Heme/Onc Job Offer Discussion

[whatup2016]

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Anyone know big picture what Chicago community oncology jobs look like/pay?

 

[vipmak]

It’s getting hard to find a PP that is not associated with MSOs like US onc or One Onc. Is US onc better than One Onc?

 

[osprey099]

It’s getting hard to find a PP that is not associated with MSOs like US onc or One Onc. Is US onc better than One Onc?

My understanding from interviewing a few years ago is that US Onc is acting as a partner for a private practice. The pp is still owned by physicians, but they pay an annual management fee to US Onc. I have heard depending on the practice, this management fee is usually the annual salary of another partner, so we're talking about $1m+. Physicians still have the final say in terms of how their practice is run, which leads to varying groups/locations even within the same US Onc organization (such as Texas Oncology) to be very different in their operations.

OneOncology groups are not owned by the physicians, but rather an organization (private equity). Places like NY Cancer & Blood and Tennessee Oncology are OneOncology groups and the physicians there don't have the final say in terms of how the practices are run.

 

[ONC2023]

All this talk about private equity/for profits and worsening reimbursement/work conditions reinforces my primary goal: get a good 15 years of high-quality work under belt, invest everything I can in the S&P500, and get out of healthcare as fast as possible.

 

[vipmak]

My understanding from interviewing a few years ago is that US Onc is acting as a partner for a private practice. The pp is still owned by physicians, but they pay an annual management fee to US Onc. I have heard depending on the practice, this management fee is usually the annual salary of another partner, so we're talking about $1m+. Physicians still have the final say in terms of how their practice is run, which leads to varying groups/locations even within the same US Onc organization (such as Texas Oncology) to be very different in their operations.

OneOncology groups are not owned by the physicians, but rather an organization (private equity). Places like NY Cancer & Blood and Tennessee Oncology are OneOncology groups and the physicians there don't have the final say in terms of how the practices are run.

Thanks for sharing this info. The One Oncology practice I recently interviewed at told me that partners still own the practice but one oncology charges a management fee that is 20% of their earnings. This is a smaller group unlike bigger groups such as NY cancer/blood or Tennessee Oncology.

 

[HemeOncHopeful19]

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.

340B may have some staying power due to lobbying but I feel it is naive to assume the government has any vested interest in private practice viability.

Nephrology used to be a highly competitive, high paying field in the early 2000s, there is nothing stopping us from ending up in a similar boat.

https://mycoa.communityoncology.org/news-updates/press-releases/analysis-oncologists-could-face-over-12-billion-cut-in-medicare-and-commercial-part-b-payments-due-to-ira-negotiations

 

[osprey099]

340B may have some staying power due to lobbying but I feel it is naive to assume the government has any vested interest in private practice viability.

Nephrology used to be a highly competitive, high paying field in the early 2000s, there is nothing stopping us from ending up in a similar boat.

https://mycoa.communityoncology.org/news-updates/press-releases/analysis-oncologists-could-face-over-12-billion-cut-in-medicare-and-commercial-part-b-payments-due-to-ira-negotiations

505b2 is the answer to combat reimbursement cuts to drugs. Our practice has a full time staff member who's sole job is to figure out which variance of rituximab or bevacizumab or etc gives us the most profit margin

 

[whatup2016]

Anyone know big picture what Chicago community oncology jobs look like/pay?

Any insight?

 

[MD46]

Any insight?

I recently moved to the area but I am a couple of hours outside. Have some friends in Greater Chicago area however.

Mostly its OSF, Northwestern and UIC affiliated hospitals.

Illinois cancer care specialists is the biggest private group.

Hospital based pays starting around 450k, Above 5000 rvus is around 85-96$ per rvu , 4.5 days a week

Private is lower base around 350k with 2-3 yr partner track. I dont have exact numbers but partner make > 1mil for 20-25 a day 5 days a week. Have to cover multiple hospitals etc.

Good luck

 

[bobow98]

I recently moved to the area but I am a couple of hours outside. Have some friends in Greater Chicago area however.

Mostly its OSF, Northwestern and UIC affiliated hospitals.

Illinois cancer care specialists is the biggest private group.

Hospital based pays starting around 450k, Above 5000 rvus is around 85-96$ per rvu , 4.5 days a week

Private is lower base around 350k with 2-3 yr partner track. I dont have exact numbers but partner make > 1mil for 20-25 a day 5 days a week. Have to cover multiple hospitals etc.

Good luck

Sounds rough to do 5 days a week of 20+ a day.

 

[gutonc]

Sounds rough to do 5 days a week of 20+ a day.

I might do it for $2-3M. But only for a year or two until I decided to eat lead instead of going to work. But for ~$1M (with all the diminishing returns on that kind of taxable income), no thank you.

