Realistic hourly rate for nocturnist locums?

[Vivid_Quail]

What is a realistic hourly rate these days for nocturnist locum jobs? I am thinking specifically suburban/rural and open ICU (I imagine this setting pays the most but I could be wrong). Ideally jobs that are open to both FM and IM. I am posting this on the IM forum since you all do much more hospitalist work than FM on average.

My very uneducated guess is $170-180/hr based on what full-time nocturnists make yearly. But, it would be sweet if it was more like $200+/hr

Also, did locums jobs dry up this past year with COVID? I have heard that the EM market has been destroyed, especially locums. I would imagine hospitalists still have had plenty of patients to admit this past year though, for better or worse.

Thanks!

P.s. I am just a naive med student so please don't bite my head off.

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[chessknt]

What is a realistic hourly rate these days for nocturnist locum jobs? I am thinking specifically suburban/rural and open ICU (I imagine this setting pays the most but I could be wrong). Ideally jobs that are open to both FM and IM. I am posting this on the IM forum since you all do much more hospitalist work than FM on average.

My very uneducated guess is $170-180/hr based on what full-time nocturnists make yearly. But, it would be sweet if it was more like $200+/hr

Also, did locums jobs dry up this past year with COVID? I have heard that the EM market has been destroyed, especially locums. I would imagine hospitalists still have had plenty of patients to admit this past year though, for better or worse.

Thanks!

P.s. I am just a naive med student so please don't bite my head off.

What is the point of asking this question as a medical student? Any answer given now will be inaccurate by the time it would apply to you assuming you even want to work nights covering an open ICU which is a horrendous setup.

 

[Vivid_Quail]

What is the point of asking this question as a medical student? Any answer given now will be inaccurate by the time it would apply to you assuming you even want to work nights covering an open ICU which is a horrendous setup.

You're right. I should just YOLO into the specialty that seems the most interesting during a 4-week rotation at an academic mothership, and ignore potential compensation and lifestyle.

Sarcasm aside, are you seriously giving me a hard time for trying to research the possibilities in a specialty? Choosing a specialty is the most important decision we make as medical students.

24-hr shifts + open ICU are common in rural areas, which is where I want to work. I added nights/nocturnist because I know that pays more, and I want to work part-time as soon as possible.

 

[chessknt]

You're right. I should just YOLO into the specialty that seems the most interesting during a 4-week rotation at an academic mothership, and ignore potential compensation and lifestyle.

Sarcasm aside, are you seriously giving me a hard time for trying to research the possibilities in a specialty? Choosing a specialty is the most important decision we make as medical students.

24-hr shifts + open ICU are common in rural areas, which is where I want to work. I added nights/nocturnist because I know that pays more, and I want to work part-time as soon as possible.

You aren't researching a specialty you are asking a question that should have literally no bearing on making a specialty choice. Is that what you are going to tell PDs at your interview--I am really interested in IM because I can make 185/hr doing locums nights with open ICU in 3 years and only work part time!!

Go do derm or neurosurgery, work full time for 3 years and earn what your night locums would make in 10 years boom done good bye.

You have no idea what rural ICU work is going to be like. How many patients have you taken care of that died at your hands?

 

[Vivid_Quail]

You aren't researching a specialty you are asking a question that should have literally no bearing on making a specialty choice. Is that what you are going to tell PDs at your interview--I am really interested in IM because I can make 185/hr doing locums nights with open ICU in 3 years and only work part time!!

Go do derm or neurosurgery, work full time for 3 years and earn what your night locums would make in 10 years boom done good bye.

You have no idea what rural ICU work is going to be like. How many patients have you taken care of that died at your hands?

Could you please just let someone who isn't so bitter answer my question?

What I research in a specialty does not mean that is the only reason I am interested in it nor will that be what I talk about in a residency interview.

I wish matching derm and nsgy was just as easy as matching FM or IM! Not everyone is competitive for those specialties, nor am I interested in them personally. Realistically though, I could be halfway to early retirement with IM/FM by the time I finish neurosurgery fellowship at PGY-8 or whatever.

It is funny because this question is totally valid if hid my flair. But you saw my "Medical Student" flair and thought it was a good opportunity to pick on a med student and make yourself feel better.

 

[chessknt]

Could you please just let someone who isn't so bitter answer my question?

What I research in a specialty does not mean that is the only reason I am interested in it nor will that be what I talk about in a residency interview.

I wish matching derm and nsgy was just as easy as matching FM or IM! Not everyone is competitive for those specialties, nor am I interested in them personally. Realistically though, I could be halfway to early retirement with IM/FM by the time I finish neurosurgery fellowship at PGY-8 or whatever.

It is funny because this question is totally valid if hid my flair. But you saw my "Medical Student" flair and thought it was a good opportunity to pick on a med student and make yourself feel better.

The answer to your question is-it depends and it would be reasonable to expect 200/hr 1099. Good luck with life and need to check your sensitivities before you start residency.

