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I don't know about the Tampa market, Florida cancer specialists recently got bought by McKesson which I think is the dominant practice in that area.
Heme/Onc Job Offer Discussion
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40 weeks M-F a year sounds not so nice.
I don't think hospitalist jobs for oncology are good for those who are earlier in their career.
I don't have answers to the two questions you have, although I suspect a job like this wouldn't really limit future opportunities.
But these jobs (and similar, inpatient only hem/onc positions) sound terrible to me for a variety of reasons. Lack of efficiency in inpatient work, no schedules, working around other care team members (from CNAs to surgeons), family members showing up later and wanting a run-down of what you already went through, and no idea if your day is going to be 3 or 30 patients when you show up in the morning. I guess the trade-off is minimal patient portal messages, but the downsides are much greater IMO than any potential upsides.
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Agreed, definitely does not sound like a fun job to me
Some of the biggest downsides for me would be:
- "Are you available for a goals of care conversation for this patient you've never seen before? They don't really understand what's happening with their cancer"
- Just generally having to be the messenger between the inpatient team and all your outpatient colleagues for their admitted (usually sick) patients. Even if you love your colleagues, this just doesn't sound fun.
- Both jobs say daytime hours, but who covers at night, then? If it's a rotating overnight call schedule, but you're always on in the day, I imagine there will just be a lot of things punted to you for the AM
- Even when you do get some interesting cases / nice saves (e.g., pts who respond well to urgent inpatient chemo), you won't get to follow-up on them in clinic
There are two main groups, one as stated above bought by US-Oncology/McKesson, the other Cancer Specialist of North Florida actually under talks with One Oncology (a competitor to McKesson) to being bought very soon. Couple of other small private practices but none hiring at this point.
I have friends/colleagues that have worked for both McKesson and One Oncology, its kind of a middle ground between true private and hospital based. There is so called partnership but not really. From Associate seeing 18-25pts a day making 400-550k you go to around 750k for the same amount of patients. Usually 4.5 days a week. Ceiling is not very high.
Good luck
Do you know how many years to "partner" it is?
I’d be curious if your USON friends are in Texas Onc or Rocky Mountain Cancer?
I’ve anecdotally heard those groups tend to be treated a bit better but it’s been a few years now.
@TexasMed22 I’ve heard usually 1.5-2 years to partner with USON
Depends on the practice actually, usually its 2-3 years for profit sharing and then around 3 or so for full partner.
all I can say is that I was in a US Onc Practice , a huge one at that. They had 3 years as associate, 3yrs with like 10,20,30% of productivity bonus and then full partner starting year 7. They actually never willingly revealed partner salaries even when I was 3 yrs in mind you.
I am inpatient only leukemia. I think there’s a narrow way for that type of position to be rewarding, financially sensible/lucrative and enjoyable but it’s not easy. I find I hit those 3 but most often in these type of roles you don’t.
@bobsmith definitely accurately laying out some of the challenges.
To me the main pros are flexible schedule. Possible inroads to admin roles (If that’s your jam) and more excitement (also if that’s your jam). It also lends itself well to academic roles teaching research etc especially if you get <40 wks on service
I used them twice over the last 4 years. Easy and professional. They also come with access to the MGMA data. Would recommend.
The bolded is probably worth the price of admission alone.
Pickles360
Full Member
Thank you! Which one did you use? My friend used Resolve but I’m open to either
Sorry about the ambiguity, I used Resolve.
I used contract diagnostics and they were helpful. Has anyone actually hired anyone for contract negotiation?
i’m not up for renewal for another 3 years but wanted to know if a formal attorney would be worth it
i’m not up for renewal for another 3 years but wanted to know if a formal attorney would be worth it
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Everybody talks a lot about contract negotiations and how to get the most out of it, but TBH, the room for flexibility is pretty minimal. You can maybe get an extra $1 or 2/wRVU or a little more CME money or signing bonus. I think the best use of a contract attorney is in removing restrictive covenants but not necessarily in getting more money.
If you're in an employed position, I think it's a huge waste of money unless you're willing to walk away from your current job.
I think it can be useful to clarify language too, so that promises your boss makes carry over to your boss 5 years from now
Agreed. That said, no guarantees that your employer won't make changes 5 years later when your contract is up for renewal.
I used Dennis Hursh. My contract was mostly boilerplate, so there wasn’t much to negotiate, but he was very patient in explaining everything. Great guy. He also compared the salary offer using MGMA and other data. Dennis Hursh - Physician's Attorney | Physician Agreements Health Law
I used both resolve and contract dx as it was what was recommended while I was in training. I think outside of the MGMA data I wouldn't recommend. Those services are more consultants rather than lawyers. And they do disclose that. Some of the advice was rather bland and not helpful. I agree with others to find a lawyer in your area who is familiar with physician contracts. That's what I would do if I had to do it all over again.
