Pickles360
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May I ask what you're seeing in Atlanta? Looking around that area and having a hard time
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Heme/Onc Job Offer Discussion
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I mean he did say within an hour so he is technically talking about Columbus lol
Are the signing bonuses usually paid out when you sign the contract or on your first day of work? I’ve got a couple of kids and an extra 2K per month times 18 months would be big time.
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Generally paid on day 1. But no reason why you can't ask for it to be distributed. You could also just DIY that by putting it in an HYSA and have it automatically transferred to your checking account on a monthly distribution.
I'm not sure where "Google" got those, but I'm not sure I'd consider ATL, HTX, DFW, LV, PHX, ORL, PITT, SLC and MSP as 3rd tier cities. And Albany, St Louis and Cleveland deserve to be demoted to tier 5 or 6.
Day 1 as in when you start working or when you sign? Sorry, I’m a bit dense.
I’ve usually seen it paid on your start date but I imagine you could negotiate it to your signing date at many places. I would caution you about singing (edit: signing, but probably don’t sing in clinic either) halfway through 2nd year, your goals may change unless you really know where you want to live
Usually your first payday. If this is one of those scenarios where you're being offered an advance for signing early, I'm with @HemeOncHopeful19
Traditional signing bonuses should usually be paid out within 30 days of your start date.
Some jobs will also offer a separate incentive in the form of a "fellowship stipend", which is what it sounds like you're looking for. Incentives are usually one of the more negotiable aspects of contract discussions, so if you find a place you really like that also really likes you, there could be some hope to improve your cash flow situation as a fellow.
That said, I agree with above that you shouldn't rush the job selection for this purpose.
any insight about hem/onc practice at Las Vegas metro or surrounding area? Sorry about such a vague question.
With any type of job there’s so many things it’s hard to point out.
Why don’t you tell us about your job and we can tell you where you may be getting screwed.
Edit: if it’s the job you posted about in April then we already covered it
Why don’t you tell us about your job and we can tell you where you may be getting screwed.
Edit: if it’s the job you posted about in April then we already covered it
Yes, same US onc PP job that I posted in April. Base 400k with 2 years to partnership without buy in. Partners median comp is around 1.1-1.2 mil with 25 patients on average with 4 day work week. Is it ok to ask practice financials for last 2-3 years as this is something I haven’t asked yet. Just making sure I don’t get screwed.
They are not going to open the books to you. You are not "buying in" in the typical way. If you were buying with money into the practice directly, yes they would have to show you all the numbers.
Ideally they should, most wont. Only one practice I interviewed at were transparent and showed me the books, its not the norm. Best thing is to ask their most recent partners if they are open to sharing their salary range and amount of patient seen to get an idea. Otherwise if they dont tell you in this day and age, I would be ready to walk away. Some places I asked them to send me a random partners pay sheet with all identifiers hidden, again only one of them shared.
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This is pretty disappointing. Especially if you're looking at a fully RVU/ancillary based compensation system. For salaried/employed jobs, it makes a little more sense, but even in my prior hospital employed, community based position we provided the full compensation structure (base, wRVU target, $/wRVU, bonuses) as well as median physician compensation in the group for the prior fiscal year (adjusted for 1.0 FTE since many docs were <1.0 cFTE). That number was 10-15% higher than the base+bonuses that were more or less guaranteed.
I think that’s different from what people mean by “showing the books” though. My current PP group is (unreasonably IMO) somewhat paranoid regarding our books and considers them on the level of trade secrets that our competition would want to use against us. I doubt we would be willing to show a potential hire the books but once you are on the partner track then our CFO will sit down and go over them with you before you make that commitment.
I doubt your hospital willingly showed your colleagues how much “non”-profit they were making off their Onc group (though IIRC you were in a directorish position so you were more aware of the numbers). The closest I got was when I was interviewing somewhere and one of the people in management let slip that 340b had “saved” their system something insane like $100-200 Million dollars in the past year alone.
I definitely think it's different when you're talking about a PP that has lots of potential ancillary income from partnership. And i wouldn't necessarily expect to see those numbers utnil I was on the cusp of partnership and trying to decide what kind of a buy-in I was willing to make.
But I don't think it's at all unreasonable to provide the information I was talking about, for any kind of a position. For a PP, things like median non-partner and median partner total annual comp is an easy number to get, doesn't compromise any "trade secrets" and the absolute bare minimum I'd expect.
Yeah, we all know the money to pay for everybody has to come from somewhere. It's just definitely more opaque in most hospital employed situations. There are a lot of people that aren't bothered by that.
