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

[wamcp]

Absolutely planning for fatFIRE, though more interested in the FI than the RE. I love my job and even if I am financially independent will want to scale back at some point.

Making $500k after taxes will be very difficult, though I'm sure it's possible. @wamcp is the master of W2 income from my perspective, and if I remember correctly he hit 600K post-tax (is that right?) working like a dog. I will be hitting around $500k this year in W2 + 1099 earnings. To get to 500k/year, I end up working 19-20 night shifts per month. To make $600k pretax, I would likely have to work 23-24ish night shifts per month. 600K after tax from W2 alone? Almost impossible in my situation.

Your goals are not unreasonable, and if you love work, there is generally no shortage of need for hospitalists.

I made 550k pretax W2 income from hospitalist work in 2020, but exceeded 1 mil in taxable income when stock gains are added.

Wrote a couple hundred thousand dollar check to the IRS before the Jan deadline...sucked

---

Members don't see this ad.

 

[tantacles]

I made 550k pretax W2 income from hospitalist work in 2020, but exceeded 1 mil in taxable income when stock gains are added.

Wrote a couple hundred thousand dollar check to the IRS before the Jan deadline...sucked

Gamestop was good to me this year, but not looking forward to writing that check, honestly.

 

[HatTricks01]

I made 550k pretax W2 income from hospitalist work in 2020, but exceeded 1 mil in taxable income when stock gains are added.

Wrote a couple hundred thousand dollar check to the IRS before the Jan deadline...sucked

Wow, how does one make 500K in a year from capital gains? Day trading? Is this something you're able to replicate every year?

 

[wamcp]

Wow, how does one make 500K in a year from capital gains? Day trading? Is this something you're able to replicate every year?

Day trading, swing trading. I started trading in October 2019. I hope I could replicate this every year but I think that will be difficult as COVID pandemics/black swan events don't happen every year.

My biggest profit gains, on the level of hundreds of thousands of dollars, were from LVGO (since merged into TDOC) and GRWG in 2020.

Other sizeable profits were from shorting the market during the COVID March 2020 crash and also 'accurately' calling the bottom of the crash/predicting indexes would reach all time high before October 2020. (My posts are preserved on reddit from that time, this is not a hindsight bias brag)

Anyway I cashed out my short term gains to give to the IRS and also pay off my house in the fall of 2020 so now I am back to a "small" cash pile to day trade.

 

[Splenda88]

8k every 2 wks post tax and deducted benefits is all I ever wanted.

500k/yr which is ~13k every 2 wks post tax would be a dream... How do you guys/gals manage to make so much $$$?

 

[YCAGA]

Wow, how does one make 500K in a year from capital gains? Day trading? Is this something you're able to replicate every year?

Lol if you could replicate that every year you could quit medicine tomorrow and start trading at a prop firm and make 7 figures per year trading other people’s money. Anyone trying to replicate their 2020 capital gains year after year is going be very disappointed and/or lose a LOT of money.

Everyone is a genius in a bull market and March 2020-present is literally the biggest bull market ever.

Add to that the clear shorting opportunity of a once in a lifetime black swan event (COVID) and suddenly a lot of people think they are the next Wolf of Wall street.

 

[wamcp]

Lol if you could replicate that every year you could quit medicine tomorrow and start trading at a prop firm and make 7 figures per year trading other people’s money. Anyone trying to replicate their 2020 capital gains year after year is going be very disappointed and/or lose a LOT of money.

Everyone is a genius in a bull market and March 2020-present is literally the biggest bull market ever.

Add to that the clear shorting opportunity of a once in a lifetime black swan event (COVID) and suddenly a lot of people think they are the next Wolf of Wall street.

I don’t think i’m a market genius at all. I agree with you 100%. March and covid was the easiest and clearest shorting plus buying opportunity of our lifetimes. (Although, still the vast majority of investors failed to recognize it). I doubt i can replicate my massive returns from 2020 in this year, but i do think the market bubble still has room to inflate and I hope to capitalize on that aggressively in the short term.

My bet is over the 12 year span from now, sp500 returns will be negative:

https://pbs.twimg.com/media/EtjvsfxXUAQeIww?format=jpg&name=large

 

[tantacles]

8k every 2 wks post tax and deducted benefits is all I ever wanted.

