Hospitalist position

[jhawk]

I am a third year internist resident in the process of negotiating a salaried hospitalist position with the current hospital I am doing my residency in. They informed me earlier when I went through the interview process followed by an informal email of offer that they only had 'swing shift' available that would be from 4pm-12am. I tried to negotiate the salary and other terms this being the less desired shift (morning shift makes the same). But, they would not budge, saying that's the standard offer they make to all incoming fresh grads to be fair to all (meaning people who lack the ability to negotiate). I was fine with it, until they emailed me back yesterday saying the hospital policy requires the hours to be 12pm-12am, 7on/7off and the salary and other terms is still the same as the morning position. My question is, is it a standard practice to ask for a salary bump (or other considerations) due to the less desired shift yet putting in the same amount of hours? I am not sure if hour change is in play if its a hospital-wide policy. Any other way to sway the admins to make the contract more palatable? Thanks

[SValleyMD]

You can always ask... but like always it comes down to have bad do you need them and how bad do they need you.

If they have more than one applicant they'll go with the "plug in and play" candidate. But if they're hurting to fill that shift and you're the only one willing to fill it then obviously they might budge.

In my experience not a lot of negotiating room for a new grad in a salaried or employed model.

Those negotiations are typically with the group and the hospital, then left up to the group to divvy up the pay to fill the needed slots..

[jhwkr542]

Always best to have options. Look around and see if you can find other openings/get other offers. Always best to negotiate from a position of strength. Especially first coming out, it's best to see all the models and get an idea of what the salary and benefits are in your market you're looking at, even if you really want to stay at this hospital.

[nolamd84]

Been a hospitalist for four years now. Totally agree that you should field other offers. Always best to negotiate from a position of strength. I've never in my life seen a nocturnist paid the same as a daytime hospitalist. Usually around a 20% markup for night time shifts.

Are you in an academic position, presumably? It gets a little bit complicated with an academic position because the competition is not necessarily with other community hospitals but with other universities.

New grads don't understand their worth, don't know how to negotiate and get taken advantage of. It's rarely worth it. The only way it would be worth it would be if you had a bourgeoning academic career, an elite institution, an unwillingness to move and a quick promotion to daytime/more salary.

[jhawk]

This is a middle shift (12p-12a) position, not nocturnist, and non-academic position. I am looking at other positions as well. However, the hospital system is so big in the area that most of the opportunities are in the same system, just different locations. Other systems only currently have nocturnist positions, which I am not open to, due to family. I can always play the waiting game to see if there are anything else opening up in the near term. I am just getting a little anxious as time nears graduation. Also, they want to hear my piece before drawing up the contract. I will have a chat with the admin, just need to figure out what/how to put it so, its fair both to me and the hospital.

[nolamd84]

12p - 12a is rough because you'll never be home for dinner. depends on your situation. there aren't many places that are single market (usually at least one big competitor and multiple smaller competitors) unless its a much smaller town. you're still 7 months from graduation - plenty of time to field other offers.

[Zaphod]

Always hard for the home institution to treat you anything but a resident. True in many fields actually, its easier to get a raise or promoted by simply changing jobs. Its dumb but seems to be a behavioral thing in systems of all types.

Wait...so this is all informal bs over email? Nothing is a real contract etc...i would dismiss everything and ask to see a real contract, they could be feeling you out to see how desperate you are, etc...

Send an email asking for a formal offer and contract. Then have it reviewed by a contract group or lawyer and then get back to them, dont get taken advantage of.

[hightower]

Being a hospitalist for the last 5 and half years, I would never agree to a schedule that is 12-12 and 7on 7off.  That's not a fun lifestyle, especially if you want to have a life outside of work.  If I were you I would shop around and be willing to move elsewhere.  Hospitalists are in very high demand in most cities, especially if you are willing to live somewhere more rural.  I know that its tough when you've already set your mind on staying in a certain city, but I just want you to know that you are in high demand and that you definitely have a lot of power in this to get a contract that you are really happy with.