Yes and probably double academic salaries
When interviewing I saw one in Wilkes Barre with Geisinger and another one in Delaware, I think New Ark, it was around 550 and 450 respectively starting - You generate more RVUs in patient specially with daily followups for the patients, hence its busy but ceiling higher.
I’m assuming these guys are mostly inpatient and take significantly more 24 hour calls?
One place had residents to help with call and the other had inpatient NP. Otherwise I dont think its sustainable
That’s pretty bad for a full time transplant job in PP.
Anyone know anything about City of Hope in Chicago?
All of the CoH clinics outside of Duarte, CA are former CTCA clinics. Make of that what you will.
Is this a good offer or can someone help me decipher? Hospital based system/community oncology position in the southeast
Base 420k, Threshold RVUs 5000, $90/RVU after 5000 with quality bonus up to $20k. 4 days clinic per week.
@gutonc - I would appreciate your review or if anything else I need to ask them
Base 420k, Threshold RVUs 5000, $90/RVU after 5000 with quality bonus up to $20k. 4 days clinic per week.
@gutonc - I would appreciate your review or if anything else I need to ask them
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Not really good unless you’re in a super desirable area.
$84RVU then $90RVU is just low
Edit: Sorry just read Southeast. I can’t imagine anywhere being “desirable” enough for this to make sense unless MAYBE you really liked Atlanta for some reason (and even then I’d call you nuts)
On a positive note 4 clinic days a week is decent. You didn’t mention call burden which can be important too
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Not great, not the worst.
Ask the typical questions:
Median comp for the group?
Support in clinic (APP, MA, RN, Pharm)?
CME?
Time off?
Call?
Inpatient coverage?
Signing/Relo bonus?
Call 1:6. What's a reasonable RVU?
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Median comp - I don't know. Have to ask.
3-4 APPs, Pharm is here.
CME $4k
Time off 30 days
Call 1:6
Inpatient coverage 1 week every 6 and that is when call is taken
Bonus they said negotiable
420 base and 90 per rvu seem dreadfully low for south.
I would be thinking 500 base and 98+ per rvu for your region AT LEAST unless you are at a safety net hospital.
Hi everyone,
I’m a Hem/Onc fellow and would appreciate some feedback for a position in New England countryside — roughly 2 hours from Boston Logan Airport. It's a community hospital (non teaching, no BMT, mostly solid with some benign heme) within a large medical group.
I'm wondering if this offer aligns with current market and if there's anything here that might be a red flag or worth negotiating. Thanks in advance for your thoughts!
I’m a Hem/Onc fellow and would appreciate some feedback for a position in New England countryside — roughly 2 hours from Boston Logan Airport. It's a community hospital (non teaching, no BMT, mostly solid with some benign heme) within a large medical group.
- Practice Sites: 2 locations, about 20 minutes apart
- Call: 1:4.5 (they’re planning to hire 1–2 more)
- Time Off: 4 weeks PTO + 5 CME days annually
- Compensation:
- Base: $400K, 3-year guarantee
- Productivity: $93 per wRVU (current providers reportedly meet targeted RVU)
- Signing bonus: $30K
- Relocation: $15K
- CME: $4k
I'm wondering if this offer aligns with current market and if there's anything here that might be a red flag or worth negotiating. Thanks in advance for your thoughts!
Doesn't seem terrible. I'm not familiar with New England rates but suspect this is somewhat in line.
What's the RVU target?
Clinic support?
Current median physician comp?
Thanks for your thoughts. The RVU target is 4,301, which aligns with a base salary $400k and $93 per wRVU (93*4301->400k). There are currently 2–3 APPs supporting the clinic, and they’re actively hiring 1-2 more. They didn't provide a median compensation number, but they mentioned that all 3 current physicians are earning over $400K and exceeding their RVU targets.
Not great not terrible
Midlevels are not a positive thing in employed positions unless you are getting credit for the RVUs they produce (which you won’t be)
How many days per week are you in clinic
This !
I think the offer is overall decent for East Coast it seems.
The devil is in the detail.
My thoughts as a seasoned physician:
1. Do they have efficiency in the clinic flow that you can get 8K-10K wRVUs per year.
2. APP - BIG PROBLEM. Do you get a cut of their productivity? if NO --> I would ask no APP case sharing. I would like to see all my cases then. There is no point extending your liability and not getting paid for extending your license.