500k/yr which is ~13k every 2 wks post tax would be a dream... How do you guys/gals manage to make so much $$$?

~250k base for 10 night shifts per month

Work 8-12 extra night shifts per month at another hospital - ~$20000-$30000 extra per month.

 

[Splenda88]

~250k base for 10 night shifts per month

Work 8-12 extra night shifts per month at another hospital - ~$20000-$30000 extra per month.

Are you trying to be FI (w/o the RE) before sh***t hit the fan (aka Medicare for all)? Is working 18-20 shifts/month even sustainable for > 3 yrs?

 

[tantacles]

Are you trying to be FI (w/o the RE) before sh***t hit the fan (aka Medicare for all)? Is working 18-20 shifts/month even sustainable for > 3 yrs?

No idea whether it’s sustainable. That remains to be seen. That being said, I love my life right now, and if and when in need to scale back, I will. Stock gains have been kind this year so it might be sooner than I expected.

 

[tantacles]

Ok, another brief update.

I've now worked shifts at about 8 hospitals working for 3 hospital systems. One of those I quit because I had to fly to get there (back near residency), but I'm still employed with the other two places.

I'm constantly reminded that every hospital system is different, and every shift is different. That doesn't necessarily lead to any specific advice as each person has different preferences. However, some thoughts about the non-clinical stuff:

1. Commute matters. At one of my sites which is a 20 mile drive away, I've elected to no longer do swing shifts as the commute around 4 pm takes around 1.5 hours. Can't deal with that. I would take the train for that shift, but it stops running around midnight. When I'm on night shift, I consistently take the train.

2. Having residents: It can be nice. Yes, you have to check over things and you have to discuss, but there is something amazing about not holding a pager/phone all night and having all calls filtered through another physician.

3. Staff matters. Familiarity is amazing. I love working at multiple places, but there is something wonderful about the nurses that know me at my home institution. They trust me when I make a decision that differs from the norm, and that means a lot.

I don't know, man. This nocturnist thing is still great.

 

[Vivid_Quail]

~250k base for 10 night shifts per month

Work 8-12 extra night shifts per month at another hospital - ~$20000-$30000 extra per month.

Am I doing the math right that you are earning over $200/hr on your extra shifts? Is that common? I didn't even think external locums paid that high for hospitalist work, but if they do that's a very pleasant surprise.

 

[tantacles]

Most of the hours I work are at $180/hr. However, one of the hospitals has shifts that are 14 hours long, so 8 of those is $20,000. I'm also doing some virtual shifts on the weekends that are 8 hours long for $180/hr. Most of the shifts, however, are 12 hours long.

 

[Vivid_Quail]

Most of the hours I work are at $180/hr. However, one of the hospital has shifts that are 14 hours long, so 8 of those is $20,000. I'm also doing some virtual shifts on the weekends that are 8 hours long for $180/hr. Most of the shifts, however, are 12 hours long.

Thanks! How do the virtual shifts work? What are your responsibilities/types of calls you get?

 

[tantacles]

Thanks! How do the virtual shifts work? What are your responsibilities/types of calls you get?

Anything and everything cross cover except admitting. However, if a patient needs to be seen in person, I ask the on-site nocturnist to go see them.

 

[HatTricks01]

Anything and everything cross cover except admitting. However, if a patient needs to be seen in person, I ask the on-site nocturnist to go see them.

Wow, that's an amazing gig. They're paying you $180/hr to sit at home and field insignificant cross cover calls and anything that's concerning, you just ask the in house doc to go and manage. Are these shifts common? As a resident soon to be fellow, this sounds like a moonlighters dream.

 

[tantacles]

Wow, that's an amazing gig. They're paying you $180/hr to sit at home and field insignificant cross cover calls and anything that's concerning, you just ask the in house doc to go and manage. Are these shifts common? As a resident soon to be fellow, this sounds like a moonlighters dream.

Extremely uncommon. Didn't exist when I started, but covid with an increased volume forced them to create the shift because literally no one wants to work a swing shift on the weekend.

But I'll do it from home!