 

[bobow98]

I might do it for $2-3M. But only for a year or two until I decided to eat lead instead of going to work. But for ~$1M (with all the diminishing returns on that kind of taxable income), no thank you.

Sounds rough to do 5 days a week of 20+ a day.

Chicago is a tough town for oncology despite it being in the "midwest" for physician reimbursement. I heard the same from pharmacy and nursing colleagues as well. Granted, COL is probably better, but that does not justify how far it lags behind the whole region. I think if you're willing to go out to Peoria or east to Indiana, the numbers look much better.

Summertime Chicago for ASCO sure is a nice place though.

 

[whatup2016]

Chicago is a tough town for oncology despite it being in the "midwest" for physician reimbursement. I heard the same from pharmacy and nursing colleagues as well. Granted, COL is probably better, but that does not justify how far it lags behind the whole region. I think if you're willing to go out to Peoria or east to Indiana, the numbers look much better.

Summertime Chicago for ASCO sure is a nice place though.

Any specifics?

 

[whatup2016]

Sounds rough to do 5 days a week of 20+ a day.

I recently moved to the area but I am a couple of hours outside. Have some friends in Greater Chicago area however.

Mostly its OSF, Northwestern and UIC affiliated hospitals.

Illinois cancer care specialists is the biggest private group.

Hospital based pays starting around 450k, Above 5000 rvus is around 85-96$ per rvu , 4.5 days a week

Private is lower base around 350k with 2-3 yr partner track. I dont have exact numbers but partner make > 1mil for 20-25 a day 5 days a week. Have to cover multiple hospitals etc.

Good luck

450k for hospital employed for 5000 wRVU target doesn’t sound bad?

 

[HemeOncHopeful19]

450k for hospital employed for 5000 wRVU target doesn’t sound bad?

Should be 500k

 

[bobow98]

450k for hospital employed for 5000 wRVU target doesn’t sound bad?

If you're not getting 100/RVU at minimum for an employed job, you're getting taken advantage of.

 

[checkpointinhibitor]

Any specifics?

Chicago is a very desirable location for a lot of people to live due to relatively low cost of living compared to other coastal places, giving same level of international connectivity.
There are many well established health care systems in Chicago that have been absorbing local private practices leading to less physician autonomy. Older folks as usual sell out on their way out.
Private equity pests have ventured in - Duly healthcare (previously DuPage Med Group), I think AMITA is also PE. They pay okay overall but big city bucks, not mid-west bucks. IMO real reason why mediocre paying jobs survive in Chicago is due to a lot of people are willing to accept those salaries which seem better than NY or LA but lower than market rate. People are willing to compromise living in a bigger city/better suburbs than going somewhere in middle of nowhere.
My 2 cents.

 

[checkpointinhibitor]

450k for hospital employed for 5000 wRVU target doesn’t sound bad?

This is like part time.
Real question is - what is the comp after hitting that threshold? Pure production per wRVU or there is a ceiling? Because 5K wRVUs is almost 0.6 FTE for most community oncologists who are good with billing skills.

 

[AmiSansNom]

What would be the approximate 50th, 75th, and 90th percentile total compensations for a community medical oncologist in 2025? Just trying to get a ball park.

 

[MD46]

What would be the approximate 50th, 75th, and 90th percentile total compensations for a community medical oncologist in 2025? Just trying to get a ball park.

Something like 500K, 700K, 900K+ respectively..

 

[gutonc]

Something like 500K, 700K, 900K+ respectively..

This is probably close enough to be true. Recognizing that there are geographic variations.

 

[solidonc2020]

Something like 500K, 700K, 900K+ respectively..

I think this maybe smidge low (add 50-75k to each) based on relatively recent job search assuming fully clinical positions. But definitely not far off.

 

[MotoMD]

anyone have any idea of pay here in socal or any leads. Ive interviewed with a few larger hospital based groups and they all seem to be at 400 to 440k for 5 days a week. I would like to find a private practice.

 

[sloh]

anyone have any idea of pay here in socal or any leads. Ive interviewed with a few larger hospital based groups and they all seem to be at 400 to 440k for 5 days a week. I would like to find a private practice.

Is that true for Kaiser as well? What is income after partnership?

 

[soccerusa]

So I was approached somewhat informally by a practice in a desirable (at least for me) mid size east coast city and am trying to get some feedback on the numbers. As an aside, I am a mid 2nd year fellow and feel a little strange with jobs being discussed so early as I am not sure how to get all the offers on the table at the same time to compare. Is it normal to say something like "I am really interested but need to wait to commit given how early it is"?

