Is this a good Job for a BC/BE intensivist?

[crafted222]

Community ICU job located in the Midwest (remote, cold)
Closed ICU, 15 bed, average census 9-10
24wks/yr, with paid time off
7 on/7 off, 7am-7pm; 1 intensivist/shift, offer for daytime only, No night calls
Will cover rapid response and codes
Separate night intensivist
No NP/PA; No residents
250 bed hospital
Base W2 pay: 432k/yr (2019 Midwest MGMA median = 424k/yr)
401k/503b/457b matching etc

The rapids/codes is an issue for me; how often do community intensivists cover rapids and codes? what happens if a patient is crashing in the ICU and a code is called at same time, since no resident or PA? All these while in training, there have been other fellows/resident/attending around.
Still negotiating with recruiter about other benefits like sign on bonus, potential to raise base pay further given remote location, and vacation instead of paid time off.

Anything else I'm missing?

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[Dr.CCM]

Community ICU job located in the Midwest (remote, cold)
Closed ICU, 15 bed, average census 9-10
24wks/yr, with paid time off
7 on/7 off, 7am-7pm; 1 intensivist/shift, offer for daytime only, No night calls
Will cover rapid response and codes
Separate night intensivist
No NP/PA; No residents
250 bed hospital
Base W2 pay: 432k/yr (2019 Midwest MGMA median = 424k/yr)
401k/503b/457b matching etc

The rapids/codes is an issue for me; how often do community intensivists cover rapids and codes? what happens if a patient is crashing in the ICU and a code is called at same time, since no resident or PA? All these while in training, there have been other fellows/resident/attending around.
Still negotiating with recruiter about other benefits like sign on bonus, potential to raise base pay further given remote location, and vacation instead of paid time off.

Anything else I'm missing?

While some of this job looks good, I’d be concerned about the rapid response requirement. See if you can negotiate a fee per rapid response because that’s kind of ridiculous for a physician to go to all RRTs which are protocolized nursing care imo. As far as codes go, each hospital I work at the Intensivist responds to all those. I’d def look for higher base pay if you are remote (not sure how far from major city) and 4 weeks vacation. Days only is pretty good though and no night time call. Good luck.

 

[CCM-MD]

At my current hospital (and previous), we respond to codes in the ICU. Hospitalists responded to codes on the floor. ER responds to codes in the ER. Rapids managed by hospitalists.

 

[crafted222]

While some of this job looks good, I’d be concerned about the rapid response requirement. See if you can negotiate a fee per rapid response because that’s kind of ridiculous for a physician to go to all RRTs which are protocolized nursing care imo. As far as codes go, each hospital I work at the Intensivist responds to all those. I’d def look for higher base pay if you are remote (not sure how far from major city) and 4 weeks vacation. Days only is pretty good though and no night time call. Good luck.

It's about 4hrs form a major city.
The days only part is one of the main draws, and I like small towns.
I'll surely be negotiating more on the rapids/codes

 

[crafted222]

At my current hospital (and previous), we respond to codes in the ICU. Hospitalists responded to codes on the floor. ER responds to codes in the ER. Rapids managed by hospitalists.

This is the setup I'm used to in training as well. Though, I have been at mostly academic centers.

 

[chocomorsel]

It's about 4hrs form a major city.
The days only part is one of the main draws, and I like small towns.
I'll surely be negotiating more on the rapids/codes

How did you find out about this job?
Hell no to RR but codes shouldn’t be a big deal.
What’s the closest airport? How large of a town?
And what’s the difference between paid time off and Vacation anyway?

 

[psychbender]

You might want to clarify the rapid response and code bit with the unit director. Maybe they meant that you go to rapids when requested, to facilitate transfer to the unit? For a hospital and ICU of the size you mention, though, it may not be that much of an issue, anyway.

Sent from my SM-G930V using SDN mobile

 

[CCM-MD]

This is the setup I'm used to in training as well. Though, I have been at mostly academic centers.

Both my previous and current hospitals are community hospitals.

Given your hospital is 4 hours from a major city, you might have some leverage negotiating the terms. Rapid responses have the potential for abuse and could get frustrating.

 

[BicepsTriceps]

I wouldn't agree to a hospitalist job that requires me to respond to rapid responses let alone an intensivist one.

RRTs should be residents/ nurses thing. Attendings shouldn't be bothered unless own patient or requested by the RRT.

It's gonna make your job way harder that it should be.

But for half a million a year working every other week maybe??

 

[crafted222]

How did you find out about this job?
Hell no to RR but codes shouldn’t be a big deal.
What’s the closest airport? How large of a town?
And what’s the difference between paid time off and Vacation anyway?