 

[Splenda88]

Extremely uncommon. Didn't exist when I started, but covid with an increased volume forced them to create the shift because literally no one wants to work a swing shift on the weekend.

But I'll do it from home!

How much you made last if you don't mind sharing?

 

[tantacles]

How much you made last if you don't mind sharing?

I make $180/hr on these shifts.

I don’t think my actual income is that helpful because it varies based on how much I work, but I’ll say that I work 10 night shifts per month at my normal job which pays about $250k/year, and I work 8-12 extra night/swing shifts a month at my second job. Swing shifts pay about $160/hr and night shifts about $180, so I try to almost always do night shifts.

 

[Splenda88]

I make $180/hr on these shifts.

I don’t think my actual income is that helpful because it varies based on how much I work, but I’ll say that I work 10 night shifts per month at my normal job which pays about $250k/year, and I work 8-12 extra night/swing shifts a month at my second job. Swing shifts pay about $160/hr and night shifts about $180, so I try to almost always do night shifts.

It's not easy to find these 10-12 night shifts per month. I saw 3 on/ 1 off/ 3 on/ 7 off, but the salary is abysmal (240k/yr).


It's safe to say you made 400k+ last year...

 

[tantacles]

It's not easy to find these 10-12 night shifts per month. I saw 3 on/ 1 off/ 3 on/ 7 off, but the salary is abysmal (240k/yr).


It's safe to say you made 400k+ last year...

Well, I just graduated in July, so not that safe. And 3 on 1 off 3 on 7 off is 12-13 nights per month for 240k, which isn’t bad, really.

Also keep in mind I’m in a very high cost of living area, so my dollar doesn’t go very far.

But yeah, I’ll probably break 500k this year.

 

[Vivid_Quail]

Well, I just graduated in July, so not that safe. And 3 on 1 off 3 on 7 off is 12-13 nights per month for 240k, which isn’t bad, really.

Also keep in mind I’m in a very high cost of living area, so my dollar doesn’t go very far.

But yeah, I’ll probably break 500k this year.

Isn't $240k pretty bad for nights though? That is like 10-25th percentile for days. Unless there is some crazy bonuses or incentives added to that 240k but even then, it doesn't seem like good pay to make below or around a median salary for 100% nights.

I guess 3 on 1 off 3 on 7 off is about 6/7th of the usual amount of shifts per year compared to 7 on 7 off. Assuming $300k to work 7 on 7 off nights, adjusted that is $257k for 6/7th so now I am thinking $240k maybe is fair for that schedule lol.

 

[tantacles]

Isn't $240k pretty bad for nights though? That is like 10-25th percentile for days. Unless there is some crazy bonuses or incentives added to that 240k but even then, it doesn't seem like good pay to make below or around a median salary for 100% nights.

I guess 3 on 1 off 3 on 7 off is about 6/7th of the usual amount of shifts per year compared to 7 on 7 off. Assuming $300k to work 7 on 7 off nights, adjusted that is $257k for 6/7th so now I am thinking $240k maybe is fair for that schedule lol.

It really depends on the job itself. 6 nights in a two week period is pretty sustainable. And again, remember that you can negotiate. Why in the world would you take the first offer available to you without asking for more? And if what you want is to work fewer nights, you tell them 3 on 1 off 2 on 8 off would be more reasonable and you see what they say. And you ask for more pay. And you ask for a signing bonus. And a retention bonus. The offer is a start.

 

[Vivid_Quail]

It really depends on the job itself. 6 nights in a two week period is pretty sustainable. And again, remember that you can negotiate. Why in the world would you take the first offer available to you without asking for more? And if what you want is to work fewer nights, you tell them 3 on 1 off 2 on 8 off would be more reasonable and you see what they say. And you ask for more pay. And you ask for a signing bonus. And a retention bonus. The offer is a start.

Hmm can I bring you with me in 3-4 years? lol

It is nice to be in a specialty that is in demand enough to negotiate. In EM right now, they have like a bazillion applications for every job so negotiating is a great way to not get hired (or so I am told).

 

[tantacles]

Hmm can I bring you with me in 3-4 years? lol

It is nice to be in a specialty that is in demand enough to negotiate. In EM right now, they have like a bazillion applications for every job so negotiating is a great way to not get hired (or so I am told).

