Intensivist salary

[nephrondoc]

Would be applying for a critical care fellowship this year. I was wondering, what would be staring salary in midwest area, assuming i work a week on and a week off. It means 180 days of work a year? Also, if i do pulmonary/critical care, what are the usual schedules like ? Is it more like 5 days a week with some weekends, which would mean a minimum of 260 days a year ? How much is the difference in salary between straight critical care vs pulmonary/critical care ? Do pulmonary/critical care guys have a lot of advantage when applying for an intensivist job?

I believe the salary difference between an intensivist and a pulmonary/critical care specialist is roughly 80k. But, do they work more days in an year than a 1 week on/1 week off intensivist?

Any information would be highly appreciated.

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[Bostonredsox]

This has been discussed alot. I would recommend a Mod moving this to the Critical Care forum to catch the eyes of Hern, JDH, Sluggs, etc. More light will probably be shed in that regard.

My 2 cents....I have offers for week on week off critical care hospitalist near 240-250k. Add in a CC fellowship and its more like 325k for my area (community hospital VA/NC area) If your Pulm/CC, they tend to spend less time in the unit, maybe only 1 week per month, but they add in all their clinic revenue, floor pulm consults, inpt/outpt bronchs and the salary goes much furthur up. If they are also sleep capable it goes even higher. Our Pulm/CC/sleep lady tops 400k and she is only in the unit 7 days/month.

 

[suryapet]

My guess is around 280k for a week on and week off position. Not significantly more than a hospitalist. But, you wont have any social issues

 

[bronx43]

My guess is around 280k for a week on and week off position. Not significantly more than a hospitalist. But, you wont have any social issues

Is this 280k for just intensivist jobs or does this also include outpatient pulm? If it's 280k for a pulm/CC job where you cover the ICU every other week, then it sounds like a rip, especially since you can probably make as much or more as a hospitalist with urgent care moonlighting. (given you can withstand social issues)

 

[jdh71]

Is this 280k for just intensivist jobs or does this also include outpatient pulm? If it's 280k for a pulm/CC job where you cover the ICU every other week, then it sounds like a rip, especially since you can probably make as much or more as a hospitalist with urgent care moonlighting. (given you can withstand social issues)

You add in pulm and you're making a lot more

 

[suryapet]

280k is only for pure intensivist position in midwest , working in 7on/7off schedule with no nights or on call responsibilities. FYI, i am not an intensivist and this is actual data from my senior who started practicing as an intensivist 10 months ago.

 

[Hernandez]

280k is only for pure intensivist position in midwest , working in 7on/7off schedule with no nights or on call responsibilities. FYI, i am not an intensivist and this is actual data from my senior who started practicing as an intensivist 10 months ago.

Then they were.....poor negotiators, unless they also get productivity bonus. Figure ~$2000/12 hour shift. Less if you get bonus or are at academic center, more if in rural area and less base if also receiving productivity.

 

[Bostonredsox]

Then they were.....poor negotiators, unless they also get productivity bonus. Figure ~$2000/12 hour shift. Less if you get bonus or are at academic center, more if in rural area and less base if also receiving productivity.

agreed. Im negotiating with my hospitals pulm/cc grp for post fellowship partnership. and for pure week on week off as micu attending im looking for 330+

for 4 week cycles of 1 week on MICU, week off, 2 weeks pulm In + Out, im looking for much higher

 

[dozitgetchahi]

agreed. Im negotiating with my hospitals pulm/cc grp for post fellowship partnership. and for pure week on week off as micu attending im looking for 330+

for 4 week cycles of 1 week on MICU, week off, 2 weeks pulm In + Out, im looking for much higher

Holy ****.

This sounds like a terrific schedule with a variety of practice arenas and great income potential. Everyone keeps telling me that pulm/ccm sucks from a lifestyle/income standpoint, but this sounds pretty damn good to me - and I like pulm and ccm. I always thought it would be neat to do it, but the ongoing negativity about lifestyle within the specialty made me think it wasn't worth it.

So....what's the catch? Why isn't pulm/ccm more competitive? Everyone seems to chase money, and it looks like it's really hard to make this sort of money in IM outside of cards or GI...

