Career Trajectory

[PainApp2021]

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Hello,

Just finished the fellowship interview cycle and excited to hopefully join your ranks.

I anticipate a career in academics vs "privademics". That said, my wife and I have a significant (550k) loan burden. I want to practice ethically and do what I think is the right treatment for the patient, so I am certainly not looking for a pill mill or injection shop when it is not the best thing for the patient. I received a very decent job offer where annual base compensation for year 1 and 2 is around 570k plus productivity if you exceed 75th percentile. Year 3 is entirely productivity w/ wRVU at roughly $65. It is an underserved location in what many would probably consider an "undesirable location" and I would be a hospital employee with very little call. It appears to be a very ethical practice and the docs seem very happy.

I may find that I love this job and not want to leave. Alternatively, I might find that I want to move back to an academic environment where I can be involved in resident/fellow education and research. Would it be bad for my career to take this job if I end up wanting to go back to academics/"privademics"?

Thank you

 

[Ducttape]

no.

it would be good to be on your own and you will bring a lot of injection experience if and when you go back to academics. your productivity and ability to work fast will help you. things do not go fast in academics...


definitely keep in touch with your academic colleagues. the difficult part may be trying to get back in because you will not be "in their face" as much as some graduating fellow. stay chummy with the program director and the fellowship director, for example, emailing them frequently to keep in touch.

consider joining organizations that are more focused on academics (ASRA comes to mind).

 

[mid|ine]

That is a CRAZY offer! I would try to do better on the wRVU rate.

....
Wait, is the combined income from the FIRST+SECOND YEARS $570k???

 

[deleted875186]

Hello,

Just finished the fellowship interview cycle and excited to hopefully join your ranks.

I anticipate a career in academics vs "privademics". That said, my wife and I have a significant (550k) loan burden. I want to practice ethically and do what I think is the right treatment for the patient, so I am certainly not looking for a pill mill or injection shop when it is not the best thing for the patient. I received a very decent job offer where annual base compensation for year 1 and 2 is around 570k plus productivity if you exceed 75th percentile. Year 3 is entirely productivity w/ wRVU at roughly $65. It is an underserved location in what many would probably consider an "undesirable location" and I would be a hospital employee with very little call. It appears to be a very ethical practice and the docs seem very happy.

I may find that I love this job and not want to leave. Alternatively, I might find that I want to move back to an academic environment where I can be involved in resident/fellow education and research. Would it be bad for my career to take this job if I end up wanting to go back to academics/"privademics"?

Thank you

Wow, wish I got this job offer

 

[PainApp2021]

That is a CRAZY offer! I would try to do better on the wRVU rate.

....
Wait, is the combined income from the FIRST+SECOND YEARS $570k???

No. I averaged the first and second year income with signing bonus, loan repayment, etc. Per year it is about 570k compensation plus productivity.

 

[drusso]

Hello,

Just finished the fellowship interview cycle and excited to hopefully join your ranks.

I anticipate a career in academics vs "privademics". That said, my wife and I have a significant (550k) loan burden. I want to practice ethically and do what I think is the right treatment for the patient, so I am certainly not looking for a pill mill or injection shop when it is not the best thing for the patient. I received a very decent job offer where annual base compensation for year 1 and 2 is around 570k plus productivity if you exceed 75th percentile. Year 3 is entirely productivity w/ wRVU at roughly $65. It is an underserved location in what many would probably consider an "undesirable location" and I would be a hospital employee with very little call. It appears to be a very ethical practice and the docs seem very happy.

I may find that I love this job and not want to leave. Alternatively, I might find that I want to move back to an academic environment where I can be involved in resident/fellow education and research. Would it be bad for my career to take this job if I end up wanting to go back to academics/"privademics"?

Thank you

The hospital-employed positions are a dime a dozen, but you may only get one chance to be your own boss. Take more risks now when you have the least to lose in terms of career and family. As you settled in family, spouse, community, in-laws, etc you will become more risk averse.

 

[Ducttape]

this hospital employed position would be riskier than an academic one.

so he is doing what you are suggesting.

 

[SSdoc33]

make sure your wife will be happy living in BFE. seriously.

