Heme/Onc Job Offer Discussion

[MdRoboto]

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Hope everyone is well!

I'm currently a 3rd year fellow.

Current job offer:
Salary: 370k
Clinics: 4 days a week, no administrative responsibilities (Min: 15pts a day)
On Call: Every 3 weeks (Monday-Monday)
Other Details: Contract for 2 years. Partner track starting on 3rd year. This is a well establish clinic covering two big hospitals near by. It will be 3 Oncologist including myself. One of the owners is looking to retire in the next 5 years.

Any help will be appreciated!

 

[gutonc]

Hope everyone is well!

I'm currently a 3rd year fellow.

Current job offer:
Salary: 370k
Clinics: 4 days a week, no administrative responsibilities (Min: 15pts a day)
On Call: Every 3 weeks (Monday-Monday)
Other Details: Contract for 2 years. Partner track starting on 3rd year. This is a well establish clinic covering two big hospitals near by. It will be 3 Oncologist including myself. One of the owners is looking to retire in the next 5 years.

Any help will be appreciated!

Soooo many questions.

What does the partner track look like? Buy in? Eat what you kill or $/wRVU? Infusion revenue? Ancillary income? Current median partner gross? Support (RN, MA, SW, Pharm)? How busy is call? How many hospitals are covered? Are they planning to hire another doc before the one retires?

Q3w call would be an immediate non-starter for me, even if it was chill AF. That's 1 of every 3 weeks that you can't plan or really do anything.

 

[HemeOncHopeful19]

Hope everyone is well!

I'm currently a 3rd year fellow.

Current job offer:
Salary: 370k
Clinics: 4 days a week, no administrative responsibilities (Min: 15pts a day)
On Call: Every 3 weeks (Monday-Monday)
Other Details: Contract for 2 years. Partner track starting on 3rd year. This is a well establish clinic covering two big hospitals near by. It will be 3 Oncologist including myself. One of the owners is looking to retire in the next 5 years.

Any help will be appreciated!

Q3 week calm and a salary of 370k for 2 years?

There are only 2 docs and one wants to retire?

I would pass personally

 

[MD46]

Hope everyone is well!

I'm currently a 3rd year fellow.

Current job offer:
Salary: 370k
Clinics: 4 days a week, no administrative responsibilities (Min: 15pts a day)
On Call: Every 3 weeks (Monday-Monday)
Other Details: Contract for 2 years. Partner track starting on 3rd year. This is a well establish clinic covering two big hospitals near by. It will be 3 Oncologist including myself. One of the owners is looking to retire in the next 5 years.

Any help will be appreciated!

Starting for a major city is ok but if not, then aim for >400K even with guarantee

Clearly get the partner track defined, so starting 3rd year are you full partner? if so what do partners make, total comp? is there a buy-in? is there a realestate buyin? ask them to hide names and show compensation of any one partner
RVU based? ancillaries?

More vague they are, further you run from them, my advise.
Good luck

 

[HemeOncHopeful19]

370k partner track is a no go in 2025 IMO I don’t care what city

 

[gutonc]

370k partner track is a no go in 2025 IMO I don’t care what city

For a 2 year partnership track, if the median for partners is 3-4X that, it's not crazy. But for <$1.2-1.5M as a partner I totally agree.

 

[HemeOncHopeful19]

For a 2 year partnership track, if the median for partners is 3-4X that, it's not crazy. But for <$1.2-1.5M as a partner I totally agree.

If you have a 2 man group bringing home 1.5m a year - which I doubt really exists given such a small group would have zero leverage to negotiate with payers - they can afford to pay their partner track doc 450k instead of 370k.

 

[Sushi5]

Hope everyone is well!

I'm currently a 3rd year fellow.

Current job offer:
Salary: 370k
Clinics: 4 days a week, no administrative responsibilities (Min: 15pts a day)
On Call: Every 3 weeks (Monday-Monday)
Other Details: Contract for 2 years. Partner track starting on 3rd year. This is a well establish clinic covering two big hospitals near by. It will be 3 Oncologist including myself. One of the owners is looking to retire in the next 5 years.

Any help will be appreciated!

No is a complete sentence.
I make wayyy more than that in CA with the same responsibilities but no call.

 

[vipmak]

Hope everyone is well!

I'm currently a 3rd year fellow.

Current job offer:
Salary: 370k
Clinics: 4 days a week, no administrative responsibilities (Min: 15pts a day)
On Call: Every 3 weeks (Monday-Monday)
Other Details: Contract for 2 years. Partner track starting on 3rd year. This is a well establish clinic covering two big hospitals near by. It will be 3 Oncologist including myself. One of the owners is looking to retire in the next 5 years.

Any help will be appreciated!

q3 week call is a no go zone. For 2 year partnership track position minimum should be 400-450k.

 

[bigboyonc]

Anyone have any idea about compensation per RVU in Chicago area (within an hour preferably)?
Thanks

 

[MD46]

Anyone have any idea about compensation per RVU in Chicago area (within an hour preferably)?
Thanks

Dont know most current however about 6-8 months ago I heard University affiliated non academic is around 68-70$ and if you are hospital employed around 75-85$. Base offerings were around 450-500k with at least 5500 rvus to maintain salary.

If you go a little more suburban you can come close to 95-100$ an rvu.

Best

 

[Impala]

Hello Friends, will appreciate your thoughts regarding following Hem Onc job offer.

Location : North East. Not very desirable city. But decent. Not too bad.
Hospital Employed position.

5 day work week.
17 patients per day. 60 minutes new, 30 minutes follow up.
Call every 6 weeks.