Details
- Large multi-specialty physician owned group
- Cover one large hospital with infusion center attached as well as a smaller hospital with large L and D practice both within a 10 min drive (notable as we covering inpatient hematology consults also - eek!)
- 4 days clinic and 1 day admin
- Round on own patients M-F in the hospital (often 1-3)
- Take call 1:6 weeks which entails hospital consults at both hospitals all week as well as seeing all of practices patients on the weekend
- Practice does handle acute leukemias and high grade lymphomas inpatient without routinely shipping them to the academic hospital about an hour a way
- 3 yr guarantee of 525k for 5.5k RVU, $95/rvu over that. After 3 yrs, $95/rvu completely on production.
- "partnership" after 3 yrs, without buy in. This entitles you to vote in large group as well as receive profit distributions which are less than 100k per year and not tied to individual productive (and are the same across different specialties)
- most experienced/busiest docs are between 10k-11k RVU per year, although most people are around 7k
- benefits with 401k match are fine but nothing exemplary

Questions
1) I'm a very solid tumor focused fellow with limited hematology expertise although I will be double boarded. The group assured me I'd get up to speed with the leukemia/lymphomas quickly with their support although this worries me a bit. I wouldn't have to see any in my clinic if I didn't want to but would need to cover them while admitted. Is this a reasonable expectation based on my experience?
2) I am certainly not here to maximize income, more to provide great clinical care and provide a good life for my young kids both by financial resources but also by having enough time to be home with them. How does this offer compare to what people have seen in terms of amount of work to be making 600k ish?
3) The $/RVU seems in line with other stuff I've seen on SDN. Is there other information apart from above I should be asking for at this point?

As always, really appreciate everyone's help!

 

[gutonc]

So I was approached somewhat informally by a practice in a desirable (at least for me) mid size east coast city and am trying to get some feedback on the numbers. As an aside, I am a mid 2nd year fellow and feel a little strange with jobs being discussed so early as I am not sure how to get all the offers on the table at the same time to compare. Is it normal to say something like "I am really interested but need to wait to commit given how early it is"?

Details
- Large multi-specialty physician owned group
- Cover one large hospital with infusion center attached as well as a smaller hospital with large L and D practice both within a 10 min drive (notable as we covering inpatient hematology consults also - eek!)
- 4 days clinic and 1 day admin
- Round on own patients M-F in the hospital (often 1-3)
- Take call 1:6 weeks which entails hospital consults at both hospitals all week as well as seeing all of practices patients on the weekend
- Practice does handle acute leukemias and high grade lymphomas inpatient without routinely shipping them to the academic hospital about an hour a way
- 3 yr guarantee of 525k for 5.5k RVU, $95/rvu over that. After 3 yrs, $95/rvu completely on production.
- "partnership" after 3 yrs, without buy in. This entitles you to vote in large group as well as receive profit distributions which are less than 100k per year and not tied to individual productive (and are the same across different specialties)
- most experienced/busiest docs are between 10k-11k RVU per year, although most people are around 7k
- benefits with 401k match are fine but nothing exemplary

Questions
1) I'm a very solid tumor focused fellow with limited hematology expertise although I will be double boarded. The group assured me I'd get up to speed with the leukemia/lymphomas quickly with their support although this worries me a bit. I wouldn't have to see any in my clinic if I didn't want to but would need to cover them while admitted. Is this a reasonable expectation based on my experience?

You'll be fine. Lots of people do this. I chose a practice where I don't have to do this. But if I had a practice that I wanted to join that did this, it would not be a deal breaker for me.

2) I am certainly not here to maximize income, more to provide great clinical care and provide a good life for my young kids both by financial resources but also by having enough time to be home with them. How does this offer compare to what people have seen in terms of amount of work to be making 600k ish?

Seems reasonable to me.

3) The $/RVU seems in line with other stuff I've seen on SDN. Is there other information apart from above I should be asking for at this point?

How frequently do they update the wRVU numbers? They change annually by CMS. Most practices don't change them that often, typically it's 2-3 years but you don't want to be stuck with the same $/wRVU for 5 years if the practice is getting reimbursed much more.

Clinic blocked/limited when you're on service? How busy is the average inpatient load? One thing I found that hospitalists and consulting docs (and patients) hate when they consult hem/onc is that, unless you have time set aside on your schedule, you're probably seeing that consult at 5:45p or 6:30a the next day when nobody's around to talk about it. Just trying to squeeze consults in between patients and during the noon hour (or after clinic) makes everybody miserable.

Overall it seems like a decent offer. Fair guarantee, workload seems reasonable. Easy enough to get to $700K+ if you want to do the work.

 

[HemeOncHopeful19]

So I was approached somewhat informally by a practice in a desirable (at least for me) mid size east coast city and am trying to get some feedback on the numbers. As an aside, I am a mid 2nd year fellow and feel a little strange with jobs being discussed so early as I am not sure how to get all the offers on the table at the same time to compare. Is it normal to say something like "I am really interested but need to wait to commit given how early it is"?

