What's your nocturnist arrangement?

[katmandu]

Our group is working on a fair arrangement for nocturnist staff. The gamut of perceptions of what is considered fair is rather broad. What setup do you have?

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[deleted77919]

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[Daiphon]

10% shift differential plus complete freedom in making your schedule. Obviously doesn't work as well with more than one per site however.

We have something similar. We also get first dibs on holiday shifts (and doesn't have to be the night).

Also, I'm in an academic shop - I get "credit" in the promotion structure that offsets some difficulties in getting to daytime meetings/committees/etc.

-d

 

[DocRGR]

I'd also be interested in hearing how different group setups handle this, i.e. private v employee v academic.

 

[katmandu]

Dakota and Daiphon,
How does scheduling work with regards to weekends? Do your nocturnists have responsibility to cover equal number of weekend shifts?

 

[Daiphon]

Dakota and Daiphon,
How does scheduling work with regards to weekends? Do your nocturnists have responsibility to cover equal number of weekend shifts?

Nope. If we want them, we take them... but 1 of us has a fixed Sunday overnight, so group only responsible for Saturdays and some open Fridays. We cover 5-6/7 nights per week.

 

[deleted77919]

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[The White Coat Investor]

Small democratic group of 12. No scheduling preferences and they still have to do their share of holidays and weekends. But we pay a rather significant shift differential. The evening shift differential is 18%, the 7p-3a shift differential is 29%, and the overnight shift differential (10-6a) is 49%. We let market forces "encourage" people to pick up all the night shifts. In reality, I do about 3 overnights a month, our pre-partner does 3 a month, and two guys work mostly the overnights. The other 8 members of the group work an occasional 7p and almost never work the overnight. They also make a lot less money. Their choice. Our choice. Everyone's happy. Try doing that in your large contract management group.

 

[TysonCook]

We have ~20% differential for overnight only. We pick our schedule (it wouldn't be worth it if we couldn't as flip flopping nights will kill you). We have the same responsibility as far as weekends go and holidays. Get academic credit for committee work etc as we are sleeping.

Market forces will determine what your group will do, and it's in flux (i.e. if you make it very attractive, many will sign up).

 

[suckstobeme]

Hospital employed group ~20 docs.
Everybody pays $400/month into an imaginary pot of money. The night differential is $20/hr and it is funded by the pot of money (plus some amount that the Hospital kicks in).
The way it works out is if you work 2 nights a month at 10hrs per night, you make back your $400. If you don't work any nights, well you're paying $400/month to not do any nights, so not bad.

I'm one of the docs that likes nights. The $20/hr extra is nice but honestly, I don't think its enough to intice a doctor who doesn't like nights. I think that those of us in our group that do nights, we do them out of a sense of responsiblity and that it's just part of the job of an ER doc to do some nights. This wasn't a problem earlier for us, but one of our guys that used to do exclusively nights just turned 60 and decided that he didn't want anymore nights (not that I blame him- once you hit 50+ you should be able to not have to nights anymore), so now there's another 14 nights a month that need covering- those of us doing some nights are being asked to do more nights; the docs that don't do nights- well, they are just not night people. Starting to feel a little taken advantage of. I would like to figure out a tactful way to tell our group leaders that we should bump up the differential to $30/hr, especially considering nights have been getting considerably busier the last couple years.

 

[The White Coat Investor]

Hospital employed group ~20 docs.
Everybody pays $400/month into an imaginary pot of money. The night differential is $20/hr and it is funded by the pot of money (plus some amount that the Hospital kicks in).
The way it works out is if you work 2 nights a month at 10hrs per night, you make back your $400. If you don't work any nights, well you're paying $400/month to not do any nights, so not bad.

I'm one of the docs that likes nights. The $20/hr extra is nice but honestly, I don't think its enough to intice a doctor who doesn't like nights. I think that those of us in our group that do nights, we do them out of a sense of responsiblity and that it's just part of the job of an ER doc to do some nights. This wasn't a problem earlier for us, but one of our guys that used to do exclusively nights just turned 60 and decided that he didn't want anymore nights (not that I blame him- once you hit 50+ you should be able to not have to nights anymore), so now there's another 14 nights a month that need covering- those of us doing some nights are being asked to do more nights; the docs that don't do nights- well, they are just not night people. Starting to feel a little taken advantage of. I would like to figure out a tactful way to tell our group leaders that we should bump up the differential to $30/hr, especially considering nights have been getting considerably busier the last couple years.

For $20 I wouldn't do any nights either. Why don't you quit doing them?

 

[Janders]

I agree with the message above that one of the advantages of having a democratic setup is customizing your night reimbursement.

We are eat what you kill set up, and nights actually reimburse a fair bit less than days at our shop just due to patient census (gets a little slow from 330-6). So without some type of tax/stipend, nights actually pay WORSE than days at our shop. As such, either we all have to work equal percentage of nights (25%), or we have to come up with a system to tax those who don't to pay those who work MORE than their share (which is what we did).

And of course, this number is variable... if I was in the above group and it cost $400 a month to get out of nights, i would do it in a HEARTBEAT!

