Nocturnist Salary (2026): What Night Hospitalists Earn a Year, a Shift and an Hour

A nocturnist is a hospitalist who works nights only, admitting patients and covering the hospital's inpatients overnight. Employers usually ask for board certification in internal medicine or family medicine. Hospitals pay extra to fill those nights, but the big salary reports don't list nocturnists separately, so the premium is easy to misjudge. This guide pulls together the surveys, contract data and 2026 job postings that do report nocturnist pay, converts per-shift and hourly rates to annual pay, and compares the result with day hospitalist pay after taxes.

What nocturnists earn

Doximity's and Medscape's compensation reports do not list hospital medicine, let alone nocturnists. The sources that do are a hospitalist trade publication's annual survey and a contract-review company's database.

The survey figures include bonuses, which make up less of a nocturnist's pay: in 2023, nocturnists reported $31,172 in bonus and incentive pay against $40,867 for all adult hospitalists. Resolve's figures are contract terms rather than what physicians ended up earning, and its hospitalist dataset includes some part-time contracts, which pull that average down. For day hospitalist pay in more detail, see our hospitalist salary guide.

The night premium: per year and per shift

The annual gap looks modest because many nocturnists work fewer shifts than day hospitalists. Divide pay by shifts worked and the premium is closer to a fifth.

Per-shift figures divide each group's mean pay by its average monthly shifts times 12, so they are estimates, not reported rates. The 2023 comparison group includes the nocturnists themselves, which narrows the gap. Nocturnists in that survey said their shifts averaged 11.6 hours, which puts their pay at about $195 per clinical hour.

Resolve's contract data shows a wider annual gap: nocturnist contracts averaged about 17% more than internal medicine hospitalist contracts, partly because the hospitalist dataset includes part-time contracts. The Society of Hospital Medicine's 2016 State of Hospital Medicine report, the most recent of its reports we could confirm on this, found that nearly 70% of groups with nocturnists paid them differently, with a median differential of 15%. Groups pay the premium as more money, fewer shifts, or both.

Schedules and shifts per year

• 7-on/7-off: strictly, 26 blocks of seven nights, or 182 nights a year; Dignity Health's Northridge posting counts 183. In the postings below, shifts run 10 or 12 hours and start between 7 and 10 p.m.
• Reduced night counts: some programs pay the premium as fewer shifts. Nocturnists in the 2023 survey averaged 13.3 shifts a month, about 160 a year, against 15 a month for all adult hospitalists. Palo Alto Foundation Medical Group's Mountain View posting asks for about 120 overnight and 40 swing shifts a year.
• Longer shifts: in the 2022 survey, 72% of nocturnists worked 12-hour shifts, against 55% of day hospitalists.

The shift count is the number to pin down first. The same salary on 160 nights and on 182 nights is a 14% difference in pay per shift.

Nocturnist pay in 2026 job postings

Pay-transparency laws in states such as California, Washington and New York mean many nocturnist postings now show a salary range. These are full-time, permanent roles with published pay. Per-shift and hourly figures are our division, using the shift count and length each posting states; for a 7-on/7-off schedule with no count given, we used 182 nights.

Posted base pay runs about $270K to $359K, below the survey means, which include bonuses. Within a range, experience and the site set where you land, and the posting itself is only the opening number. The lowest salary is not always the lowest pay per night: Palo Alto Foundation Medical Group's range is the lowest here but comes with fewer shifts and a shareholder track, while the Syracuse base adds productivity and quality bonuses.

From per-shift rate to annual pay

Some groups quote nocturnist pay per shift. The table shows what common per-shift rates pay over a year at the survey's average night count and on a strict 7-on/7-off schedule, and what each works out to per hour on 10- and 12-hour nights.

For per-shift pay across day, night and per-diem hospitalist work, see hospitalist pay per shift.

Nocturnist vs. day hospitalist pay after taxes

Using the 2022 survey's day and night means, the premium shrinks after federal and state income tax and payroll taxes, since it is taxed at the top of your bracket.

Take-home uses 2026 tax rules for a single filer with no retirement contributions or other income. Of the $28,355 annual premium, a single nocturnist keeps about $17,764 in Texas and $14,759 in California. Run your own figures in the take-home pay calculator.

