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Renegotiating a fair compensation

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I have been working my first job as a hospitalist for 7 months and am starting to realize the inefficiencies in my contract. It is 7 on 7off 6pm to 6am. with a base of $85,000 plus nocturnist shift differential of $5 extra an hour…I am salaried but basically work at a rate of $45 an hour including shift dif. However I wasn't explained the exact responsibilities of my job.


1. I was promised 6 months of intensive mentorship and training. It turned out to be 2 months working with a nurse practitioner who basically had me do her busy work "H n Ps" and taught me how to use the EMR. I had to really push for the physician that hired me to give me any time of day. Then at the start of month three I was transferred to the second facility to start night shift on my own with no physician there (as a new grad)…however they claimed to always be available by phone.


2. When i went to nights I learned that I would also be taking call from from another hospital, albeit a smaller facility and taking cross coverage floor calls from that facility. Which i was not informed about prior to my starting this position. So I take admissions and cross coverage floor calls overnight from two hospitals in a major city alone as a new grad PA..sometimes the back up physician "who is paid $1500 a night to be back up responds and sometimes he doesn't. From the two hospitals combined I get anywhere from 16-35 admits a night plus the floor calls from about 10 hospitalists from my group that work in these two facilities. which is around 40-60 calls in addition to the admissions. I'm also expected to see as many new admits as I can overnight so that the docs in the morning have less work to do when getting new patients that were admitted overnight.


3. I don't get vacation, (26 weeks off a year) or PTO. From doing all this I rarely get out in under 12 hours a night…its more like 105 hr week. I rarely get time to eat or even use the bathroom. And the nurse pracs on day shift have the luxury of having all the physicians there onsite for back up and questions, they get pad about $15,000 more than me and they get pto and vacation.


I am overwhelmed and I understand that i'm a new grad but i feel like i'm being taken advantage of and i'm underpaid. Is this a reasonable workload? What are some demands I should have when renegotiating my contract? I plan to stay at least another year for the experience but just feel like I can't  continue without at least one thing improving. The thing that keeps me wanting to stay is the incredible experience I've gained working at such a high volume. I know staying here another year would prepare me for just about anything. Suggestions needed!!!

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Wow.. i am in a similar job as well a nocturnal hospitalist where I do admits from ed and cross coverage but I am only responsible for one hospital. We have a md nocturnust on at all times. This is way too much responsibility for new grad let alone even a seasoned pa/np. You are being taken advantage and def underpaid. I too was started at 85k but no night diff. So essentially 40 an hr. I have 21 days pto though. I have been doing this a year and I cannot immagine doing 16-35 admits a night. I usually get about 10 admits a night. The doctors will get on a busy on worse case shift 16-24 admits but that is with periodic coverage from pa/np who writes the note and orders. they Just co sign. If they want to see that many they should be paying you er pay rates.. you have experience even if its a couple of month for another facility that will.hire you. I am currently leaving my current nocturnust job to go to another facility that was will willing to pay me 55 an hr for day shift. There are other jobs out there. People dont realize admits can take a while. Most of the time that simple uti case that the er doc told you about with vss turns into :

Er nurse: hey nocturnal pa! er doc ordered a 5th liter of ns. Pt just completed it bp still 60/80. You want another liter?


Nocturnist: wait? What?! 5liters? I wasnt told about this. I cant accept this to the floor.. i was told vss!


Now pt becomes an icu admit ending with you to stabilize pt and placing pt on pressor. In my hospital setting with closed icu now I have to call up icu doc and consult with him.


Yes er pas are expected to see 20+ pts a shift plus procedures but when admitting you have look at past records, order labs, talk to consultants, order new tests, get surgical clerences, discharge back to nursing homes ( which is always a night mare gettting the facilities to accept pts back), deal with combative sundowning pts, bp checks, electrolyte replacing, etc. ER does the same but we dont have the luxury and passing the pt on to be taken of by aanother provider for further tx. We are that other provider. Cross coverages can slow you down ranging from ordering a sleep aid all the way up to "hey nocturnal pa sooo just an fyi pt in rm 123 is now having profuse rectal bleeding and hypotenssive 70/50.hx of varices. Please advise. " Now youre stopping to see the rectal bleeding pt and not admitting, calling GI doc in the middle of the nights throwing buckets of prbc and fluids into the pt. I dont care what others will say there is no way you will be able to give appropriate attention and medical care to acutely sick pts if your expected to see such a high amount. This isnt 16-34 urti, sinus infections or ankle sprains mixed in with acutely sick pts.. This is 16-34 admits of deconpensated chf, hip fx, chest pains, a.fib with rvr, sepsis, pna, copd exas, gi bleed,dka, liver failure,drug overdoses, resp failure, cardiac arrest, etc. I know er staff see this on daily but as hospitalist you're responsible but taking care of the pts once they leave the ed.

Either start applying at other facilities and get more help at night. 16 -35 admits in a 12 hr period is dangerous... its easy to not pay close attention and miss an elevated k or new onset aki and forget to address it. Er sees the same thing but we have to address and find out why then proceed to tx it.

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Should be a notice to new grads to realize that you need mentoring and training and you need protected time to do this, i.e. In writing your contract it needs to be in writing.


The only time you have to negotiate items like this with any efficiency is before your hired... Once you are an employee you are likely locked in.


It is also a case that you refuse to shift out of the training role in accordance with your contract, but this is very contentitiuos and might get you fired.....


Overall. You need to realize you are not in an ideal position.


Work what is in your contract, do not work for free

Involve HR in the process and ask to get transferred to a better position if they can not accomidate your needs for training...




Next job, get everything in writing....

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so essentially you are doing twice the work of an md with no experience and at most likely 1/3 the salary, who benefits?.......... the hospital. you need to cut and run.

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