You don't need me, but truth be told you may want me in a couple of years . . . Stay tuned. Won't be able to speak freely about it on SDN for long since that would be advertising!

And generally, you don't negotiate before you've received an offer. You negotiate after you've received an offer.

 

[Splenda88]

Yeah, I make $500k pre-tax, but that's working 19-20 shifts per month.

This is still excellent...

 

[deleted849476]

Do you think being med-peds had anything to do with your current working situation that you wouldn’t have been able to get as IM alone?

And do you think you could’ve got this exact same setup (main job and side gigs/per diems) as an FM hospitalist?

 

[tantacles]

Do you think being med-peds had anything to do with your current working situation that you wouldn’t have been able to get as IM alone?

No. Wish I had just done IM.

And do you think you could’ve got this exact same setup (main job and side gigs/per diems) as an FM hospitalist?

No idea.

 

[wamcp]

Am I doing the math right that you are earning over $200/hr on your extra shifts? Is that common? I didn't even think external locums paid that high for hospitalist work, but if they do that's a very pleasant surprise.

>200/hr is not common for nights or admitter shifts.

Usually it exists if at least one of the following is present:

-bad geographical area that no one wants to live in

-horrific constant high volumes of admits

-open icu and expected to act as a real intensivist

A true unicorn job is where pay is >200/hr but none of the above. I am fortunate to work where this is the case- as I said in the past I’ll prove it and reveal the location when I retire early in a few years. Last shift i worked I was paid $2000 for 8 hours of admitting but only had 7 admissions...no procedures.. no rrt happened..got home before midnight...it is amazing and very sustainable...40 minute commute from downtown where I live. Before covid it was more common to get $2400 for these shifts when they were more short staffed

 

[Splenda88]

>200/hr is not common for nights or admitter shifts.

Usually it exists if at least one of the following is present:

-bad geographical area that no one wants to live in

-horrific constant high volumes of admits

-open icu and expected to act as a real intensivist

A true unicorn job is where pay is >200/hr but none of the above. I am fortunate to work where this is the case- as I said in the past I’ll prove it and reveal the location when I retire early in a few years. Last shift i worked I was paid $2000 for 8 hours of admitting but only had 7 admissions...no procedures.. no rrt happened..got home before midnight...it is amazing and very sustainable...40 minute commute from downtown where I live. Before covid it was more common to get $2400 for these shifts when they were more short staffed

I know someone at Cancer Treatment Centers of America who is getting $225/hr and he told me 3 admissions is considered a bad night. For him it is a side gig. He said one of his colleagues consistently break in ~700k/yr for the past 5+ years. That is truly a unicorn 1099 job.

 

[tantacles]

>200/hr is not common for nights or admitter shifts.

Usually it exists if at least one of the following is present:

-bad geographical area that no one wants to live in

-horrific constant high volumes of admits

-open icu and expected to act as a real intensivist

A true unicorn job is where pay is >200/hr but none of the above. I am fortunate to work where this is the case- as I said in the past I’ll prove it and reveal the location when I retire early in a few years. Last shift i worked I was paid $2000 for 8 hours of admitting but only had 7 admissions...no procedures.. no rrt happened..got home before midnight...it is amazing and very sustainable...40 minute commute from downtown where I live. Before covid it was more common to get $2400 for these shifts when they were more short staffed

Yeah, the open ICU really kills the sustainability of the job. It means that every shift is likely to truly suck because for patients that are acutely ill, ICU nurses are likely to feel every problem, no matter how small, is an emergency. Granted, many of their problems are, in fact, emergencies. However, they are extremely motivated to call for literally anything.

 

[robellis]

Yeah, the open ICU really kills the sustainability of the job. It means that every shift is likely to truly suck because for patients that are acutely ill, ICU nurses are likely to feel every problem, no matter how small, is an emergency. Granted, many of their problems are, in fact, emergencies. However, they are extremely motivated to call for literally anything.

As they should be..

