Physician (Pulmonary Medicine)-- Critical Care Nocturnist

The full-time Physician (Pulmonary Medicine), for a Critical Care Nocturnist Physician (Overnight) in the Intensive Care Unit at The Robley Rex VA Medical Center will perform a wide range of critical care procedures independently and competently. Demonstrate proficiency in critical care management, including mechanical ventilation, invasive monitoring, and emergency interventions. Ability to work efficiently and calmly in a fast-paced, high-stress environment.

Duties to include:

1. Patient Care:

• Assessments and Care Planning: Conduct thorough initial assessments of critically ill patients upon admission to the ICU during night shifts. Develop, implement, and evaluate individualized care plans to address the complex medical needs of these patients.
• Critical Procedures: Perform, interpret, and manage advanced life support procedures including but not limited to intubation, central and arterial line placement, thoracentesis, paracentesis, and emergency dialysis initiation.
• Monitoring and Maintenance: Oversee the management of mechanically ventilated patients, ensuring appropriate settings and weaning protocols. Utilize invasive hemodynamic monitoring tools to assess and adjust treatment plans for optimal patient outcomes.
• Emergency Response: Lead and respond to all code blue situations, rapid response activations, and other emergent clinical scenarios in the ICU and throughout the hospital as needed.

2. Medical Management:

• Collaboration: Work closely with a multidisciplinary team, including but not limited to nurses, respiratory therapists, pharmacists, and consulting specialists, to provide holistic care.
• Continuity of Care: Facilitate seamless transition of care by conducting thorough handoff reports to daytime critical care teams, ensuring continuity and comprehensive understanding of patient conditions and ongoing treatment plans.
• Evidence-Based Practice: Stay current with the latest research and advancements in critical care medicine, integrating evidence-based practices into patient care to enhance outcomes and ensure the highest standard of care.

3. Admissions and Procedures:

• Patient Admissions: Independently manage the admission process for patients presenting to the ICU during night shifts, including timely completion of necessary documentation and initiation of treatment protocols. Some limited admissions to the floor will also be part of the workflow.
• Clinical Procedures: Assist ICU staff with complex procedures and interventions, providing mentorship and technical expertise to ensure successful outcomes.

4. Resident Support and Education:

• Performance Feedback: Regularly provide constructive feedback to residents and trainees on their clinical skills, decision-making, and overall Serve as a clinical mentor and supervisor to residents and medical trainees, offering guidance and support in the management of critically ill patients.
• Educational Activities: Participate in and contribute to formal and informal educational opportunities, including bedside teaching, case discussions, and morbidity and mortality conferences.
• Performance Feedback: Regularly provide constructive feedback to residents and trainees on their clinical skills, decision-making, and overall performance.

5. Communication:

• Patient and Family Interaction: Engage in compassionate and clear communication with patients and their families, explaining complex medical conditions, treatment options, and care plans. Provide emotional support and address concerns with empathy and professionalism.
• Interdisciplinary Communication: Maintain open and effective communication channels with all members of the healthcare team, ensuring that pertinent information is shared in a timely and efficient manner.

6. Documentation:

• Accurate Record-Keeping: Ensure meticulous and prompt entry of all clinical notes, orders, and patient interactions in the electronic medical record (EMR) system.
• Compliance: Adhere to all documentation standards required for billing, quality reporting, and regulatory compliance.

7. Quality Improvement:

• Initiatives and Projects: Actively participate in quality improvement projects aimed at enhancing patient care processes, outcomes, and overall ICU performance.
• Review and Analysis: Engage in regular morbidity and mortality reviews, root cause analyses, and other quality assurance activities to identify areas for improvement and implement changes as needed.

VA offers a comprehensive total rewards package. VHA Physician Total Rewards.