Paid time off is them giving extra 2wks of pay instead of dedicated 2wks of vacation. Nice thing is the offer is for 24wks/yr rather than 26wks/yr. Hence, a 2wks-off is already baked in the offer/yr, meaning when combined with a regular 1wk-off, can translate to a 3wk stretch of vacation (or 4wks if the regular 1wk-off is on both ends of the 2wk-off).
Small town, with closest airport about 45mins away, so doable for travels. Heard about openings mostly from program grads.

 

[chocomorsel]

Paid time off is them giving extra 2wks of pay instead of dedicated 2wks of vacation. Nice thing is the offer is for 24wks/yr rather than 26wks/yr. Hence, a 2wks-off is already baked in the offer/yr, meaning when combined with a regular 1wk-off, can translate to a 3wk stretch of vacation (or 4wks if the regular 1wk-off is on both ends of the 2wk-off).
Small town, with closest airport about 45mins away, so doable for travels. Heard about openings mostly from program grads.

Paid time off and vacation is the same thing if you are talking of salaried positions.

In the context of what you are saying, unless they are specifically not going to pay you for those two weeks you take off, it is the exact same thing.

Sounds like a very doable job. I would say no to Rapid response but maybe try to negotiate a little bit more for codes? Either way, without rapid response it sounds very doable. I can’t seem to find a job that gives any actual vacation time besides the week off between shifts and that’s not vacation. Seems like doctors are totally OK with working the equivalent of working the equivalent of 42-44 hours a week for 52 weeks a year and then boasting about 26 weeks off. I don’t get

What state is this? Sounds very similar to a place I am interviewing in next month in the Dakotas.

To me it sounds like a pretty nice gig. Lots of ICU gigs will pay similar but expect you to see about 16 patients a day and no vacation.

 

[crafted222]

Paid time off and vacation is the same thing if you are talking of salaried positions.

In the context of what you are saying, unless they are specifically not going to pay you for those two weeks you take off, it is the exact same thing.

Sounds like a very doable job. I would say no to Rapid response but maybe try to negotiate a little bit more for codes? Either way, without rapid response it sounds very doable. I can’t seem to find a job that gives any actual vacation time besides the week off between shifts and that’s not vacation. Seems like doctors are totally OK with working the equivalent of working the equivalent of 42-44 hours a week for 52 weeks a year and then boasting about 26 weeks off. I don’t get

What state is this? Sounds very similar to a place I am interviewing in next month in the Dakotas.

To me it sounds like a pretty nice gig. Lots of ICU gigs will pay similar but expect you to see about 16 patients a day and no vacation.

This one is in Michigan.
yes, no vacation can be quite an issue

 

[chocomorsel]

This one is in Michigan.
yes, no vacation can be quite an issue

But it’s very common. I say doctors are idiots for accepting these gigs and boasting about 26 weeks of vacation. That ain’t no vacation.
Let me know if you don’t take it, or you got other hookups.

 

[CCM-MD]

This one is in Michigan.
yes, no vacation can be quite an issue

Careful if this is in Marquette. I know about this spot.

 

[crafted222]

Careful if this is in Marquette. I know about this spot.

Not in Marquette, but good to know where to stay away from.
In terms of caution, what crucial red flags would you advice to look out for in terms of liability in general?
-specialist support-mostly procedural-GI bleed/STEMI especially?, ECMO availability?, anesthesia support?

 

[CCM-MD]

Not in Marquette, but good to know where to stay away from.
In terms of caution, what crucial red flags would you advice to look out for in terms of liability in general?
-specialist support-mostly procedural-GI bleed/STEMI especially?, ECMO availability?, anesthesia support?

Would be good to have support from surgeons and other specialists but most community hospitals will not be able to provide every available therapy and have every specialist. If you really need something or someone that you don’t have, you may have to transfer.

 

[Hamhock]

Careful if this is in Marquette. I know about this spot.

What's up with Marquette?

HH

 

[CCM-MD]

What's up with Marquette?

HH

Adfinitas is shady.

 

[deleted171991]

Community ICU job located in the Midwest (remote, cold)
Closed ICU, 15 bed, average census 9-10
24wks/yr, with paid time off
7 on/7 off, 7am-7pm; 1 intensivist/shift, offer for daytime only, No night calls
Will cover rapid response and codes
Separate night intensivist
No NP/PA; No residents
250 bed hospital
Base W2 pay: 432k/yr (2019 Midwest MGMA median = 424k/yr)
401k/503b/457b matching etc

The rapids/codes is an issue for me; how often do community intensivists cover rapids and codes? what happens if a patient is crashing in the ICU and a code is called at same time, since no resident or PA? All these while in training, there have been other fellows/resident/attending around.
Still negotiating with recruiter about other benefits like sign on bonus, potential to raise base pay further given remote location, and vacation instead of paid time off.