Contract terms that set nocturnist pay

• The nocturnist differential: it can be a higher salary, a higher per-shift rate, a per-night add-on, or fewer required shifts for the same salary. Get it in writing as a number, and check whether it applies to extra shifts too.
• Night differentials: in the 2024 Today's Hospitalist survey, 65% of adult hospitalists got extra pay for working nights, averaging $452 a night. It varied by employer: $722 at local hospitalist groups, $566 at universities and medical schools, $434 at multispecialty and primary care groups, and $410 at national hospitalist management companies.
• Bonuses: productivity bonuses tied to encounters or work RVUs can pay less on nights, when there are fewer encounters. Nocturnists reported smaller bonuses in both survey years ($37,281 against $44,479 for day hospitalists in 2022).
• Scope: whether you cover the ICU, rapid responses, codes and procedures overnight, and whether an intensivist or advanced practice provider is in house. A posting that mentions a closed ICU or no procedures is telling you the night covers less.
• Employer type and PSLF: a nonprofit hospital employer qualifies for Public Service Loan Forgiveness; a for-profit staffing company placing you at the same hospital does not. See does my hospital qualify for PSLF.
• Noncompete and moonlighting clauses: the off weeks are what make extra income possible, so read any restriction on outside work. See our noncompete guide.

Locums, 1099 work and moonlighting

AMN Healthcare's locum nocturnist page shows a historical average of $191 an hour, in a range of $179 to $200, and $187 an hour in Texas. Some 2026 postings pay more: $210 an hour for 12-hour nights in York, Pennsylvania, and $220 an hour for week-on, week-off nights at a Michigan teaching hospital. At $191 an hour, a 12-hour night is $2,292 and a 10-hour night $1,910.

Locum work is usually 1099, and the rate has to be higher than a W-2 rate to come out even: you pay both halves of Social Security and Medicare tax and your own health insurance, and get no retirement match. For example, $191 an hour on a full 7-on/7-off year of 12-hour nights is $417,144. After self-employment tax ($35,541), income tax, a $9,325 health premium and $5,000 of licenses and dues, that matches a W-2 salary of about $361,692 with a typical retirement match, for a single physician in Texas with agency-paid malpractice. That is about $1,987 a night as an employee. Run your own numbers in our locum rate calculator, and see 1099 physician taxes for estimated payments and a solo 401(k).

Extra shifts are the other income lever. In the 2024 Today's Hospitalist survey, 44.6% of hospitalists got a differential for working extra shifts, averaging $896 a shift on top of the regular rate. A nocturnist on a week-on, week-off block can also pick up locum or per-diem shifts in the off week, if the contract allows it. Agencies usually provide malpractice coverage on locum work; confirm that it includes tail coverage.

Sleep, health and workload

• Health risk: the International Agency for Research on Cancer, part of the World Health Organization, classified night shift work as probably carcinogenic to humans (Group 2A) in 2019. The human evidence is limited: the larger case-control studies found links with breast, prostate, colon and rectal cancer, while cohort studies were inconsistent. The label describes how strong the evidence is, not how large the risk is.
• Lighter patient load: nocturnists in the 2023 survey averaged 10.7 patient encounters a shift, against 16.1 for day hospitalists on 7-on/7-off. They put a reasonable night load at 9.1 encounters.
• Satisfaction: 90.5% of nocturnists in the 2023 survey said they were satisfied with their careers, up from 83.3% in 2022 and above the 86.5% of all adult hospitalists.
• Protecting the income: if your plan depends on years of high night pay, your income is your main asset. Make sure your disability insurance covers your own occupation and enough of your pay, including the premium.

Who nocturnist work suits

• Physicians paying down debt or saving hard: a higher rate per shift and off weeks free for extra shifts raise income without a fellowship or a move to a higher-paid specialty.
• People who already sleep well by day: natural night owls, and households where a daytime schedule at home helps with child care or a partner's job.
• Hospitalists who want a lower census: fewer encounters per shift, though with more admissions and cross-cover, and often less support overnight.

It suits physicians less when they need daytime routines at home, have trouble sleeping after night shifts, or want a path into hospital leadership, teaching or committee work, which mostly happen in the daytime. If you plan nocturnist work as a phase of a few years, decide in advance what the extra pay is for, such as a debt payoff or a down payment, so the premium doesn't simply raise spending.

What to ask before you sign

1. Shifts a year: the number of nights that counts as full-time, shift length and start time, and how holidays are split.
2. The differential: how the night premium is paid, as a number, and whether day hospitalists at the same group would earn less for the same shift count.
3. Extra shifts: the rate for extra nights, and whether you can be required to work them.
4. Bonus formula: what productivity or quality bonus is realistic on nights, given fewer encounters.
5. Coverage overnight: census, expected admissions, ICU and rapid-response duties, and in-house support.
6. Employer: nonprofit hospital or for-profit staffing company, which decides PSLF eligibility.
7. Outside work and noncompete: what the contract allows in your off weeks, and its radius and length. See physician contract negotiation.