 

[bronx43]

agreed. Im negotiating with my hospitals pulm/cc grp for post fellowship partnership. and for pure week on week off as micu attending im looking for 330+

for 4 week cycles of 1 week on MICU, week off, 2 weeks pulm In + Out, im looking for much higher

What city are you in? In my town (mid-sized city in the Midwest), the average for pulm/CC seems to be around 250k for CC alone. Pulm seems to add another 50-75k.

 

[suryapet]

What city are you in? In my town (mid-sized city in the Midwest), the average for pulm/CC seems to be around 250k for CC alone. Pulm seems to add another 50-75k.

250 seems too low for an intensivist in midwest...hospitalists are easily making 230-240k in midwest for a 7on/7off position....i guess 300-325 might be a reasonable salary for an intensivist.

 

[bronx43]

250 seems too low for an intensivist in midwest...hospitalists are easily making 230-240k in midwest for a 7on/7off position....i guess 300-325 might be a reasonable salary for an intensivist.

The hospitalists in my town are pulling 200-220k for a 15-18 shift month. I don't know what the schedules are like for the 250k ICU jobs, but the number seems pretty consistent with the medscape salary survey for 2012 in the Midwest.

 

[Hernandez]

The hospitalists in my town are pulling 200-220k for a 15-18 shift month. I don't know what the schedules are like for the 250k ICU jobs, but the number seems pretty consistent with the medscape salary survey for 2012 in the Midwest.

For $250k/year, I'd be working less than 3 months a year.....

Ok, that's a little bit bravado, but like I've said before, I didn't even bother to talk to places paying less than $2000/shift plus benefits & malpractice covered. I know of a place offering nocturnists $3000/shift plus malpractice/benefits

 

[RemyMcswain]

For $250k/year, I'd be working less than 3 months a year.....

Ok, that's a little bit bravado, but like I've said before, I didn't even bother to talk to places paying less than $2000/shift plus benefits & malpractice covered. I know of a place offering nocturnists $3000/shift plus malpractice/benefits

How long is a shift, 12Hrs? For 3000$ for 12Hrs, I would consider doing nocturnist work

 

[Hernandez]

How long is a shift, 12Hrs? For 3000$ for 12Hrs, I would consider doing nocturnist work

Yup.

 

[bronx43]

For $250k/year, I'd be working less than 3 months a year.....

Ok, that's a little bit bravado, but like I've said before, I didn't even bother to talk to places paying less than $2000/shift plus benefits & malpractice covered. I know of a place offering nocturnists $3000/shift plus malpractice/benefits

That's more lucrative than I previously thought, probably because the academic ICU attendings at my institution barely pull 200k. But then again, they are on service MAYBE one week every 3 months.

How many shifts do you typically do a month? Do you do any pulm work?

 

[Bostonredsox]

my plans in discussion with my current shop to return post fellowship are for week on week off coverage as the MICU attending. Covering all MICU pts, all CC consults, all floor pulm consults and rounding on the floor pulm pts. (there are 4-5 residents on MICU and 1-2 on inpt pulm service doing the scutwork). My demands are 2k per shift + benefits and malpractice. Plus the option to work extra shifts on offweek for the same 2k per if there are open shifts 2/2 vacations. Community hospital. IM program, no fellows. 250beds. 19 bed unit. That comes out to base 183 shifts per year, $369,000 salary. The trick I am working on is I want $69,000/year as a fellow and $300,000/year the first 3 attending years. If that goes down I will be in good shape with wife/kids and overall family dynamic. Now I just need to actually match.....

 

[suryapet]

my plans in discussion with my current shop to return post fellowship are for week on week off coverage as the MICU attending. Covering all MICU pts, all CC consults, all floor pulm consults and rounding on the floor pulm pts. (there are 4-5 residents on MICU and 1-2 on inpt pulm service doing the scutwork). My demands are 2k per shift + benefits and malpractice. Plus the option to work extra shifts on offweek for the same 2k per if there are open shifts 2/2 vacations. Community hospital. IM program, no fellows. 250beds. 19 bed unit. That comes out to base 183 shifts per year, $369,000 salary. The trick I am working on is I want $69,000/year as a fellow and $300,000/year the first 3 attending years. If that goes down I will be in good shape with wife/kids and overall family dynamic. Now I just need to actually match.....

If your ICU has 19 beds and if you also have to do pulmonary consults on the floor, that seems like a lot of work. How many patients are you expected to see, both ICU and floor consults included?

