PCCM vs CCM Practice Models

[doctorkid]

I was just hoping to get some clarification on the general practice models for people interested in doing Pulm + Crit. I am interested in doing both. When I look at the CCM-only jobs, they're generally "7 on/7 off" or "~15 shift/month" which sounds very reasonable. But when I see job listings for Pulm + Crit, they're often somewhere closer to "2 weeks clinic + 1 week ICU," and it's not clear to me if the 4th week in the month is meant to be your off-week after the ICU, or if it's a 3 week-long rotation and you rotate right back to the clinic after the ICU week. If that's the case, then it seems that the marginal increase in salary from CCM job listings --> PCCM job listings is not worth the extra 10-14 days of work each month.

Is it possible to just sign for a 7/7 CCM job then try to do part-time outpatient Pulm/Sleep/IP during the off weeks for a little supplemental income? Or is the only feasible 7/7 practice model going to be to do ICU full time with per diem shifts on off-weeks for supplemental income?

Thanks in advance for any insight.

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[jdh71]

It’s usually a week off. And that two weeks in clinic usually isn’t 10 full days. Remember clinic weeks don’t have weekend shifts. A lot of times you’d probably add clinics during that week at some point because “why not?” Extra scratch if you want it. At some point clinic becomes easier and adding a few days is NBD if you are in town anyway.

Now I don’t work that kind of schedule exactly. But it’s pretty benign from my perspective depending very heavily on how night call is managed.

 

[doctorkid]

I know that rates for an ICU shift will be very variable based on geography, staffing, etc., but is anyone able to give me a rough estimate range of what I should expect? I have friends doing PCCM fellowships in the Northeast who are making ~$100-150/hr for shifts. I would like to think that an attending would make considerably more per hour, especially outside of the Northeast?

Also, for someone who plans on doing a combined Pulm/Crit job, what’s the typical inpatient expectation? 16-20 weeks in inpatient (ICU, consults, or both) then the remainder in clinic?

Thanks in advance

 

[chessknt]

I know that rates for an ICU shift will be very variable based on geography, staffing, etc., but is anyone able to give me a rough estimate range of what I should expect? I have friends doing PCCM fellowships in the Northeast who are making ~$100-150/hr for shifts. I would like to think that an attending would make considerably more per hour, especially outside of the Northeast?

Also, for someone who plans on doing a combined Pulm/Crit job, what’s the typical inpatient expectation? 16-20 weeks in inpatient (ICU, consults, or both) then the remainder in clinic?

Thanks in advance

It is all over. Pay per hour is a tricky metric especially with bonuses but roughly 200+ per hour is approaching 'fair' for CCM. I don't know fi that is considerably more but in my experience that is usually jobs that are at least paying median + salaries.

Combined pulm crit is becoming less common and at smaller hospitals can involve AM ICU rounds and PM clinic. Otherwise dedicated time in an ICU rotating clinic in weeks off is the other way. This is increasingly being recognized for the scam it is since pure intensivists don't work in their off weeks and many jobs will not give a week off after ICU so you are working >1.0 FTE. This model should pay more but somehow in the employed physician logic does not.

 

[CCM-MD]

Should get ~$200+/hour in most locations for CCM permanent jobs. Locum opportunities can pay close to double. Wouldn’t drop pulmonary completely if you want to go back to it eventually.

 

[pccm_guy]

It is all over. Pay per hour is a tricky metric especially with bonuses but roughly 200+ per hour is approaching 'fair' for CCM. I don't know fi that is considerably more but in my experience that is usually jobs that are at least paying median + salaries.

Combined pulm crit is becoming less common and at smaller hospitals can involve AM ICU rounds and PM clinic. Otherwise dedicated time in an ICU rotating clinic in weeks off is the other way. This is increasingly being recognized for the scam it is since pure intensivists don't work in their off weeks and many jobs will not give a week off after ICU so you are working >1.0 FTE. This model should pay more but somehow in the employed physician logic does not.

What are you saying should be the pay for someone who has a dedicated icu week and weeks in the Pulm clinic? I’m not understanding your comment. Are you saying physicians who work such a schedule are scamming employers or what?

 

[chessknt]

What are you saying should be the pay for someone who has a dedicated icu week and weeks in the Pulm clinic? I’m not understanding your comment. Are you saying physicians who work such a schedule are scamming employers or what?

You work 3 weeks clinic 1 week ICU that is 1.25 fte but you get paid like 1.0 fte. You should've compensated a week off for every week in the ICU but it isn't conducive to good clinic function so hospitals try to spin it as important for patient care so you get to have maybe a day or 2 off or some bull**** instead of the standard week.

Then it gets even more scammy when they put you on a productivity pay model but don't adjust rvu targets so your vacation that you thought was part of your benefit package for being their employee is actually shooting yourself in the foot because you can't hit targets needed to get a bonus if you actually take the vacation.

 

[pccm_guy]

You work 3 weeks clinic 1 week ICU that is 1.25 fte but you get paid like 1.0 fte. You should've compensated a week off for every week in the ICU but it isn't conducive to good clinic function so hospitals try to spin it as important for patient care so you get to have maybe a day or 2 off or some bull**** instead of the standard week.

Then it gets even more scammy when they put you on a productivity pay model but don't adjust rvu targets so your vacation that you thought was part of your benefit package for being their employee is actually shooting yourself in the foot because you can't hit targets needed to get a bonus if you actually take the vacation.

What are your thoughts on the 2 week clinic, 1 week icu and 1 week off after icu model?

 

[chessknt]

What are your thoughts on the 2 week clinic, 1 week icu and 1 week off after icu model?

If you can find it then it is fair on paper at least but there is a lot of nuance. You need to find someone to go over the contract at length for fairness with you if you dont know what to look for.

 

[realrebelohio]

I just took a job in a major city in the south (think dallas, atlanta, nashville) that is 1 week ICU, 1 week Clinic/consults, 1 week ltach, 1 week clinic. 6 weeks off per year. APP's at night in ICU (we'll see how that goes haha) Salary is 460 + productivity. So working hard, but I feel the compensation is fair after reading MGMA data and some baseline negotiating. I got a few offers in the low 4's that were more time off but with less established groups/more eat what you kill models (which I was honestly fine with).

 

[CCM-MD]

I just took a job in a major city in the south (think dallas, atlanta, nashville) that is 1 week ICU, 1 week Clinic/consults, 1 week ltach, 1 week clinic. 6 weeks off per year. APP's at night in ICU (we'll see how that goes haha) Salary is 460 + productivity. So working hard, but I feel the compensation is fair after reading MGMA data and some baseline negotiating. I got a few offers in the low 4's that were more time off but with less established groups/more eat what you kill models (which I was honestly fine with).

It’s fair depending on how your productivity is set up and how generous your bonus will be, otherwise you might be working too much. I know someone who started as an intensivist in Atlanta area: 24 weeks a year for 450k+ bonuses.

 

[Benzo4every1]

15 shifts per month sounds decent. I average out to be that. You can always moonlight if you want more.
I get on the average one week of ICU a month. The rest is clinic and inpt pulm. But each is compartmentalized. You don't ever do pulm and cc on the same day. But clinic follows you everywhere you go.

 

[ldct99]

Is there extra PTO/vacation time with 1 week ICU, 1 week off and 2 weeks office model? Or that 1 week off is considered as PTO/vacation time?