 

[Redpancreas]

What is a realistic hourly rate these days for nocturnist locum jobs? I am thinking specifically suburban/rural and open ICU (I imagine this setting pays the most but I could be wrong). Ideally jobs that are open to both FM and IM. I am posting this on the IM forum since you all do much more hospitalist work than FM on average.

My very uneducated guess is $170-180/hr based on what full-time nocturnists make yearly. But, it would be sweet if it was more like $200+/hr

Also, did locums jobs dry up this past year with COVID? I have heard that the EM market has been destroyed, especially locums. I would imagine hospitalists still have had plenty of patients to admit this past year though, for better or worse.

Thanks!

P.s. I am just a naive med student so please don't bite my head off.

For what it's worth, I had the same question and I'm not even interested in hospitalist medicine. I think it's a good thing to discuss but I get how it comes off as naive akin to pre-meds who ask how many Ferraris a neurosurgeon owns. Thanks @chessknt for the answer. No one's saying the work isn't hard and agree that I don't have a true scope of that yet.

 

[Vivid_Quail]

The answer to your question is-it depends and it would be reasonable to expect 200/hr 1099. Good luck with life and need to check your sensitivities before you start residency.

Thanks.

I don't think I was being overly sensitive--you were being needlessly hostile. Any question a med student asks can be answered with "you have no idea what X is even like" and most of the time you aren't technically wrong. Med students don't know ****, doesn't mean we aren't curious.

SDN is a place for us to ask questions questions to attendings/residents without our actual attendings giving us bad evals. If I asked my attending on IM how much I could make doing part-time locums for 10 years because I want to retire in Mexico when I am 40, he would probably fail me and/or get a psych consult on me. On SDN, I would still get called an idiot for the question but at least I might get an hourly rate along the way lol.

Maybe you can get away with being a jerk in the hospital by telling students they have no idea what they are interested in and their questions are stupid, but the more reasonable thing to do is just answer the question, THEN ask "have you worked in a rural hospital before? have you considered a higher paying specialty?"

You have no idea what rural ICU work is going to be like.

I probably have a better idea than you think I do, but you didn't care to ask before talking down to me.

 

[chessknt]

For what it's worth, I had the same question and I'm not even interested in hospitalist medicine. I think it's a good thing to discuss but I get how it comes off as naive akin to pre-meds who ask how many Ferraris a neurosurgeon owns. Thanks @chessknt for the answer. No one's saying the work isn't hard and agree that I don't have a true scope of that yet.

I see it more akin to going to ortho forums, asking how much per hour I can make doing spine surgery without a fellowship as a locums when I have only rotated in the OR for 2 weeks seeing elective knees because, for some indecipherable reason, the hourly rate in 2021 is somehow going to mean something to me in 2025 when I finish, then acting all affronted when someone has the audacity to point out my cluelessness as 'picking on medical students.'

 

[chessknt]

I probably have a better idea than you think I do, but you didn't care to ask before talking down to me.

You actually dont because someone else is responsible for what happens. When you **** up an airway trying to be a cowboy and someone dies that isnt your fault, that is your attendings fault. Once it is all on you then you will begin to understand. I know this because I was a nocturnist in an open ICU hospital in a community of about 20k for a year before I had formal ICU training. I was a ****ing ******* back then and didnt even know it.

 

[Vivid_Quail]

I see it more akin to going to ortho forums, asking how much per hour I can make doing spine surgery without a fellowship as a locums when I have only rotated in the OR for 2 weeks seeing elective knees because, for some indecipherable reason, the hourly rate in 2021 is somehow going to mean something to me in 2025 when I finish, then acting all affronted when someone has the audacity to point out my cluelessness as 'picking on medical students.'

The only reason I was specific about rural, nights and open ICU was because I was naively trying to create a situation with the highest hourly rate. Yes, I am clueless, that is why I am asking this question. I should have just said "what is the highest rate a hospitalist can make if they don't care about location or working nights?" That is less specific so maybe it would have rustled less jimmies.

I understand what you are saying about the ortho thing but you kind of prove my point as well. 2 weeks in the OR shadowing elective knees is not much shorter than most med students get on their general IM inpatient rotation, at least at my school. We don't know much at all about different specialties without asking around a bunch and going on forums for most sensitive questions.

I get "ortho spine locums without fellowship" is hyperbole but it is hyperbolic to the point of being apples to oranges. There are a TON of doctors working nocturnist hospitalist jobs and a big locum market. Also IM/FM with no fellowship is like an order of magnitude easier to match than ortho.

The ortho questions are so annoying and meme-y because half of the students asking them haven't even taken the MCAT or Step 1 yet. As long as I don't get arrested, I have a pretty decent chance of matching FM or IM somewhere.