 

[RemyMcswain]

my plans in discussion with my current shop to return post fellowship are for week on week off coverage as the MICU attending. Covering all MICU pts, all CC consults, all floor pulm consults and rounding on the floor pulm pts. (there are 4-5 residents on MICU and 1-2 on inpt pulm service doing the scutwork). My demands are 2k per shift + benefits and malpractice. Plus the option to work extra shifts on offweek for the same 2k per if there are open shifts 2/2 vacations. Community hospital. IM program, no fellows. 250beds. 19 bed unit. That comes out to base 183 shifts per year, $369,000 salary. The trick I am working on is I want $69,000/year as a fellow and $300,000/year the first 3 attending years. If that goes down I will be in good shape with wife/kids and overall family dynamic. Now I just need to actually match.....

Thanks for sharing that dude.

Were there similar job offers in more desirable cities or community hospitals with no IM residency, but PA/NP service?

Thanks

 

[Bostonredsox]

If your ICU has 19 beds and if you also have to do pulmonary consults on the floor, that seems like a lot of work. How many patients are you expected to see, both ICU and floor consults included?

Can be up to 30. Unit usually runs around 12 pts I will be primary on. Plus 2-3 I'm consult on. Pulm service will have 6-9 + 2-4 new consults. Highest I've seen for unit encounters in a day was 20 and for pulm is 15. But remember, residents are writing the notes, h/p, dc summaries and consults on both services. No paperwork on my end makes it smoother.

But yes they will be long days. But that's why I have every other week off.

370k for 4 week blocks of 90 hours - 0 - 90 - 0. That's basically 45hrs/wk for 370k. I'm solid with that

 

[Bostonredsox]

Thanks for sharing that dude.

Were there similar job offers in more desirable cities or community hospitals with no IM residency, but PA/NP service?

Thanks

Dunno. Based on my current hospitalist contract my fellowship can only work out if the hospital subsidizes part of it and I join with them after, so I'm not considering other offers atleast for the first 3 years I will owe here.

 

[inspirationmd]

Dunno. Based on my current hospitalist contract my fellowship can only work out if the hospital subsidizes part of it and I join with them after, so I'm not considering other offers atleast for the first 3 years I will owe here.

How easy is it to line fellowship supplementation up?

 

[Hernandez]

Were there similar job offers in more desirable cities or community hospitals with no IM residency, but PA/NP service?

No.

And why would you want to work with a Midlevel? They're extenders, not over paid note writers, it isn't that hard to manage a 15-20 bed ICU alone.

 

[Bostonredsox]

How easy is it to line fellowship supplementation up?

depends. my current residency shop needs pulm/cc badly. they have been recruiting for several years and have no replacements. One of is down to seeing like 8 a day in clinic 4 1/2 days a week...one is in his 60s and looking at retirement in 5 years and the other is sort of in her prime. To them, they get someone who they know well, who has worked their system well, and who gets along well with the 2 current pulm/cc attendings. And if they are gonna pay 350k/yearly for 3 year contract...what does it matter to them if they pay 50k/yr during fellowship and 300k/yr after? the contract still stands as I have to work for them and the total $ over the deal is the same.

 

[RemyMcswain]

No.

And why would you want to work with a Midlevel? They're extenders, not over paid note writers, it isn't that hard to manage a 15-20 bed ICU alone.

It would be nice if I didnt have to do intern activities when I am an attending. Its not the patient volume.

 

[gutonc]

It would be nice if I didnt have to do intern activities when I am an attending. Its not the patient volume.

You'd be surprised how much nurses out in the community can and will do on their own compared to in academics. I'm not in CC but pretty much all the "intern work" I have to do is write a daily note (5, maybe 10 min per patient) and orders (another 5 min per patient). It's actually called "patient care".

 

[NNguyenMD]

I posted on this topic in another thread, but the gist of it is that intensivist pay and schedule is highly variable. There is a low and and a high end for starting intensivists who are IM trained, and do not hold down a pulmonary practice.

But the general idea is that large academic institutions pay the lowest, and start you at roughly
~$200,000, +/- $20,000 as a clinical instructor. Some jobs are pure salary, and some offer productivity bonuses. The highest paying jobs are private groups where your pay is linked to your productivity and you can easily earn in the 300's if not higher. There are private jobs that are pure salary, and pay you per shift. Most private jobs ask for at least 14 shifts a month. I have seen shift pay range from $1400 to 2000.

