Hem-Onc job advice - thinking of quitting my current job

[Hem_onc1331]

Newly minted attending here - I'm not sure if I should consider looking for a new job. Here's the break down of my current job.
- 5 days/week, EPIC EMR, 2 days of clinic , 3 days of inpatient hospital rounds, call 1:5, Private practice in the tristate area (close to nyc), 4 weeks of PTO
- clinic volume ~16-18 pts/day, 5 new pts/clinic , hospital volume ~20-25 pts- but always have an NP (usually see 12-15 pts 3-5 new consults). Only issue is that the hospital coverage is extremely inconsistent- for instance there are some weeks when I cover 3 different hospitals on 3 different days (one of which is part of a different healthcare system with completely different non epic EMR) , and learning about new patients every time is very challenging further my clinic is also more difficult as not all the patients that were seen by me in the hospital end up seeing me in clinic so feel like its a lot of cognitive load given that I'm in a general oncology practice. Comp Y1: 360 K, Y2: 400 K- not individual RVU based.
writing this post as I wanted a better idea of how other oncology practices work. My understanding was hospital coverage is supposed to feed into your clinic, but since I'm covering random hospitals on different days that doesn't usually happen as my office is not in the same geographic region as the hospitals I'm covering.

I'm kind of tied to this region for family reasons, and know that jobs in the North east in general pay less for more work. But just wondering what other oncology practices look like, I don't care too much regarding compensation honestly - feel like the salary is more or less the same in most community oncology jobs depending on area, and a small difference in compensation will not make that much of a difference in my life overall. Also I hate the private practice culture of treating medicine like "customer service", and doing medically unnecessary things to appease patients and referring physicians- is this typical in all private practices?
I do feel burned out on most weeks - but I'm just not sure based on the volume if this is typical and it's because I'm still starting out. Also even though my practice is a private group- there isn't really any kind of "partnership track" and really no guarantee that I will be offered any sort of partnership in the practice after a few years. Think I'm considering moving to a more hospital-employed practice where I do not have to deal with switching between different hospitals. Also feel like culture here is to have junior attendings do more hospital based work- senior attendings are more clinic based (which is fine with me), but senior attendings get more time off so there are times when we are even more stretched thin as so many people are on vacation :/.

Its been < 1 year- so my plan was to give it some more time, and if they are not able to fix the hospital coverage system in a way that helps build my clinic practice - start looking elsewhere. Also work-life balance is extremely important to me, and feel like not having any admin time (technically our admin time is on hospital days - but because the hospital is so busy and I'm learning about new set of patients - this doesn't really work for me), so a lot of my clinic things spill into the weekend.

---

Members don't see this ad.

 

[Mehena]

They say it would take ~ 2 years to reach a steady state and have a sense of some control. The issues you've mentioned are the same reasons that led me to favor employed position versus PP.
PM if you're interested in employed gig a little farther afield in the Atlantic coast.

 

[HemeOncHopeful19]

Also even though my practice is a private group- there isn't really any kind of "partnership track" and really no guarantee that I will be offered any sort of partnership in the practice after a few years.

I’m very pro-private practice and anti-employment but this is a huge red flag IMO.

Nobody should be joining a practice without a well defined partnership track with a recent track record of people making partner.

 

[gutonc]

This practice structure sounds terrible. Are you covering all 3 of those hospitals on the days you're not in clinic? Are there other clinics geographically closer to the hospitals? Who else is covering the hospitals?

Unless you're running a leukemia/BMT service, 25 patients a day sounds like a f***ton of inpatients to be seeing in oncology. I cover 2 hospitals with about 700 beds between them and a crazy busy day is having to see 10 patients (usually on top of 15-18 patients in the clinic on my hospital coverage days). Unless these are the type of hospitals with hospitalists and surgeons who "consult heme because patient has blood", I'm having a hard time figuring out why there's such a huge need for you on the inpatient side.

The fact that you joined a "PP" group that doesn't have a defined partnership track, or a production-based comp plan after a 1-2y guarantee is a huge red flag to me (and I'm not particularly pro-PP). This sounds like one of the predatory/exploitative groups where only 1 or 2 of the docs are making all the money and relying on "fresh meat" to bring in the new business for them while they sit back and cash the checks. they know you'll quit in a couple of years, but they don't really care, because there are another dozen people finishing fellowship who are "kind of tied to this region for family reasons" so will put up with a bad job like this until they realize what a bad job it is, and then the pattern repeats.

Anyway, I would bounce hard and fast right now. Start looking as far afield as you're willing to commute/move. I don't think there's anything inherently better about an employed or PP model in general, although one is likely better for some people than others, so don't let that limit you. But if you find another PP group, make sure it has a well described partnership track and ask about the median compensation for partners. If it's an employed gig, make sure there's a productivity aspect if you work hard. If you're doing 50th %ile work, you should get paid accordingly, whether it's PP or employed.

