Help with current job offers

[dramw]

Hello. Would appreciate some insight regarding 2 offers I have for vascular neurology. I am finishing up stroke fellowship this year.

1) academic in a major city. Pay in mid 200s. Resident run so don’t have to do much. Patient census about 15 per day consult and primary service. Will have to take stroke calls as well but usually not too busy. Total of about 8 blocks inpatient ( 14 days per block ) and about 1.5 days outpatient vascular clinic during outpatient weeks.

-Pro: resident run. Can round and leave unless I have to do academic service stuff like give lectures etc. Don’t have to see ICU patient because there is a neuroicu floor.
-Con: I hate outpatient so much. I can probably get used to it but really dislike clinics. Also, less pay.

2) neurohospitalist at a small hospital. 7on7off 24 hr calls. Consults only. Patient census about 30-35 daily seeing all types of patients including ICU. Have 2 APPs and sometimes might have a medicine resident. Have to write about 15 notes daily. Stroke calls one week a month only.

-Pro: no clinic. 100K more than the offer above. When im off, im off.
-Con: high patient census. Have to write notes daily. I will always be the one getting pages for consults. Don’t always have residents to help filter out consults.

Based on the above, are there any recommendations or experiences with similar types of jobs? Thank you in advance.

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[Telamir]

Both kinda suck not gonna lie but the academic one sounds a little better.

 

[curiousneuro]

Yeah both of those options sound pretty bad....

 

[dramw]

Both kinda suck not gonna lie but the academic one sounds a little better.

Yeah both of those options sound pretty bad....

Thanks for the replies. I kind of have to stay in the area of these 2 offers due to location and family. So I guess I have to take best of the 2 even though I can probably find something a lot better elsewhere

 

[Captain_Falcon]

Counter the offers, everything is a negotiation

 

[neophyte2008]

Honestly after just being in the job market myself as a new grad , I can say that both option suck. The second one seems like a disaster and would not be great for your long term health and sanity.

If I were you I would try to move out, if that wasn’t an option I would do option 1. I wonder how people in option 2 are actually surviving.

I wonder if they will let you lose the NPs and pay you 200 grand more 😜. Even then wouldn’t do it.

 

[dramw]

Honestly after just being in the job market myself as a new grad , I can say that both option suck. The second one seems like a disaster and would not be great for your long term health and sanity.

If I were you I would try to move out, if that wasn’t an option I would do option 1. I wonder how people in option 2 are actually surviving.

I wonder if they will let you lose the NPs and pay you 200 grand more 😜. Even then wouldn’t do it.

Lol. I guess I would do it for 500-600k but yes, it is too much work.

If you don’t mind me asking, what kind of offer did you accept?

 

[neophyte2008]

It definitely is too much work for me , even in residency we had a max census of 30 -40 on general plus consults. I think the sweet spot for me is 10-20 with 7 news a day.

Will PM you the details . A lot of places when I interviewed were offering 350k for 12 hour shifts and 10-20 volumes . I suggest you speak with people working in the hospital, they usually will let you know if they are unhappy or at least hint at it. I am also vascular trained.

 

[Telamir]

Hello. Would appreciate some insight regarding 2 offers I have for vascular neurology. I am finishing up stroke fellowship this year.

1) academic in a major city. Pay in mid 200s. Resident run so don’t have to do much. Patient census about 15 per day consult and primary service. Will have to take stroke calls as well but usually not too busy. Total of about 8 blocks inpatient ( 14 days per block ) and about 1.5 days outpatient vascular clinic during outpatient weeks.

-Pro: resident run. Can round and leave unless I have to do academic service stuff like give lectures etc. Don’t have to see ICU patient because there is a neuroicu floor.
-Con: I hate outpatient so much. I can probably get used to it but really dislike clinics. Also, less pay.

2) neurohospitalist at a small hospital. 7on7off 24 hr calls. Consults only. Patient census about 30-35 daily seeing all types of patients including ICU. Have 2 APPs and sometimes might have a medicine resident. Have to write about 15 notes daily. Stroke calls one week a month only.

-Pro: no clinic. 100K more than the offer above. When im off, im off.
-Con: high patient census. Have to write notes daily. I will always be the one getting pages for consults. Don’t always have residents to help filter out consults.

Based on the above, are there any recommendations or experiences with similar types of jobs? Thank you in advance.

Out of the two jobs here the academic one is likely better for your long term well-being, and even then it's pretty busy. Don't forget that while the census is lower if you have residents then you owe it to them to teach meaning rounds will progress slowly. They pay pretty ****, but that's standard for academia. The primary service sucks and it is the one thing I will never do again after finishing residency/fellowship.

What I have found is that some academic places want a neurohospitalist model (12-24 hours on, 7 days) and then not give you time off, make you go back to clinic. If this is the case then I wouldn't take it honestly. That being said, stroke clinic isn't as painful as general neuro clinic. It's pretty cookbook the vast majority of the time and you don't have long term followup typically unless you're wanting to manage spasticity or other post-stroke complications yourself.

The SECOND job however is absolutely insane. If it is legitimately 30-35 patients (and not just bad list keeping) you're going to make mistakes, or someone you supervise will make mistakes. I'd say the upper limit of what you can see reasonably is 20. I've done 25 once and don't wish that on anyone.

 

[Telamir]

I forgot to mention:

What you typically reasonably expect for inpatient jobs is a 10-20 patient census, typically consult only, for 12 or 24 hour coverage (depending on how busy it is, and depending on how much the E.D. calls you at night). You may have to cover more than 1 hospital usually by phone or transfers since people "don't feel comfortable managing" or "we don't have neurology tee-hee". There may or may not be need to do EEGs, and typically cover whatever comes in; general or stroke.

