Home Career Nocturnists are paid more, but they don’t get all the perks

Nocturnists are paid more, but they don’t get all the perks

Nocturnists earn less in bonuses than daytime hospitalists and they seem to have less flexibility in shift length.

February 2023

extra-bonus-neon-signYOU PROBABLY KNOW that nocturnists earn more money for working fewer shifts than their daytime colleagues, but our latest survey of hospitalists shows that there are some downsides to working nights. Here’s what nocturnists told us in the Today’s Hospitalist 2022 Compensation & Career Survey.

When it comes to compensation, nocturnists reported earning a mean annual compensation of $362,938. Hospitalists working day shifts, by comparison, made an average of $334,583. That’s a difference of $28,400 or 8.5%.

Nocturnists working for non-academic practices earned even more: $367,362. Non-academic hospitalists working days earned an average of $335,084—a difference of $32,278 or nearly 10%.

nocturnists-compensationWhen you look at compensation not by annual pay but by the hourly rate that nocturnists reported, the gap is even bigger. Nocturnists said they earned an average hourly rate of $153.37 compared to an hourly rate of $136.98 for daytime hospitalists. That’s a difference of 12%.

Nocturnists’ hourly rate is likely so much higher because they work fewer shifts than their daytime colleagues. Divide their annual compensation by fewer shifts worked, and the hourly rate goes up.

Bonuses and shifts
As for bonuses, nocturnists reported receiving an average bonus of $37,281. That’s about 20% ($7,198) less than the average bonus of $44,479 reported by their daytime colleagues. 

Nocturnists also reported working an average of 13.7 shifts per month, while daytime hospitalists worked 15.3 shifts per month. But nocturnists seem to be locked into working 12-hour shifts. While 72% of nocturnists work 12-hour shifts, only 55% of daytime hospitalists work shifts of that length.

nocturnists-shifts-monthIn fact, nocturnists reported a mean of 12.5 hours per shift. Hospitalists working only days, on the other hand, had a mean of 11.5 hours per shift.

Patients per shift
According to our survey, nocturnists have 10.9 patient encounters per shift vs. 16.7 patient encounters per shift for hospitalists working days. When we asked how many patient encounters per shift was reasonable, nocturnists answered 9.8. That’s 11% fewer encounters than they’re actually having.

Daytime hospitalists, by comparison, thought that 14.8 patient encounters per shift was reasonable, which is 12% less than their actual number of encounters.

nocturnist-patient-shiftCritical care
Nearly 45% of both hospitalists who work days and nocturnists see patients in the ICU. While they are equally likely to work in the ICU, more daytime hospitalists serve as attendings in the ICU (39.8%) than their nocturnist colleagues (33.3%).

Experience and satisfaction
Nocturnists average one fewer year of experience as a hospitalist (10.3 years) than hospitalists working days (11.3 years).

Nearly two-thirds of nocturnists (66.7%) reported being satisfied or somewhat satisfied with their hospitalist career. By comparison, 61.5% of daytime hospitalists said they were very satisfied or satisfied with their career.

On the lower end of the satisfaction scale, 16.7% of nocturnists were somewhat unsatisfied or unsatisfied. Hospitalists working days reported the same amount of career dissatisfaction.

nocturnist-experience-satisfactionPandemic changes
When asked if they were making more or less than before the pandemic, nocturnists said that on average they were making 4.6% more than before covid hit. That’s roughly the same increase reported by hospitalists working days.

Nocturnists, however, were less likely to report receiving a pandemic bonus. While 18% of nocturnists got a pandemic bonus, 22% of daytime hospitalists reported getting such a bonus. The dollar amount of bonuses for nocturnists was less (an average of $4,145) than bonuses for daytime hospitalists (an average of $8,141).

One area that has favored nocturnists is changes in work hours because of the pandemic. While 49.6% of daytime hospitalists said their hours have increased since the pandemic began, that’s the case for only 40.5% of nocturnists.

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April 2023 6:35 pm

More important than pay, some of us nocturnists get a time differential. I work 1 week on, 2 weeks off, which my practice partners and I have turned into an incredibly comfortable 10 on 20 off schedule. That opens a door to travel, family time, hobbies, and locum work we are very privileged to have. If you split that with another doc wanting to work 0.5 and live on a comfortable $170k (plus slightly more costly health benefits) with locums on the side, that’s 1 week in 6. Life’s good.