Details
- Large multi-specialty physician owned group
- Cover one large hospital with infusion center attached as well as a smaller hospital with large L and D practice both within a 10 min drive (notable as we covering inpatient hematology consults also - eek!)
- 4 days clinic and 1 day admin
- Round on own patients M-F in the hospital (often 1-3)
- Take call 1:6 weeks which entails hospital consults at both hospitals all week as well as seeing all of practices patients on the weekend
- Practice does handle acute leukemias and high grade lymphomas inpatient without routinely shipping them to the academic hospital about an hour a way
- 3 yr guarantee of 525k for 5.5k RVU, $95/rvu over that. After 3 yrs, $95/rvu completely on production.
- "partnership" after 3 yrs, without buy in. This entitles you to vote in large group as well as receive profit distributions which are less than 100k per year and not tied to individual productive (and are the same across different specialties)
- most experienced/busiest docs are between 10k-11k RVU per year, although most people are around 7k
- benefits with 401k match are fine but nothing exemplary

Questions
1) I'm a very solid tumor focused fellow with limited hematology expertise although I will be double boarded. The group assured me I'd get up to speed with the leukemia/lymphomas quickly with their support although this worries me a bit. I wouldn't have to see any in my clinic if I didn't want to but would need to cover them while admitted. Is this a reasonable expectation based on my experience?
2) I am certainly not here to maximize income, more to provide great clinical care and provide a good life for my young kids both by financial resources but also by having enough time to be home with them. How does this offer compare to what people have seen in terms of amount of work to be making 600k ish?
3) The $/RVU seems in line with other stuff I've seen on SDN. Is there other information apart from above I should be asking for at this point?

As always, really appreciate everyone's help!

Straight wRVU based pay is a little odd for a PP group but I guess you get a distribution of profits.

How big is this group? I’m assuming you’d be Oncologist #6 but are we talking a group that is MO + RO + a couple surgeons or like 10 different specialties?

You said infusion is attached to the hospital… is this a hospital based practice or do you have your own infusion? Does the hospital also have their own Onc docs employed? If yes are they 340b?

 

[soccerusa]

Straight wRVU based pay is a little odd for a PP group but I guess you get a distribution of profits.

How big is this group? I’m assuming you’d be Oncologist #6 but are we talking a group that is MO + RO + a couple surgeons or like 10 different specialties?

You said infusion is attached to the hospital… is this a hospital based practice or do you have your own infusion? Does the hospital also have their own Onc docs employed? If yes are they 340b?

They are the only oncologists at the hospital. The multi specialty group is large like 50-100 docs and includes many different specialties with a significant number not treating cancer at all. Infusion is owned by the specialty group so my understanding is the infusion profit is rolled into the "distribution" that goes to all the docs in the group, not just the oncologists.

 

[soccerusa]

You'll be fine. Lots of people do this. I chose a practice where I don't have to do this. But if I had a practice that I wanted to join that did this, it would not be a deal breaker for me.

Seems reasonable to me.

How frequently do they update the wRVU numbers? They change annually by CMS. Most practices don't change them that often, typically it's 2-3 years but you don't want to be stuck with the same $/wRVU for 5 years if the practice is getting reimbursed much more.

Clinic blocked/limited when you're on service? How busy is the average inpatient load? One thing I found that hospitalists and consulting docs (and patients) hate when they consult hem/onc is that, unless you have time set aside on your schedule, you're probably seeing that consult at 5:45p or 6:30a the next day when nobody's around to talk about it. Just trying to squeeze consults in between patients and during the noon hour (or after clinic) makes everybody miserable.

Overall it seems like a decent offer. Fair guarantee, workload seems reasonable. Easy enough to get to $700K+ if you want to do the work.

As always gutonc, thanks for sharing your experience! Really appreciate it!

 

[gutonc]

Straight wRVU based pay is a little odd for a PP group but I guess you get a distribution of profits.

This is actually pretty common for a large MSG (which is kind of a hybrid between hospital based and true PP). What is a little different here (at least to my understanding of this job) is that the couple of MSG's I'm familiar with (one that has oncology and that I used to technically be the medical director of and one that does not) is that the annual profit distributions are "equitable, but not equal" and typically based on patient volume and RVUs generated. It's not typically a 1:1 but the spine surgeon pulling in 15-20K wRVU or the GI doc scoping for cash at the MSG-owned ASC is going to get a larger distribution than the endocrinologist.

