Why has Hem/Onc salary declined, While Cardiologist held steady???

[olivarynucleus]

If you look at the Medscape surveys, Hemonc salary has decreased dramatically since 2011. Cardiology has held steady however, I though the big wigs were going to cut all specialist, what happened.

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[bashwell]

Not sure if Medscape is all that accurate when it comes to salaries. It depends a lot on who responds that particular year, right?

 

[gutonc]

The switch to employment among oncologists, and the lack of getting a cut of the drug money is probably the biggest change. Base salaries aren't all that different, it's the total compensation that has taken a hit.

 

[olivarynucleus]

The switch to employment among oncologists, and the lack of getting a cut of the drug money is probably the biggest change. Base salaries aren't all that different, it's the total compensation that has taken a hit.

So why are they switching to employment? is it impractical for oncologist to go into PP nowadays for some reason??

 

[bashwell]

I might be wrong, but I think gutonc is in part alluding to the change from "buy and bill" to "white bagging". For eg:

http://obroncology.com/obrgreen/print/The-Evolving-Use-of-White-Bagging-in-Oncology

Regarding employment options and trends:

http://www.onclive.com/publications/oncology-fellows/2013/December-2013/Selecting-Your-Career-Path

 

[bashwell]

Also see the newer posts in this thread:

http://forums.studentdoctor.net/threads/hem-onc-lifestyle-salary-satisfaction.800145/page-2

 

[gutonc]

So why are they switching to employment? is it impractical for oncologist to go into PP nowadays for some reason??

1. It's expensive to start up an Oncology practice unless you turf all your chemo to an inpatient infusion unit (my medium sized office has 5 front desk staff, 6-8 RNs depending on the day, 3-4 MAs, a pharmacist and 2 pharm techs, a lab tech and 2 people whose FT job is doing prior auths...and that doesn't count the 4 docs and 1 NP). Or have a turnkey thing with something like US Oncology, in which case, they're going to be making the money off the chemo, not you. Buy and bill is too expensive for many smaller groups, especially with the pricing that academics and non-profits get.
2. Hospitals are buying up PP groups like they're going out of style. For senior partners, this can be a good thing since theyll get a pretty nice payout in lieu of decreased annual compensation. Sucks for the junior folks though.

As a very practical example, in my medium-sized metro area, 10 years ago there were 7 PP groups, the University Hospital and a Kaiser hospital. Today, all but 2 of the PP groups have been bought by various hospitals. One of those 2 remaining PP groups is looking to sell but can't find a buyer, the other is a US Oncology group and is hemorrhaging docs (6 down in the last 3 years, none hired)

 

[bashwell]

Sorry if this is a dumb question, but I am honestly totally ignorant here: Is compensation for hospital-employed oncologists usually base salary + production like in many PP groups?

 

[gutonc]

Sorry if this is a dumb question, but I am honestly totally ignorant here: Is compensation for hospital-employed oncologists usually base salary + production like in many PP groups?

I can only speak for a few groups where I know people (plus myself), but the answer is generally yes. Although it may not be a strict production based bonus but may have other factors included (QI projects, admin duties, etc). Even Kaiser (a completely closed system) uses this structure for their oncologists.

 

[RustBeltOnc]

The other reason it is impractical to be in conventional private practice is "the referral issue." Much easier to get referrals if you are in a hospital system with surgeons, etc.

In 2015 the only justification for joining an extant private practice is if a) you have geographic restrictions and b) the hospital-employed group in the region in question is dysfunctional.

 

[gutonc]

The other reason it is impractical to be in conventional private practice is "the referral issue." Much easier to get referrals if you are in a hospital system with surgeons, etc.

In 2015 the only justification for joining an extant private practice is if a) you have geographic restrictions and b) the hospital-employed group in the region in question is dysfunctional.

Yup. And since it's not just oncologists that are being brought "in-house", the referral issue will only get worse in the future for PP docs. I anticipate that the one remaining, fiercely independent group in my town has about 5 years left before they shrivel up and blow away in the wind. All the hospital systems but one have either brought employed docs in-house or made strategic partnerships/collaborations (like the one I'm in). The one hospital that hasn't done that already kicked that group out anyway.

 

[bashwell]

Thanks @gutonc and @RustBeltOnc. Very good info here. I don't suppose it'd be possible to move this thread to the heme/onc specific forum rather than where it is now in the more I guess general IM forum, where it's less likely to get buried or at least it seems it'd be easier to search for and find this thread in the heme/onc forum once it is buried, so that it'd benefit future people considering heme/onc, as they'd presumably be more likely to look for this kind of info in the heme/onc specific forum? Then again, maybe I have no idea what I'm talking about, or this might otherwise be a bad idea, and if it is, apologies!

