To follow up on my previous post I ended up taking the nocturnist job and have worked about 3 months now.
Here are my thoughts.
Setting/Hospital:
My primary reason for taking this job was location. It is across the street from my residency hospital and I am still living in the same apartment I lived in residency. It is only a 3 min drive from my apartment and I could walk there if I had car trouble. The hospital is much bigger than my residency hospital, It is a level 1 center with >1000 beds. The ER is in the top 10 busiest in the country. This is a blessing and a curse becauce while we have full subspecialty support there is no such thing as a "chill night." For example one of my friends was telling me about a swing shift they did where they had 3 admissions. Not a reality at my shop. There are 35 day rounders/day, 1-2 day admitters, 3-4 swing admitters, 2-3 nocturnist/night. We accept ~25-35 admissions/night, the most I have seen is 50 admissions a night on a bad night.
The work:
I only admit.
The shift is 9 hours from 11 pm -8am, however the day admitters and rounders get there at 7am so If you are done with your work there's no reason to stay till 8. We are CAPPED at 8 admits/nocturnist. This is something that I think is very rare in a nocturnist job. Any admissions after 6am and any admits over 8 per nocturnist get passed to the day team. This is not really a problem staffing-wise with 35 day docs. With this said If you are 1st call you do have to do hold orders which I am not a fan of, but most nights I am 2nd or 3rd call and only have to worry about my 8. My last 1st call I actually went over my cap and admitted 12 because they were really sick and I did not feel comfortable leaving them for the morning. But 90% of shifts have been 2nd or 3rd call. On a "good night" I will get all 8 of my admissions by midnight and I can finish by 5-6am but most nights I am working till 730ish. We have a closed ICU so I dont do any ICU admits and If any of my pts decompensate I call ICU and they take over. There is 24/7 intensivist in-house for codes and procedures. We have 4 NPs that do all cross-coverage. The hospital is ~1000 beds so they do get very busy. I usually only get 1-2 calls per night from the NPs if they have a question. The NPs will also do ~2 admits per nocturnist that counts to your cap of 8. I still see every patient as if I was doing the admit myself but having the help with the note is a big time saver.
Some other perks:
-24/7 ED pharmacist Its nice being able to ask questions face to face. They can help with med recs for complicated patients.
-The cafeteria is actually open at night (limited options) and physicians get free food.
-There is a doctors lounge with pre packaged food and drinks as well.
-We get sleep rooms with a bed/computer/65 inch TV. on two occasions I have finished my work at 5am and went to sleep but this is very rare.
-EPIC EMR and Dragon.
Schedule/Comp:
-15 shifts/month, this is flexible based on our requests. So far I have asked for 10ish days per month off and have had all my requests granted which is nice. One of the major reasons I chose this job is for flexibility. Most of the nocturnists like to travel so we all work with each other's travel plans. We generally do 7on/7off but sometimes do 4-8 days. For example, I only worked 1 night this week. My next stretch will be 10 nights.
-I am making 322K/year. They gave me a 40K sign on bonus. The downside is there is no RVU. The day docs make RVU which I think is unfair. The model is essentially by working nights we are making the maximum a day doc could theoretically make. Most of the day docs I have talked to are making ~290-305 after the bonus. This is still the highest paying job I found in the market here. My residency hospital offered me 180K for days. The other major university hospital offered me 250 for nocturnist.
Cons:
-8 admits in 8 hours is alot. Alot of people here told me this so I did go into this with a warning. I did similar numbers in residency but as an attending it hits differently. All of the patients here are complex being a level 1 downtown hospital. With that said having a cap and knowing exactly how much work I will be doing every night is game-changing and seems to be very rare in nocturnist work.
-nights have been tougher as an attending. I think since in residency we would only do 2-3 weeks at a time. Now doing only nights I do feel it takes more of a toll.
-First night off is a scam, you still worked that morning and I'm always exhasted. I generally will wait to travel till the 2nd day off so you kind of lose a travel day that the day docs dont have to worry about.
-I know 322 is on the lower end for comp. Based on what I have read here I can be making much more money in a gig with RVU but I am not ready to move yet.
-I only see myself doing nocturnist for a few years max because of the nights themselves. Unless I can find a 7on/14off gig with RVU in which case I think It can be much more sustainable. BUT those jobs dont exist in my area.
Overall I have enjoyed it and Attending life has been much better than residency life. My weeks off have been great and the money def helps.