 

[checkpointinhibitor]

So I was approached somewhat informally by a practice in a desirable (at least for me) mid size east coast city and am trying to get some feedback on the numbers. As an aside, I am a mid 2nd year fellow and feel a little strange with jobs being discussed so early as I am not sure how to get all the offers on the table at the same time to compare. Is it normal to say something like "I am really interested but need to wait to commit given how early it is"?

Details
- Large multi-specialty physician owned group
- Cover one large hospital with infusion center attached as well as a smaller hospital with large L and D practice both within a 10 min drive (notable as we covering inpatient hematology consults also - eek!)
- 4 days clinic and 1 day admin
- Round on own patients M-F in the hospital (often 1-3)
- Take call 1:6 weeks which entails hospital consults at both hospitals all week as well as seeing all of practices patients on the weekend
- Practice does handle acute leukemias and high grade lymphomas inpatient without routinely shipping them to the academic hospital about an hour a way
- 3 yr guarantee of 525k for 5.5k RVU, $95/rvu over that. After 3 yrs, $95/rvu completely on production.
- "partnership" after 3 yrs, without buy in. This entitles you to vote in large group as well as receive profit distributions which are less than 100k per year and not tied to individual productive (and are the same across different specialties)
- most experienced/busiest docs are between 10k-11k RVU per year, although most people are around 7k
- benefits with 401k match are fine but nothing exemplary

Questions
1) I'm a very solid tumor focused fellow with limited hematology expertise although I will be double boarded. The group assured me I'd get up to speed with the leukemia/lymphomas quickly with their support although this worries me a bit. I wouldn't have to see any in my clinic if I didn't want to but would need to cover them while admitted. Is this a reasonable expectation based on my experience?
2) I am certainly not here to maximize income, more to provide great clinical care and provide a good life for my young kids both by financial resources but also by having enough time to be home with them. How does this offer compare to what people have seen in terms of amount of work to be making 600k ish?
3) The $/RVU seems in line with other stuff I've seen on SDN. Is there other information apart from above I should be asking for at this point?

As always, really appreciate everyone's help!

I agree with gutonc.
This is a decent offer.
Just figure out the inpatient part and try to understand how busy the life is especially when inpt + outpt.

Also - APP support (you should own them and pay for them but they work FOR you).

 

[Plutarch02]

So I was approached somewhat informally by a practice in a desirable (at least for me) mid size east coast city and am trying to get some feedback on the numbers. As an aside, I am a mid 2nd year fellow and feel a little strange with jobs being discussed so early as I am not sure how to get all the offers on the table at the same time to compare. Is it normal to say something like "I am really interested but need to wait to commit given how early it is"?

Details
- Large multi-specialty physician owned group
- Cover one large hospital with infusion center attached as well as a smaller hospital with large L and D practice both within a 10 min drive (notable as we covering inpatient hematology consults also - eek!)
- 4 days clinic and 1 day admin
- Round on own patients M-F in the hospital (often 1-3)
- Take call 1:6 weeks which entails hospital consults at both hospitals all week as well as seeing all of practices patients on the weekend
- Practice does handle acute leukemias and high grade lymphomas inpatient without routinely shipping them to the academic hospital about an hour a way
- 3 yr guarantee of 525k for 5.5k RVU, $95/rvu over that. After 3 yrs, $95/rvu completely on production.
- "partnership" after 3 yrs, without buy in. This entitles you to vote in large group as well as receive profit distributions which are less than 100k per year and not tied to individual productive (and are the same across different specialties)
- most experienced/busiest docs are between 10k-11k RVU per year, although most people are around 7k
- benefits with 401k match are fine but nothing exemplary

Questions
1) I'm a very solid tumor focused fellow with limited hematology expertise although I will be double boarded. The group assured me I'd get up to speed with the leukemia/lymphomas quickly with their support although this worries me a bit. I wouldn't have to see any in my clinic if I didn't want to but would need to cover them while admitted. Is this a reasonable expectation based on my experience?
2) I am certainly not here to maximize income, more to provide great clinical care and provide a good life for my young kids both by financial resources but also by having enough time to be home with them. How does this offer compare to what people have seen in terms of amount of work to be making 600k ish?
3) The $/RVU seems in line with other stuff I've seen on SDN. Is there other information apart from above I should be asking for at this point?

As always, really appreciate everyone's help!

It's a decent offer, but dealing with acute leukemias would make me say no to this personally. Do you have BMT support in house, acute leukemias have become very complicated to manage than the days of 7+3 and pray.

 

[ONC2023]

Wanted to add some anecdotal evidence to the perennial academic vs community practice debate.

I just received an email sent out to the whole division from our chair. The message beneath all of the fluff about our exciting academic mission and collaborative mentality is that there’s no money due to uncertainty about federal funding and that we shouldn’t expect any money for anything any time soon, including travel and food. The message is clear: if you don’t have your own grant money, you’re an RVU monkey for the division - and no, you won’t be paid a reasonable RVU rate.

