Allergy/Immunology Job Market: Post-COVID

[ftcm23]

I want to build on the discussion in a prior thread Allergy/Immunology with a few more detailed questions

Thread started off on a pretty bleak note: "Job market has collapsed, offers rescinded, revenue sharply contracted in existing practices due to COVID"

For this new crop of graduating fellows and first years, what does the job market look like now?
Those starting new jobs this summer, how was the search?

More detailed questions if they get your thoughts going:

• Location: did you end up where you wanted?
• Support staff: do you have a scribe? What is the PA/NP support like? How much prior auth/appeal letter/management did you expect and how much do you actually do?
• Volume: what does part time in allergy look like for people in your practice?
• Salary: general ranges by private vs academic, regions? Is partnership a possibility in allergy or is private equity at all in the allergy space?

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[MHYDE]

I want to build on the discussion in a prior thread Allergy/Immunology with a few more detailed questions

Thread started off on a pretty bleak note: "Job market has collapsed, offers rescinded, revenue sharply contracted in existing practices due to COVID"

For this new crop of graduating fellows and first years, what does the job market look like now?
Those starting new jobs this summer, how was the search?

More detailed questions if they get your thoughts going:

• Location: did you end up where you wanted?
• Support staff: do you have a scribe? What is the PA/NP support like? How much prior auth/appeal letter/management did you expect and how much do you actually do?
• Volume: what does part time in allergy look like for people in your practice?
• Salary: general ranges by private vs academic, regions? Is partnership a possibility in allergy or is private equity at all in the allergy space?

I’m in the Midwest. Lots of jobs posted, had several interviews and a few offers. The search went well, reached out to postings and recruiters in my first year and got lots of interest. Looked as far as the South and mid-Atlantic but otherwise mostly in Ohio, Michigan, Indiana, Kentucky. Location-wise I landed where I wanted to. Lots of retiring independent docs looking to sell/hand off practices too, which I didn’t want. I didn’t look as much at smaller practices with partnership opportunity, was more interested in larger hospital-based multispecialty groups. I’d rather work, get paid, and go home, without the risk (or the reward I guess) of ownership. Offers I got were all in $300k range guaranteed first year plus incentives, with transition to productivity. One academic offer in $220-40 range that I declined (for other reasons). I will have a scribe, and at least the current docs there say their support staff and admin is good. No mid-levels. I will be full time, which is 4 clinic days per week, 20 appts/day. No part time docs in this group. Hospital consult call but very light volume. Hope that helps.

 

[hotsaws]

Job market seems strong. Last years fellows ended up in the cities they wanted, desirable areas too. One took an employed position and the other academics. My co fellow and I both signed for jobs in the cities we wanted and were able to secure this early in fellowship. Both of us are going private practice. There were multiple opportunities for both of us including PP, employed, and academics.

Support staff varies. As far as midlevels, some use them, some don't. This applies to PP, academics, and employed. Hiring and retaining good ancillary staff seems to be a challenge everywhere and reflective of the country's job market and not allergy specifically. Not sure exactly about things like PA, appeals, logistic stuff like that -- it will likely vary based on practice setting and payor mix. Larger groups are likely to centralize this as they have the staff to delegate this more effectively. Very small groups or solo practice will probably put more work on the doc. PP is built to be efficient and the partners have vested interest in creating and maintaining that environment.

Volume also varies by practice structure with academics probably being lighter (in terms of patient volume) and PP being the highest. Employed probably in the middle. Academics has plenty of work that's not as easy to view quantitatively as patient load, sounds terrible to me. You might be able to contractually protect yourself at an employed position but, anecdotally, they have ways of increasing your workload down the line without paying you more for it. If you can get into a PP partnership, then at least your compensation is correlated with workload. Based on my experience and that of my friends: academics probably sees no more than 16pts per day, PP can see upwards of 30 but probably not much less than 20, and employed positions probably cap in lower 20s. I knew that I'd rather be busy at work and I'd rather see that extra patient as an opportunity and not a burden. Who knows? I may be naive and clueless.