 

[Daiphon]

I agree with the message above that one of the advantages of having a democratic setup is customizing your night reimbursement.

We are eat what you kill set up, and nights actually reimburse a fair bit less than days at our shop just due to patient census (gets a little slow from 330-6). So without some type of tax/stipend, nights actually pay WORSE than days at our shop. As such, either we all have to work equal percentage of nights (25%), or we have to come up with a system to tax those who don't to pay those who work MORE than their share (which is what we did).

And of course, this number is variable... if I was in the above group and it cost $400 a month to get out of nights, i would do it in a HEARTBEAT!

If you're in an "eat what you kill" shop, then you're gonna have difficulty incentivizing people to do the night shifts. You may want to consider running reports on what the average RVU/reimbursements are for each of your shifts and then creating a flat "bonus" in addition to the aforementioned differential. Alternatively, you could internally consider any patient encounter, regardless of actual E&M level, a Level 5 in terms of paycheck which has a built-in bump in pay. In a lot of ways, this is more fair as, even though it's slow/dead for a portion of the shift, your physician coverage is still awake & not at home.

If as you say many in the group just aren't night people, then they may find this palatable in lieu of working the nights.

 

[Janders]

If you're in an "eat what you kill" shop, then you're gonna have difficulty incentivizing people to do the night shifts. You may want to consider running reports on what the average RVU/reimbursements are for each of your shifts and then creating a flat "bonus" in addition to the aforementioned differential. Alternatively, you could internally consider any patient encounter, regardless of actual E&M level, a Level 5 in terms of paycheck which has a built-in bump in pay. In a lot of ways, this is more fair as, even though it's slow/dead for a portion of the shift, your physician coverage is still awake & not at home.

If as you say many in the group just aren't night people, then they may find this palatable in lieu of working the nights.

Your first option is basically exactly what we did. We reviewed the billing data, determined the MEAN difference between any random night shift and any random day/eve shift. We'll call that $X. People who work extras nights must be given $X per EXTRA shift, gleaned from a tax on those who didn't work their share of nights. This basically evens the playing field, and makes the extra nights you do pay as well as any random day shift.

On top of that, and additional $Y was added, to function as an additonal incentive / penalty.

It sounds complicated, but our business end does this quarterly, and its really not all that difficult at all.

 

[deleted547339]

Your first option is basically exactly what we did. We reviewed the billing data, determined the MEAN difference between any random night shift and any random day/eve shift. We'll call that $X. People who work extras nights must be given $X per EXTRA shift, gleaned from a tax on those who didn't work their share of nights. This basically evens the playing field, and makes the extra nights you do pay as well as any random day shift.

On top of that, and additional $Y was added, to function as an additonal incentive / penalty.

It sounds complicated, but our business end does this quarterly, and its really not all that difficult at all.

Then why not just do a flat hourly rate? Or am I misunderstanding your reimbursement structure?

 

[Janders]

We are literally eat what you kill, so each patient you see (assuming they pay) goes to your bottom line.

 

[EctopicFetus]

Our group does a flat $40/ hr. We discussed moving this up as we did find some data that average was $50/hr.

 

[Daiphon]

Our group does a flat $40/ hr. We discussed moving this up as we did find some data that average was $50/hr.

This is effectively our differential. We do 8's and only half of the overnight is single coverage... so $50/hr for the unopposed portion.

Again, we also get academic credit which goes towards P&T as well as the bonus pool, so it works out pretty well.

-d

 

[thorg12]

I am salaried at academic community shop.
Half of my shifts are overnight. In exchange I got 2 hours off my weekly hourly requirement and set schedule, ie off every weekend; except I need to work an extra shift every 4-5 weeks too make sure I'm meeting my hours.

 

[Venko]

Our night shifts equate to 1.25 shift credit

 

[emergentmd]

Hospital employed group ~20 docs.
Everybody pays $400/month into an imaginary pot of money. The night differential is $20/hr and it is funded by the pot of money (plus some amount that the Hospital kicks in).
The way it works out is if you work 2 nights a month at 10hrs per night, you make back your $400. If you don't work any nights, well you're paying $400/month to not do any nights, so not bad.

I'm one of the docs that likes nights. The $20/hr extra is nice but honestly, I don't think its enough to intice a doctor who doesn't like nights. I think that those of us in our group that do nights, we do them out of a sense of responsiblity and that it's just part of the job of an ER doc to do some nights. This wasn't a problem earlier for us, but one of our guys that used to do exclusively nights just turned 60 and decided that he didn't want anymore nights (not that I blame him- once you hit 50+ you should be able to not have to nights anymore), so now there's another 14 nights a month that need covering- those of us doing some nights are being asked to do more nights; the docs that don't do nights- well, they are just not night people. Starting to feel a little taken advantage of. I would like to figure out a tactful way to tell our group leaders that we should bump up the differential to $30/hr, especially considering nights have been getting considerably busier the last couple years.

20/hr to do night is chump change. No one in our group would do this. We have a private group and most hate to do night. Years ago, we started out at 20/night which didn't get much volunteers. We just kept increasing it and now it is at 65/hr. Even now, we still have some nights that are not covered. If this keeps up, we may have to bump it to 80/hr