 

[Ubba]

Wow, your compensation is a joke for the kind of workload shoveled onto you. Your salary numbers should be double what they are, though I get that there's a premium for living near NYC.

EDIT: Back-of-the-napkin math: 360k/48 weeks = 7.5k/week. /5 days per week = 1.5k/day to see 20-25 subspecialty care-level pts in the hospital or 16-18 new pts in the clinic with 5 new consults on average. And I didn't even factor in the 1:5 call. And on top of that, likely high state taxes. WTF?! A generalist practicing after 3 years of training makes more per work-hour. Your practice should be ashamed of itself.

EDIT 2: Since I'm drilling into this rabbit hole, why not: I estimate that for this amount of work, we're talking 9-10 hour days when including charting, guideline-checks, record review, etc. That translates to 150/hr. For a physician's liability load. Good luck finding a lawyer who charges <400/hr, and a lawyer at that rate would be (no offense to our colleagues in this specialty) the "Pediatrics" of lawyers. And that's after just 3 years of law school, no residency (though maybe a year of clerkship). Honestly, the OP's work is practically pro bono.

 

[Mehena]

I don't think there's anything inherently better about an employed or PP model in general, although one is likely better for some people than others, so don't let that limit you.

Exactly.
I actually want the PP model in oncology to succeed and flourish in this extremely challenging atmosphere. IMO, the suits would have more respect for us employed physicians if other opportunities existed, be it from PP or pharma.

 

[whoknows2012]

I too am curious how you’re seeing so many inpatients. Seems like you should be making more for the work you’re putting in…

No bonus potential?

 

[Hem_onc1331]

This practice structure sounds terrible. Are you covering all 3 of those hospitals on the days you're not in clinic? Are there other clinics geographically closer to the hospitals? Who else is covering the hospitals?

Unless you're running a leukemia/BMT service, 25 patients a day sounds like a f***ton of inpatients to be seeing in oncology. I cover 2 hospitals with about 700 beds between them and a crazy busy day is having to see 10 patients (usually on top of 15-18 patients in the clinic on my hospital coverage days). Unless these are the type of hospitals with hospitalists and surgeons who "consult heme because patient has blood", I'm having a hard time figuring out why there's such a huge need for you on the inpatient side.

The fact that you joined a "PP" group that doesn't have a defined partnership track, or a production-based comp plan after a 1-2y guarantee is a huge red flag to me (and I'm not particularly pro-PP). This sounds like one of the predatory/exploitative groups where only 1 or 2 of the docs are making all the money and relying on "fresh meat" to bring in the new business for them while they sit back and cash the checks. they know you'll quit in a couple of years, but they don't really care, because there are another dozen people finishing fellowship who are "kind of tied to this region for family reasons" so will put up with a bad job like this until they realize what a bad job it is, and then the pattern repeats.

Anyway, I would bounce hard and fast right now. Start looking as far afield as you're willing to commute/move. I don't think there's anything inherently better about an employed or PP model in general, although one is likely better for some people than others, so don't let that limit you. But if you find another PP group, make sure it has a well described partnership track and ask about the median compensation for partners. If it's an employed gig, make sure there's a productivity aspect if you work hard. If you're doing 50th %ile work, you should get paid accordingly, whether it's PP or employed.

Hi, thanks for that in-sight. We have a rounding system where 1physician/NP covers the 1 hospital when they're not in clinic, and no commuting between different hospitals on the same day. I'm usually the consult service and the hospitalists are pretty reliable so very similar to the set up on consult service when I was in fellowship, and yes from the 20-25 would say 12-15 are DVT/anemia consults, and the rest are usually cancer work up pts- pts who presented with a mass etc and kind of have to figure out the cancer staging work up so that they can initiate tx in clinic quickly or pts that are admitted for treatment related problems. I agree about the huge inpatient load, think we don't sign off on pts as often (for the RVU's- which I think is another sketchy practice), the anemia/DVT consult notes are typically all done by the NP with me. And I'm typically in the same hospital on 1 day, so basically d1: hospital A, D2: hospital B, D3: hospital B, no commuting between hospitals on the same day for me
I do agree that the work load is still a lot compared to the compensation, and also covering 1:5 weekends is a bit much. And also about the predatory nature of the practice. Thanks this was helpful, as every time I bought up issues I was pretty much gaslighted by saying "im asking for too much".

 

[Hem_onc1331]

Wow, your compensation is a joke for the kind of workload shoveled onto you. Your salary numbers should be double what they are, though I get that there's a premium for living near NYC.

EDIT: Back-of-the-napkin math: 360k/48 weeks = 7.5k/week. /5 days per week = 1.5k/day to see 20-25 subspecialty care-level pts in the hospital or 16-18 new pts in the clinic with 5 new consults on average. And I didn't even factor in the 1:5 call. And on top of that, likely high state taxes. WTF?! A generalist practicing after 3 years of training makes more per work-hour. Your practice should be ashamed of itself.