New folks should remember - the practices always share that they have APP support. What that actually means is that APPs will see easy cases and you will be left with more complex ones. You will see less patients and be more tired due to complexity of cases and once you make a plan then APPs will take over their care and not let you reap the productivity of all your hard work.
I really appreciate these perspectives. This is a 4-day clinic position. I hadn’t thought about the APP angle that way — in fellowship, it was common for APPs to alternate visits with us to help accommodate more cases. I’ll also inquire about their average wRVU productivity and get a better sense of whether it’s feasible to reach 8,000-10,000 wRVUs when I become more efficient.
Just to be clear, 8-10K wRVU is a lot of work. And you need to be cognizant of the marginal gains going from 5K to 6K to 7K, etc. Will you make more money? Sure. Will it be worth it? Not necessarily. That's a decision only you can make.
Much better offer than I got 8yrs ago, 45mins out of Boston, Catholic Hospital, 300k base, 4500 rvus to make base then 55$ an rvu.
This seems ok, but as others pointed out makes sure if APP visit RVUs count towards you, if not, they become a liability with no financial benefit. (have them cover infusion, inbasket, portal messages and calls)
I think Sign-on bonus is weak, even for east coast you are looking upwards of 50-80K , can negotiate that
Other things seem ok
Good Luck!
Shockingly 300k in 2017 is equivalent to 393k in 2025 according to Google!
Could you message what hospital systems or groups in Omaha you heard those offers from?
Interested to hear about inpatient coverage models others see in current positions. Are most positions now consulting only without primary inpatient coverage of patients? Do solid tumor primary services exist outside of academic centers and is there any benefit to having these primary services? Our institution has a primary oncology service and trying to understand if this is a viable model. It is very complex and burdensome on outpatient oncologists to staff even part time and every weekend / after hours when there is no hospitalist coverage.
Primary service sounds like a nightmare. I can only imagine it if you had 24/7 fellow (or midlevel) coverage, or in niche settings like BMT of course which also typically come with that extra coverage.
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IMO it's not really a sustainable model for solid tumor, but that doesn't mean people don't try it.
In order to make it financially viable (from the physician comp side), you need to have a service that generates 120-150 wRVU weekly at a minimum. That's in the neighborhood of 60-70 patient encounters weekly. But that's only if you expect one person to cover 24/7. If you're going to pay 2 people to cover an inpatient service so that you can provide 24h inpatient coverage, double that number. Outside of major academic cancer centers I'm not sure how many hospitals are seeing 120-150 legitimate inpatient solid tumor patient encounters weekly. If you're turfing your night coverage to the hospitalists anyway, just have them cover the days too and consult as appropriate.
The inpatient solid tumor 'primary' service is obsolete in community practices. Inpatient care and more importantly care coordination has become too complex.
New grads will run away if there is an inpatient 'primary' service.
Hospitalists can do majority of things.
Most places have only consult service.
It's a recipe for burnout imo.
Absolutely agree.
We have 5 days straight 24 hrs coverage. Busy hospital so about 4-7 consults per day, 10-15 follow ups per day. Both heme and onc. APPs help with inpatient work.
When I was a fellow we managed inpatient solid tumor services as primary.
As an attending, never again. Unless you're in academics don't take a job with that, it's a recipe for burnout.
As an attending, never again. Unless you're in academics don't take a job with that, it's a recipe for burnout.
Most of us did as fellows. Which is why we won't ever do it as attendings.
employed setting, what is the average wRVU per patient? (typical setting of general practice). I have been following this forum for a while, I see anywhere between 2 to 2.4 wRUV. Below is the compensation part of an offer (initial one) I received. This is 5 days per week schedule, 20 patients per day with 4-5 new patients among them. Welcome any comments. Too low or average or anything else?
base is 500K, guarantee
anything above guarantee in dollar amount in a true-up
Avg wRVUs per New Patient Visit 2.81
Value of each wRVU for new patient $166.72
Avg wRVUs per Follow-Up Visit 1.93
Value of each wRVU for follow-up $45.00
I calculate 4 new patients and 16 follow up on daily basis (5 days per week and 46 weeks per year) = 2585 + 7100= 9685 wRVU per year.
base is 500K, guarantee
anything above guarantee in dollar amount in a true-up
Avg wRVUs per New Patient Visit 2.81
Value of each wRVU for new patient $166.72
Avg wRVUs per Follow-Up Visit 1.93
Value of each wRVU for follow-up $45.00
I calculate 4 new patients and 16 follow up on daily basis (5 days per week and 46 weeks per year) = 2585 + 7100= 9685 wRVU per year.