$475,000 (straight salary model – eligible for 3% merit increase year over year).
Recruitment Loan: $250000 (on 5-year work commitment).
They don't have RVU system.
I don't know if 3 percent merit increase is decent.

Thank you.

 

[MifflinDunder]

I would not do 5 days a week and no RVU in oncology.

What happens when you’re faced with “This patient on active chemo can only see you this Thursday”. If they get added to your schedule, would you get paid for that encounter?

 

[gutonc]

Hello Friends, will appreciate your thoughts regarding following Hem Onc job offer.

Location : North East. Not very desirable city. But decent. Not too bad.
Hospital Employed position.

Do you love the area?

5 day work week.

Nope

17 patients per day. 60 minutes new, 30 minutes follow up.

Is 17 a max? The norm?

Call every 6 weeks.

Weekend call? The whole week? Inpatient duties? How many hospitals? Workload?

$475,000 (straight salary model – eligible for 3% merit increase year over year).

Not a bad base. Not great, but not bad.

Recruitment Loan: $250000 (on 5-year work commitment).

What does this mean? Is this forgiven after 5 years? Do you get the full 250K on day 1 or 50K a year for the 5 years? Do you have to pay back the whole thing, or just whatever's left?

They don't have RVU system.

Stupid. Do they have any other bonuses? Citizenship? Quality?

CME? PTO?

I don't know if 3 percent merit increase is decent.

That's probably almost enough to cover inflation. Calling it "merit" is insulting.

Could this be a good job? Sure. If the location is great, the COL is low and the work is fabulous.

But at my current job, if I saw 17 patients a day, 5 days a week, 46 weeks a year, I'd be making a little over $1M (employed, base+RVU). And I don't have to take call.

 

[MifflinDunder]

This might be one of the worst specialties to take a straight salary job with no RVU component. Patients are on strict schedules, need to be seen urgently, and you often have to work around their schedules instead of your own. I’m just a fellow but I’m 99% sure I’ll end up doing unpaid work if there’s no RVU.

 

[ONC2023]

17 patients per day. 60 minutes new, 30 minutes follow up.

I just want to emphasize what's been said above. This comes out to 85 patients a week.

Assuming 85 patients a week * 46 weeks a year * 2.5 wRVU per visit (a typical number, perhaps conservative) * $90 per RVU (a pretty typical number as well) = $880,000.

From the perspective of workload to pay ratio, I have to say this is a bad offer.

My current job in the Midwest would give me > $1 million for 85 patients a week with less call.

Does the job have other perks - sub specialization, a nurse practitioner in clinic to do notes/orders, etc?

I don't know if 3 percent merit increase is decent.

Definitely not. For the one job I looked into that had a straight salary model, the salary increase was based on MGMA metrics - they basically promised to keep salaries at something like 65% percentile of MGMA data.

Just doing a 3% raise (just inflation really) is not a model I’d accept.

 

[HemeOncHopeful19]

Hello Friends, will appreciate your thoughts regarding following Hem Onc job offer.

Location : North East. Not very desirable city. But decent. Not too bad.
Hospital Employed position.

5 day work week.
17 patients per day. 60 minutes new, 30 minutes follow up.
Call every 6 weeks.

$475,000 (straight salary model – eligible for 3% merit increase year over year).
Recruitment Loan: $250000 (on 5-year work commitment).
They don't have RVU system.
I don't know if 3 percent merit increase is decent.

Thank you.

 

[Impala]

I would not do 5 days a week and no RVU in oncology.

What happens when you’re faced with “This patient on active chemo can only see you this Thursday”. If they get added to your schedule, would you get paid for that encounter?

That's very good point.

Do you love the area?

Not very much.

Weekend call? The whole week? Inpatient duties? How many hospitals? Workload?

Will further clarify this, 2 hospitals to cover.

What does this mean? Is this forgiven after 5 years? Do you get the full 250K on day 1 or 50K a year for the 5 years? Do you have to pay back the whole thing, or just whatever's left?

It will be given in 1st month of job, but all the bonus will be for 5 year commitment.


Thank you friends, appreciated your thoughts.
That was very helpful.

 

[gutonc]

That's very good point.


Not very much.


Will further clarify this, 2 hospitals to cover.

It will be given in 1st month of job, but all the bonus will be for 5 year commitment.


Thank you friends, appreciated your thoughts.
That was very helpful.

Just to add on a few things I thought of later.

17 patients a day with a 30/60 setup means 8-10 patient facing hours a day depending on how many new patients you're seeing. I'd demand no more than 7 patient facing a hours a day, 13 patient max a day. The APPs can see the rest of them.

 

[checkpointinhibitor]

Hello Friends, will appreciate your thoughts regarding following Hem Onc job offer.

Location : North East. Not very desirable city. But decent. Not too bad.
Hospital Employed position.

5 day work week.
17 patients per day. 60 minutes new, 30 minutes follow up.
Call every 6 weeks.

$475,000 (straight salary model – eligible for 3% merit increase year over year).
Recruitment Loan: $250000 (on 5-year work commitment).
They don't have RVU system.
I don't know if 3 percent merit increase is decent.

Thank you.

IMO this is a very poor offer.
It comes down to about $50.00 per WRVU which is substantially lower than the national average.
In Midwest, the average is $95-115 $/wRVU.
On the east coast my friends work around 80-90 $/wRVU (DC Area), may be more this year as they are having a hard time recruiting.

If this was before 2020, would be a decent/average offer.

