My hospital system just hired two GI docs to do ONLY outpatient (aka scope robot). I was told today by another physician who was in the leadership and has been there for over 30 years that these guy are getting 850k/yr + benefit. Will these guys be able to generate enough revenue to support that kind of salary?
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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Probably… most GI want to do scopes as outpt… they get better reimbursement than if done inpt.
ya it'll pay for itself esp with downstream referrals from cancer.
procedures don't pay well by themselves (eg a LHC is ~4.5 RVUs) but they generate massive facility fees, for which the hospital can subsidize salaries from (again, LHC generates ~20k in facility fees).
It's similar to anesthesia; on paper, anesthesia basically generates no revenue, but also, without anesthesia, no CABGs, so the hospital subsidizes them in order to keep the cash cow running.
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Around $200/hr. Plenty of shifts available most of the time.
To follow up on my previous post I ended up taking the nocturnist job and have worked about 3 months now.
Here are my thoughts.
Setting/Hospital:
My primary reason for taking this job was location. It is across the street from my residency hospital and I am still living in the same apartment I lived in residency. It is only a 3 min drive from my apartment and I could walk there if I had car trouble. The hospital is much bigger than my residency hospital, It is a level 1 center with >1000 beds. The ER is in the top 10 busiest in the country. This is a blessing and a curse becauce while we have full subspecialty support there is no such thing as a "chill night." For example one of my friends was telling me about a swing shift they did where they had 3 admissions. Not a reality at my shop. There are 35 day rounders/day, 1-2 day admitters, 3-4 swing admitters, 2-3 nocturnist/night. We accept ~25-35 admissions/night, the most I have seen is 50 admissions a night on a bad night.
The work:
I only admit.
The shift is 9 hours from 11 pm -8am, however the day admitters and rounders get there at 7am so If you are done with your work there's no reason to stay till 8. We are CAPPED at 8 admits/nocturnist. This is something that I think is very rare in a nocturnist job. Any admissions after 6am and any admits over 8 per nocturnist get passed to the day team. This is not really a problem staffing-wise with 35 day docs. With this said If you are 1st call you do have to do hold orders which I am not a fan of, but most nights I am 2nd or 3rd call and only have to worry about my 8. My last 1st call I actually went over my cap and admitted 12 because they were really sick and I did not feel comfortable leaving them for the morning. But 90% of shifts have been 2nd or 3rd call. On a "good night" I will get all 8 of my admissions by midnight and I can finish by 5-6am but most nights I am working till 730ish. We have a closed ICU so I dont do any ICU admits and If any of my pts decompensate I call ICU and they take over. There is 24/7 intensivist in-house for codes and procedures. We have 4 NPs that do all cross-coverage. The hospital is ~1000 beds so they do get very busy. I usually only get 1-2 calls per night from the NPs if they have a question. The NPs will also do ~2 admits per nocturnist that counts to your cap of 8. I still see every patient as if I was doing the admit myself but having the help with the note is a big time saver.
Some other perks:
-24/7 ED pharmacist Its nice being able to ask questions face to face. They can help with med recs for complicated patients.
-The cafeteria is actually open at night (limited options) and physicians get free food.
-There is a doctors lounge with pre packaged food and drinks as well.
-We get sleep rooms with a bed/computer/65 inch TV. on two occasions I have finished my work at 5am and went to sleep but this is very rare.
-EPIC EMR and Dragon.
Schedule/Comp:
-15 shifts/month, this is flexible based on our requests. So far I have asked for 10ish days per month off and have had all my requests granted which is nice. One of the major reasons I chose this job is for flexibility. Most of the nocturnists like to travel so we all work with each other's travel plans. We generally do 7on/7off but sometimes do 4-8 days. For example, I only worked 1 night this week. My next stretch will be 10 nights.
-I am making 322K/year. They gave me a 40K sign on bonus. The downside is there is no RVU. The day docs make RVU which I think is unfair. The model is essentially by working nights we are making the maximum a day doc could theoretically make. Most of the day docs I have talked to are making ~290-305 after the bonus. This is still the highest paying job I found in the market here. My residency hospital offered me 180K for days. The other major university hospital offered me 250 for nocturnist.