 

[gutonc]

Done. I wasn't really sure why it got put it in the general IM forum in the first place.

To answer the 2nd part of your question about cards staying level-ish, there is less pressure on them to become employed as they remain a money maker for the hospitals they have privilieges at. Sure, there's a pretty decent RVU reimbursement for the cath jockey, but the facility fee is way more money for the hospital that runs the cath lab.

 

[asprin81]

In South (FL, AL, TN, MS, AR, MO etc) most oncologist make more than cardiologist or GI in Hospital employed and Private Practice setting. For hospital employed, especially those bigger groups who negotiated their contracts well earn much better. This may change in future. In Academic, Northeast desired cities/states, oncologist make less than cardio or GI. Oncologist salary info on medscape like surveys is inaccurate as oncologists income is more complex than other specialities.. Lot depends on contract negotiation. Unfortunately new folks get crappy contracts due to poor negotiation..

 

[olivarynucleus]

1. It's expensive to start up an Oncology practice unless you turf all your chemo to an inpatient infusion unit (my medium sized office has 5 front desk staff, 6-8 RNs depending on the day, 3-4 MAs, a pharmacist and 2 pharm techs, a lab tech and 2 people whose FT job is doing prior auths...and that doesn't count the 4 docs and 1 NP). Or have a turnkey thing with something like US Oncology, in which case, they're going to be making the money off the chemo, not you. Buy and bill is too expensive for many smaller groups, especially with the pricing that academics and non-profits get.
2. Hospitals are buying up PP groups like they're going out of style. For senior partners, this can be a good thing since theyll get a pretty nice payout in lieu of decreased annual compensation. Sucks for the junior folks though.

As a very practical example, in my medium-sized metro area, 10 years ago there were 7 PP groups, the University Hospital and a Kaiser hospital. Today, all but 2 of the PP groups have been bought by various hospitals. One of those 2 remaining PP groups is looking to sell but can't find a buyer, the other is a US Oncology group and is hemorrhaging docs (6 down in the last 3 years, none hired)

Are all these people necessary? Are they being paid a salary based on what the doctors bring in? Healthcare to me seems to be extremely bloated. There are a lot of direct primary care offices that are opening with 1 doctor and a Medical Assistant that is also a phlebotomist, and receptionist.

 

[gutonc]

Are all these people necessary? Are they being paid a salary based on what the doctors bring in? Healthcare to me seems to be extremely bloated. There are a lot of direct primary care offices that are opening with 1 doctor and a Medical Assistant that is also a phlebotomist, and receptionist.

It's not completely clear to me if you're being intentionally obtuse, or are terminally naive (I'll assume the latter) here.

Try opening an oncology office with 5 providers without that support staff and let me know how it works out for you.

Sure, a solo PCP can get away with one assistant doing all that work. But they outsource everything else.

My office sees 70-80 patients on a routine day. I need vitals and med checks on all those people and labs on a bunch of them...so we need MAs. We give chemo (or some other infusion/injection) to about half of them. I need stat labs to give chemo...so I need a lab tech, or be willing to waste an hour waiting for the hospital lab to do it. I need a pharmacist to review and approve the chemo and a tech to mix it. I need a chemo certified nurse to administer it. Preferably one who knows how to safely access a variety of CVCs. I need people to answer patient calls (we get about 75 a day in my office). I need somebody to schedule scans and procedures and place consults...I order about 10 or so of these a day on a slow day, and I'm not the only one doing it. I need somebody to get insurance authorization for all that chemo, those scans, that bone marrow biopsy, etc, etc, etc.

So yes, I do need all those people.

 

[sachida]

Thanks gutonc for detailed replies. My hospitalist program now also has a community oncologist as nocturnist..since his solo practice has financial viability issues. It gives a pause to aspiring fellows like me.
How do you think ACO will end up affecting oncology practice...would it not also promote overall consolidation towards hospital based organisations? And how will impact future salaries?

 

[RustBeltOnc]

Thanks gutonc for detailed replies. My hospitalist program now also has a community oncologist as nocturnist..since his solo practice has financial viability issues. It gives a pause to aspiring fellows like me.

Sachida, this doesn't apply to you.
Possible etiologies of this:

1) This "soloist" is in a conventional private practice, holding out for things to improve, and refuses to join hospital system (employed). This won't be you.

2) This individual was placed somewhere by a hospital system that had the idea "if we just build a chemo unit, the patients will come." This doc got little real help, then appears to be unproductive, has compensation lowered. This will only be you if you fall for this.