For that you can expect anywhere between (in my experience) 350-430 and maybe a bit more or a bit less taking into account location (always more money in the boonies) and production--all depends on how it's structured.

Hope that helps.

 

[CnsCrit]

In my region starting pay for academic stroke is even less than your offer, roughly around 220, maybe less. The census seems reasonable although 16 weeks inpatient might be on the high side if you factor in clinic.

I agree with others, second job sounds like ridiculous volume. Also why couldn't the APPs at least hold the pager during the day? Doesn't make sense. Plus, medicine rotators means more teaching and slower rounds which is fine unless your census is 30+.

If you take the academic job at least you might have some extra time time, can explore non-clinical side gigs to increase your income if interested.

 

[Thama]

That academic job sounds pretty good, TBH. 250K is well above median starting academic pay, and the gig sounds very chill based on that inpatient volume and only 1.5 days clinic per week. Working inpatient 1 in 3 weeks on average with residents doing all the busy work is about as good a hedge against burnout as exists in modern medicine.

 

[neophyte2008]

Actually looking back at the academic job details which I just glanced the first time, I think it is decent, and is in line with the market.

 

[Drhappyface]

If you a limited by region, then why not telestroke? I think you would make more working less from what I've been hearing. You could also supplement with locums every few months so you don't lose your skills

 

[CnsCrit]

If you a limited by region, then why not telestroke? I think you would make more working less from what I've been hearing. You could also supplement with locums every few months so you don't lose your skills

Nothing wrong with telestroke and yes could probably make more money than an academic gig but realistically I doubt many people looking to build a career are doing full time telestroke as first job out of fellowship. Probably better to do tele or moonlighting on the side for extra money when you have the time, focus on building relationships in your field, take advantage of mentorships with other experienced stroke docs, engage in projects if anything seems interesting, etc. If academics is that horrible after a couple years, then re-evaluate.

 

[dramw]

I forgot to mention:

What you typically reasonably expect for inpatient jobs is a 10-20 patient census, typically consult only, for 12 or 24 hour coverage (depending on how busy it is, and depending on how much the E.D. calls you at night). You may have to cover more than 1 hospital usually by phone or transfers since people "don't feel comfortable managing" or "we don't have neurology tee-hee". There may or may not be need to do EEGs, and typically cover whatever comes in; general or stroke.

For that you can expect anywhere between (in my experience) 350-430 and maybe a bit more or a bit less taking into account location (always more money in the boonies) and production--all depends on how it's structured.

Hope that helps.

Thanks everyone for the help.

I’m gonna try to speak to them regarding patient load and if they can make a cap or help by another neurologist then maybe it won’t be too bad after all.

 

[deathmerchant]

Depends on your preference too. I would personally prefer the first job just because of volume in the second job is too much. Overall both jobs are comparable and sorta 'mid', unless its a desirable location, then they are both decent. If you want to climb the academic ladder, do research and/or teach- pick the first one. If you want to make more money and not interested in non-clinical stuff that much, pick the latter. Highly unlikely that they will let you cap as an attending. They might say they will hire another neurologist but no guarantee that would happen in the current market.
Negotiate number of outpatient days or even just half days during your On-Call blocks only, or maybe resident clinic only in the former job. And negotiate midlevel supervision and/or directorship position extra salary in the latter job.

 

[dramw]

Depends on your preference too. I would personally prefer the first job just because of volume in the second job is too much. Overall both jobs are comparable and sorta 'mid', unless its a desirable location, then they are both decent. If you want to climb the academic ladder, do research and/or teach- pick the first one. If you want to make more money and not interested in non-clinical stuff that much, pick the latter. Highly unlikely that they will let you cap as an attending. They might say they will hire another neurologist but no guarantee that would happen in the current market.
Negotiate number of outpatient days or even just half days during your On-Call blocks only, or maybe resident clinic only in the former job. And negotiate midlevel supervision and/or directorship position extra salary in the latter job.

Thank you for the reply. I will try to talk to both of them sometime next week.

Do you think the 100 K difference is worth the extra patient load in the second offer?

 

[Telamir]

Not at the eventual expense of your sanity, in my opinion.

 

[deathmerchant]

Thank you for the reply. I will try to talk to both of them sometime next week.

Do you think the 100 K difference is worth the extra patient load in the second offer?

IMO after taxes, from 150k to 250k makes a noticeable difference in lifestyle, 250k to 350k not that much. I think once patient load reaches 15-18/day that gets unsustainable in the long term. You could do it for 3-5 years, finish off any debt/loans etc.

 

[dramw]

If I decline an offer after we have interviewed, and let’s say after 3 years I wanted to re-interview at that place again, will they have a red flag on me because I had previously declined their offer?

 

[DrSatan]

I mean, if they're still hiring...They may be a little desperate or have high turnover. Not sure whether it'd be a real flag though.

 

[Postictal Raiden]

If I decline an offer after we have interviewed, and let’s say after 3 years I wanted to re-interview at that place again, will they have a red flag on me because I had previously declined their offer?

Not necessarily. I’m sure it differs from place to place, but I can tell you that few of the places that I declined their offers knees deep into the process told me to let them know if I changed my mind and wanted a job.

 

[Phantom Spike]

Not necessarily. I’m sure it differs from place to place, but I can tell you that few of the places that I declined their offers knees deep into the process told me to let them know if I changed my mind and wanted a job.

Sure, they *say* that, but do they really mean it?