The Nocturnist is a medical job which increasingly features in job searches and often arouses curiosity amongst doctors who are unfamiliar with the term and if the job is suitable for them; so let us start with a definition of the job title and its scope of medical practice.

The Nocturnist - Definition

A nocturnist is a hospital based physician who works exclusively overnight admitting patients from the emergency department, managing  inpatients and supervising resident medical officers (RMOs). The job is very similar to that of a hospitalist who performs similar duties throughout the day and both practise exclusively in the area of in patient medicine with no out patient consultations or follow up.  The nocturnist assesses patients referred by emergency physicians, formulates differential diagnoses, arranges investigations and develops treatment plans, referring to other specialists as appropriate.

Nocturnists are usually trained in internal medicine or family medicine, but some are trained in other specialties, such as paediatrics. They differ from on-call doctors in that they work exclusively at night, rather than a regular 40 hour week with on call duties.

The Factors Increasing Demand for Nocturnists

Over 50% of teaching hospitals in the United States have nocturnists on staff and other hospitals throughout the world are starting to appoint doctors to this role. Some studies in the USA and Canada have shown that nocturnists do not enhance patient outcomes and report no difference in specific indicators such as patient mortality, 30-day readmissions, mean length of stay, or upgrades to intensive care with the addition of these overnight hospitalists. However the appointment of nocturnists appears to be driven by the need to have senior medical cover present on the wards rather than on call from home. This is fueled by:

• Work hour limitations: Resident Medical Officer work hour limitations require more hospitalist coverage overnight. 
• Trainee supervision: There are more requirements for specialist-level trainee supervision of resident medical officers
• On-site coverage: There is a trend toward on-site coverage of hospital wards overnight. 
• Rural and underserved areas: Hospitals in these areas rely on nocturnists and general practitioners, like hospitalists, but it can be difficult to recruit and retain them. 

Could this job be right for you?

Nocturnists are unique among hospitalists because they are often the only doctors on the floor after all of the other physicians have finished their rounds and gone home. Working the night shift, they can enjoy more autonomy and often a quieter working environment. Yet the job is not without its challenges. If you are intrigued by the possibilities of working as a nocturnist, here are some pros and cons to consider:

The Advantages Of Nocturnist Jobs

1. Reduced Working Hours: nocturnists' work schedules vary from hospital to hospital but working hours are often less than those of hospitalists and other physicians. Shifts may be of 8 or 10 hours duration as opposed to 12 hours and may be grouped together with extended time off. For example a work schedule of 7 shifts followed by 7 days off is common.
2. Increased Free Time: the freedom from day duties and on call rotas combined with extensive time off creates plenty of time to pursue other activities and interests. Parents can sleep during the day when children are at school, waking in time to collect them and enjoy meals and activities together before going off to work. Professional development, research and further study can be pursued in the weeks off duty.
3. Independent Medical Practice:  working overnight without other specialists on duty in the hospital requires a level of experience, confidence and self reliance and creates independence to make clinical decisions and treatment plans. In most cases, there is still the option to consult other specialists if required.
4. Focus on Medical Practice: night duties are free of meetings, ward rounds and administrative tasks which take up much time during the day enabling the physician to focus on clinical practice without distractions.
5. Camaraderie with the RMOs and night staff:  nocturnists are not entirely on their own. They work with resident medical officers and nursing staff, and the staff of the emergency department as they transition patients for admittance. You will get to know your fellow night-shift workers well, and enjoy the camaraderie which can develop.
6. Higher pay: the pay can vary from hospital to hospital but can be very attractive for many hospitalists considering a nocturnist position. A recent article in The Hospitalist, published by the Society of Hospital Medicine, estimates a 15 percent pay differential for nocturnists’ salaries. According to Indeed.com, the average annual salary for a nocturnist is currently $229,980, compared to $207,565 for hospitalists in general. Other sources put nocturnists’ salaries even higher.
7. Increasing demand for nocturnist services: As the State of Hospital Medicine Report noted, at least 70 percent of hospitalist programs in the USA now include a nocturnist, and demand is growing in other places. If you have the qualifications and experience for this role, browse currently available nocturnist jobs.
   

The Disadvantages Of Nocturnist Jobs

1. Solo Practice: nocturnists, as mentioned above, must be confident and self reliant as during most of their working hours, they will be the most senior doctor in the medical department and must be able to manage patients independently and safely as well as supervise RMOs who may be inexperienced. Other specialists are normally called only in extreme emergencies and there are no other physician colleagues to consult informally.  Independence may morph into loneliness for some doctors.
2. Insomnia: working night shifts can interfere with the body’s natural circadian rhythm, and lead to insomnia.
3. Personal lifestyle adjustments: the unusual work schedule of the nocturnist may impact other family members and commitments to activities and interests. It is not a lifestyle which would appeal to all doctors, although for some it may be manageable for a short time.
4. Administrative Duties: although the bulk of administrative work can be avoided at night, in many hospitals, some day time attendance may be required for staff meetings and educational and quality improvement programs.