 

[MD46]

Hello Friends, will appreciate your thoughts regarding following Hem Onc job offer.

Location : North East. Not very desirable city. But decent. Not too bad.
Hospital Employed position.

5 day work week.
17 patients per day. 60 minutes new, 30 minutes follow up.
Call every 6 weeks.

$475,000 (straight salary model – eligible for 3% merit increase year over year).
Recruitment Loan: $250000 (on 5-year work commitment).
They don't have RVU system.
I don't know if 3 percent merit increase is decent.

Thank you.

Hello,

This is a very weak offer even for the Northeast area however I am not surprised as they always low ball

One thing I learned is that I was not satisfied with my job until I had productivity in my hand. I would like to control how much I work and then also if I work hard, then I am appropriately paid for it.

Having no real productivity model out side of academics is a no go.

For employed, regardless of the region, Aim for at least $85 a rvu or more. For example if they give you base 500k for 2 years, then from year 3 you need to pull in around 5900 RVUS to make that base, this sort of set up sounds reasonable.

For Private, its much more complicated than that.

Best

 

[GrassrootMaltan]

I just want to emphasize what's been said above. This comes out to 85 patients a week.

Assuming 85 patients a week * 46 weeks a year * 2.5 wRVU per visit (a typical number, perhaps conservative) * $90 per RVU (a pretty typical number as well) = $880,000.

From the perspective of workload to pay ratio, I have to say this is a bad offer.

My current job in the Midwest would give me > $1 million for 85 patients a week with less call.

Does the job have other perks - sub specialization, a nurse practitioner in clinic to do notes/orders, etc?


Definitely not. For the one job I looked into that had a straight salary model, the salary increase was based on MGMA metrics - they basically promised to keep salaries at something like 65% percentile of MGMA data.

Just doing a 3% raise (just inflation really) is not a model I’d accept.

What is your $/wRVU rate, if you wouldn’t mind sharing? Just to get an idea about how rates are in 2025.

 

[GrassrootMaltan]

IMO this is a very poor offer.
It comes down to about $50.00 per WRVU which is substantially lower than the national average.
In Midwest, the average is $95-115 $/wRVU.
On the east coast my friends work around 80-90 $/wRVU (DC Area), may be more this year as they are having a hard time recruiting.

If this was before 2020, would be a decent/average offer.

Do you know which areas give $115/wRVU? Are they more rural/undesirable areas, or do even small/medium cities offer these kinds of rates?

 

[gutonc]

What is your $/wRVU rate, if you wouldn’t mind sharing? Just to get an idea about how rates are in 2025.

You didn't ask me, but $95. Will go to $98 after the first of the year.

 

[checkpointinhibitor]

Do you know which areas give $115/wRVU? Are they more rural/undesirable areas, or do even small/medium cities offer these kinds of rates?

Large healthcare organizations (with decent support) think 200-500 bed hospitals 1-2 hrs away from large metro in midwest are around 100-105 IMO. Smaller hospitals (critical access) with everything done outside except for infusions are closer to 120 or so. Recently, a hospital advertised for 121. The smaller hospitals require more experienced MDs. They are usually solo oncologists and only do infusions, typically have no inpatient calls. Everything is shipped out to local bigger hospitals. No calls typically except for answering your own patients. It's a different setup IMO and not everyone's cup of tea.

 

[djokovic30]

Hi all,

Looking for perspective from others who have navigated career transitions in oncology.

I recently accepted a community-based position primarily to be closer to my aging parents and because the salary (double my current academic salary at a mid-western NCI center) and location made sense at the time. Mid-Atlantic NCI centers were bit saturated during my search and/or roles did not align. The community program is solid, but no strong academic affiliation. No hospital coverage (which I love).

Since signing, I’ve been approached with an unexpected opportunity at a large NCI-designated cancer center. It’s a true academic role with research support, protected time, and the institutional prestige that comes with working in an NCI center.

I’m torn. On one hand, the academic opportunity aligns more with my long-term interests and would open doors that a community role may not. On the other hand, I worry about the optics of backing out of a contract before starting—or within the first year. I don’t want to burn bridges or look unprofessional, especially since I had personal reasons for choosing the community role initially.

Questions for the group:

1. For those who have worked at or moved to an NCI-designated center, was the designation and academic environment truly worth the transition (I am early-mid career oncologist)?
2. Has anyone backed out of a contract before starting, or left within the first year? How was it handled, and what were the consequences (legal, professional, reputational)?
3. Any advice on navigating this without damaging relationships?

Appreciate any insight from people who have been through similar situations.

Thanks in advance.

 

[Pickles360]

Hi all,

Looking for perspective from others who have navigated career transitions in oncology.

I recently accepted a community-based position primarily to be closer to my aging parents and because the salary (double my current academic salary at a mid-western NCI center) and location made sense at the time. Mid-Atlantic NCI centers were bit saturated during my search and/or roles did not align. The community program is solid, but no strong academic affiliation. No hospital coverage (which I love).

Since signing, I’ve been approached with an unexpected opportunity at a large NCI-designated cancer center. It’s a true academic role with research support, protected time, and the institutional prestige that comes with working in an NCI center.

I’m torn. On one hand, the academic opportunity aligns more with my long-term interests and would open doors that a community role may not. On the other hand, I worry about the optics of backing out of a contract before starting—or within the first year. I don’t want to burn bridges or look unprofessional, especially since I had personal reasons for choosing the community role initially.