The advantage to private or HMO jobs over academic is that when you are off you are off. Academic jobs will require you to fufill additional obligations in addition to your clinical work. If you are interested in research or graduate education, you can ask any academic faculty how extraordinarily difficult it is to obtain support from your leadership when you haven't yet secured any grants.

Many jobs I interviewed for were not pure 7 on and 7 off. The schedule largely depends what the partners decide is fair. If you have a group that is a mix of PCCM and CCM, this can be quite complicated, as PCCM physicians will often also maintain a pulmonary and/or sleep practice. There are private jobs that specifically will not let you do week on/off blocks due to concerns of fatigue and burn out. Some schedules are pure 12hrs day or night. Some groups require you to do a number of "swing" or half shifts. Some are 10 hrs in the day, and home call through the next morning.

There are a lot of considerations to think about than just the salary. Some jobs offer excellent benefits and retirement, these tend to pay in the middle salaray range. The ones that don't offer many benefits tended to have the higher starting salaries, but no retirement, limited health coverage, and no 401K.

Everyone has their own ideal job. You have to decide if you want to still take care of super high acuity patients at major referral centers, or if you prefer a lower acuity hospital. Some jobs are heavily tilted toward CTICU and SICU care, others will be exclusively MICU. You have to decide if you still want to work with house staff and/or physician extenders, or if you prefer to work on your own. But most importantly, you have to like the people you work with, especially your partners. I would say that this is one of the most important components of a good job. Working with people you dislike will only add to your unhappiness, its important to get a feel of what your partners are like. And it is ok to visit a job site multiple times to get an idea of what its like working there.

 

[GeekDoc]

I posted on this topic in another thread, but the gist of it is that intensivist pay and schedule is highly variable. There is a low and and a high end for starting intensivists who are IM trained, and do not hold down a pulmonary practice.

But the general idea is that large academic institutions pay the lowest, and start you at roughly
~$200,000, +/- $20,000 as a clinical instructor. Some jobs are pure salary, and some offer productivity bonuses. The highest paying jobs are private groups where your pay is linked to your productivity and you can easily earn in the 300's if not higher. There are private jobs that are pure salary, and pay you per shift. Most private jobs ask for at least 14 shifts a month. I have seen shift pay range from $1400 to 2000.

The advantage to private or HMO jobs over academic is that when you are off you are off. Academic jobs will require you to fufill additional obligations in addition to your clinical work. If you are interested in research or graduate education, you can ask any academic faculty how extraordinarily difficult it is to obtain support from your leadership when you haven't yet secured any grants.

Many jobs I interviewed for were not pure 7 on and 7 off. The schedule largely depends what the partners decide is fair. If you have a group that is a mix of PCCM and CCM, this can be quite complicated, as PCCM physicians will often also maintain a pulmonary and/or sleep practice. There are private jobs that specifically will not let you do week on/off blocks due to concerns of fatigue and burn out. Some schedules are pure 12hrs day or night. Some groups require you to do a number of "swing" or half shifts. Some are 10 hrs in the day, and home call through the next morning.

There are a lot of considerations to think about than just the salary. Some jobs offer excellent benefits and retirement, these tend to pay in the middle salaray range. The ones that don't offer many benefits tended to have the higher starting salaries, but no retirement, limited health coverage, and no 401K.

Everyone has their own ideal job. You have to decide if you want to still take care of super high acuity patients at major referral centers, or if you prefer a lower acuity hospital. Some jobs are heavily tilted toward CTICU and SICU care, others will be exclusively MICU. You have to decide if you still want to work with house staff and/or physician extenders, or if you prefer to work on your own. But most importantly, you have to like the people you work with, especially your partners. I would say that this is one of the most important components of a good job. Working with people you dislike will only add to your unhappiness, its important to get a feel of what your partners are like. And it is ok to visit a job site multiple times to get an idea of what its like working there.

This is well thought out, and incredibly informative. Its hard for people not to just see $$ after a decade of eating Ramen for dinner. There is so much more to compensation packages than base salary. Thank you for addressing this more eloquently than I could!

 

[suryapet]

Any more new inputs ? Maybe, the class for 2014 can add more information based what sort of offers they are getting?