 

[HatTricks01]

Yeah, the open ICU really kills the sustainability of the job. It means that every shift is likely to truly suck because for patients that are acutely ill, ICU nurses are likely to feel every problem, no matter how small, is an emergency. Granted, many of their problems are, in fact, emergencies. However, they are extremely motivated to call for literally anything.

As a resident, I've never quite understood the concept of hospitalists working open ICUs. I train at an institution that has a closed ICU and on nearly every one of my call shifts, I'm spending the majority of the night posted outside (or inside) the room of a patient that is getting progressively more sick. I can't imaging having to manage that and cross cover x amount of floor patients and do x amount of admissions. I feel like one decompensating ICU patient can consume your entire night.

Am I missing something here? Are ICU patients in an open ICU generally less ill than those in a hospital with a closed ICU? Admittedly, I've been told that a lot of floor patients at my institution would be in the ICU if they were at other hospitals.

 

[wamcp]

As a resident, I've never quite understood the concept of hospitalists working open ICUs. I train at an institution that has a closed ICU and on nearly every one of my call shifts, I'm spending the majority of the night posted outside (or inside) the room of a patient that is getting progressively more sick. I can't imaging having to manage that and cross cover x amount of floor patients and do x amount of admissions. I feel like one decompensating ICU patient can consume your entire night.

Am I missing something here? Are ICU patients in an open ICU generally less ill than those in a hospital with a closed ICU? Admittedly, I've been told that a lot of floor patients at my institution would be in the ICU if they were at other hospitals.

You're not missing anything. Open ICU can really really suck and could impede your workflow all shift long.

Most small community hospitals however use their ICU as 'stepdown' beds. But if you have patients who meet true ICU level of care they are usually real time sinks

The main hospital I work at is closed ICU and I love it. If someone is crumping on the floor, call the intensivist, all done. Not my problem any more and they will receive better care than I could provide, while the regular floor patients can continue to get the best care/attention I can offer.

 

[tantacles]

As they should be..

Nah. A potassium of 3.4 probably doesn't require intervention within seconds. A fever in a patient who has been consistently febrile due to pyelonephritis does not require intervention within seconds. A patient who hasn't pooped in 3 days doesn't require intervention within seconds. Just because someone is in the ICU does not mean every complaint is an emergency.

 

[tantacles]

As a resident, I've never quite understood the concept of hospitalists working open ICUs. I train at an institution that has a closed ICU and on nearly every one of my call shifts, I'm spending the majority of the night posted outside (or inside) the room of a patient that is getting progressively more sick. I can't imaging having to manage that and cross cover x amount of floor patients and do x amount of admissions. I feel like one decompensating ICU patient can consume your entire night.

Am I missing something here? Are ICU patients in an open ICU generally less ill than those in a hospital with a closed ICU? Admittedly, I've been told that a lot of floor patients at my institution would be in the ICU if they were at other hospitals.

Intensivists don't want to be in the hospital all night, particularly in a community hospital.

Open ICU's do suck.The saving grace of my hospital's open ICU is that I have a nurse practitioner working with me to handle the small stuff, but as you might imagine, working with a nurse practitioner, particularly one right out of school, is not the greatest since you're still liable for every patient, but you have someone covering the unit with a ton less training than you who doesn't have the insight to know what they don't know.

In addition, I must admit that my ICU takes patients who are much less sick than I expect to go to an ICU, so the patients, on average, are not as time consuming as ICU patients in residency.

 

[Splenda88]

Intensivists don't want to be in the hospital all night, particularly in a community hospital.

Open ICU's do suck.The saving grace of my hospital's open ICU is that I have a nurse practitioner working with me to handle the small stuff, but as you might imagine, working with a nurse practitioner, particularly one right out of school, is not the greatest since you're still liable for every patient, but you have someone covering the unit with a ton less training than you who doesn't have the insight to know what they don't know.

In addition, I must admit that my ICU takes patients who are much less sick than I expect to go to an ICU, so the patients, on average, are not as time consuming as ICU patients in residency.

I am starting to think that you have a unicorn job...

 

[tantacles]

I am starting to think that you have a unicorn job...

My job is great! It's just hard because I don't get to compare my job with other jobs, so it's hard for me to say if my job is a unicorn job. I have a physician group that does a great job advocating for its doctors.