EDIT 2: Since I'm drilling into this rabbit hole, why not: I estimate that for this amount of work, we're talking 9-10 hour days when including charting, guideline-checks, record review, etc. That translates to 150/hr. For a physician's liability load. Good luck finding a lawyer who charges <400/hr, and a lawyer at that rate would be (no offense to our colleagues in this specialty) the "Pediatrics" of lawyers. And that's after just 3 years of law school, no residency (though maybe a year of clerkship). Honestly, the OP's work is practically pro bono.

yup there is a premium for living near NYC, I felt the same during residency/fellowship . I usually am only billing for 10-15 pts as inpatient though- rest of pts seen and billed by NP (they're allowed to practice independently in my state, and I answer questions as needed )- but this is useful feedback , gives me a reason to push back and I'm not unreasonable for wanting less work. thanks !

 

[Mehena]

yup there is a premium for living near NYC, I felt the same during residency/fellowship . I usually am only billing for 10-15 pts as inpatient though- rest of pts seen and billed by NP (they're allowed to practice independently in my state, and I answer questions as needed )- but this is useful feedback , gives me a reason to push back and I'm not unreasonable for wanting less work. thanks !

There to me is also some undercutting. Its nonsense to say they can practice independently and needing hand holding. They offered me an NP in employed model and for me to bill any work contribution by them required double the effort. Thus, i see most patients solo to avoid any chance of RVU loss.

 

[gutonc]

Wow, your compensation is a joke for the kind of workload shoveled onto you. Your salary numbers should be double what they are, though I get that there's a premium for living near NYC.

EDIT: Back-of-the-napkin math: 360k/48 weeks = 7.5k/week. /5 days per week = 1.5k/day to see 20-25 subspecialty care-level pts in the hospital or 16-18 new pts in the clinic with 5 new consults on average. And I didn't even factor in the 1:5 call. And on top of that, likely high state taxes. WTF?! A generalist practicing after 3 years of training makes more per work-hour. Your practice should be ashamed of itself.

EDIT 2: Since I'm drilling into this rabbit hole, why not: I estimate that for this amount of work, we're talking 9-10 hour days when including charting, guideline-checks, record review, etc. That translates to 150/hr. For a physician's liability load. Good luck finding a lawyer who charges <400/hr, and a lawyer at that rate would be (no offense to our colleagues in this specialty) the "Pediatrics" of lawyers. And that's after just 3 years of law school, no residency (though maybe a year of clerkship). Honestly, the OP's work is practically pro bono.

Since we're doing back of the envelope math:
Assume 17 patients a day (regardless of inpt/outpt)
Assume 2wRVU/encounter (reasonable rough estimate and about what I pull across practice settings)
Assume 5d/wk (I just want to say that this, by itself, would have been enough for me to walk away from this job)
Assume 48 weeks a year
That's >8000 wRVU/yr, which is 50-75th %ile work
Assume $90/wRVU (which is roughly the 50th %ile for my region, I don't know what it is for the NYC metro)
That's $720K/y, half of what the OP is making now. Even at my current job's mediocre $75/wRVU, it's >$600K.

OP...you're getting hosed. Start looking elsewhere.

 

[whoknows2012]

Since we're doing back of the envelope math:
Assume 17 patients a day (regardless of inpt/outpt)
Assume 2wRVU/encounter (reasonable rough estimate and about what I pull across practice settings)
Assume 5d/wk (I just want to say that this, by itself, would have been enough for me to walk away from this job)
Assume 48 weeks a year
That's >8000 wRVU/yr, which is 50-75th %ile work
Assume $90/wRVU (which is roughly the 50th %ile for my region, I don't know what it is for the NYC metro)
That's $720K/y, half of what the OP is making now. Even at my current job's mediocre $75/wRVU, it's >$600K.

OP...you're getting hosed. Start looking elsewhere.

Some academic positions in nyc have a better pay structure than what the op is getting….