You actually dont because someone else is responsible for what happens. When you **** up an airway trying to be a cowboy and someone dies that isnt your fault, that is your attendings fault. Once it is all on you then you will begin to understand. I know this because I was a nocturnist in an open ICU hospital in a community of about 20k for a year before I had formal ICU training. I was a ****ing ******* back then and didnt even know it.

That is fair, but you could have just said something like "open ICU without CCM fellowship is a horrible idea--you don't want to try that, I have and it is a bad idea. Anyways, the hourly rate for locums gig with a closed ICU is $XXX/hr."

 

[IMGASMD]

It depends.
100-250/hr.

Does that answer your question?

Surely you need some context right? Do you know how much work can there be when you admit for open icu? Do you know if your hospital has some relationship with some tertiary center that will take your patients without run around and waste half of your night when there are 5 other patients that need to be admitted? Do you know if your ED is managed by locums too, or are they actual competent ED physicians? Are there NP or PA that work with you? How many admissions are you getting every night? How about how many patients you cross cover every night? Will CCM actually come in, is there CCM that physically come in and round?

These are questions for YOU, OP.

Are you taking vacations? Do you have a family? Are you managing COVID patients? Are you in the middle of a pandemic when you make it?

Let me know when you know. I will give you a fair price. But probably somewhere between less than a crna to more than an NP.

Good luck.

@chessknt they censor the word dub as? Or that was something else.

 

[chessknt]

@chessknt they censor the word dub as? Or that was something else.

Yep, even in a self-deprecating fashion it is apparently too offensive.

 

[IMGASMD]

Yep, even in a self-deprecating fashion it is apparently too offensive.

YOU may just get too offended by yourself calling yourself a dumb butt

 

[Vivid_Quail]

It depends.
100-250/hr.

Does that answer your question?

Surely you need some context right? Do you know how much work can there be when you admit for open icu? Do you know if your hospital has some relationship with some tertiary center that will take your patients without run around and waste half of your night when there are 5 other patients that need to be admitted? Do you know if your ED is managed by locums too, or are they actual competent ED physicians? Are there NP or PA that work with you? How many admissions are you getting every night? How about how many patients you cross cover every night? Will CCM actually come in, is there CCM that physically come in and round?

These are questions for YOU, OP.

Are you taking vacations? Do you have a family? Are you managing COVID patients? Are you in the middle of a pandemic when you make it?

Let me know when you know. I will give you a fair price. But probably somewhere between less than a crna to more than an NP.

Good luck.

@chessknt they censor the word dub as? Or that was something else.

Where does it fall in $100-250/hr for a non-train wreck job? Two possible options:

1. Closed ICU where CCM actually rounds and will come in at night if needed, decent transfer agreement with a tertiary center, ED managed by competent physicians (most of the time), NP or PA to help out with cross-coverage/pages. 5-10 admits a night, 40-50 cross cover census, and cover rapid responses.

2. Critical access hospital. No ICU, really you just stabilize before shipping ICU-level patients if they get sick after admission, otherwise ED should transfer them when they present, <25 beds so limited cross coverage, excellent transfer agreement with tertiary center. Sometimes competent EM-trained docs in ED, sometimes octogenarian OBGYN who doesn't know what a laryngoscope is. No PA/NP and no CCM because too expensive for a CAH. No idea how many admits a night is common in these places. Probably not a lot since many of them are 10-20 beds. I would expect this to be much lower volume than option 1 so lower pay even though it is more rural. Maybe even 24hr shifts because so low volume but critical access hospital to it stays open.

And then what about a train-wreck job?

3. Rural hospital with open ICU, CCM that "rounds" but conveniently doesn't answer their phone after 5pm. ED doctors more incompetent than I am. No NP/PA. 4-8 admits a night, 40 cross coverage, codes and rapid responses, all ICU procedures at night. COVID patients because every hospital has them at this point. Only silver lining is there is a transfer agreement with an in-system tertiary center that wants to keep patients in-system at all costs.

Vacation would be whenever I am not working. Ideally would want to work 90-100 12-hour shifts a year. So about half time compared to a normal 7 on 7 off hospitalist. Basically 1 week on 3 weeks off (averaged over year…I don’t expect to get anything this consistent). Go where the money is and be able to take off as much time as I want. No family yet but working 1/4 weeks a year away from home with the rest of the time 100% off is better than working 50/52 weeks per year in home city in other specialities.

 

[tantacles]

The answer is that it varies widely by responsibilities, location, and specific hospital. That's the only answer I can really give you. Anything more you'll have to negotiate yourself.

 

[tantacles]

Where does it fall in $100-250/hr for a non-train wreck job? Two possible options:

1. Closed ICU where CCM actually rounds and will come in at night if needed, decent transfer agreement with a tertiary center, ED managed by competent physicians (most of the time), NP or PA to help out with cross-coverage/pages. 5-10 admits a night, 40-50 cross cover census, and cover rapid responses.