Questions for the group:

1. For those who have worked at or moved to an NCI-designated center, was the designation and academic environment truly worth the transition (I am early-mid career oncologist)?
2. Has anyone backed out of a contract before starting, or left within the first year? How was it handled, and what were the consequences (legal, professional, reputational)?
3. Any advice on navigating this without damaging relationships?

Appreciate any insight from people who have been through similar situations.

Thanks in advance.

I dont have a personal say or insight into your situation but it sounds like your heart truly lies with the second opportunity you were offered. Based off logic and reasoning, I think its likely better to back out of your contract before it begins instead of trying to navigate starting a role and then leaving it very early. It looks much worse to leave a role very soon after starting it, and then it requires the hiring company to go through all of the steps of finding someone new (again). No matter what you decide, I would get a lawyer's opinion ASAP so that you dont have anything hanging over your head personally.

 

[HemeOncHopeful19]

Double your current pay and zero hospital coverage? I would keep that job personally

 

[MifflinDunder]

Someone who mentions NCI x 5 and prestige x 1 will most likely choose the academic job.

 

[gutonc]

Hi all,

Looking for perspective from others who have navigated career transitions in oncology.

I recently accepted a community-based position primarily to be closer to my aging parents and because the salary (double my current academic salary at a mid-western NCI center) and location made sense at the time. Mid-Atlantic NCI centers were bit saturated during my search and/or roles did not align. The community program is solid, but no strong academic affiliation. No hospital coverage (which I love).

Since signing, I’ve been approached with an unexpected opportunity at a large NCI-designated cancer center. It’s a true academic role with research support, protected time, and the institutional prestige that comes with working in an NCI center.

I’m torn. On one hand, the academic opportunity aligns more with my long-term interests and would open doors that a community role may not. On the other hand, I worry about the optics of backing out of a contract before starting—or within the first year. I don’t want to burn bridges or look unprofessional, especially since I had personal reasons for choosing the community role initially.

Questions for the group:

1. For those who have worked at or moved to an NCI-designated center, was the designation and academic environment truly worth the transition (I am early-mid career oncologist)?
2. Has anyone backed out of a contract before starting, or left within the first year? How was it handled, and what were the consequences (legal, professional, reputational)?
3. Any advice on navigating this without damaging relationships?

Appreciate any insight from people who have been through similar situations.

Thanks in advance.

Let's answer the easy question first. Of course you can back out now. You send them an email stating that your circumstances have changed, thank them for the opportunity and wish them luck in filling the position. They will be annoyed, maybe even a little upset, but in about 3 days they will have forgotten you and moved on. You absolutely will be burning a bridge with this particular group in the future. But if you don't really want to be in academics.

Now, should you bail on this job and take the academic job? That's a much harder question. There are many people who will say (as @HemeOncHopeful19 did), "F*** prestige, get paid!" Others will tell you to take the job that will make you happy. If your heart (and skills) lie in academics, then taking a community position is a recipe for failure. If you're truly on the fence and "prestige" is the only thing holding you back from taking the community job, then remember that prestige won't pay the mortgage, and only your grandma cares about it.

 

[Onc2026T]

Hi friends,
I am a fellow graduating 2026. I would very much appreciate any thoughts on the following 2 job offers, if any other details/questions left out, please feel free to ask

Both are located at South East. Both are community practice

Location: suburb of a major metropolitan city, very nice area, I like it a lot, has lots of options I and my family likes to have, but cost of living (particularly housing) is much more expensive that 2nd offer's location),
type of practice: employed, large hospital system, 1 clinic and 1 hospital (next to each other, within the same building complex), call 1:7, nice group, patient mix with be benign hematology (evenly spread among all physicians) and GU (for oncology) with a focus in prostate cancer (GU oncology is my clinic interest in fellowship, I feel like it's a semi-subspecialty job), 1 MA and 1 RN as assigned clinic staff
compensation: 500k guaranteed for 1st 2 years, and each unit above 5208 wRUV will be productivity bonus for the first two years, $96 per each wRUV , and after 2 years, $96 per each wRUV straight, each physicians typically gets 20-30k quality bonus per year as extra
sign on: 45k (including relocation, appears to have some room to increase if negotiate)
Benefit: all typical items, tail coverage, 401k match, all in all slightly better than 2nd offer, non compete is reasonable

Location: much smaller city compare to the one above, still nice area, I like it, has its unique offerings I like a lot, but has less of options I and my family likes to have in terms of daily living, and cost of living (particularly housing) is much more affordable
type of practice: private practice, covers 2 clinics and 1 hospital (close to each other), call 1:5, very nice group, I like the group a lot, patient mix typical of average general practice, pathway to partnership is based on cumulative production (25000 wRUV), typically achieved partnership 2-3 years as told, after meeting certain criteria, can hire NP (NP production count towards yours), clinical support staff pooled MA and RN, not dedicated or assigned
compensation: year 1 475k, $50, above 5000, year 2 500k, $55, above 6250, year 3 525k, $60, above 7500 (II understand this is much worse in terms of production value per unit, but I guess because its partnership tracked). Partnership buy in is required and in the neighborhood of 300-400k, no future large capital expenditure and practice is very stable, hire to replace a just retired partner, partner earning is approx. 1M per year as told
sign on: 35k (including relocation)
Benefit: all typical items, and 401k match, all in all slightly worse than 1st offer, but no tail coverage if left the group, non compete is reasonable

Thanks!

 

[MD46]

Hi all,

Looking for perspective from others who have navigated career transitions in oncology.