Pickles360
Full Member
Thank you all!
What do you like about oncology? What do you want your career to look like? What kind of things do you enjoy doing in hem/onc? What matters most to you, compensation, location, work/life balance? What kinds of experiences have you had in fellowship? What do your clinical mentors have to say about your career plans?
You seem to just be casting around blindly hoping that something will stick. Perhaps that's your technique in life and it's worked well for you in the past, but it doesn't seem like the path to a successful, fulfilling career.
To specifically answer your question, Phase 1 is typically going to be much more focused on the drugs than the patients. You are likely going to need at least some experience managing Phase 1 trials in fellowship to get a job like this. There is a LOT of non-clinical work in Phase I. Lots of paperwork. Lots of regulatory stuff. The treatment decisions are basically made for you based on study protocols, with very little flexibility or room for clinical judgement.
All of these may be positives or negatives for you. They are clearly the right thing for some people. As far as pay goes, in a setting like Texas Onc, where productivity matters, pay is definitely going to be less because the amount of work needed for each patient will be much greater than in a general hem/onc practice. Sure, you'll be billing 99215+G2211 for most of them, plus the occasional 99417, but doing that for 10-12 a day won't be anywhere near 99214-5+G2211 on 20+ a day.
I totally agree. I am in the same boat as @Pickles360 to graduate next year. If you like early phase/phase 1, you can even consider doing an additional 1 year fellowship at places like MDA, or if your program has a center like that, you can request rotation and work with the center faculty to learn things you want to know/learn.
Posting here for my wife.
TL;DR: Wife finishing oncology fellowship, choosing between $250k academic job with potentially better work-life balance vs $450-550k community job with more stress. I'm still in med school for 3 more years, then we'll likely move for my residency.
Background: My wife is finishing oncology fellowship and needs to choose between job offers. I'm a med student with 3 more years left, then will apply to residency (could be anywhere). In all honestly we'd like to leave our current city in 2 years but are open to staying. We have no kids right now though would like to start trying within the next 2 years.
Our thinking:
Option 1 - Academic ($250k):
TL;DR: Wife finishing oncology fellowship, choosing between $250k academic job with potentially better work-life balance vs $450-550k community job with more stress. I'm still in med school for 3 more years, then we'll likely move for my residency.
Background: My wife is finishing oncology fellowship and needs to choose between job offers. I'm a med student with 3 more years left, then will apply to residency (could be anywhere). In all honestly we'd like to leave our current city in 2 years but are open to staying. We have no kids right now though would like to start trying within the next 2 years.
Our thinking:
Option 1 - Academic ($250k):
- Stay at her current institution
- Focus on one cancer type/organ system (she wants to see multiple disease types)
- Good schedule: 6 weeks inpatient/year, day shift only
- Clinic is brutal: 2 days/week seeing 30-40 patients per day
- 3 days for research/admin (she is NOT big on research)
- Strong colleague support, good work-life balance, lots of support staff
- Has non-compete clause the covers the entire metro area
- Same city, community hospital
- Multiple cancer types (what she wants)
- Much more call: inpatient every 3 weeks, weekend call every 6 weeks
- Disorganized workplace, leadership turnover in the department
- One friend in leadership but he's junior
- They'd offer her an academic appointment "in name only" - no real teaching; she'd like to at least have her foot in the door with some teaching
- Less support staff and fewer colleagues (she'd be one of 3-4 oncologists at her hospital)
- Has non-compete clause that covers a big chunk of the metro area
- Has a 3 year contract, but can't find any penalty in the contract for leaving after 2 years (at which point I'd be off to residency)
- She's leaning toward option 2
- Non-competes make these options practically binding for ~2 years
- However if we DO end up staying in the metro area for my residency, she will be stuck wherever she signs
- I'm concerned about Option 2 stress, however the financial difference is substantial early in career, and
- This is essentially a 2-year decision before we likely move. I just don't want her to be miserable all the time.
- We're not sure about the penalty of leaving after 2 years on this 3 year contract - there's nothing in the contract about it; the contract only states she has to refund the fellowship stipend and signing bonus if she leaves in the first 2 years, and that the noncompete lasts for a year after she leaves.
- Question: Originally we thought she might be more marketable in the future if she stays at the prestigious academic institution, but after reflecting we wonder if she might actually be more marketable after the Community job, because she would have a wider breadth of expertise and more robust clinical experience. As compared to having a narrow academic focus, where she'd have the appeal of the name-brand institution behind her but less clinical expertise as a result of focusing on just one cancer type. Is this wise or accurate?
