There is no perfect way to gauge the appropriate adjustments in workload and compensation that will attract people to a nocturnist position in your practice. Estimate what seems equitable and see if any of your doctors would be willing to become a dedicated nocturnist. If none find the deal attractive enough to consider seriously, the chances are a new doctor you try to recruit will come to the same conclusion.
While a good “juice-to-squeeze ratio” is most important in attracting nocturnists, you could also consider a nocturnist recruitment ad that screams at the top “Never work another day in your life!” That might attract a lot of attention amid competing ads that describe the wonderful schools, quality of life, and proximity to shopping, lakes, and recreation other positions offer.
How to Pay Them
Where can you find the money to pay the nocturnist well for doing less work than his or her daytime counterparts? Most practices can appeal to their “sponsoring” hospital for more money to support this valuable component of the practice. If doctors in the practice want to be relieved of night work badly enough, they might give up some salary that can be put toward the nocturnist position.
Ask your hospital to match the contribution the doctors make. For example, each of the eight doctors in the practice might accept a $5,000 reduction in annual compensation to be relieved of all night shifts. That $40,000 could be matched 100% by the hospital for a total of $80,000. Each of two nocturnists hired by the group could split that $80,000 so they could be paid the same salary as the day doctors plus $40,000.
The Long View
Nearly everyone tires of working the night shift eventually—even if it does mean less work and more pay. Two to five years of working solely as a nocturnist might be as long as most people can do it, so plan for relatively frequent turnover. But I know of several hospitalists who have worked only at night for more than 10 years, provide excellent patient care, and seem quite happy to continue working nights. TH
Dr. Nelson has been a practicing hospitalist since 1988 and is co-founder and past president of SHM. He is a principal in Nelson/Flores Associates, a national hospitalist practice management consulting firm. He is also part of the faculty for SHM’s “Best Practices in Managing a Hospital Medicine Program.” This column represents his views and is not intended to reflect an official position of SHM.