Cons:
-8 admits in 8 hours is alot. Alot of people here told me this so I did go into this with a warning. I did similar numbers in residency but as an attending it hits differently. All of the patients here are complex being a level 1 downtown hospital. With that said having a cap and knowing exactly how much work I will be doing every night is game-changing and seems to be very rare in nocturnist work.
-nights have been tougher as an attending. I think since in residency we would only do 2-3 weeks at a time. Now doing only nights I do feel it takes more of a toll.
-First night off is a scam, you still worked that morning and I'm always exhasted. I generally will wait to travel till the 2nd day off so you kind of lose a travel day that the day docs dont have to worry about.
-I know 322 is on the lower end for comp. Based on what I have read here I can be making much more money in a gig with RVU but I am not ready to move yet.
-I only see myself doing nocturnist for a few years max because of the nights themselves. Unless I can find a 7on/14off gig with RVU in which case I think It can be much more sustainable. BUT those jobs dont exist in my area.
Overall I have enjoyed it and Attending life has been much better than residency life. My weeks off have been great and the money def helps.
Here are my thoughts.
Setting/Hospital:
My primary reason for taking this job was location. It is across the street from my residency hospital and I am still living in the same apartment I lived in residency. It is only a 3 min drive from my apartment and I could walk there if I had car trouble. The hospital is much bigger than my residency hospital, It is a level 1 center with >1000 beds. The ER is in the top 10 busiest in the country. This is a blessing and a curse becauce while we have full subspecialty support there is no such thing as a "chill night." For example one of my friends was telling me about a swing shift they did where they had 3 admissions. Not a reality at my shop. There are 35 day rounders/day, 1-2 day admitters, 3-4 swing admitters, 2-3 nocturnist/night. We accept ~25-35 admissions/night, the most I have seen is 50 admissions a night on a bad night.
The work:
I only admit.
The shift is 9 hours from 11 pm -8am, however the day admitters and rounders get there at 7am so If you are done with your work there's no reason to stay till 8. We are CAPPED at 8 admits/nocturnist. This is something that I think is very rare in a nocturnist job. Any admissions after 6am and any admits over 8 per nocturnist get passed to the day team. This is not really a problem staffing-wise with 35 day docs. With this said If you are 1st call you do have to do hold orders which I am not a fan of, but most nights I am 2nd or 3rd call and only have to worry about my 8. My last 1st call I actually went over my cap and admitted 12 because they were really sick and I did not feel comfortable leaving them for the morning. But 90% of shifts have been 2nd or 3rd call. On a "good night" I will get all 8 of my admissions by midnight and I can finish by 5-6am but most nights I am working till 730ish. We have a closed ICU so I dont do any ICU admits and If any of my pts decompensate I call ICU and they take over. There is 24/7 intensivist in-house for codes and procedures. We have 4 NPs that do all cross-coverage. The hospital is ~1000 beds so they do get very busy. I usually only get 1-2 calls per night from the NPs if they have a question. The NPs will also do ~2 admits per nocturnist that counts to your cap of 8. I still see every patient as if I was doing the admit myself but having the help with the note is a big time saver.
Some other perks:
-24/7 ED pharmacist Its nice being able to ask questions face to face. They can help with med recs for complicated patients.
-The cafeteria is actually open at night (limited options) and physicians get free food.
-There is a doctors lounge with pre packaged food and drinks as well.
-We get sleep rooms with a bed/computer/65 inch TV. on two occasions I have finished my work at 5am and went to sleep but this is very rare.
-EPIC EMR and Dragon.
Schedule/Comp:
-15 shifts/month, this is flexible based on our requests. So far I have asked for 10ish days per month off and have had all my requests granted which is nice. One of the major reasons I chose this job is for flexibility. Most of the nocturnists like to travel so we all work with each other's travel plans. We generally do 7on/7off but sometimes do 4-8 days. For example, I only worked 1 night this week. My next stretch will be 10 nights.
-I am making 322K/year. They gave me a 40K sign on bonus. The downside is there is no RVU. The day docs make RVU which I think is unfair. The model is essentially by working nights we are making the maximum a day doc could theoretically make. Most of the day docs I have talked to are making ~290-305 after the bonus. This is still the highest paying job I found in the market here. My residency hospital offered me 180K for days. The other major university hospital offered me 250 for nocturnist.