And I totally agree with Zaphod.  Get everything they promise you in writing before agreeing to anything and pay to have a contract lawyer review it before you sign it.  Its amazing how sneaky they can be.  Especially big corporate healthcare systems.  My contract has some pretty BS stuff in it that I would never agree to now that I know better.

Be confident in yourself and don't settle for a contract that you're not 100% happy with.  Lifestyle is really, really important in the long run.  You will get burnt out quick if you chose a schedule that you're not happy with.

Congrats on being done with residency though!  Its exciting getting your first job and big paycheck

[nolamd84]

Agree with @hightower and @Zaphod, remember that you're in demand. I decided to leave my job 3.5 years into practice and found that I could make 20-30% more in other neighboring hospitals with some negotiation. Get it in writing. Play hardball. This isn't getting into medical school or residency, they should be recruiting you. They know they can take advantage of you when you're first coming out of residency, shop around and don't let them.

[MrsIMDoc]

It depends on how bad you want to stay at your home residency institution as discussed above. I had friends stay at our residency program as a hospitalist and get paid $140,000/year.   They could literally stay in the same city and make $220,000 doing the same position but wanted to stay academic.  The academic hospitals can get away with it because people are willing to stay.  They will always have third year residents wanting to just stay put and they can low ball the offers.  They also tend NOT to negotiate.  There was also this opinion that leaving academic medicine meant you were selling out or not taking care of the needy.  I can tell you that no matter where you go you are caring for the underserved and elderly as a hospitalist so do not let anyone tell you that.

[jhawk]

I appreciate all the encouraging thoughts. I don't necessarily have any ties to the residency hospital, since at this point I don't see myself teaching, plus there is an actual university teaching hospital in the city but, currently only have nocturnal position. My husband's job is in this area so, I want to stick around. And it did seem straight forward to transition from residency to attending in the same organization. I will be honest, I thought it was weird too that they wanted to get the numbers via email before drawing up the contract. I think it is their standard practice. Then you consult lawyer or whatever to get other parts of the contract looked at. What is a good measure for salary scale? I see numbers anywhere from $190k to $280k listed in various compensation surveys for hospitalists. Its not clear if its averaged for entry level and experienced positions and for all shifts. This place (midwest) is currently offering me $210k for the aforementioned 12p-12a 7on/7off, which is the same amount they offered my resident colleague for the 7a-7p shift. So, no shift differential adjustment in pay and that is rubbing me the wrong way.

[SValleyMD]

Unless youre in Chicago then 210k a year in the Midwest is about 100k less than what I would expect to see. At least talk around to get a better feel for the local/state market.

[hightower]

For your reference; In my group in Ohio our base salary is 220k, plus productivity and quality bonuses.  Its not hard to get 250k-290k if you are productive and meet all the quality measures.  We work 200 shifts per year required (16-17 shifts per month).  The shifts are days only with several swing shifts per month (3-10pm).  We have to answer our pagers from 8-8, but we can leave the hospital as early as 2pm.  No codes, No procedures, No ICU coverage.  Its a busy hospital though and there are many days that we round on 20+ patients.  Admitting shifts are 12-8pm and you can easily get 15-20 admissions during that time, but there is a resident service and a swing shift person to help.  And we're almost always short staffed so trust me, you are in high demand

[bomgd3]

Hey, I'm a third year IM resident who just completed my job search. I'm in a rural part of New England. Your offer sounds like a pretty tough job. Is there paid time off in addition to the 7 off? Or are you working 26 weeks/year? Also the fact that they told you 4-12 and later changed to 12-12 sounds really fishy. 12-12 seems like a terrible shift to do long-term.

Hospitalists are in huge demand, although I don't know where you live so YMMV. If you're in NYC or something then the offers may be a lot less generous.

[The White Coat Investor]

Hospitalists are in such huge demand that they are paid more than they could possibly generate in physician fees.

But the way to negotiate is to do so from a position of power- i.e. to have another job offer. So start there if you want more from this job.