 

[Splenda88]

My job is great! It's just hard because I don't get to compare my job with other jobs. I have a physician group that does a great job advocating for its doctors.

I am not working yet but from what I have heard, your job is atypical... Some of the offers I am getting are ridiculous. For instance, one place said they would pay me $300/day on my 7 days off to be on call for the in-house NP in case he/she needs help. Seriously!

 

[tantacles]

Negotiate! I'd do that job for $1000/day. Ultimately, if a job isn't worth it, you have to be willing to say no to it.

 

[Osteoth]

Do you do procedures? Some recent jobs I’ve seen at smaller shops say they prefer hospitalists to do central’s, a lines, tubes if the icu is open. Also do you run rapids and codes at night?

 

[tantacles]

Do you do procedures? Some recent jobs I’ve seen at smaller shops say they prefer hospitalists to do central’s, a lines, tubes if the icu is open. Also do you run rapids and codes at night?

I don't do procedures.

However, I do run every rapid and code.

 

[Planes2Doc]

Awesome thread. Thanks for sharing your experience. I found the perfect nocturnist gig that I have been working since residency. I wanted to do night work, so interviewed for different positions. It's crazy how much they vary! I figured I would share it so people get the idea how different the experiences can be.

I'm currently working as a nocturnist in a large community hospital in a midwestern metro area. It's a little bit under 5 hours from our home in Chicago, so I drive out there. It's 5 days on and 10 days off, so this is doable. I have a cheap apartment about 5 minutes from work. Here are the details of the position and why it's great.

10 hour shifts from 9 to 7, although I come in earlier usually before 8 since I am alone here and like to get started on things early. I work with two nurse practitioners, one that does ALL cross-coverage the entire night (similar to our split in residency, I never realized how grueling cross-coverage can be), and one that does additional admissions. We have caps (I can still go above depending on the workflow, but it's in no way expected), so once we max out regardless of how early it is (it can be so busy that you max out when you walk in the door), the other patients go into an unseen list. The essential orders are put in by the admissions NP. Closed ICU, so we only run rapid responses on our patients. No code blues and no procedures. Pay is similar to what you describe. I absolutely love this position. I feel like I have won the lottery. The only thing that sucks is the commute. Even though I miss my wife and child when I'm gone, I realize that I would barely see them during my work block even if I were home. That's why I actually felt less lonely in residency when my wife and baby were back home in Chicago since it was 6 on 1 off for the entire month.

I did have offers back near home, and here is why I passed them up. One was at a hospital I liked as a medical student. It was just over an hour from home without traffic (sadly you are going with traffic if doing a nocturnist schedule). It was 7 on 7 off. Open ICU. All codes. All lines. All intubations. Cross-coverage for around 250 beds. No caps. The "average" number of patients was well over what my cap is at my current job.

There was also another position that was similar but more reasonable within WALKING distance from our townhouse. I contemplated it, but it wasn't worth it. Even my wife and the rest of my family were glad I did not take this position.

At the end of the day, I'm grateful I found something with excellent mid-level support and no cross-coverage. I had to cover one night of it because the NP was out unexpectedly (had much lower patient cap that night), and never realized how much constant calls bite into workflow, since the work was mostly divided in residency. Interestingly, the rest of the night and swing folks at my hospital are very happy. I was under the impression that some people start nocturnist positions to get their foot in the door and switch to days as soon as possible. Definitely not here. As @tantacles had mentioned, there are a lot of things you don't have to deal with on nights. It's great dealing with medicine, and not the social and administrative issues. I wouldn't change it for anything.

 

[tantacles]

Great addition.

Let me just say that these nocturnist jobs are only unicorn jobs because people are accepting jobs that are worse. The second everyone stops taking these ****ty jobs with the open ICU and no help for **** pay, the second the hospital admin enters the struggle bus and starts changing things.

 

[Splenda88]

Awesome thread. Thanks for sharing your experience. I found the perfect nocturnist gig that I have been working since residency. I wanted to do night work, so interviewed for different positions. It's crazy how much they vary! I figured I would share it so people get the idea how different the experiences can be.