I recently accepted a community-based position primarily to be closer to my aging parents and because the salary (double my current academic salary at a mid-western NCI center) and location made sense at the time. Mid-Atlantic NCI centers were bit saturated during my search and/or roles did not align. The community program is solid, but no strong academic affiliation. No hospital coverage (which I love).

Since signing, I’ve been approached with an unexpected opportunity at a large NCI-designated cancer center. It’s a true academic role with research support, protected time, and the institutional prestige that comes with working in an NCI center.

I’m torn. On one hand, the academic opportunity aligns more with my long-term interests and would open doors that a community role may not. On the other hand, I worry about the optics of backing out of a contract before starting—or within the first year. I don’t want to burn bridges or look unprofessional, especially since I had personal reasons for choosing the community role initially.

Questions for the group:

1. For those who have worked at or moved to an NCI-designated center, was the designation and academic environment truly worth the transition (I am early-mid career oncologist)?
2. Has anyone backed out of a contract before starting, or left within the first year? How was it handled, and what were the consequences (legal, professional, reputational)?
3. Any advice on navigating this without damaging relationships?

Appreciate any insight from people who have been through similar situations.

Thanks in advance.

Parents/location/Double salary vs Academic Prestige. that is the question
You can easily back out now as GutOnc stated but I agree, at least with that group you will burn the bridges. Best of luck

 

[MD46]

Hi friends,
I am a fellow graduating 2026. I would very much appreciate any thoughts on the following 2 job offers, if any other details/questions left out, please feel free to ask

Both are located at South East. Both are community practice

Location: suburb of a major metropolitan city, very nice area, I like it a lot, has lots of options I and my family likes to have, but cost of living (particularly housing) is much more expensive that 2nd offer's location),
type of practice: employed, large hospital system, 1 clinic and 1 hospital (next to each other, within the same building complex), call 1:7, nice group, patient mix with be benign hematology (evenly spread among all physicians) and GU (for oncology) with a focus in prostate cancer (GU oncology is my clinic interest in fellowship, I feel like it's a semi-subspecialty job), 1 MA and 1 RN as assigned clinic staff
compensation: 500k guaranteed for 1st 2 years, and each unit above 5208 wRUV will be productivity bonus for the first two years, $96 per each wRUV , and after 2 years, $96 per each wRUV straight, each physicians typically gets 20-30k quality bonus per year as extra
sign on: 45k (including relocation, appears to have some room to increase if negotiate)
Benefit: all typical items, tail coverage, 401k match, all in all slightly better than 2nd offer, non compete is reasonable

Location: much smaller city compare to the one above, still nice area, I like it, has its unique offerings I like a lot, but has less of options I and my family likes to have in terms of daily living, and cost of living (particularly housing) is much more affordable
type of practice: private practice, covers 2 clinics and 1 hospital (close to each other), call 1:5, very nice group, I like the group a lot, patient mix typical of average general practice, pathway to partnership is based on cumulative production (25000 wRUV), typically achieved partnership 2-3 years as told, after meeting certain criteria, can hire NP (NP production count towards yours), clinical support staff pooled MA and RN, not dedicated or assigned
compensation: year 1 475k, $50, above 5000, year 2 500k, $55, above 6250, year 3 525k, $60, above 7500 (II understand this is much worse in terms of production value per unit, but I guess because its partnership tracked). Partnership buy in is required and in the neighborhood of 300-400k, no future large capital expenditure and practice is very stable, hire to replace a just retired partner, partner earning is approx. 1M per year as told
sign on: 35k (including relocation)
Benefit: all typical items, and 401k match, all in all slightly worse than 1st offer, but no tail coverage if left the group, non compete is reasonable

Thanks!

1st options sounds the best. It may take you a few years to buy maybe the forever home you are looking for.

With the same model you will need 10-11k RVUs to hit a million the partner there is making but one thing missing is that do the partners in the 2nd option have a base salary as well or all of them make 1 million or above? If you look at 525K as base, 7500 rvus to reach that base salary, you will need at least another 7500 RVUs to reach a goal of 1million (hence 1.5 times more than 1st option)

I have been dinged by private practice before and these numbers dont sound good at all for the risk.

for the 1st job, you can ask for more upfront bonus, relocation money or even retention bonus. $96 per RVU sounds reasonable.

Good luck

 

[gutonc]

Hi friends,
I am a fellow graduating 2026. I would very much appreciate any thoughts on the following 2 job offers, if any other details/questions left out, please feel free to ask

Both are located at South East. Both are community practice

Location: suburb of a major metropolitan city, very nice area, I like it a lot, has lots of options I and my family likes to have, but cost of living (particularly housing) is much more expensive that 2nd offer's location),
type of practice: employed, large hospital system, 1 clinic and 1 hospital (next to each other, within the same building complex), call 1:7, nice group, patient mix with be benign hematology (evenly spread among all physicians) and GU (for oncology) with a focus in prostate cancer (GU oncology is my clinic interest in fellowship, I feel like it's a semi-subspecialty job), 1 MA and 1 RN as assigned clinic staff
compensation: 500k guaranteed for 1st 2 years, and each unit above 5208 wRUV will be productivity bonus for the first two years, $96 per each wRUV , and after 2 years, $96 per each wRUV straight, each physicians typically gets 20-30k quality bonus per year as extra
sign on: 45k (including relocation, appears to have some room to increase if negotiate)
Benefit: all typical items, tail coverage, 401k match, all in all slightly better than 2nd offer, non compete is reasonable

