Heme/Onc Job Offer Discussion
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I just want to reiterate this for any fellows like me who were initially fooled into thinking APP support is always a good thing.
I had one academic-ish offer where I would see new patients and APPs saw my followups; however; I got no RVUs from the follow-ups but was still supervising. Their model was clearly to have the physicians do all the work of setting up treatment plan and then taking the follow-ups RVUs for themselves.
The offer I'm accepting gives me 70% of APP RVUs (minus APP salary/benefits, of course).
I had a very similar dilemma: high flat salary offer with decent work-life balance or potential for 1M+ but working very very hard. Because I'm so financially behind from wasting so many years doing a PhD, I decided I value money more than time right now and chose the harder-working job. I plan on working very hard for a few years to make up for lost earnings, make partner, and then slow down.
If I didn't have this consideration and felt I was on track for retirement at my desired age (I want to retire early), I would absolutely choose a job that hits 650K and no weekend call (in a state with no income tax!!) versus working so hard in a high-tax state like California. For every extra dollar you make above $650K, about 40-50% is going away in taxes.
This assumes they have reasonable patient expectations in Florida.
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Please expand. Curious about your perspective
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Thank you for everyone's input with this. I wanted to come back with an update. On more questioning, it looks like I would get a NP/PA about 6 months into starting. Before that, it looks like I would be responsible for my own inbox etc. They are offering 20K (on top of base salary and bonus) for what is labeled as " midlevel supervision" which they said is contingent on meeting my own wRVU threshold (~5000) as well as the NP/PA meeting their wRVU threshold which I'm told is ~800. So technically, I'm not getting RVUs from the midlevel visit but they are building in an incentive for supervising them.
After careful consideration, I'm leaning towards declining the offer. The low $/RVU (~$50 per RVU) offer coupled with the workload seems less than ideal. Thank you to all for your input and advice.
I f***ing hate Florida. It's pretty straightforward.
Incoming fresh attending on the job search here. Would really appreciate any input on the following academic oncology job.
Assistant professor, small Midwest metro
Guaranteed base 410K x 2 years without bonus then 450K base + 10% academic bonus + RVU bonus $29/wRVU above target (2400) starting year 3 with subsequent raises in base salary based on academic rank
Sign-on/relo 75K
2.5 days clinic + 3 weeks inpatient
Assistant professor, small Midwest metro
Guaranteed base 410K x 2 years without bonus then 450K base + 10% academic bonus + RVU bonus $29/wRVU above target (2400) starting year 3 with subsequent raises in base salary based on academic rank
Sign-on/relo 75K
2.5 days clinic + 3 weeks inpatient
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love the metrics. There're some finance bros weirdoes slowly creeping into managing the metrics.
Is the bro sitting on a swivel chair, cocking his chin as if he owns you while talking about wRVU?
immediately declined the offer the next day.
I am trying to find the catch in this offer because I have been conditioned by my experiences to believe academia is always exploitative, but this seems like a fantastic offer for academia. The $29/RVU is laughably low, but if you stick to the very low RVU goal, you'll be making $187/RVU ($450,000/2400 RVUs) and not working very hard.
I think the catch is there’s a high base but low ceiling which could work out fine for the right* person.
Hospital is probably 340B so still raking it in even at $187/RVU.
I would make absolutely sure the 2.5 clinic days is in the contract otherwise you might show up and 6 months later it’s 3.5 then 4 etc
The right way of looking at this is that 'you are allowing the hospital to use your license/expertise/liability to hire APPs' to expand their income. If you don't get a share of that, that is a very very bad deal. 20K for APP supervision is laughable. I would never accept it.
New fellows should be very careful. APPs are not there to 'help you', they are there to 'help the healthcare system generate more revenue'. PERIOD. Unless, you have a vested interest in the APP training/productivity and you get a slice of the APP PIE. Don't be fooled by people in suits.
Yep.
Only reason for a system to hire an APP is because they don’t want to pay an Oncologist to do the work.
In PP it may be the only way to keep the doors open with revenue cuts but in theory you have more control over training/supervision/hiring and quality control. In an employed 340B system that is nowhere near the case.
Opinions on private practice position affiliated with usoncology. Two years to partnership.