I suspect academia is going to get worse over the next few years for everyone except superstar investigators, and community practice will look relatively better even if it worsens in absolute terms.

 

[MifflinDunder]

My senior fellows have already decided on academia because they don't want to see and keep up with everything.

Would be interesting to see how this affects people's choices.

 

[osprey099]

My former fellowship program has suspended all reimbursement for conference travel. I imagine they will make clinicians have more clinic time and less research/admin days. Funny thing is the hospital CMOs probably continue to make their 7 figures like usual

 

[Nitpicky]

Wanted to get some opinions on an offer, just to get a sense of what is reasonable given location/work performed etc.

Job is located in northern part of Mid-West, community hospital, relatively rural and a few hours from a larger city

-Base salary 750K for 2 years
-If exceed 8,600 wRVU's then each additional wRVU pays $103
-Moderate sign on bonus at ~50K
-There might be some performance incentives

Coming out of fellowship is it reasonable to expect to get over 8600 wRVUs in order to get a bonus if sufficient work is done? For a more rural location, does that base number seem reasonable?

Appreciate the input

 

[osprey099]

Wanted to get some opinions on an offer, just to get a sense of what is reasonable given location/work performed etc.

Job is located in northern part of Mid-West, community hospital, relatively rural and a few hours from a larger city

-Base salary 750K for 2 years
-If exceed 8,600 wRVU's then each additional wRVU pays $103
-Moderate sign on bonus at ~50K
-There might be some performance incentives

Coming out of fellowship is it reasonable to expect to get over 8600 wRVUs in order to get a bonus if sufficient work is done? For a more rural location, does that base number seem reasonable?

Appreciate the input

You're not going to exceed 8600 wRVUs year 1, unless you're taking over a retired doc panel or this middle of nowhere place has been rotating locums for years and you're the first permanent doc. 4 or 5 days per week and what is call volume?

750k guaranteed base is very good. But that usually means location is absolute crap

 

[HemeOncHopeful19]

Wanted to get some opinions on an offer, just to get a sense of what is reasonable given location/work performed etc.

Job is located in northern part of Mid-West, community hospital, relatively rural and a few hours from a larger city

-Base salary 750K for 2 years
-If exceed 8,600 wRVU's then each additional wRVU pays $103
-Moderate sign on bonus at ~50K
-There might be some performance incentives

Coming out of fellowship is it reasonable to expect to get over 8600 wRVUs in order to get a bonus if sufficient work is done? For a more rural location, does that base number seem reasonable?

Appreciate the input

It should be 750k for 7500 RVUs but I agree unless you are taking over someone’s panel or they are going to work you to the bone you will not hit 8600 that first year. If you end up doing 5000-6000s RVU the 750k is fantastic *until you get busy, then you’re underpaid by about 10-15%

I would ask them how many new hires in past 3 years and what RVUs they hit in their first year.

 

[checkpointinhibitor]

It should be 750k for 7500 RVUs but I agree unless you are taking over someone’s panel or they are going to work you to the bone you will not hit 8600 that first year. If you end up doing 5000-6000s RVU the 750k is fantastic *until you get busy, then you’re underpaid by about 10-15%

I would ask them how many new hires in past 3 years and what RVUs they hit in their first year.

Thoughts:
Option 1 - historically if they have good PCP/NP referral base (never say no to consults and accept all crap) and if partners are hitting that benchmark then I would ask for 750K for 2 years (current proposal) and then after 2 years - just pure wRVU. That way, you don't have the 15% loss of productivity. Currently 750K for up to 8600wRVU is ONLY 87.20 $/wRVU which is very low for midwest especially if remote. Typical is more around 95-1000. I would ask for all wRVU production after year 2 at the rate of $103 and negotiate from there.
Option 2 - if the referral base is poor, you are okay with working less and making less and previous partners are not getting to 8600 wRVUs then it's best to work less and keep productivity limited to 7800 wRVUs (median $/wRVU will be about $95).

In this formula, if you exceed 7800 wRVU --> you get compensated less $/wRVU and is a loosing preposition.

Hence, in this system, you will make less per WRVU if you work harder. Median $/wRVU is much higher in midwest.
Hope it makes sense.

 

[BRCA123]

Is it normal for PP (USON) to see patients 30-35 per day in clinic and hospital consults? And then still push to see more patients and add a Midlevel to “help” you and get more RVUs. On top of that still need to do more for the practice and join a committee. How is this even safe for the patient? Call is 1 q7 weekends, Infusion calls once a week, hospital day consult call twice a week, round on patients every week, night calls 1 every 7th night.