Location: much smaller city compare to the one above, still nice area, I like it, has its unique offerings I like a lot, but has less of options I and my family likes to have in terms of daily living, and cost of living (particularly housing) is much more affordable
type of practice: private practice, covers 2 clinics and 1 hospital (close to each other), call 1:5, very nice group, I like the group a lot, patient mix typical of average general practice, pathway to partnership is based on cumulative production (25000 wRUV), typically achieved partnership 2-3 years as told, after meeting certain criteria, can hire NP (NP production count towards yours), clinical support staff pooled MA and RN, not dedicated or assigned
compensation: year 1 475k, $50, above 5000, year 2 500k, $55, above 6250, year 3 525k, $60, above 7500 (II understand this is much worse in terms of production value per unit, but I guess because its partnership tracked). Partnership buy in is required and in the neighborhood of 300-400k, no future large capital expenditure and practice is very stable, hire to replace a just retired partner, partner earning is approx. 1M per year as told
sign on: 35k (including relocation)
Benefit: all typical items, and 401k match, all in all slightly worse than 1st offer, but no tail coverage if left the group, non compete is reasonable

Thanks!

There seems to be some things missing in job 2 here. How do you go from 525K at 7500 wRVU to >1M? Are the partners really pulling in 10K+ wRVU/y and paying themselves >$100/wRVU? Are they siphoning off $40-50/wRVU for each non-partner? Is that buy-in cash? Do you have that kind of money hanging around now, or a plan to get it in time? What is the partner conversion rate in that group (might be hard to know if it's been awhile since they last hired)? Or is it automatic once you hit the 25K mark? It's probably going to take you 4 years (or more) to hit that number...is there a cutoff for that?

Job 1 seems pretty darn good TBH. Sounds like better location (other than COL) for your family, the job itself seems better (assuming you do get to focus on GU) and the compensation is at or above the median, with transparent compensation and upside if you want to be really busy.

 

[checkpointinhibitor]

Job 1 sounds good, you can save money and get a home eventually. Job 2 is average if partners are making 1MM. If partners were north of 1.5mm then it'd peak my interest.
IMO if community pays close to $100 per wRVU in a 'desirable' place, it's worth it.
For PP, my rule would be 1.5 - 2 x community salary minimum.

 

[Onc2026T]

1st options sounds the best. It may take you a few years to buy maybe the forever home you are looking for.

With the same model you will need 10-11k RVUs to hit a million the partner there is making but one thing missing is that do the partners in the 2nd option have a base salary as well or all of them make 1 million or above? If you look at 525K as base, 7500 rvus to reach that base salary, you will need at least another 7500 RVUs to reach a goal of 1million (hence 1.5 times more than 1st option)

I have been dinged by private practice before and these numbers dont sound good at all for the risk.

for the 1st job, you can ask for more upfront bonus, relocation money or even retention bonus. $96 per RVU sounds reasonable.

Good luck

Thanks for the input. I really appreciate it!

My apologies that I did not clarify the job #2 compensation after reaching partnership. The 3 year compensation structure is for new hire before reaching partnership. (as they expect 2-3 years to become partner)They did not write down the compensation after becoming partner, but I asked around and this is what I found out (not sure whether this is 100% correct though, not provided in writing), partner has base of ~300k per year, and rest is bonus from the pool, derived from billing, infusion center, scans, drug margin etc. with 25% sharing evenly and 75% proportionally based on production. Each partner has 1-2 NP, and NP production counts towards partners production (it is my understanding that they has a large panel of patients per day, 30-40 patients, and each NP seeing approx. 15 patients for them, I assume this is what PP does).

One more thing, the PP job is 5 days per day before partnership and 4 days (generally speaking, as told that partner has more flexibility because of NP) after partnership. Employed job is 4.5 days to start, 0.5 days for admin, if interested in research (the health care system/hospital has some early and late phase trials ongoing), can take less than 1 FTE for direct patient contact and doing 4 days per week for clinical practice with 0.5-1 day for research as told

 

[Onc2026T]

There seems to be some things missing in job 2 here. How do you go from 525K at 7500 wRVU to >1M? Are the partners really pulling in 10K+ wRVU/y and paying themselves >$100/wRVU? Are they siphoning off $40-50/wRVU for each non-partner? Is that buy-in cash? Do you have that kind of money hanging around now, or a plan to get it in time? What is the partner conversion rate in that group (might be hard to know if it's been awhile since they last hired)? Or is it automatic once you hit the 25K mark? It's probably going to take you 4 years (or more) to hit that number...is there a cutoff for that?

Job 1 seems pretty darn good TBH. Sounds like better location (other than COL) for your family, the job itself seems better (assuming you do get to focus on GU) and the compensation is at or above the median, with transparent compensation and upside if you want to be really busy.

Thank you very much for the input! Regarding the topic of making to the partner, I was told once again the it is more than 90%. the 25K mark is the hardline and rest is more people part as long as you do not piss anyone (as told). I thought the 25K production is really high number to cross too! they said 3 years is a more reasonable estimate to reach 25K.
The whole group has a large presence in the state, the hiring position is to cover one of their local practice/clinics. I talked to a partner (I met at a GU ASCO) from another location, she told me the chance of marking to partner is very high, and the organization/practice management wants new hire to make to partner

How do you go from 525K at 7500 wRVU to >1M?
this is the comp structure before making partner, the structure after making partner is the following (as far as the information I can dig out), I copy and paste from prior reply.
They did not write down the compensation after becoming partner, but I asked around and this is what I found out (not sure whether this is 100% correct though, not provided in writing), partner has base of ~300k per year, and rest is bonus from the pool, derived from billing, infusion center, scans, drug margin etc. with 25% sharing evenly and 75% proportionally based on production. Each partner has 1-2 NP, and NP production counts towards partners production (it is my understanding that they has a large panel of patients per day, 30-40 patients, and each NP seeing approx. 15 patients for them, I assume this is what PP does).