 

[mid|ine]

An employed position with $570k guarantee is a no brainer. Stay for at least 2 years, then decide what you want to do. I would work to negotiate the wRVU to $75+

 

[PainApp2021]

An employed position with $570k guarantee is a no brainer. Stay for at least 2 years, then decide what you want to do. I would work to negotiate the wRVU to $75+

Do you (or anyone else) have a contract lawyer that you recommend? Would they typically be the one to negotiate or would it be me?

 

[Agast]

make sure your wife will be happy living in BFE. seriously.

If their combined loan burden is $550k I’m assuming she also has to find a job. OP is she also a doctor?

 

[PainApp2021]

If their combined loan burden is $550k I’m assuming she also has to find a job. OP is she also a doctor?

I'm also trying to work with the hospital system to get her a job.

I did get a really great feeling about the people I've talked with... I think I am just paranoid about the giant amount of money in front of my eyes and if it is giving me tunnel vision about the job.

I anticipate matching at a fellowship that has a high volume of clinic patients, B&B, and advanced procedures so hopefully it will train me well such that I won't need to originally be in an academic environment surrounded by people who can help/mentor me in the beginning.

 

[mid|ine]

Do you (or anyone else) have a contract lawyer that you recommend? Would they typically be the one to negotiate or would it be me?

You can negotiate that. I would start higher than 75 but target that. $85/wRVU would be great.

Negotiate the productivity basis on a shorter time scale, ideally monthly, but at least quarterly (NOT annually)

Also, negotiate having a mid-level to help you once you exceed a certain number of wRVUs. Most hospitals will bill for the midlevel but give you a small stipend. When I worked for a hospital, I had an NP I used like a resident. They saw all the News and F/Us, discussed them with me, then I went in and saw the patient, finalized the plan and the NP did the note and I signed. If I was out on vacation the NP could see patients independently and keep things moving.

 

[lobelsteve]

I love the fantastic advice. Although my number is $56. My hospital would never consider $85 per RV you. Especially now that you get paid more to see patients in the office.

 

[Doctodd]

how old are you? If you are young you can bust your ass without consequence. As for undeserved, those typically pay the most and you get tons of experience. I remember Laredo, TX on the border was around $1m/year because nobody wanted to live there.

 

[BobBarker]

I have a long manifesto that would help you. I like that you are already trying to get a job. Try to negotiate a stipend from match day through training. 😎

 

[DOctorJay]

I have a long manifesto that would help you. I like that you are already trying to get a job. Try to negotiate a stipend from match day through training. 😎

link it back here Bob, that was great info

 

[BobBarker]

I’m having a hard time finding it. It is in a thread someone else started I think.

 

[DOctorJay]

https://forums.studentdoctor.net/threads/newbie-here-with-questions-regarding-rvu.1425480/post-22202410

this is Bob's previous post

You can keep things super simple and make a lot of money.

I am putting myself in your shoes and going to give you the keys to the kingdom. So listen and make it happen.

1. I want the MGMA median for salary guaranteed for 2 years. National or local. Whatever is in your favor.
2. I want the MGMA median WRVU conversion factor. National or local. Whatever is in your favor.
3. I want a bonus for every RVU in excess of the median salary at the conversion factor. Paid quarterly. So if salary is $600,000 and conversion factor is $60 you will get an extra $60 for every RVU greater than 2500 quarterly.
4. I want you to keep track and inform me of not only my RVU’s monthly but also every imaging study, PT, and in system surgical referral. The EMR can likely do this for them

5. Once I reach MGMA median production, I want the employer portion of the 401k fully funded. This is around $37k. I also want HSA and 457b account available.
6. Here is the one that is the biggest deal. For every RVU in excess of the 80th percentile production then I am paid at the 80th percentile conversion factor.

You have to be a complete slug to do less than 7000 RVU in a hospital system. I did almost 10000 my first year in a town of 16,000 people. There are around 10 employed pcp types. No employed ortho. You do need to do stimulators , but you can probably do it also by doing a lot of RFA. You don’t have to do Vflex and other spacers or pumps.

Also, the wrvu value for office visits is going up. I told my NP she is getting a 33% raise next year on that alone. The hospital won’t adjust our conversion factors to make up for it.