2. Critical access hospital. No ICU, really you just stabilize before shipping ICU-level patients if they get sick after admission, otherwise ED should transfer them when they present, <25 beds so limited cross coverage, excellent transfer agreement with tertiary center. Sometimes competent EM-trained docs in ED, sometimes octogenarian OBGYN who doesn't know what a laryngoscope is. No PA/NP and no CCM because too expensive for a CAH. No idea how many admits a night is common in these places. Probably not a lot since many of them are 10-20 beds. I would expect this to be much lower volume than option 1 so lower pay even though it is more rural. Maybe even 24hr shifts because so low volume but critical access hospital to it stays open.

And then what about a train-wreck job?

3. Rural hospital with open ICU, CCM that "rounds" but conveniently doesn't answer their phone after 5pm. ED doctors more incompetent than I am. No NP/PA. 4-8 admits a night, 40 cross coverage, codes and rapid responses, all ICU procedures at night. COVID patients because every hospital has them at this point. Only silver lining is there is a transfer agreement with an in-system tertiary center that wants to keep patients in-system at all costs.

Vacation would be whenever I am not working. Ideally would want to work 90-100 12-hour shifts a year. So about half time compared to a normal 7 on 7 off hospitalist. Basically 1 week on 3 weeks off (averaged over year…I don’t expect to get anything this consistent). Go where the money is and be able to take off as much time as I want. No family yet but working 1/4 weeks a year away from home with the rest of the time 100% off is better than working 50/52 weeks per year in home city in other specialities.

This job you're describing in terms of number at shifts is at most a 0.7 FTE position, but it can be found in some places.

 

[Vivid_Quail]

This job you're describing in terms of number at shifts is at most a 0.7 FTE position, but it can be found in some places.

Sorry, I meant to say I expect 0.5 FTE pay for 90-100 12-hour night shifts a year, even if it was an actual 1040 job. Or whatever length and number of shifts that end up equaling 1/2 the yearly hours that a normal 7 on 7 off hospitalist works. I was asking about locums in my original question because I assume that no individual hospital would want to hire a nocturnist to work 1 week per month. 0.7 FTE would be great...didn't even know that was possible.

I might be misunderstanding what you mean by 0.7FTE though. Do you mean it would pay 70% of a normal job? Normally I have seen FTE used as number of hours worked not pay, but I haven't had a paid job as a physician yet (obviously)

 

[tantacles]

Sorry, I meant to say I expect 0.5 FTE pay for 90-100 12-hour night shifts a year, even if it was an actual 1040 job. Or whatever length and number of shifts that end up equaling 1/2 the yearly hours that a normal 7 on 7 off hospitalist works. I was asking about locums in my original question because I assume that no individual hospital would want to hire a nocturnist to work 1 week per month. 0.7 FTE would be great...didn't even know that was possible.

I might be misunderstanding what you mean by 0.7FTE though. Do you mean it would pay 70% of a normal job? Normally I have seen FTE used as number of hours worked not pay, but I haven't had a paid job as a physician yet (obviously)

1.0 would be full time work, and 0.7 FTE is just that - seven tenths of a normal job. The pay is not necessarily 7/10 - it may actually be a little bit less.

And honestly, if you want to work nights, anything is possible. People HATE working nights, so many places would probably let you work 4 nights per month if you really wanted to, though that probably would be a non-benefitted position. If I did that with one of my jobs it would likely pay about $8000-$10000/month.

 

[IMGASMD]

Go where the money is

That’s your answer right there. Which is also what the market can bear, and that also depends on your supply and demand. If there are people who are available, who’s willing to undercut you, then there’s nothing else that matters.

When you’re a locum, you’re trading availability for stability. Hospitals/groups know that. They don’t expect the best nor the cheapest. But you bet your bottom, you will be the first to be cut no matter how good of a job you’re doing. Because you/they don’t expect you to stay anyway.

I no longer do nocturnist work. The last two locum jobs I had.

1. 125 incr to 150/hr. Cross cover up to 100 patients with another physician. 12-18 admissions/shift. We usually split the night 1/2 admission, 1/2 cross cover. Can be a little crazy, especially if there’s only one of you.... and it happens. And I was cut pretty soon after they found a perm.

2. 150 incr to 170/hr. 25 patients in house, covers everything. 3 admissions, up to 6 in icu. Also 20 patients in the psych ward. You’re it, other than one ED attending who rarely leaves ED.

Both are okay jobs. Nothing to write home about. When you’re locum, it’s a very different mindset.

Too many factors in play to say exactly what a job is worth. At the end, only you can determine what your time is worth. Even at @tantacles shop, on paper it may be 200/hr. But they “only” need you 4 nights a month. Let’s say there’s a job far away that need you for 3 weeks @ 125/hr. Dates conflict.... what will you do? Forgo a 30k job or stay at the 10k job? Just food for thought.

 

[CCM-MD]

I’m sure these high hospitalist/nocturnist hourly numbers are out there but aren’t as common in real life as they are on SDN.