Are the partners really pulling in 10K+ wRVU/y and paying themselves >$100/wRVU?
yes, with NP seeing part of their patients (I assume easy cases), I estimate 12k wRVU per year for 1M comp

Are they siphoning off $40-50/wRVU for each non-partner? Is that buy-in cash? Do you have that kind of money hanging around now, or a plan to get it in time?
yes, for the years before making to partner as one reason they share is that the retiring partner get distribution for one year after retirement from the equity, that is where the money went.
for buy in, it is either from the partner compensation or cash from bank loan (they said they have established financial institute can loan out the buy-in money if needed, not sure about the loan term though), I was told the 1st comp after becoming partner will be much less

 

[Onc2026T]

Job 1 sounds good, you can save money and get a home eventually. Job 2 is average if partners are making 1MM. If partners were north of 1.5mm then it'd peak my interest.
IMO if community pays close to $100 per wRVU in a 'desirable' place, it's worth it.
For PP, my rule would be 1.5 - 2 x community salary minimum.

thanks for the expected pay from PP, that helps a lot!

 

[gutonc]

Thank you very much for the input! Regarding the topic of making to the partner, I was told once again the it is more than 90%. the 25K mark is the hardline and rest is more people part as long as you do not piss anyone (as told). I thought the 25K production is really high number to cross too! they said 3 years is a more reasonable estimate to reach 25K.
The whole group has a large presence in the state, the hiring position is to cover one of their local practice/clinics. I talked to a partner (I met at a GU ASCO) from another location, she told me the chance of marking to partner is very high, and the organization/practice management wants new hire to make to partner

How do you go from 525K at 7500 wRVU to >1M?
this is the comp structure before making partner, the structure after making partner is the following (as far as the information I can dig out), I copy and paste from prior reply.
They did not write down the compensation after becoming partner, but I asked around and this is what I found out (not sure whether this is 100% correct though, not provided in writing), partner has base of ~300k per year, and rest is bonus from the pool, derived from billing, infusion center, scans, drug margin etc. with 25% sharing evenly and 75% proportionally based on production. Each partner has 1-2 NP, and NP production counts towards partners production (it is my understanding that they has a large panel of patients per day, 30-40 patients, and each NP seeing approx. 15 patients for them, I assume this is what PP does).

Are the partners really pulling in 10K+ wRVU/y and paying themselves >$100/wRVU?
yes, with NP seeing part of their patients (I assume easy cases), I estimate 12k wRVU per year for 1M comp

Are they siphoning off $40-50/wRVU for each non-partner? Is that buy-in cash? Do you have that kind of money hanging around now, or a plan to get it in time?
yes, for the years before making to partner as one reason they share is that the retiring partner get distribution for one year after retirement from the equity, that is where the money went.
for buy in, it is either from the partner compensation or cash from bank loan (they said they have established financial institute can loan out the buy-in money if needed, not sure about the loan term though), I was told the 1st comp after becoming partner will be much less

And that was the missing part I was talking about. Thanks for the clarification.

I do think that trying to do >8K wRVU/y for your first 3 years out of fellowship is both unrealistic and a recipe for burnout. A 4+ year onramp is more realistic IMO, but that's just me.

Honestly, what do you want your life to look like? Not just your career, but your whole life (at least for the period of time you have your first job)? Both of these will pay you well enough for the work that you do. If you want the mythical "work-life-balance" now, rather than after 15+ years of work, Job 1 seems like the better option. If you're down to grind hard for the 10 or so years in order to get yourself very financially comfortable, then Job 2 might be a better bet.

 

[Onc2026T]

And that was the missing part I was talking about. Thanks for the clarification.

I do think that trying to do >8K wRVU/y for your first 3 years out of fellowship is both unrealistic and a recipe for burnout. A 4+ year onramp is more realistic IMO, but that's just me.

Honestly, what do you want your life to look like? Not just your career, but your whole life (at least for the period of time you have your first job)? Both of these will pay you well enough for the work that you do. If you want the mythical "work-life-balance" now, rather than after 15+ years of work, Job 1 seems like the better option. If you're down to grind hard for the 10 or so years in order to get yourself very financially comfortable, then Job 2 might be a better bet.

Thank you so much for the feedback!

 

[checkpointinhibitor]

Great advice everyone ! Keep us posted about your final decision.

 

[Onc2026T]

Great advice everyone ! Keep us posted about your final decision.

definitely, will do so.
Thanks everyone!

 

[MD46]

4 days a week - ok
15-18pts a day- ok
sign-on bonus: 30k - very weak- need >60K or more
Stewardship = residents?fellows?APPs?

Total comp: $450k

assuming 18pts a day 4 days a week: thats 288 patients a month x 11: 3168 = Avg RVUS around 6500-7000. $ per RVU: $64
very weak for heme onc, specially if no incentive.

It is a Niche job with ok call

I think if you are set on this location, only thing would be to get a better base maybe like 500-550k plus supplement 100k not 50k
otherwise maybe once you reach over 5000k RVUs as for $ per RVU ( ideally great than $85).

Ask also for relocation bonus 20k or more.

Good luck

 

[HemeOncHopeful19]

Hospitals don’t build out new programs if they don’t project them to be wildly profitable.