 

[RoloTomassi]

Also make sure there's no fine print on that loan repayment and bonus, saying you have to pay them back if you leave.

 

[drusso]

https://forums.studentdoctor.net/threads/newbie-here-with-questions-regarding-rvu.1425480/post-22202410

this is Bob's previous post

You can keep things super simple and make a lot of money.

I am putting myself in your shoes and going to give you the keys to the kingdom. So listen and make it happen.

1. I want the MGMA median for salary guaranteed for 2 years. National or local. Whatever is in your favor.
2. I want the MGMA median WRVU conversion factor. National or local. Whatever is in your favor.
3. I want a bonus for every RVU in excess of the median salary at the conversion factor. Paid quarterly. So if salary is $600,000 and conversion factor is $60 you will get an extra $60 for every RVU greater than 2500 quarterly.
4. I want you to keep track and inform me of not only my RVU’s monthly but also every imaging study, PT, and in system surgical referral. The EMR can likely do this for them

5. Once I reach MGMA median production, I want the employer portion of the 401k fully funded. This is around $37k. I also want HSA and 457b account available.
6. Here is the one that is the biggest deal. For every RVU in excess of the 80th percentile production then I am paid at the 80th percentile conversion factor.

You have to be a complete slug to do less than 7000 RVU in a hospital system. I did almost 10000 my first year in a town of 16,000 people. There are around 10 employed pcp types. No employed ortho. You do need to do stimulators , but you can probably do it also by doing a lot of RFA. You don’t have to do Vflex and other spacers or pumps.

Also, the wrvu value for office visits is going up. I told my NP she is getting a 33% raise next year on that alone. The hospital won’t adjust our conversion factors to make up for it.

Someone should make this a sticky.

 

[kstarm]

Good advice. I would recommend having a financial plan in place. White Coat Investor or Physician on Fire has lots of great info on how to get set up well financially as you transition out of training. The first years can make a huge difference with how the rest will go.

 

[cowboydoc]

Do you (or anyone else) have a contract lawyer that you recommend? Would they typically be the one to negotiate or would it be me?

You need someone local that has experience in medical contracts to review the contract and give advice. Then negotiate yourself.
There is nuance to localities that a remote atty may miss. They charge too much per hour to be worthwhile with the negotiations. Expect to pay $1000-1500 for their review and subsequent edits.

 

[IYKYK]

How did you get a job lined up before rank lists are due??

 

[NY172]

https://forums.studentdoctor.net/threads/newbie-here-with-questions-regarding-rvu.1425480/post-22202410

this is Bob's previous post

You can keep things super simple and make a lot of money.

I am putting myself in your shoes and going to give you the keys to the kingdom. So listen and make it happen.

1. I want the MGMA median for salary guaranteed for 2 years. National or local. Whatever is in your favor.
2. I want the MGMA median WRVU conversion factor. National or local. Whatever is in your favor.
3. I want a bonus for every RVU in excess of the median salary at the conversion factor. Paid quarterly. So if salary is $600,000 and conversion factor is $60 you will get an extra $60 for every RVU greater than 2500 quarterly.
4. I want you to keep track and inform me of not only my RVU’s monthly but also every imaging study, PT, and in system surgical referral. The EMR can likely do this for them

5. Once I reach MGMA median production, I want the employer portion of the 401k fully funded. This is around $37k. I also want HSA and 457b account available.
6. Here is the one that is the biggest deal. For every RVU in excess of the 80th percentile production then I am paid at the 80th percentile conversion factor.

You have to be a complete slug to do less than 7000 RVU in a hospital system. I did almost 10000 my first year in a town of 16,000 people. There are around 10 employed pcp types. No employed ortho. You do need to do stimulators , but you can probably do it also by doing a lot of RFA. You don’t have to do Vflex and other spacers or pumps.

Also, the wrvu value for office visits is going up. I told my NP she is getting a 33% raise next year on that alone. The hospital won’t adjust our conversion factors to make up for it.

When you say “whatever is in your favor”, who are you referring to, me or the hospital?

 

[DOctorJay]

When you say “whatever is in your favor”, who are you referring to, me or the hospital?

Bob is referring to you as the employee here asking for what's most in your favor.