Are there no other community options? These are both terrible.
I think there was one other community option where she'd take over a local hospital-owned clinic where she'd be literally the only oncologist, and the pay would be similar to or lower than Option 2 above. There was also a PE-owned private practice option that she liked more than those two, but it's a 2 hour commute and starts at $575k so not that much greater of a boost.
Unfortunately, there are no other options in a reasonable distance.
Unfortunately, there are no other options in a reasonable distance.
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If you have to choose between the two I'd go for the community practice. The academic practice you outlined is just plain predatory; that volume in private practice (60-80 patients a week) would get you well more than double the money, not to mention she isn't even into research or a single organ type. Would definitely have the contract reviewed with a lawyer and see if you can whittle down the non-compete, negotiate a sign-on bonus that vests quickly (i.e. within 2-3 years to coincide with you), and make sure she can exit on the early side.
Thank you for your thoughts. Looking ahead at her finding a job wherever we move to next - do you have any thoughts on whether it'd be easier for her to find a job with 2 years experience in one cancer type at a "name brand" large academic center or with 2 years of multiple cancer types in the community? This was a question we have. I often hear people recommend staying in academia because you can always leave and find a job elsewhere especially with the "institution's name" behind you, but someone recently suggested she'd actually be more employable with the community experience. I just don't know but want us to remain flexible in the future.
First of all, I agree these are two terrible options. I also don’t believe she will be expected to see 30-40 patients per day in the academic practice. Are you sure about this? It’s quite hard to fathom. Our most senior docs who aren’t specialized beyond benign heme with 2 nps and fellows ONLY occasionally touch this volume. With the understanding that there are differences between institutions most yr1-3 attendings are seeing between 10-15 and eventually 20 patients at most per session. Also if I were expected to see 60 patients per week I’d make sure I have 3 clinic sessions not 2. This type of stuff is frequently negotiable
Secondly re; the academic option, are there incentive bonuses? Does she have mid level support?
The research admin time is not a negative. Especially if this is a temporary job.
Re; the community job, you say 3-4 colleagues and q6 wk call. Who covers the rest? Why a range for the community job? Is there a bonus involved or did you or she feel this was negotiable ?
Agree the academic job sounds brutal if those
Volumes are expected but highly doubt that happening. In the same vain the community job while higher paying and has maybe more of the variety she would like there’s a few potential traps there.
Also re; your question about being marketable I don’t think it matters much. Wherever you’re busy seeing patients that builds experience and makes you marketable wherever you’re coming from. This piece of it I don’t think should factor in. It will definitely be easier to go from one community job to another but not necessarily perceived as “better” by a community practice. Though would defer to @gutonc on now he would view it.
Agree with others about any other option besides these two. Hope that helps
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Community job will make it easier to get a new community job.
Some hiring docs won’t like “I’ve only seen breast for 2 years” if they’re recruiting you to see everything IMO - I definitely felt that happened at one interview when I was coming from the VA and had not seen breast in 1-2 years, although I still had plenty of offers.
Only time name brand matters is if it’s some super big name that your grandma from the other side of the country would recognize, and that only matters to patients. That shouldn’t be discounted because even though we as doctors know brand name is relatively pointless, ultimately the patients are the customer at the end of the day. I’ve had patients specifically request referral to a certain Rad Onc because he had MDACC on his job history even though I think our other Rad Oncs are just as good at Rad Oncing.
Some hiring docs won’t like “I’ve only seen breast for 2 years” if they’re recruiting you to see everything IMO - I definitely felt that happened at one interview when I was coming from the VA and had not seen breast in 1-2 years, although I still had plenty of offers.
Only time name brand matters is if it’s some super big name that your grandma from the other side of the country would recognize, and that only matters to patients. That shouldn’t be discounted because even though we as doctors know brand name is relatively pointless, ultimately the patients are the customer at the end of the day. I’ve had patients specifically request referral to a certain Rad Onc because he had MDACC on his job history even though I think our other Rad Oncs are just as good at Rad Oncing.
Lots of good advice above. I'll add a few things.
There is literally no academic oncology practice that can support one doc seeing 40 patients a day in less than 16 hours of clinic time. And even then...nah.
Doing the "gutonc math", 30-40 patients a week, 46 weeks a year, 2.25 (it's pretty close to median and a nice number) wRVU/patient = 6000-8000 wRVU a year (and that ignores the inpatient work). That works out to ~$30-40/wRVU (probably closer to $25/wRVU once you take the inpatient work into account). Even ID and endocrine are LOLing at that kind of money. For that kind of work, she should be making >$450K in academics and $700-800K in community practice.
No information on amount of work expected or $/wRVU so harder to gauge. May not be a great job, but may not be terrible either.
