for the night role, because they think midlevels can put in admit ordersets and get the patient tucked in for the night and let the day team can take over the rest. If these hospitals think midlevels are good enough I would say even asking us for ABIM boards is bull****.

 

[Ianmrz]

Dmed you @stanfordpa2005

 

[JustPass]

So... I have a pulse and it was enough to get me a job as a noctunist.

 

[shotgunlagoon]

congrats! hope it's all you dreamed it would be and more

 

[JustPass]

congrats! hope it's all you dreamed it would be and more

definitely not what i've dreamed and more but it's good enough!