Our permanent nocturnists get $140/h. They do admits and cover 300-400 patients. Open ICU 40 beds. Intensivists in house day time, on call from home at night. 2 on each night, no midlevels. This is in a small city in the south. Hospital has had no problems recruiting.

 

[robellis]

I’m sure these high hospitalist/nocturnist hourly numbers are out there but aren’t as common in real life as they are on SDN.

Our permanent nocturnists get $140/h. They do admits and cover 300-400 patients. Open ICU 40 beds. Intensivists in house day time, on call from home at night. 2 on each night, no midlevels. This is in a small city in the south. Hospital has had no problems recruiting.

140/hr seems low..like really low..jeez

 

[CCM-MD]

140/hr seems low..like really low..jeez

That’s at least 275k a year plus benefits. Welcome to reality. That’s not far from the median.

 

[chessknt]

That’s at least 275k a year plus benefits. Welcome to reality. That’s not far from the median.

Well the uninitiated who use SDN as a primary source for income information think 650k/yr and 225/hr is the median and the proactive people either start their own practice and becomes multimillionaires running 6+ offices or make 550/hr while making 4x that in the stock market.

In real life I agree that 110-200ish/hr is realistic for a nocturnist highly dependent on setup. Rural areas don't always pay pie in the sky numbers because local economics have trouble supporting it long term. A locums assignment is fine but they can usually find someone (potentially with a legal history or visa issues) to take a job in an undesirable area for middle of the road pay.

There are other benefits to rural work aside from pay like being left alone and getting to take leadership opportunities early but there are drawbacks from sparse/subpar subspecialty support. It sounds romantic when you havent actually done the day to day work to be the 'town doctor' in XYZ specialty but the reality is much more oppressive. Sprinkle in that most of these rural hospitals are being consumed by megacorps like HCA that treat physicians complete **** and the romanticism dies even faster when you realize your hospital CEO views you as a billing liability and doesn't care if you grew up there or have worked there for decades if they can fire you and replace you with a fresh grad or near-retired dinosaur doc with 4 medmal suits against him as long as they can pay less.

 

[Vivid_Quail]

That’s at least 275k a year plus benefits. Welcome to reality. That’s not far from the median.

Thanks for the data point and description of the job. It’s good to be reminded that not everyone is making $225/hr admitting 3 patients a night with 2 PA’s doing all the charting, even though that’s the SDN standard lol.

2019 MGMA median nationally looks to be $300-325k for hospitalists, depending on IM or FM trained respectively. Kinda weird FM makes more than IM but they do at every percentile (10, 25, 50, 75, 90) so I don’t think it is just a difference in sample size (400 vs 5000). Maybe FM self-selects and/or is forced into to more undesirable areas which pay more?

Anyways, $275k is 25th percentile for hospitalists nationally…nights + in the south + small city + open ICU + insanely high cross coverage + no midlevels seems…very low.

Is this small city super “desirable“? I.e. in the mountains (Asheville, etc) or on the beach (Charleston, etc), or very close to a “cool” larger city like Chattanooga, Charlotte, Nashville, etc.

I’m not surprised that a hospital would offer such a low rate but I am surprised that they have had no problems recruiting.

I wonder if they get a hefty RVU or productivity bonus because MGMA includes those in total comp, but $140/hr might not include bonuses. On one hand nights aren’t known for a ton of RVU’s I don’t think, on the other hand, I can only imagine how busy they are with 300-400 patients. MGMA doesn’t include health insurance and other benefits so that’s not the missing piece.

If you said it was closed ICU and a much smaller census to cover then it wouldn’t seem as crazy, but if the night people are making that much, how much do the day people get? $225k/yr? That’s like 10th percentile.

Also, how do 2 doctors and no mid-levels cover 300-400 patients?! Is that normal/legal/safe? They must get a page every 2 minutes.

Any ideas why this job seems to pay so low? I have by far the least experience of anyone in this thread so I am probably missing something.

 

[CCM-MD]

Thanks for the data point and description of the job. It’s good to be reminded that not everyone is making $225/hr admitting 3 patients a night with 2 PA’s doing all the charting, even though that’s the SDN standard lol.

2019 MGMA median nationally looks to be $300-325k for hospitalists, depending on IM or FM trained respectively. Kinda weird FM makes more than IM but they do at every percentile (10, 25, 50, 75, 90) so I don’t think it is just a difference in sample size (400 vs 5000). Maybe FM self-selects and/or is forced into to more undesirable areas which pay more?

Anyways, $275k is 25th percentile for hospitalists nationally…nights + in the south + small city + open ICU + insanely high cross coverage + no midlevels seems…very low.

Is this small city super “desirable“? I.e. in the mountains (Asheville, etc) or on the beach (Charleston, etc), or very close to a “cool” larger city like Chattanooga, Charlotte, Nashville, etc.

I’m not surprised that a hospital would offer such a low rate but I am surprised that they have had no problems recruiting.