First two years, 4.5 day workweek, q4 call, 5 weeks PTO, 1 week cme.
60k signing, yr 1 salary 375k, year 2 385k, + production bonus equal to 25% of collections minus overhead.
Partners do 4 day workweek, 10 weeks PTO plus 10 paid holidays, q6 call. Partners this last year on average made 900k with variation between 700k-1mil based on production.
First two years, 4.5 day workweek, q4 call, 5 weeks PTO, 1 week cme.
60k signing, yr 1 salary 375k, year 2 385k, + production bonus equal to 25% of collections minus overhead.
Partners do 4 day workweek, 10 weeks PTO plus 10 paid holidays, q6 call. Partners this last year on average made 900k with variation between 700k-1mil based on production.
You didn’t specify how many patients per day but that is pretty typical. If you want to work hard-ish and get paid fairly I’ve known multiple people who were happy working for (“with”) USON.
Call being q4 as a new hire and q6 as a partner is a small/medium red flag to me.
Do people actually take 10 weeks of PTO? That is a pretty big outlier in our field IMO especially for making the amount of money they report making. My group does 6 weeks and most hospital jobs will give you 4ish
I think this sounds like a fair offer, as long as they have a good historical track record to partnership (ie nobody being denied partnership or nobody leaving prior to being made partner).
It's very similar to my pre-partner contract at a non-MSO non-PE 100% physician owned private practice except my associate length is 3 years and the average partner salary is a little north of 1m.
What’s the buy in?
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Minimal, they said it's like $1000 just for the partnership paperwork. I think it's mostly sweat equity since presumably your collections the first two years are much higher than your compensation.
So does the practice rely on a steady stream of associates coming in that the partners can feed on?
If you are starting a clinic from scratch, year 1 is 435k all in and that should be pushed up to 450k. You may need to ask for higher sign on (make it an even 75k). Year 2 is a little below fair - you probably will generate 750k at least so that means a net 25% of (750k minus 450k) = 75k bonus for a total of roughly 450k as well. Your year 2 comp should be a little higher than year 1 because you'll have a full clinic. I'd ask for a base of 400 year 2 with the same comp structure otherwise.
So:
Year 1 375k base + 75k bonus: 450k
Year 2 400k base + 25% of net collections minus overhead: likely : 465k
Year 3 Partner
If you are starting with a full panel year 1 (taking over a retiring doc), you need to ask for more than 450k total (maybe 490k). The bonus is the easiest to bump up because it's a 1 time payment off the books rather than recurring.
Ask for the above numbers and you'll get it without issue. Try to go to high and you'll offend your future partners who need to vote you in to partnership.
I second this.
Very fair. USON is a decent group to work with. I've seen my friends mostly happy with the practice.
Better than joining a corporate hospital IMO.
Would really appreciate some input on another academic job offer for fresh grad:
Assistant professor, SW metro
Base 300K + 10% quality bonus, Sign on 30K
2 days clinic/wk + 1-2 weeks light call per year
Clinic census 12-14 patients/d
Some start up fund, CME 6k/yr
Assistant professor, SW metro
Base 300K + 10% quality bonus, Sign on 30K
2 days clinic/wk + 1-2 weeks light call per year
Clinic census 12-14 patients/d
Some start up fund, CME 6k/yr
Is this a research based position or a clinical position? When you mention start up funds, that leads me to think this is a lab based research job. So what are you doing on your other 3 days a week? $300K to see 25-30 patients a week is a pretty good gig. But I'm curious where the catch is here.
Thanks GutOnc. It’s a clinical research position, mainly trials, and not lab-based, so the 3 days is research and admin. I do think its a good gig overall as well.
Any productivity goals/bonuses? Are you expected to get grant support and if you do, can you use it to supplement your salary or is it just for clinical time buy-down?
Seems like a reasonable gig for only 2 days clinic a week. If it’s light service like really only 2 weeks and 2 weekends a year, then very good deal. Most academic jr jobs require 4-7 weeks service a year.
If you are doing 40 rvu/ day, that’s 3600 rvu a year. That would be about 300k/3600 =84 dollars per rvu for your salary. Slightly low for the southwest but again, academic.
Your pp colleagues seeing patients 4.5 days a week will probably be making 3x what you do in the community.
