Attending job salary - Palliative Vs Hospice?

[Entadus]

Greetings Palli-SDNer's! This forum is a fantastic trove of information. I have scoured the threads here for more guidance, and while many threads have been helpful for me, I have not been able to find anything that comprehensively answers my question.

For a little background, I am a current HPM fellow set to graduate in June 2022. My HPM board exam will be this fall, and I am already B.C. in Internal Medicine. I have started talking to recruiters and looking into attending jobs for next year, and although I don't intend to start working immediately (residency and the pandemic have each taken their toll...) I also am starting to feel woefully unprepared to navigate the job market and make a decision about my first gig(s). What has amazed me more than anything is the wide variety of jobs that exist (and thank goodness for that, as this seems like a good problem to have, as opposed to unfortunate fields that have had squeezes in job availability lately, e.g. Emergency med)

So besides the obvious dimensions I have been trying to wrap my head around, i.e.
Full time vs Part time
Academic vs Private practice
Inpatient vs Outpatient
Location
etc.
The even bigger question I am trying to address is the (false?) dichotomy between Hospice jobs VS palliative jobs. What am I looking at here???

I know there are going to be plenty of jobs that offer both. And I know it's possible to combine both, for example working part time as a hospice medical director while also keeping a part-time or full-time job in academics or private practice. But for the sake of argument, can anyone with experience highlight the basics on each end of the spectrum? For example if I could reasonably be expected to find Palliative positions that offer Monday-Friday 9-5pm at or above $200,000 , would the same be true for hospice? Or is it more common for hospice work to be limited to part-time/in the neighborhood of $50,000?

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The beginning of my job search has revealed the following so far:

1) I've talked with recruiters about one job in Home Health that was looking for geriatricians or palliative care docs, they wanted someone to do purely home visits Mon-Friday (full time), low volume of visits but in a metropolis with a lot of traffic, in the range of $240k base with around $260-280k estimated after bonuses.

2) I've applied for one academic job with a very small and growing palliative department, which is mostly inpatient palliative (no hospice visits), I have not interviewed yet and honestly don't even know what the hours would be (40 hours? less?), and also not sure about starting salary. Due to it being academic, I was thinking in the ballpark of $160k, not really expecting $200k.

3) I've started talking with recruiters in a well known Hospice company that have a wide range of job openings (including 'team physician' and 'medical director'), again I'm not sure of the hours or pay, so I would really like to get input from SDN. I know the hours, responsibilities, call, salary, etc vary tremendously, but I would really benefit at least a couple data points to help me start out. Thanks for any assistance!

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[Frazier]

Hi. Exciting.
You're right, there is a large mix and variety.
My fellowship was at an academic center that also ran a hospice... so many of the attendings wore both palliative hats and hospice hats.
My current position is at an academic center that does not have a hospice and also comes with a noncompete clause... so I am 100% palliative, whether I like it or not, when it comes to who signs my paychecks.

Yes, full-time palliative can be 9-5 (or 8-4) and easily pull over 200k. Closer to mid 200's or pushing 300 with all benefits accounted for more likely. There are some places that will pay lower either due to the extreme desirability of the region or it is one of those institutions that pay dirt for having the privilege of their name on your CV. Some places will consider RVU's others will be straight salary.

Hospice is more variable I would say given the big variety between entities... for-profit nationals, nonprofit locals, hospital ran hospices, sketchy scam hospices (don't work for one of these... they are the type of gigs you read about in the news for the wrong reasons). The part-time hospice medical director position is going to be more common than the full-time. Part-time wage depends on exactly how part-time (0.25 FTE, 0.5, 0.75, etc). Full-time medical director positions are often >200k. Part-time could be 10k stipend, 50k, 100k, etc. Ensure you know your call schedule and volume. How seasoned the nurses are and how they typically utilize their HMD on call.

I am extremely happy with my decision with full-time palliative. You do good and the job itself is quite low stress. I never dread the night before or AM going to work. Night and day from my primary specialty. I have trouble putting the sense of liberation between these two fields into words.

I feel fairly compensated... but as anyone would be happy to make more if I could wave a magic wand.

Eventually, I do see myself transitioning to part-time hospice medical director as I do miss that population.

 

[Entadus]

Hi. Exciting.
You're right, there is a large mix and variety.
My fellowship was at an academic center that also ran a hospice... so many of the attendings wore both palliative hats and hospice hats.
My current position is at an academic center that does not have a hospice and also comes with a noncompete clause... so I am 100% palliative, whether I like it or not, when it comes to who signs my paychecks.