I wonder if they get a hefty RVU or productivity bonus because MGMA includes those in total comp, but $140/hr might not include bonuses. On one hand nights aren’t known for a ton of RVU’s I don’t think, on the other hand, I can only imagine how busy they are with 300-400 patients. MGMA doesn’t include health insurance and other benefits so that’s not the missing piece.

If you said it was closed ICU and a much smaller census to cover then it wouldn’t seem as crazy, but if the night people are making that much, how much do the day people get? $225k/yr? That’s like 10th percentile.

Also, how do 2 doctors and no mid-levels cover 300-400 patients?! Is that normal/legal/safe? They must get a page every 2 minutes.

Any ideas why this job seems to pay so low? I have by far the least experience of anyone in this thread so I am probably missing something.

The MGMA numbers you are referring to include TOTAL cash compensation (retirement plan contributions, stipends, reimbursements, quality incentives).

Using an hourly rate and comparing it to those MGMA medians directly is comparing apples to oranges. $140/h probably translates to slightly above the median MGMA. It’s not a popular/“cool” location, an hour from the beach.

 

[Vivid_Quail]

The MGMA numbers you are referring to include TOTAL cash compensation (retirement plan contributions, stipends, reimbursements, quality incentives).

Using an hourly rate and comparing it to those MGMA medians directly is comparing apples to oranges. $140/h probably translates to slightly above the median MGMA. It’s not a popular/“cool” location, an hour from the beach.

I understand MGMA is total cash comp that’s why I said:

I wonder if they get a hefty RVU or productivity bonus because MGMA includes those in total comp, but $140/hr might not include bonuses.

You might say it’s apples to oranges, I would say it’s lemon to limes. Not great but it’s the best we have and still makes it seem like that job pays horribly.

That combination of things…nights, open ICU, small town, south, massive census, no midlevels…is basically what someone else in this thread asked me about when describing a worst-case job. The only thing missing from the job in your town is no CCM coverage at all over night, but as it is, CCM isn’t in house for what I imagine is a LOT of ICU patients if the hospital’s total census is 300-400 patients.

 

[CCM-MD]

I understand MGMA is total cash comp that’s why I said:

You might say it’s apples to oranges, I would say it’s lemon to limes. Not great but it’s the best we have and still makes it seem like that job pays horribly.

That combination of things…nights, open ICU, small town, south, massive census, no midlevels…is basically what someone else in this thread asked me about when describing a worst-case job. The only thing missing from the job in your town is no CCM coverage at all over night, but as it is, CCM isn’t in house for what I imagine is a LOT of ICU patients if the hospital’s total census is 300-400 patients.

It’s not the most ideal nocturnist job by any means, especially by SDN standards. Though saying it pays horribly is taking it a bit far. It is easy to think that if you’re used to seeing the unicorn jobs talked about on here.

 

[Vivid_Quail]

It’s not the most ideal nocturnist job by any means, especially by SDN standards. Though saying it pays horribly is taking it a bit far. It is easy to think that if you’re used to seeing the unicorn jobs talked about on here.

Gotcha. That makes sense.

How often do you get woken up by the nocturnists when you are on call? Just wondering how CCM works when there is not 24/7 in-house coverage. I have only seen how it works with 24/7 coverage in medical school. Before medical school, I worked at some hospitals with no joke like 4-6 hours of physician CCM coverage per day and ZERO physician coverage overnight, not even a non-CCM trained MD/DO nocturnist...just NP's covering the floor and ICU from like 5pm-7am. Pretty big hospital too. Few hundred beds and multiple ICU's.

 

[CCM-MD]

Gotcha. That makes sense.

How often do you get woken up by the nocturnists when you are on call? Just wondering how CCM works when there is not 24/7 in-house coverage. I have only seen how it works with 24/7 coverage in medical school. Before medical school, I worked at some hospitals with no joke like 4-6 hours of physician CCM coverage per day and ZERO physician coverage overnight, not even a non-CCM trained MD/DO nocturnist...just NP's covering the floor and ICU from like 5pm-7am. Pretty big hospital too. Few hundred beds and multiple ICU's.

We try to get patients tucked in during the day time. Anesthesia handles airways at night. Get calls occasionally but rarely have to go in. Is it ideal? Probably not. But the hospital doesn’t want to pay for an in house night time intensivist.

 

[Vivid_Quail]

We try to get patients tucked in during the day time. Anesthesia handles airways at night. Get calls occasionally but rarely have to go in. Is it ideal? Probably not. But the hospital doesn’t want to pay for an in house night time intensivist.

Anesthesia in house for airway seems pretty huge (and I assume lines if needed?). At the hospital I mentioned, it was only EM and NP's overnight, so ED had to come up to codes and airway emergencies IF they were able to. Not really possible if someone was actively dying in the ED at the same time. So at least your situation is not grossly negligent like that.