Cons:
-8 admits in 8 hours is alot. Alot of people here told me this so I did go into this with a warning. I did similar numbers in residency but as an attending it hits differently. All of the patients here are complex being a level 1 downtown hospital. With that said having a cap and knowing exactly how much work I will be doing every night is game-changing and seems to be very rare in nocturnist work.
-nights have been tougher as an attending. I think since in residency we would only do 2-3 weeks at a time. Now doing only nights I do feel it takes more of a toll.
-First night off is a scam, you still worked that morning and I'm always exhasted. I generally will wait to travel till the 2nd day off so you kind of lose a travel day that the day docs dont have to worry about.
-I know 322 is on the lower end for comp. Based on what I have read here I can be making much more money in a gig with RVU but I am not ready to move yet.
-I only see myself doing nocturnist for a few years max because of the nights themselves. Unless I can find a 7on/14off gig with RVU in which case I think It can be much more sustainable. BUT those jobs dont exist in my area.
Overall I have enjoyed it and Attending life has been much better than residency life. My weeks off have been great and the money def helps.
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What region?
are you sure rvu would be better?
8 admits x 3.5 rvu per admit x 182 nights = 5.1k rvu, so would need like 60 bucks per rvu to make it worth more, not sure if that's a reasonable rvu rate for a hospitalist.
8 admits x 3.5 rvu per admit x 182 nights = 5.1k rvu, so would need like 60 bucks per rvu to make it worth more, not sure if that's a reasonable rvu rate for a hospitalist.
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You need to compare apples to apples. 322k might be on the lower end for 15 twelve hour shifts, but you're doing 9 hours. You must compare hourly wages.
Personally i prefer longer shifts in return for working less days a month, but the math works out to you making $199/hr and that's if you stay til 8am. For doing essentially 6 admits a night and 1-2 more with a midlevel with no cross coverage, this is a very solid gig. Definitely a top 25% if not top 10% gig. Nearly one admit per hour is a little heavy for my liking-I do as much work as you but in a 12 hour shift and that's definitely the sweet spot for longevity. You have plenty hours left per day and plenty of days per month to moonlight if you want to make more.
Would be nice if you got *some* bonus..if not a productivity bonus then at least some yearly quality bonus, but that said it's still a very good gig. Congrats.
I would say top 10% job.
OP has a solid job but as you say 1 admit per hour is not the best but not outrageous.
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For people who are looking for locum gig...
We have a government facility in Oklahoma looking for some hospitalist help 12/25-1/5. Speedy credentialing and all state licenses accepted. Some details are posted below. Take a moment to review and let me know if you'd like to be considered for presentation.
Connect with me by sending your current CV to [email protected] or call/text me at 678.690.7268.
Details:
We have a government facility in Oklahoma looking for some hospitalist help 12/25-1/5. Speedy credentialing and all state licenses accepted. Some details are posted below. Take a moment to review and let me know if you'd like to be considered for presentation.
Connect with me by sending your current CV to [email protected] or call/text me at 678.690.7268.
Details:
- Credentialing in 7 days or less
- Next day answers to presentation
- Negotiable Rate starting at $195/hr
- 10 hour day (7a-5p)
- M-F (12/25-1/5)
- Average 10 patients per day
- Accepts all state licenses
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That’s a terrible rate for holiday coverage
Agree. I would not work locum/1099 for less than $2400/day regardless.
To be fair, it says:
- Negotiable Rate starting at $195/hr
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1 year post starting locums - best decision I ever made. Not being an employee means recruiters can't mess with my schedule. They can still technically take away shifts if the situation demands it, but no more will my 3 days on 6 days off turn into 2 on 1 off 2 on 1 off 2 on 1 off.
And I'm paid more hourly than I ever was as a staff physician.
And the hotel is super close to the hospital.
And I don't have to own a car because they rent one for me.
Seriously. Locum tenens is a life hack if you can find a good place to practice.
Edit: Oh, and I only work days now.
And I'm paid more hourly than I ever was as a staff physician.
And the hotel is super close to the hospital.
And I don't have to own a car because they rent one for me.
Seriously. Locum tenens is a life hack if you can find a good place to practice.
Edit: Oh, and I only work days now.