Most non-competes are practically, if not actually legally, unenforceable. So I don't know if I'd hang my had on that one.
I'd keep looking TBH. If she wants a community generalist job in the future, a community generalist job now is the right move.
solo is not a good option either
I have been solo for 2+ years.
I get my new partner next week.
I am taking most of the next 2 months off.
Don’t think I could go solo and I’m a couple years out. Maybe if I was 5-10 years out. Maybe.
I was 10+ when I did. I could do it longer, but I don't want to.
O, just curious, how do you handle time off and call situation?
I am part of a large regional hospital system (8 hospitals, 7 with hem/onc) that is part of a larger national system. I also have a PT NP who was here before me.
After hours/weekend calls are taken by the regional mothership and handled by me in the morning/Monday. I work at a rural CAH so anything that needs my immediate input (other than an OK to go on hospice) probably can't be managed there anyway, so they get shipped if needed.
When I'm gone, the NP covers the clinic and takes first calls from ED/PCP with backup from the Doc of the Day at the regional mothership. When we're both gone, everything goes to them. I should say that this amounts to one or two calls a month at the most.
Hello, @whoknows2012, I am currently looking into inpatient leukemia only positions because of family flexibility reasons. Can you tell me about how you went about getting the job and schedule? Of course, these jobs are not advised so I have to cold call/email places. Would be nice to talk to and actually hear from someone who is doing it. I feel a little lost.
Very niche role for sure. Are you looking in a particular geographic area , your own institution or all over? That’ll help with my advice
Reach out to your leukemia attendings. Request them to contact their colleagues in the location/institution of your choosing. That's the best way IMHO. Leukemia is a small world and people know people. This is the way.
Have an offer at a hospital based system brand new cancer center in southeast
Base: $600K, 100/RVU
Signon bonus: $60K
Call: 1:4 with the other group in town for unassigned patients for weekdays.
Given brand new cancer center, will be the first doc with one APP at start.
I think it’s a decent offer monetary wise – but what should I consider when joining a brand new cancer center in the beginning? I feel being the only doc for the practice with call and clinic could get very busy potentially
@gutonc any thoughts?
Base: $600K, 100/RVU
Signon bonus: $60K
Call: 1:4 with the other group in town for unassigned patients for weekdays.
Given brand new cancer center, will be the first doc with one APP at start.
I think it’s a decent offer monetary wise – but what should I consider when joining a brand new cancer center in the beginning? I feel being the only doc for the practice with call and clinic could get very busy potentially
@gutonc any thoughts?
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Are you a new grad?
Does that mean you’re on call every day for your patients?
What did the other group in town that you’d share call with offer you?
No been in an academic practice for a few years - want to go into community. Yes, on call every day for my patients but APP will take weekend call while I only do weekday call for my patients. Another MD is at another location with similar call schedule but his hospital has about 100 beds. I didn't interview with the other group.
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How does the APP take call for your patients without you?
Seems like I will be have to be available for questions by phone that may come up on weekend if they have any but they can come see the patient (like if weekend) and then I come on Monday to see if patient still there.
So you’re on call/legally liable 365 days a year? What if your patient rolls in at 2am on Saturday, who takes that call?
The pay is fine but the job smells funky to me. I would be reaching out to the other group/“competition” in town and trying to interview with them instead personally.
You need to understand what kind of support you're going to have to help you build a practice from the ground up. If there's another group in town, everyone is already going to be calling them for hospital consults and sending their outpatient referrals to them. You need time and support to build a practice in a situation like this.
If the location is good for you, the pay isn't terrible. I'd ask for a 3 year guarantee on the base. And I wouldn't buy a house there until I had 5 or 6 quarters of solid production above the base.
Your money isn't going to come from hospital coverage, it's going to come from infusion. So what's the current/future infusion situation?
What's the support system like in clinic? MA, RN, Infusion staff, pharmacist, SW? Just because somebody wrote "cancer center" on the door in Sharpie doesn't really make it one. I would want, at a minimum: 2 MAs, 1 onc certified pharmacist available to me...not just in the hospital somewhere, 4 RNs, at least one of which is primarily dedicated to triage and coordination but can also cover infusion when needed (and at least one of the other RNs cross-trained for that job), a SW at least 0.5 FTE to start out with an agreement to move to 1.0 when the clinic gets ramped up. If that kind of staffing is in place, or they're willing to pony up for that, I'd say go for it. If they offer you 1 MA, 1 RN and the pager numbers for pharmacy and the hospital SW, just walk away.
Thank you for the insight! Will ask for the setup details further. Will ask for 3 year base. Infusion is 15 chairs and they said they would give portion of infusion coverage money per quarter.