No productivity bonuses. Expected to support my protected time after 3 years with extramural funding and grant support only for clinical time buy-down and not salary supplement. No complaints from junior faculty in terms of CRC, grant writing, biostats support.
Most of us are in community practice, so I'm not sure how useful our advice will be to you at this point. But overall it seems pretty reasonable for a true academic position.
Thanks for the input. I do recognize the pay disparity but do want to give academics an earnest go. Perhaps I may change my mind down the road, who knows.
Just for my understanding/comparison, what would be a reasonable RVU conversion rate in the SW major metro propers in community/hybrid practices?
Probably the $100 neighborhood. But again, for academics, what you're being offered seems pretty reasonable. And TBH, if you were working 4.5 days a week at this job, you'd be making 2+x what they're offering you. It's not always about the "hourly rate", sometimes it's about the hours.
I interviewed for academics and community both. This is a very good gig for academics.
My questions - chance of securing funding (is the environment at the institution fertile enough to have good chance of academic success), what if someone leaves, increased clinic burden and inpatient call? does it come with increased compensation? may not be a question directly to admin but to prospective colleagues.
Good luck !
Hey everyone, quick update after visiting a couple of job sites.
The Florida job seems pretty chill. It’s a new program with very few patients right now but has a lot of potential due to a big investment. The city is decent and nice overall. The salary is $650k with call every 3rd week. The call isn’t bad given how small the program is, but I’m not thrilled about the frequency. The work is super specialized, focusing on a very specific patient population. I haven’t discussed CME or other perks yet. That said, the clinical load is really light—just three clinics a week—and other physicians are even working some days remotely. There’s good APP support too, which is a plus.
The California job is way more clinical. The current chief there is making $1.4M a year, but they’re seeing 50 patients a day. They do have a lot of support with scribes and APPs, but it’s definitely high-volume. Call is also every 3rd week and super busy. They’re trying to improve the offer but expect me to work like the chief with $98 per RVU. They even suggested doing straight RVUs with no base salary, estimating I’d hit 10k RVUs a year. The city is bigger than I expected and wanted, but it’s workable.
Overall, Florida feels much more laid-back, and almost academic while California is intense and community. The main difference is salary. I ran some numbers, and if I take the California job and work as much as they expect, I’d save around $110k liquid per year after factoring in cost of living and taxes. The question is: does that extra $110k justify working so much harder?
Both locations work for my family goals, though Florida has the edge with commute and housing, while California wins on culture. Long-term, the Florida job seems more sustainable and personally exciting. Still undecided—what do you guys think? Is the extra money worth the grind? How would you approach a negotiation? On Florida they also said they want to have a multi year (5) deal, which I don’t know if is good or bad.
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All of those are personal decisions that we won't be able to make for you.
I would pick the Cali job and negotiate a base salary guarantee with RVU bonus above certain threshold, just in case it's not as busy as they advertise. But I also don't have kids right now and don't mind working my butt off or spending nights/weekends working
How is it possible to see 50 hematology oncology patients a day? What type of patient mix is this to make this even possible or safe?
I have a lot of sympathy and thoughts on this because I was faced with generally the same kind of decision last year: do I take a job with a high base but ceiling around $700K for a very reasonable workload in a 4 day work week or do I work harder so I can make 1 million or more.
I ended up choosing to to join a practice where there is no ceiling but where I will work more for the extra money. The primary reason is that I am old (late 30s, MD-PhD) so I want to make as much money as I can for several years to make up for lost income. So I am all for taking harder jobs in exchange for more money.
But this Cali job seems very very suspect - 50 patients in a day heme onc is absolutely outrageous. And even if it is possible to see 50 a day (and I don't think it is), even 1.4 million is low for that work load. And call every 3 weeks, especially if it is busy as you say it is, is bad.
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It's a mix of inpatient and outpatient. With good app the right type of patient and hospitalist support it can be done. Also he probably see less than 50 in a ordinary day. But still he must see a lot.
Look you're mid career and have probably a decade or two more experience than me so take this with a grain of salt but I honestly think you're either delusional or not presenting this job accurately. I also still don't understand why your two options when moving for "family reasons" are two crappy jobs in opposite ends of the country.