Yes, full-time palliative can be 9-5 (or 8-4) and easily pull over 200k. Closer to mid 200's or pushing 300 with all benefits accounted for more likely. There are some places that will pay lower either due to the extreme desirability of the region or it is one of those institutions that pay dirt for having the privilege of their name on your CV. Some places will consider RVU's others will be straight salary.

Hospice is more variable I would say given the big variety between entities... for-profit nationals, nonprofit locals, hospital ran hospices, sketchy scam hospices (don't work for one of these... they are the type of gigs you read about in the news for the wrong reasons). The part-time hospice medical director position is going to be more common than the full-time. Part-time wage depends on exactly how part-time (0.25 FTE, 0.5, 0.75, etc). Full-time medical director positions are often >200k. Part-time could be 10k stipend, 50k, 100k, etc. Ensure you know your call schedule and volume. How seasoned the nurses are and how they typically utilize their HMD on call.

I am extremely happy with my decision with full-time palliative. You do good and the job itself is quite low stress. I never dread the night before or AM going to work. Night and day from my primary specialty. I have trouble putting the sense of liberation between these two fields into words.

I feel fairly compensated... but as anyone would be happy to make more if I could wave a magic wand.

Eventually, I do see myself transitioning to part-time hospice medical director as I do miss that population.

Awesome response, thanks so much for all this information. Your replies are always enlightening, but even more so when it's answering my own particular question!

More feedback from others is kindly appreciated. I'm hoping for at least a couple replies over the next few months, and I can also add some more input as soon as I actually get tangible offers.

 

[tealeafexplorer]

Is hospice and palli fellowship necessary for hospice? I think most if not all palliative jobs require it now, but can you do hospice as FM or IM? Just requires some training right?

 

[WilcoWorld]

1) I've talked with recruiters about one job in Home Health that was looking for geriatricians or palliative care docs, they wanted someone to do purely home visits Mon-Friday (full time), low volume of visits but in a metropolis with a lot of traffic, in the range of $240k base with around $260-280k estimated after bonuses.

2) I've applied for one academic job with a very small and growing palliative department, which is mostly inpatient palliative (no hospice visits), I have not interviewed yet and honestly don't even know what the hours would be (40 hours? less?), and also not sure about starting salary. Due to it being academic, I was thinking in the ballpark of $160k, not really expecting $200k.

3) I've started talking with recruiters in a well known Hospice company that have a wide range of job openings (including 'team physician' and 'medical director'), again I'm not sure of the hours or pay, so I would really like to get input from SDN. I know the hours, responsibilities, call, salary, etc vary tremendously, but I would really benefit at least a couple data points to help me start out. Thanks for any assistance!

#1 sounds like a sweet gig as long as you enjoy listening to stuff in your car 🙂
#2 salary sounds too low, unless you're working in a super desirable area and have a real sweetheart set up. I would expect something in the mid to low 200k range for full time academic palliative position (that's what I've seen where I've looked)

 

[WilcoWorld]

Is hospice and palli fellowship necessary for hospice? I think most if not all palliative jobs require it now, but can you do hospice as FM or IM? Just requires some training right?

You're correct, Hospice Medical Directors do not need HPM boarding at this time.

 

[Entadus]

Okay friends, here's a quick apples-to-oranges comparison of two offers. Would love to see your thoughts and input.

Job#1
Palliative care (No hospice)
1.0 FTE (4.5 clinical days, 0.5 admin days)
70% clinic / 30% inpatient consults
Limited to 1-2 locations (minimal travel)
Full support staff (SW, psych, RN, etc)
Salary $240K, no bonuses for signing or retention
Raises depend on union contract negotiations, expect 8% retroactive increase (259K?), plus 3-4% per year
36 days PTO (includes sick days)
13 guaranteed holidays
5 CME days
No call, no weekends, no after-hours duties
Some teaching of Palliative fellows, residents, med students

Job#2
Geriatrics/Palliative
Variety of duties and clinical sites (see below)
Moderate amount of travel required (15-30 minute drives)
1.0 FTE
Full support staff
Salary $265K base, $25K signing bonus (give back if leaving before 3 years), Retention bonuses $20K after 1st year, $15K after 2nd year
Total compensation if staying for 3 years: (290K, 298K, 301K)
18 days PTO, increases by 5 days every 4 years
10 sick days
7 holidays
-0- CME days initially, 5 CME days after 1st year
Call schedule as below

Primary duty: Provides care for patients in Nursing Facilities, including:

• Custodial/long-term care
• Routine skilled rehab after discharge (PT/OT/SLP)
• Routine SNF's
• Subacute care – patients requiring mechanical ventilation, long-term respiratory support, weaning, and teach care
• Special services – patients in nursing facilities receiving bedside HD, PD, and transfusions

Secondary roles:

• Cognitive impairment consults in geriatrics clinic
• visits with patients at home for the Home Care Programs [Home-based Palliative Care, Hospice, and Chronic Population Management, or AMCAH (acute medical care at home)].
• Some teaching of IM residents
• Vacation coverage for palliative clinic or inpatient palliative care consultation service.