I've seen offers for part time but most people I know work either 4 or 5 days a week. Call is probably the worst at a large academic center (although, you have fellows) and best in small PP. Most PP docs I know are rarely actually going into a hospital, like maybe not even once in a year. Some just don't maintain hospital privileges at all. Larger practices can have midlevels take call and spread it out more. Solo practices or very small practices often have some kind of call/vacation coverage sharing with other small practices in the area.

Starting salaries vary by structure. Academic tends to be the lowest -- I've heard mostly about $150 starting and a very low ceiling. Employed probably starts the highest but has a low ceiling as well. I know of someone who got an employed gig starting about $275 + benefits. This clearly varies with location, volume, bonus structure, etc. PP that is offering a partnership track usually starts low as well, high 100s/low 200s. Once partner, its usually collections based and can be quite lucrative -- the ceiling is high. The biggest challenge with partnership tracks is they are often vaguely written, require a buy in, and also good faith. So you want to make sure you're not signing up for some crappy non-compete or something like that and get as much as you can in writing. Feel free to DM me for more details.

Private equity definitely has allergy on its radar. There are a few large groups that are starting to capture market share and territory. They should always be viewed as predatory and I wish the college and academy would stop letting them set up booths at meetings or supporting them in any way. Private equity cares about the bottom line only and doesn't have a reputation to maintain. They have a reputation of hanging high starting salaries and seemingly great perks but then grinding out docs once they've got them. Private equity jobs might appeal to certain docs for varying reasons but I think they mostly exploit the naive or desperate. The ones that benefit are older partners who are looking to sell out and care more about a smooth, lucrative exit than what happens to the younger docs (or possibly patients). At the end of the day, you are working for a for-profit company that answers to investors/bankers and cares about the bottom line.

For those who want to be a true academic, publishing papers and chasing tenure...none of this really applies. That's a different breed. Good luck to you. That sentiment applies similarly to A/I docs who really want to practice clinical immunology primarily. I am not one to weigh in on those at all.

 

[Deecee2DO]

Does anyone know what a private practice Allergist can expect to make on average? I have heard anywhere between 380K-450K+ depending on location and volume is this correct? Other specialties seem to be pretty straight forward as far as pay but have never really gotten a straight answer for Allergy?

 

[hotsaws]

You can DM me for details on salary if you'd like.

 

[ftcm23]

Thanks @MHYDE and @hotsaws. Both shared info I was looking for - and I hope others benefit as well. Overall reassuring to see the job market improve post-COVID.

 

[Immunogoblin E]

LOTS of jobs (in 2022). Academic and private practice. I feel lucky for the timing of my fellowship because it's the perfect storm of older providers retiring post-COVID as well as a persistent surge of patients that have been backed up the last couple years.

Primarily clinical jobs can be 3 to 5 days a week depending on how much you want to make. PP see more patients and more standard bread and butter things. Academics see less patients and get some complicated/demanding patients which can suck up time but also keep things interesting.

These things can change year to year as well as in your specific area. I read the previous thread a couple years ago and expected the market to look one way and it ended up being better that. But, if you're reading this post in a couple years time who knows the changes we'll see.

 

[ftcm23]

Thanks for replies so far. More and more I'm thinking of efficiency/QOL and the issue of support staff seems key:

- Scribes: never had one as a fellow of course, so would love to learn what I can. If your practice didn't have one, worth negotiating for one? Can you employ your own and what's the cost? Was 'training up' your scribe a pain? Is high turnover with scribes an issue (and then training up again)? Can you sign notes as you leave the room?

- Patient messaging/Triage: do you have nurses or NP/PA on staff to triage/reply messages or do you end up managing all the messages? Can patients reach you by message through an EMR portal - or can you turn that function off?

Given the documentation "never ends" phenomena in training, trying to understand what to look for to manage when things get even busier/working full time!

 

[Legend of Link]

You can DM me for details on salary if you'd like.

@hotsaws can I DM you?