Anything else I'm missing?

That's a lot of work for that money and area and 24 weekends a year. It's actually worse than alternating between night and day shifts. There is probably a reason the night intensivists don't want to work days. I would ask for 80-90% MGMA.

Running to every RR can be scutwork in community hospitals, which call a rapid response for every BS (especially with 250 beds). The only thing you should cover are RR/codes IN THE ICU. Everything else - hospitalist. Same goes for probably having to practice antiquated critical care, not because of the lack of technology, but the lack of IQ of pharmacy, nurses, bureaucrats etc. in a non-academic setting.

Get EVERYTHING you want included in the contract. If it's not in the contract, it will never happen. I would also assume that the average census is more like 15 (margin of safety) and negotiate based on that (or include extra salary for whenever the census is above 10 etc). Sounds like it's a doctor's market; don't sell yourself short. There are enough other CCM jobs in the country.

This is not a job that will open doors for your future. Don't compromise unless it's worth it. If everybody takes 50% MGMA, it basically decreases everybody's salary big time, over the years. They are using a recruiter, meaning that people are not lining up to work there.

 

[Splenda88]

But it’s very common. I say doctors are idiots for accepting these gigs and boasting about 26 weeks of vacation. That ain’t no vacation.
Let me know if you don’t take it, or you got other hookups.

I don't think doctors see that as 26 wks vacation. It's the flexibility of having 7 days off in a row that makes it appealing.

I would rather work an extra 2 days/wk and having 7 days off in a row than working M-F with weekends off. Some of these 7 days on/off jobs are 7-5pm, but you are responsible to answer call until 7pm.

I agree that not having at least a 1 month vacation should be a deal breaker...


I don't think OP's offer is that great based on hospitalist offers (300-350k with NP/PA help) that PGY3 in my programs are getting in rural areas in the south...

 

[Hamhock]

Community ICU job located in the Midwest (remote, cold)
Closed ICU, 15 bed, average census 9-10
24wks/yr, with paid time off
7 on/7 off, 7am-7pm; 1 intensivist/shift, offer for daytime only, No night calls
Will cover rapid response and codes
Separate night intensivist
No NP/PA; No residents
250 bed hospital
Base W2 pay: 432k/yr (2019 Midwest MGMA median = 424k/yr)
401k/503b/457b matching etc

The rapids/codes is an issue for me; how often do community intensivists cover rapids and codes? what happens if a patient is crashing in the ICU and a code is called at same time, since no resident or PA? All these while in training, there have been other fellows/resident/attending around.
Still negotiating with recruiter about other benefits like sign on bonus, potential to raise base pay further given remote location, and vacation instead of paid time off.

Anything else I'm missing?

Rapid-fire responses/thoughts (haven't read the other responses carefully; maybe redundant!):
- 432 is not that different (absolute) than the midwest median 424 (yes, I don't know the mean or sd)
- yet W2 with matching could WAY offset this (% matters) depending if you are a FIRE-type or "lifer"
- rapid response, as typically known/defined, is not worth it
- no nights, as I get older, is way worth it -- but this MUST be negotiable
- you haven't let me know if you may bill for patients on top of salary -- this is THE most important factor (esp if there's a reasonable payor mix)
- 24w at this salary is less, hourly, than five jobs I am aware of in prime coastal CA (with CA taxes); but if I worked 24w at these jobs, I am making >550K

HH

 

[chocomorsel]

Rapid-fire responses/thoughts (haven't read the other responses carefully; maybe redundant!):
- 432 is not that different (absolute) than the midwest median 424 (yes, I don't know the mean or sd)
- yet W2 with matching could WAY offset this (% matters) depending if you are a FIRE-type or "lifer"
- rapid response, as typically known/defined, is not worth it
- no nights, as I get older, is way worth it -- but this MUST be negotiable
- you haven't let me know if you may bill for patients on top of salary -- this is THE most important factor (esp if there's a reasonable payor mix)
- 24w at this salary is less, hourly, than five jobs I am aware of in prime coastal CA (with CA taxes); but if I worked 24w at these jobs, I am making >550K

HH

Ok, but how about the Midwest? Let’s not compare apples to oranges.
What should this person be looking for salary wise in the Midwest?