 

[CCM-MD]

Anesthesia in house for airway seems pretty huge (and I assume lines if needed?). At the hospital I mentioned, it was only EM and NP's overnight, so ED had to come up to codes and airway emergencies IF they were able to. Not really possible if someone was actively dying in the ED at the same time. So at least your situation is not grossly negligent like that.

More places are switching to 24h in house intensivist coverage in this area it seems. Hospitals just gotta be willing to pay for it. It’s a hefty price tag because there just isn’t as much billing at night.

 

[Vivid_Quail]

More places are switching to 24h in house intensivist coverage in this area it seems. Hospitals just gotta be willing to pay for it. It’s a hefty price tag because there just isn’t as much billing at night.

That is definitely best for patients I imagine, even if it is expensive.

How does in-house CCM coverage look as a community attending? Are there "nocturnist" intensivists or do you rotate through a week of nights for each partner? Or some version of qX call with X hopefully being a big number haha.

 

[Splenda88]

That’s at least 275k a year plus benefits. Welcome to reality. That’s not far from the median.

That is more like 300k/yr + benefits. Most FT hospitalist/nocturnist gigs are ~180 shifts/yr (15 shifts/month). Will not work night under most circumstances for < $150/hr. That is just me.

 

[Splenda88]

I’m sure these high hospitalist/nocturnist hourly numbers are out there but aren’t as common in real life as they are on SDN.

Our permanent nocturnists get $140/h. They do admits and cover 300-400 patients. Open ICU 40 beds. Intensivists in house day time, on call from home at night. 2 on each night, no midlevels. This is in a small city in the south. Hospital has had no problems recruiting.

I know people who are making 300k as hospitalist (not nocturnist) in south GA. I actually got offers for ~300k as well there. Why would someone take < 300k in rural Georgia (or any rural part of the south) working night? I can understand if that small city is < 1 hr away from a major metropolitan area.

 

[CCM-MD]

That is definitely best for patients I imagine, even if it is expensive.

How does in-house CCM coverage look as a community attending? Are there "nocturnist" intensivists or do you rotate through a week of nights for each partner? Or some version of qX call with X hopefully being a big number haha.

Various set ups are out there.

That is more like 300k/yr + benefits. Most FT hospitalist/nocturnist gigs are ~180 shifts/yr (15 shifts/month). Will not work night under most circumstances for < $150/hr. That is just me.

I know people who are making 300k as hospitalist (not nocturnist) in south GA. I actually got offers for ~300k as well there. Why would someone take < 300k in rural Georgia (or any rural part of the south) working night? I can understand if that small city is < 1 hr away from a major metropolitan area.

You are right, it is >300k base if working 180 shifts a year. Idk why someone would/wouldn't take something but our hospital hasn't had any issues recruiting for $140/h.

 

[Splenda88]

Various set ups are out there.




You are right, it is >300k base if working 180 shifts a year. Idk why someone would/wouldn't take something but our hospital hasn't had any issues recruiting for $140/h.

Not sure why they don't have hard time recruiting physicians since the job you describe does not appear to be cushy IMO...

 

[CCM-MD]

Not sure why they don't have hard time recruiting physicians since the job you describe does not appear to be cushy IMO...

My suspicion is there are lots of hospitalists in the market right now.

 

[collegestud2013]

Night-time coverage at any non-academic hospital is going to be minimal. Academic places or any places with residents tend to be slightly better at night coverage since residents are essentially free labor (with their salary supported by tax dollars). When hospitals have to pay physicians or midlevels out of their own pockets, they will want to make sure they can get at least as much from billing. With the current hospital-based billing system in the U.S. one specialty can bill only once per calendar day. So at night, cross coverage work does not directly generate any RVUs (will RVUs at night being generated mostly by new admissions and some occasional consults) but despite this nocturnists are expected to be paid higher per hour than daytime hospitalists. So hospitals see most night coverage more as a necessary business expense rather than a revenue generator and hence will try to skimp on night staffing as much as possible. And often any increases in hiring night coverage often come at the expense of increased productivity expectations from the day hospitalists.

 

[Splenda88]

My suspicion is there are lots of hospitalists in the market right now.

Yes, there are.

It seems like before Covid19, PGY3 where I am were securing decent jobs. My experience so far has been different.

 

[Nocturnist]

What is a realistic hourly rate these days for nocturnist locum jobs? I am thinking specifically suburban/rural and open ICU (I imagine this setting pays the most but I could be wrong). Ideally jobs that are open to both FM and IM. I am posting this on the IM forum since you all do much more hospitalist work than FM on average.

My very uneducated guess is $170-180/hr based on what full-time nocturnists make yearly. But, it would be sweet if it was more like $200+/hr

Also, did locums jobs dry up this past year with COVID? I have heard that the EM market has been destroyed, especially locums. I would imagine hospitalists still have had plenty of patients to admit this past year though, for better or worse.

Thanks!