Is this why midlevels are triaging calls from other midlevel hospitalist.

This whole situation is f***. All these PP is happy that they have to hire more admins and midlevels for doctors “owners” to work more and “see” more patients.

 

[HemeOncHopeful19]

Is it normal for PP (USON) to see patients 30-35 per day in clinic and hospital consults? And then still push to see more patients and add a Midlevel to “help” you and get more RVUs. On top of that still need to do more for the practice and join a committee. How is this even safe for the patient? Call is 1 q7 weekends, Infusion calls once a week, hospital day consult call twice a week, round on patients every week, night calls 1 every 7th night.

Is this why midlevels are triaging calls from other midlevel hospitalist.

This whole situation is f***. All these PP is happy that they have to hire more admins and midlevels for doctors “owners” to work more and “see” more patients.

It is normal for some PP groups.

I also know of other groups where 18 is the norm. I would say my group typically does 20-24 about 4-4.5d/week. We do use midlevels for alternating some chemo visits (like Q2w FOLFOX or weekly chemoXRT visits) but unlike most hospital employed groups at least we actually see the $ from those visits and if someone was awful we could get rid of them.

I don't think there are many PP groups that are "happy" with the direction PP Oncology is heading, either. The rise of USON is pretty much the natural response to hospital / insurance / PBM consolidation. You either get big or get eaten unfortunately

 

[BRCA123]

It is normal for some PP groups.

I also know of other groups where 18 is the norm. I would say my group typically does 20-24 about 4-4.5d/week. We do use midlevels for alternating some chemo visits (like Q2w FOLFOX or weekly chemoXRT visits) but unlike most hospital employed groups at least we actually see the $ from those visits and if someone was awful we could get rid of them.

I don't think there are many PP groups that are "happy" with the direction PP Oncology is heading, either. The rise of USON is pretty much the natural response to hospital / insurance / PBM consolidation. You either get big or get eaten unfortunately

How much do partners make? Cause I calculated about 19000 RVUs with 30pts/day, 5days/week, 46weeks. In hospital employed thats about 1.9m. But I feel like the partners in this PP group make 2M.

 

[HemeOncHopeful19]

How much do partners make? Cause I calculated about 19000 RVUs with 30pts/day, 5days/week, 46weeks. In hospital employed thats about 1.9m. But I feel like the partners in this PP group make 2M.

No hospital will ever pay you 1.9m unless *maybe* it's some sort of weird deal where you are the top of the top of the food chain bringing in massive amounts of Pharma $$. They will cite stark law or some random crap to justify capping your pay.

Partners in that group may well be making $1-1.5m I have no idea, I would quit way before that point

 

[sloh]

No hospital will ever pay you 1.9m unless *maybe* it's some sort of weird deal where you are the top of the top of the food chain bringing in massive amounts of Pharma $$. They will cite stark law or some random crap to justify capping your pay.

Partners in that group may well be making $1-1.5m I have no idea, I would quit way before that point

The good old “fair” market value trope

 

[Nitpicky]

You're not going to exceed 8600 wRVUs year 1, unless you're taking over a retired doc panel or this middle of nowhere place has been rotating locums for years and you're the first permanent doc. 4 or 5 days per week and what is call volume?

750k guaranteed base is very good. But that usually means location is absolute crap

Thoughts:
Option 1 - historically if they have good PCP/NP referral base (never say no to consults and accept all crap) and if partners are hitting that benchmark then I would ask for 750K for 2 years (current proposal) and then after 2 years - just pure wRVU. That way, you don't have the 15% loss of productivity. Currently 750K for up to 8600wRVU is ONLY 87.20 $/wRVU which is very low for midwest especially if remote. Typical is more around 95-1000. I would ask for all wRVU production after year 2 at the rate of $103 and negotiate from there.
Option 2 - if the referral base is poor, you are okay with working less and making less and previous partners are not getting to 8600 wRVUs then it's best to work less and keep productivity limited to 7800 wRVUs (median $/wRVU will be about $95).

In this formula, if you exceed 7800 wRVU --> you get compensated less $/wRVU and is a loosing preposition.

View attachment 399795
Hence, in this system, you will make less per WRVU if you work harder. Median $/wRVU is much higher in midwest.
Hope it makes sense.

It should be 750k for 7500 RVUs but I agree unless you are taking over someone’s panel or they are going to work you to the bone you will not hit 8600 that first year. If you end up doing 5000-6000s RVU the 750k is fantastic *until you get busy, then you’re underpaid by about 10-15%

I would ask them how many new hires in past 3 years and what RVUs they hit in their first year.

Thank you for all of your replies, including those I didn't reply to directly.

I actually made a small error, the base is 805K (the RVUs are still 8600) and there is a 5% of base salary Performance Bonus as well.