Call schedule: Approximately 7 nights of call spread over 4-5 weeks. Weeknight call is from 5 pm to 11 pm. Week-end and holiday call is from 8 AM to 11 PM. Week-end and holiday duties requires on-site rounding is reimbursed at 120% of normal hourly rate.

 

[Frazier]

Okay friends, here's a quick apples-to-oranges comparison of two offers. Would love to see your thoughts and input.

Job#1
Palliative care (No hospice)
1.0 FTE (4.5 clinical days, 0.5 admin days)
70% clinic / 30% inpatient consults
Limited to 1-2 locations (minimal travel)
Full support staff (SW, psych, RN, etc)
Salary $240K, no bonuses for signing or retention
Raises depend on union contract negotiations, expect 8% retroactive increase (259K?), plus 3-4% per year
36 days PTO (includes sick days)
13 guaranteed holidays
5 CME days
No call, no weekends, no after-hours duties
Some teaching of Palliative fellows, residents, med students

Job#2
Geriatrics/Palliative
Variety of duties and clinical sites (see below)
Moderate amount of travel required (15-30 minute drives)
1.0 FTE
Full support staff
Salary $265K base, $25K signing bonus (give back if leaving before 3 years), Retention bonuses $20K after 1st year, $15K after 2nd year
Total compensation if staying for 3 years: (290K, 298K, 301K)
18 days PTO, increases by 5 days every 4 years
10 sick days
7 holidays
-0- CME days initially, 5 CME days after 1st year
Call schedule as below

Primary duty: Provides care for patients in Nursing Facilities, including:

• Custodial/long-term care
• Routine skilled rehab after discharge (PT/OT/SLP)
• Routine SNF's
• Subacute care – patients requiring mechanical ventilation, long-term respiratory support, weaning, and teach care
• Special services – patients in nursing facilities receiving bedside HD, PD, and transfusions

Secondary roles:

• Cognitive impairment consults in geriatrics clinic
• visits with patients at home for the Home Care Programs [Home-based Palliative Care, Hospice, and Chronic Population Management, or AMCAH (acute medical care at home)].
• Some teaching of IM residents
• Vacation coverage for palliative clinic or inpatient palliative care consultation service.

Call schedule: Approximately 7 nights of call spread over 4-5 weeks. Weeknight call is from 5 pm to 11 pm. Week-end and holiday call is from 8 AM to 11 PM. Week-end and holiday duties requires on-site rounding is reimbursed at 120% of normal hourly rate.

non-compete clauses?

First one sounds like a VA job to me almost with that PTO structure.

Both sound like pretty awesome options. Given the increased breadth of option 2, keep in mind that makes for more opportunity for things to suck and grind your gears... in the setting of a sign-on bonus, it might feel like handcuffs if you decide you don't like it after 1 year.

Same location? If not which region do you prefer?
Do you have family/SO? Which region do they prefer?

Learned this last point the hard way. I am happy with my job, but wife hates the region. Have a 3-year signing bonus chained to my leg, will likely leave a year early so stinks having to save for repaying that on the side instead of living/saving.

My next job I would advocate harder to have the signing bonus/loan prorated into salary instead.

Don't get too stressed, very high odds you will be switching jobs within a few years anyway. As you know, very few stay at their first gig forever. Whichever you choose will give you great experience and new insight into what you like and don't like going forward.

You are in a great position!

 

[hihimedmed]

Hi there Frazier,

Would Job#2 be a job that an EM trained HPM physician could do? It seems like it is geriatrics/primary care with some HPM sprinkled in. Just curious as an EM resident myself.

Thank you!

 

[Frazier]

Hi there Frazier,

Would Job#2 be a job that an EM trained HPM physician could do? It seems like it is geriatrics/primary care with some HPM sprinkled in. Just curious as an EM resident myself.

Thank you!

Everyone will have unique training, experience, and philosophy.
Speaking only for myself, I am more than comfortable to initiate and manage the ongoing palliative medicine-related needs of geriatric patients.

I do not feel I am the best option to manage the primary care needs of geriatric patients -- to that I leave it to those with the focused training.

So, for me, I "could" do it -- but I wouldn't apply for this job. I wouldn't be comfortable -- neither EM or HPM training makes me a geriatrician. If I did FM, IM, or geri fellowship it would be different.

That's just my thoughts n=1