I would want to be paid much better for that personally but I guess transplant may skew more toward “academic” pay

 

[bobow98]

4 days a week - ok
15-18pts a day- ok
sign-on bonus: 30k - very weak- need >60K or more
Stewardship = residents?fellows?APPs?

Total comp: $450k

assuming 18pts a day 4 days a week: thats 288 patients a month x 11: 3168 = Avg RVUS around 6500-7000. $ per RVU: $64
very weak for heme onc, specially if no incentive.

It is a Niche job with ok call

I think if you are set on this location, only thing would be to get a better base maybe like 500-550k plus supplement 100k not 50k
otherwise maybe once you reach over 5000k RVUs as for $ per RVU ( ideally great than $85).

Ask also for relocation bonus 20k or more.

Good luck

Agree
Anyone treating cancer full time at an employed practice should be getting 500k or more in 2025. That's the new basement.

 

[EEtoPre-Med]

Hello everyone,

I was hoping for the groups opinion on a job offer I received.

The job is 4.5 days per week with a half day of admin. 1:12 call.

Hospital employed with the clinic and the hospital being next to one another.

650,000 guaranteed for two years with a 100,000 sign-on bonus, paid back over 2 years. Midwest.

RVU: 85 dollars per RVU for the first 6500 RVU's, if you make above 6500 RVU's then all of your RVU's are paid at 105 dollars per RVU. So if you make 6501 RVU's that is 105 x 6501, for example.

As a fellow, it's hard to know how difficult it is to get to 6500 RVU's but it seems like it's about 15 patients per day. 15 patients per day x 4.5 days per week x 46 weeks per year x 2.2 wRVU's=6831.

Is this a good offer?

 

[checkpointinhibitor]

Hello everyone,

I was hoping for the groups opinion on a job offer I received.

The job is 4.5 days per week with a half day of admin. 1:12 call.

Hospital employed with the clinic and the hospital being next to one another.

650,000 guaranteed for two years with a 100,000 sign-on bonus, paid back over 2 years. Midwest.

RVU: 85 dollars per RVU for the first 6500 RVU's, if you make above 6500 RVU's then all of your RVU's are paid at 105 dollars per RVU. So if you make 6501 RVU's that is 105 x 6501, for example.

As a fellow, it's hard to know how difficult it is to get to 6500 RVU's but it seems like it's about 15 patients per day. 15 patients per day x 4.5 days per week x 46 weeks per year x 2.2 wRVU's=6831.

Is this a good offer?

Offer is reasonable IMO.
Kind of silly the games admins play with us. $105 is acceptable standard for wRVU in Midwest.
If you get paid only $85 for first 6500 and then $105 after that. Hence, if you produce 10K wRVU per year, the average $/wRVU rate would be $92.

This is below average for midwest but it depends if you have good school districts, low state and city tax, property tax and good access to large city then it's doable. If you are in lower tier city with ****ty schools, high tax state, high RE rates then it's' a **** offer.

Generating 6500 wrvus is going to be easy after 1-2 years. Average I'd think 8000-10000 in community program.

I'd NOT do 4.5 days clinic. Thats another BS. 4.5 days = 5 days.
On paper get 4 days official. That's where oncology is headed. Then YOU can choose what day to work half days.

 

[EEtoPre-Med]

Offer is reasonable IMO.
Kind of silly the games admins play with us. $105 is acceptable standard for wRVU in Midwest.
If you get paid only $85 for first 6500 and then $105 after that. Hence, if you produce 10K wRVU per year, the average $/wRVU rate would be $92.

This is below average for midwest but it depends if you have good school districts, low state and city tax, property tax and good access to large city then it's doable. If you are in lower tier city with ****ty schools, high tax state, high RE rates then it's' a **** offer.

Generating 6500 wrvus is going to be easy after 1-2 years. Average I'd think 8000-10000 in community program.

I'd NOT do 4.5 days clinic. Thats another BS. 4.5 days = 5 days.
On paper get 4 days official. That's where oncology is headed. Then YOU can choose what day to work half days.

Yeah the weird part about this is that if you meet the threshold then all of the RVU’s are paid at the higher dollar figure. So there isn’t any averaging of the RVU’s. But I appreciate your feedback!

 

[MD46]

To get to your base salary you would need 7600 RVUs, after that its $105 per RVU however if you negotiate being paid after guarantee at $105 , then its only 6200 RVUs to reach your base of 650k. this would definitely be better long term

 

[HemeOncHopeful19]

Hello everyone,

I was hoping for the groups opinion on a job offer I received.

The job is 4.5 days per week with a half day of admin. 1:12 call.

Hospital employed with the clinic and the hospital being next to one another.

650,000 guaranteed for two years with a 100,000 sign-on bonus, paid back over 2 years. Midwest.

RVU: 85 dollars per RVU for the first 6500 RVU's, if you make above 6500 RVU's then all of your RVU's are paid at 105 dollars per RVU. So if you make 6501 RVU's that is 105 x 6501, for example.

As a fellow, it's hard to know how difficult it is to get to 6500 RVU's but it seems like it's about 15 patients per day. 15 patients per day x 4.5 days per week x 46 weeks per year x 2.2 wRVU's=6831.

Is this a good offer?

That sounds like a good offer WITH caveat

I would ask how many RVUs each physician has produced the past 2 years, or if they don’t want to tell you that ask “how many docs did NOT produce 6500 RVUs?”

I would expect any full time Onc working 4.5d/week would get there although I would expect more than 15 pt per day too. The 85/RVU thing may not be Admin playing games it may just be their way of reducing the pay for a few docs who want to work part time