They told me the current full-time docs meet the RVU (but it was kind of touched upon briefly, didn't go into detail).

I had a few questions about what I should expect to have written in a contract, would appreciate your input.

-Should the specific call be mentioned in the contract (i.e., 1:5 for example)?
-They mentioned clinic is 4.5 days the 1st year and 4 days the next, do I need to have this in writing?
-The contract is reviewed annually and compensation adjusted based of market survey/productivity and other factors, is that normal?
-The range of patients per day is not mentioned

 

[HemeOncHopeful19]

Thank you for all of your replies, including those I didn't reply to directly.

I actually made a small error, the base is 805K (the RVUs are still 8600) and there is a 5% of base salary Performance Bonus as well.

They told me the current full-time docs meet the RVU (but it was kind of touched upon briefly, didn't go into detail).

I had a few questions about what I should expect to have written in a contract, would appreciate your input.

-Should the specific call be mentioned in the contract (i.e., 1:5 for example)?
-They mentioned clinic is 4.5 days the 1st year and 4 days the next, do I need to have this in writing?
-The contract is reviewed annually and compensation adjusted based of market survey/productivity and other factors, is that normal?
-The range of patients per day is not mentioned

- Yes but it never will be
- Yes absolutely should be mentioned
- Normalish, I guess, some places renegotiate every few years. This is their way of saying “we will change what we pay you to whatever we want”
- this is normal

 

[gutonc]

Thank you for all of your replies, including those I didn't reply to directly.

I actually made a small error, the base is 805K (the RVUs are still 8600) and there is a 5% of base salary Performance Bonus as well.

They told me the current full-time docs meet the RVU (but it was kind of touched upon briefly, didn't go into detail).

I had a few questions about what I should expect to have written in a contract, would appreciate your input.

-Should the specific call be mentioned in the contract (i.e., 1:5 for example)?

The problem with this is what happens when you lose a doc or hire 2 new ones? The contract I used to write said "call will be shared equitably among the physicians based on the total number in the group" or something like that. There should be something about it, but making it a firm number isn't really practical.

-They mentioned clinic is 4.5 days the 1st year and 4 days the next, do I need to have this in writing?

100%. Same for what is expected on your admin day (in the office? available by phone? expected to be in the EMR and responding to things?)

-The contract is reviewed annually and compensation adjusted based of market survey/productivity and other factors, is that normal?

Yes. Regular review and renegotiation is standard. Annual is a little ridiculous but Q2-3 years is common.

-The range of patients per day is not mentioned

It couldn't and shouldn't be.

 

[Nitpicky]

The problem with this is what happens when you lose a doc or hire 2 new ones? The contract I used to write said "call will be shared equitably among the physicians based on the total number in the group" or something like that. There should be something about it, but making it a firm number isn't really practical.

100%. Same for what is expected on your admin day (in the office? available by phone? expected to be in the EMR and responding to things?)

Yes. Regular review and renegotiation is standard. Annual is a little ridiculous but Q2-3 years is common.

It couldn't and shouldn't be.

- Yes but it never will be
- Yes absolutely should be mentioned
- Normalish, I guess, some places renegotiate every few years. This is their way of saying “we will change what we pay you to whatever we want”
- this is normal

Hmm got it okay, so the "patients per day" is something I shouldn't expect to have in writing. The call also seems unlikely to be in writing. I like the way you phrased it Gutonc "call shared equitably", I think that prevents a practice from assigning less call to locums.

The re-negotiation each year threw me off a bit, so I just wanted to clarify that with them (in my mind I just want to protect myself against the salary suddenly dropping sharply in subsequent years).

And that's helpful, the admin portion of things and the drop to 4 days clinic subsequent years should be in writing.

Thank you

 

[HemeOncHopeful19]

The re-negotiation each year threw me off a bit, so I just wanted to clarify that with them (in my mind I just want to protect myself against the salary suddenly dropping sharply in subsequent years).

Yeah, good luck with that.

I would not stress about that too much, if they want to try and drop your pay they will do it. Even if it's not in your contract they can come to you with "well we need to lower your pay... sign here or consider this your 90 days notice."

Best thing you can do to protect yourself there is to work in a state with banned non-competes or try to remove the non-compete if you do live in a state that allows them (unlikely you will succeed there)

 

[gutonc]

Hmm got it okay, so the "patients per day" is something I shouldn't expect to have in writing. The call also seems unlikely to be in writing. I like the way you phrased it Gutonc "call shared equitably", I think that prevents a practice from assigning less call to locums.

I have never seen a locums hem/onc contract that included taking call. Primarily because nobody is willing to pay $4-5K/d for the weekend for what typically amounts to a day or less worth of actual work.