Many colleagues with wRVU based bonus structure that rewards very hard workers. Those about 8-9000 wRVUs can sometimes pull an extra 100-200k depending on the institution. I also have a friend at an nyc metro academic satellite getting 60/rvu above 5k. So anyway, op you should definitely be making a whole lot more, nyc metro paltry standards notwithstanding

 

[MD46]

Newly minted attending here - I'm not sure if I should consider looking for a new job. Here's the break down of my current job.
- 5 days/week, EPIC EMR, 2 days of clinic , 3 days of inpatient hospital rounds, call 1:5, Private practice in the tristate area (close to nyc), 4 weeks of PTO
- clinic volume ~16-18 pts/day, 5 new pts/clinic , hospital volume ~20-25 pts- but always have an NP (usually see 12-15 pts 3-5 new consults). Only issue is that the hospital coverage is extremely inconsistent- for instance there are some weeks when I cover 3 different hospitals on 3 different days (one of which is part of a different healthcare system with completely different non epic EMR) , and learning about new patients every time is very challenging further my clinic is also more difficult as not all the patients that were seen by me in the hospital end up seeing me in clinic so feel like its a lot of cognitive load given that I'm in a general oncology practice. Comp Y1: 360 K, Y2: 400 K- not individual RVU based.
writing this post as I wanted a better idea of how other oncology practices work. My understanding was hospital coverage is supposed to feed into your clinic, but since I'm covering random hospitals on different days that doesn't usually happen as my office is not in the same geographic region as the hospitals I'm covering.

I'm kind of tied to this region for family reasons, and know that jobs in the North east in general pay less for more work. But just wondering what other oncology practices look like, I don't care too much regarding compensation honestly - feel like the salary is more or less the same in most community oncology jobs depending on area, and a small difference in compensation will not make that much of a difference in my life overall. Also I hate the private practice culture of treating medicine like "customer service", and doing medically unnecessary things to appease patients and referring physicians- is this typical in all private practices?
I do feel burned out on most weeks - but I'm just not sure based on the volume if this is typical and it's because I'm still starting out. Also even though my practice is a private group- there isn't really any kind of "partnership track" and really no guarantee that I will be offered any sort of partnership in the practice after a few years. Think I'm considering moving to a more hospital-employed practice where I do not have to deal with switching between different hospitals. Also feel like culture here is to have junior attendings do more hospital based work- senior attendings are more clinic based (which is fine with me), but senior attendings get more time off so there are times when we are even more stretched thin as so many people are on vacation :/.

Its been < 1 year- so my plan was to give it some more time, and if they are not able to fix the hospital coverage system in a way that helps build my clinic practice - start looking elsewhere. Also work-life balance is extremely important to me, and feel like not having any admin time (technically our admin time is on hospital days - but because the hospital is so busy and I'm learning about new set of patients - this doesn't really work for me), so a lot of my clinic things spill into the weekend.

Hello,

I was in a similar situation when i joined a large private group in the DC metro area right out of fellowship due to family reasons.

My base was 240k, 5 full day clinics with 16-18pts each alternating with hospital cover weeks where each day would be half day of 12 patients and then round/consult at 1-2 hospitals ( about 8-10 patients inpatient on avg)

We had to stay for infusion that could be uptil 9pm some days as we did non onc things like tysabri, ivig for rheum , remicade etc

Call was 1:4 weekend for me even-though we were 8 oncologist and 4 NPs

Weekend would be covering 5 hospitals and on a avg day seeing 20-22 patients total each day.


No productivity with 10k. Yearly bonus to complete charts, make calls, attend all meetings, do PR with local pcp practices etc etc. year one they paid for asco ash memberships and abim exam fees as part of signon bonus. 10k relocation from texas to dc lol. 3 weeks vacation, gets to 4 weeks after 3 years. 5 days cme :$1500 yearly cme
Thats it.

Partnership track was 3 years and then junior partner, 7 years full partner. ( not in writing, my mistake not to add it)

They couldnt tell me exactly how much junior or senior makes until i reach that point. When i reached 3rd year they decided they will not offer junior partnership in pandemic and just offer full partner at year 7 but that also will not be in writing and at the “discretion” of the partners. Yearly 10k increase in salary till then which they thought was very generous and partners were cutting their stomachs to make that happen.

Compensation for partner? They said you can buy a mansion in the potomac was an answer i got, no other figure lol ( btw none of them had mansions in the potomac, one did own a weekend Porsche track car)

I left and have been employed 3 years now. Eventhough not making as much as in private practice i easily clear half a mil and work 4.5 days.
Start clinic at 9 and home before 5 most days.
Have 6 weeks pto and 2 weeks cme and still in dmv area. No job is ideal.

Get out when u easily can as i dont think these things get better unless you have partnership noted in the contract etc. I learned the hard way, dont believe in any hand shakes or gentlemen agreements, all non sense.

Good luck

 

[Hem_onc1331]

Some academic positions in nyc have a better pay structure than what the op is getting….

Many colleagues with wRVU based bonus structure that rewards very hard workers. Those about 8-9000 wRVUs can sometimes pull an extra 100-200k depending on the institution. I also have a friend at an nyc metro academic satellite getting 60/rvu above 5k. So anyway, op you should definitely be making a whole lot more, nyc metro paltry standards notwithstanding

thanks! though NYC jobs usually have poor ancillary support was what I felt based on my job interviews, maybe academics is different as you'll always have residents/fellows- thanks for that insight. totally agree with all the comments listed here - this is wayyy too much work for the compensation .