Pay: Competitive salary, annual performance bonus, regular salary increases
Paid Time Off: 50-55 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year and possible 5 day paid absence for CME)
Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA
Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement)
Licensure: 1 full and unrestricted license from any US State or territory
CME: Possible $1,000 per year reimbursement (must be full-time with board certification)
Malpractice: Free liability protection with tail coverage provided
Contract: No Physician Employment Contract and no significant restriction on moonlighting



Work Schedule: 7pm-7am, 7 days on, 7 days off, Night Shifts (12-hour shifts)

To qualify for this position, you must meet the basic requirements as well as any additional requirements (if applicable) listed in the job announcement. Applicants pending the completion of training or license requirements may be referred and tentatively selected but may not be hired until all requirements are met. Currently employed physician(s) in VA who met the requirements for appointment under the previous qualification standard at the time of their initial appointment are deemed to have met the basic requirements of the occupation.

Basic Requirements:

• United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• Degree of doctor of medicine or an equivalent degree resulting from a course of education in allopathic medicine or osteopathic medicine. The degree must have been obtained from one of the schools approved by the Department of Veterans Affairs for the year in which the course of study was completed.
• Current, full and unrestricted license to practice medicine or surgery in a State, Territory, or Commonwealth of the United States, or in the District of Columbia.
• Residency Training: Physicians must have completed residency training, approved by the Secretary of Veterans Affairs in an accredited core specialty training program leading to eligibility for board certification. (NOTE: VA physicians involved in academic training programs may be required to be board certified for faculty status.) Approved residencies are:
  • (1) Those approved by the accrediting bodies for graduate medical education, the Accreditation Council for Graduate Medical Education (ACGME) or American Osteopathic Association (AOA), in the list published for the year the residency, or fellowship if applicable, was completed; OR
  • (2) One year of post medical school training (internship, first year of residency, or transitional year residency) approved by ACGME or AOA followed by two years of post-training independent practice (performing under a full and unrestricted license) in the United States; OR
  • (3) Non-US residency training programs followed by a minimum of three years of verified independent practice in the United States (performing under a full and unrestricted license) performing duties related to the position they are applying for (United States fellowships would be creditable towards this requirement), which the local Medical Staff Executive Committee deems to have provided the applicant with appropriate professional training and believes has exposed the Physician to an appropriate range of patient care experiences.
  • Exceptions:
    • Residents currently enrolled in ACGME/AOA accredited residency training programs and who would otherwise meet the basic requirements for appointment are eligible to be appointed as "Physician Resident Providers" (PRPs). PRPs must be fully licensed physicians (i.e., not a training license) and may only be appointed on an intermittent basis. PRPs are not considered independent practitioners and will not be privileged; rather, they are to have a "scope of practice" that allows them to perform certain restricted duties under supervision. Additionally, surgery residents in gap years may also be appointed as PRPs.
    • In rare and unusual circumstances, the Facility Director can submit a memo to the VISN Director through the VISN Chief Medical Officer, who may approve requests for reasonable exceptions to the residency training requirement for Physicians whose composite record of experience, accomplishments, performance, and qualifications warrant such action.
• Proficiency in spoken and written English.

Preferred Experience: 5 Yrs Experience Preferred

Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

Physical Requirements: See VA Directive and Handbook 5019, Employee Occupational Health Service

Degree of Doctor of Medicine or an equivalent degree resulting from a course of education in allopathic medicine or osteopathic medicine. The degree must have been obtained from an institution whose accreditation was in place for the year in which the course of study was completed. Approved schools are:

1. Schools of medicine accredited by the Liaison Committee on Medical Education (LCME) for the year in which the degree was granted.
2. Schools of osteopathic medicine approved by the Commission on Osteopathic College Accreditation (COCA) for the year in which the degree was granted.
3. For foreign medical graduates not covered in (1) or (2) above, confirmation must be made that the medical school meets (or met) Educational Commission for Foreign Medical Graduates (ECFMG) eligibility requirement for year graduated.

NOTE: The Under Secretary of Health or designee in the VHA Central Office may approve the appointment under authority of 38 U.S.C. 7405 of a physician graduate of a school of medicine not covered above if the candidate is to be assigned to a research, academic, or administrative position with no patient care responsibilities. The appointment will be made only in exceptional circumstances where the candidate's credentials clearly demonstrate high professional attainment or expertise in the specialty area.