 

[FattySlug]

I have the same question and would appreciate any input. So pure intensivist is about 250k-280k and if you have a pul clinic that adds around 80k? A friend of my older brother's is doing pul/cc in south California and says he is making close to 500k in private practice. Does it sound possible to you guys??

 

[Hernandez]

Yes it's possible but would be a very busy practice. Unless there are other revenue streams in the practice.

 

[Handsome88]

I have the same question and would appreciate any input. So pure intensivist is about 250k-280k and if you have a pul clinic that adds around 80k? A friend of my older brother's is doing pul/cc in south California and says he is making close to 500k in private practice. Does it sound possible to you guys??

250-280k for plain CCM and 360k+ for Pulm/CC!?

 

[Hernandez]

250-280k for plain CCM and 360k+ for Pulm/CC!? That's just as much as if not more than what an average cardiologist brings in...working half the amount of time!.

A hospitalist can earn not much less than $250 working 7 on 7 off. And no one said pulm/cc makes 360 working 7/7. And I suspect your cards numbers are likely low

 

[FattySlug]

250-280k for plain CCM and 360k+ for Pulm/CC!?

That's the number I have been hearing about in this forum. From one thread that I now couldn't find the link to.

A hospitalist can earn not much less than $250 working 7 on 7 off. And no one said pulm/cc makes 360 working 7/7. And I suspect your cards numbers are likely low

By 7/7 you mean 7 on 7 off? I am sure the pulm/cc guy I know is not doing that. He is working full time. He just told me recently in SoCal if you do private practice, the pay ranges from 300k to 700k. I just want to hear opinion from different sources on here. Thank you.

 

[Hernandez]

By 7/7 you mean 7 on 7 off? I am sure the pulm/cc guy I know is not doing that. He is working full time. He just told me recently in SoCal if you do private practice, the pay ranges from 300k to 700k. I just want to hear opinion from different sources on here. Thank you.

If you're doing more pulm than CC, it's not likely you will make $350 doing 7 on 7 off, I had co-follow make that doing pure CC 14 shifts a month, pulm salary depends on the set up (how much in patient vs out pt vs CC), depends on the location and "desirability" of the location.

 

[jdh71]

By 7/7 you mean 7 on 7 off? I am sure the pulm/cc guy I know is not doing that. He is working full time. He just told me recently in SoCal if you do private practice, the pay ranges from 300k to 700k. I just want to hear opinion from different sources on here. Thank you.

700? Maybe as a senior partner in a lucrative private practice. You might be able to find the 300 end doing 7 on 7 off, half ICU, half pulm, but I sort of doubt much higher than that and in southern california?? What area? Chino?

 

[Postictal Raiden]

700? Maybe as a senior partner in a lucrative private practice. You might be able to find the 300 end doing 7 on 7 off, half ICU, half pulm, but I sort of doubt much higher than that and in southern california?? What area? Chino?

Chino is not a bad area. Housing prices there have gone up dramatically. Areas such as Indio, Palm Springs, and San Bernardino, on the other hand, are...

 

[jdh71]

Chino is not a bad area. Housing prices there have gone up dramatically. Areas such as Indio, Palm Springs, and San Bernardino, on the other hand, are...

The hills were nice. But chino itself?? Lol. Pass. But my point stands.

 

[FattySlug]

700? Maybe as a senior partner in a lucrative private practice. You might be able to find the 300 end doing 7 on 7 off, half ICU, half pulm, but I sort of doubt much higher than that and in southern california?? What area? Chino?

He is in a private group down near OC and he is not a senior partner. I know the guy who does his taxes so 600k must be pretty close to his income. I doubt this is the norm though. Just wanna hear how much people are making with Pul/CCM combined. Thanks.

 

[tartesos]

He is in a private group down near OC and he is not a senior partner. I know the guy who does his taxes so 600k must be pretty close to his income. I doubt this is the norm though. Just wanna hear how much people are making with Pul/CCM combined. Thanks.

It all depends. You can negotiate and find the best opportunity and it varies, they usually use mgma data.
Last numbers I saw for 2013 median salary for Pulm Ccm was 386 k.
A recruiter let me take a picture of the numbers.

That's only one of the factors used to negotiate your pay, and in the end, salary is not the only factor to consider.
I saw my dream job in a 35k pop town, great people, great hospital, awesome schedule, good $, but schools were badly rated( only had public schools) and good ones entailed a 55m commute each way... And a happy wife.... You all know the rest.