The idea of taking a job in California because you'll take home more money than a job in Florida is insane and a hilariously huge red flag IMO. The other job where they claim they'll pay you 650k to not work very hard only 3 days a week also incredibly suspect. I would be very wary of either of these jobs but I'm young and might take a gamble on the Florida one, making sure 650k is written in stone in the contract, but with the expectation that I will get down there and it will be a bait and switch of comical proportions. .
100% agree with this part. In my current hospital employed job, if I was willing to see that many patients (which I'm not), and the system didn't play the FMV card on me (which it would) I'd be somewhere between $1.2 and 2.3M for that workload (low end assumes every single encounter is a 99213, high end assumes my current wRVU/encounter average for the past 12 months). And I don't take call or make any money from the work the APP in my clinic does. So the math doesn't really math here IMO.
@hemmd, it seems clear that you've made your choice. I think we'd all be interested in what it is and why.
Where in CA is this if I may ask ? I mean
- Greater LA metro
- Greater SF metro
- Greater SD metro
- Central Valley
- Up north
I am in CA and make similar. So just curious
I am currently in a hospital employed position but want to switch to a private practice. Most of the current opportunities are within the MSO networks (US onc, One Onc).
Are there any negatives linked with MSO affiliated PP groups in comparison to 100% physician owned groups?
Are there any negatives linked with MSO affiliated PP groups in comparison to 100% physician owned groups?
Yes, you pay a maintenance fee to the MSO. Specifics vary depending on the individual practice. Generally speaking, you get a more favorable negotiation on drug pricing because you have the MSO pricing. It's not 340b clearance level but you get a nice discount based on GPO power.
Need input on this PP job that I recently interviewed at. I am currently in a hospital based community practice (2 years out from fellowship).
- PP with MSO network (One Oncology), located in Southeast about an hour away from a metro area.
- 5 partners looking for 6th, 5 day work week, Call: 1:4 for the location they are hiring for. Docs round on their own patients on weekdays.
- 2 year path to partnership. No buy in. There is an option to buy the real estate equity as they own their office buildings.
- Base 450k, Sign on bonus 40k. Average compensation for partners was 650k - 1.1 mil over last 2-3 years. They have shared the recent financial numbers with me (revenue, expenses, earnings etc).
- Location: Didn't like the town. I would probably live in a suburb close to the metro area so will have around 40-45 mins one way commute.
- PP with MSO network (One Oncology), located in Southeast about an hour away from a metro area.
- 5 partners looking for 6th, 5 day work week, Call: 1:4 for the location they are hiring for. Docs round on their own patients on weekdays.
- 2 year path to partnership. No buy in. There is an option to buy the real estate equity as they own their office buildings.
- Base 450k, Sign on bonus 40k. Average compensation for partners was 650k - 1.1 mil over last 2-3 years. They have shared the recent financial numbers with me (revenue, expenses, earnings etc).
- Location: Didn't like the town. I would probably live in a suburb close to the metro area so will have around 40-45 mins one way commute.
45 minute commute would be a nonstarter for me. I’m at 20m right now and that feels about my limit.
I also don’t like 6 partners but 1:4 call.
Was thinking the same on both counts. That said, I have a 1h commute but I have a home close to work and split my time...so it doesn't really count. If I had to take call here, there's no way. And a group where the senior partners don't take call is BS and a hard no from me. I guess if they're tapering their practice on the way to retirement, that's something different. But for FT docs who just feel like they deserve to not take call is crap.
How hard are those partners working? I know you mentioned 5d/week and call, but $650k to see 20 patients/day for 5 days a week is a bad deal, whereas 1.1M is pretty good for example.
OK...that makes more sense then.
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I mean you could also say Private Practice and 340B are ticking timebombs too IMO
340B is likely going to stay. Hospitals are going to lose a lot of money if 340B goes away, and they have the lobbying power to make it stay. 340B is the single reason why hospitals can pay community oncologists $$$
Private practice is here to stay as well, IMO. As long as we can buy and sell (bill) chemo and make drug-margin, private practice will be profitable. CMS will continue to cut reimbursements for office visits, but that's across the board for all specialties. Oncology, whether hospital based or private practice or private equity-run, makes the bulk of its money from drug-margin through chemo.
Anyone know big picture what Chicago community oncology jobs look like/pay?