I'm currently working as a nocturnist in a large community hospital in a midwestern metro area. It's a little bit under 5 hours from our home in Chicago, so I drive out there. It's 5 days on and 10 days off, so this is doable. I have a cheap apartment about 5 minutes from work. Here are the details of the position and why it's great.

10 hour shifts from 9 to 7, although I come in earlier usually before 8 since I am alone here and like to get started on things early. I work with two nurse practitioners, one that does ALL cross-coverage the entire night (similar to our split in residency, I never realized how grueling cross-coverage can be), and one that does additional admissions. We have caps (I can still go above depending on the workflow, but it's in no way expected), so once we max out regardless of how early it is (it can be so busy that you max out when you walk in the door), the other patients go into an unseen list. The essential orders are put in by the admissions NP. Closed ICU, so we only run rapid responses on our patients. No code blues and no procedures. Pay is similar to what you describe. I absolutely love this position. I feel like I have won the lottery. The only thing that sucks is the commute. Even though I miss my wife and child when I'm gone, I realize that I would barely see them during my work block even if I were home. That's why I actually felt less lonely in residency when my wife and baby were back home in Chicago since it was 6 on 1 off for the entire month.

I did have offers back near home, and here is why I passed them up. One was at a hospital I liked as a medical student. It was just over an hour from home without traffic (sadly you are going with traffic if doing a nocturnist schedule). It was 7 on 7 off. Open ICU. All codes. All lines. All intubations. Cross-coverage for around 250 beds. No caps. The "average" number of patients was well over what my cap is at my current job.

There was also another position that was similar but more reasonable within WALKING distance from our townhouse. I contemplated it, but it wasn't worth it. Even my wife and the rest of my family were glad I did not take this position.

At the end of the day, I'm grateful I found something with excellent mid-level support and no cross-coverage. I had to cover one night of it because the NP was out unexpectedly (had much lower patient cap that night), and never realized how much constant calls bite into workflow, since the work was mostly divided in residency. Interestingly, the rest of the night and swing folks at my hospital are very happy. I was under the impression that some people start nocturnist positions to get their foot in the door and switch to days as soon as possible. Definitely not here. As @tantacles had mentioned, there are a lot of things you don't have to deal with on nights. It's great dealing with medicine, and not the social and administrative issues. I wouldn't change it for anything.

It's hard to find these positions now because of a tight market. Do you make 250k+? Do you have benefits (401k, health insurance etc...)?

I feel like I know this place...

 

[Planes2Doc]

It's hard to find these positions now because of a tight market. Do you make 250k+? Do you have benefits (401k, health insurance etc...)?

I feel like I know this place...

Approaching $250k after the RVU bonuses. Full benefits. 401k and 457b (though only maxing out the former currently). I definitely got lucky.

 

[Splenda88]

Approaching $250k after the RVU bonuses. Full benefits. 401k and 457b (though only maxing out the former currently). I definitely got lucky.

Count your blessings man! It's a job you should keep. Hopefully, your wife can move closer soon.

 

[Planes2Doc]

Count your blessings man! It's a job you should keep. Hopefully, your wife can move closer soon.

Thanks! Definitely a keeper. Family and friends are still in Chicago, and that was the appeal of taking this job. I'm out here only 10 days per month, with the rest being back home. So it works out great. Gotta love the block scheduling flexibility.

 

[tantacles]

Ok. Another comment that might be important. A piece of life that makes nocturnist life awful vs. great: How do nurses contact you? For me, here's my ranking in order of best to worst:

1. Chart chat or secure message within EMR
2. Pager
3. Phone call
4. Your workspace is public and they just walk up to you.

If 3 and 4 is the way you'll get the majority of your cross cover calls at night, I would definitely reconsider the job.

Keep in mind that this applies to admissions too. Speaking on the phone with the ED doc (and being interrupted with their calls) can be extremely mentally taxing. If they can text you or chat you some other way that is written down so you don't have a phone ringing in your ear, it can make life a lot better.

 

[wamcp]

Approaching $250k after the RVU bonuses. Full benefits. 401k and 457b (though only maxing out the former currently). I definitely got lucky.

Is that 208/hr including the bonuses?

Then down to 170/hr after factoring in the extra apartment and 10 hour round trip commute per block?