P.s. I am just a naive med student so please don't bite my head off.

In my neck of the woods in the northeast, nocturnist locums seem to be in the $150-175/hr range in the suburbs. I've heard of a couple gigs that pay $200/hr a couple hours away from the city. I've not heard from any of the locums I've come across that they're hurting for work in any way this year.

 

[BorntobeDO?]

Yes, there are.

It seems like before Covid19, PGY3 where I am were securing decent jobs. My experience so far has been different.

Same at my shop. Third years having to be pretty geographically open to get hospitalist positions, especially daytime ones. Nocturnes the available still and primary care, but nobody wants those.

 

[OldButReady]

What is a realistic hourly rate these days for nocturnist locum jobs? I am thinking specifically suburban/rural and open ICU (I imagine this setting pays the most but I could be wrong). Ideally jobs that are open to both FM and IM. I am posting this on the IM forum since you all do much more hospitalist work than FM on average.

My very uneducated guess is $170-180/hr based on what full-time nocturnists make yearly. But, it would be sweet if it was more like $200+/hr

Also, did locums jobs dry up this past year with COVID? I have heard that the EM market has been destroyed, especially locums. I would imagine hospitalists still have had plenty of patients to admit this past year though, for better or worse.

Thanks!

P.s. I am just a naive med student so please don't bite my head off.

Jeez what is wrong with you people? I think this med student understands that this forum is not an end all for information, he was just wondering what range he could expect. And if he takes good care of his pts, does his job efficiently, and is true to the profession, who cares what his motivations are? Sometimes I wonder how many of you made it in life without getting a beating. Or, if you just behave crudely online because you’re too cowardly to do so in real life.

In answer to your q, OP, many of my friends in the situation you are describing make about $170-180. As a full time nocturnist, closed ICU, but no in-house intensivist overnight, and most things are managed by me unlesd triple pressors or newly vented, I made $139, now I work in a setting with closed ICU but work for a national group, $128. Tbh, I would take the lower income for job stability and better location though.

 

[OldButReady]

What is a realistic hourly rate these days for nocturnist locum jobs? I am thinking specifically suburban/rural and open ICU (I imagine this setting pays the most but I could be wrong). Ideally jobs that are open to both FM and IM. I am posting this on the IM forum since you all do much more hospitalist work than FM on average.

My very uneducated guess is $170-180/hr based on what full-time nocturnists make yearly. But, it would be sweet if it was more like $200+/hr

Also, did locums jobs dry up this past year with COVID? I have heard that the EM market has been destroyed, especially locums. I would imagine hospitalists still have had plenty of patients to admit this past year though, for better or worse.

Thanks!

P.s. I am just a naive med student so please don't bite my head off.

What is a realistic hourly rate these days for nocturnist locum jobs? I am thinking specifically suburban/rural and open ICU (I imagine this setting pays the most but I could be wrong). Ideally jobs that are open to both FM and IM. I am posting this on the IM forum since you all do much more hospitalist work than FM on average.

My very uneducated guess is $170-180/hr based on what full-time nocturnists make yearly. But, it would be sweet if it was more like $200+/hr

Also, did locums jobs dry up this past year with COVID? I have heard that the EM market has been destroyed, especially locums. I would imagine hospitalists still have had plenty of patients to admit this past year though, for better or worse.

Thanks!

P.s. I am just a naive med student so please don't bite my head off.

Jeez what is wrong with you people? I think this med student understands that this forum is not an end all for information, he was just wondering what range he could expect. And if he takes good care of his pts, does his job efficiently, and is true to the profession, who cares what his motivations are? Sometimes I wonder how many of you made it through life without getting a beating. Or, if you just behave crudely online because you’re too cowardly to do so in real life.

In answer to your q, OP, many of my friends in the situation you are describing make about $170-180. As a full time nocturnist, closed ICU, but no in-house intensivist overnight, and most things are managed by me unlesd triple pressors or newly vented, I made $139, now I work in a setting with closed ICU but work for a national group, $128. Tbh, I would take the lower income for job stability and better location though.

 

[DrMetal]

Jeez what is wrong with you people? I think this med student understands that this forum is not an end all for information, he was just wondering what range he could expect. And if he takes good care of his pts, does his job efficiently, and is true to the profession, who cares what his motivations are? Sometimes I wonder how many of you made it through life without getting a beating. Or, if you just behave crudely online because you’re too cowardly to do so in real life.

In answer to your q, OP, many of my friends in the situation you are describing make about $170-180. As a full time nocturnist, closed ICU, but no in-house intensivist overnight, and most things are managed by me unlesd triple pressors or newly vented, I made $139, now I work in a setting with closed ICU but work for a national group, $128. Tbh, I would take the lower income for job stability and better location though.

What's da matta whichyu?! Why do you post the same thing twice?

 

[IMGASMD]

What's da matta whichyu?! Why do you post the same thing twice?

And almost a year later.