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Heme/Onc Job Offer Discussion
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drreddy7
New Member
Hello everyone, thanks for all your help with the prior replies.
I was wondering if anyone had insights on the DMV job market? It seems private practice dominated and my wife and I are interested in moving there after fellowship. Haven't really had any luck connecting with any of the groups thus far.
I was wondering if anyone had insights on the DMV job market? It seems private practice dominated and my wife and I are interested in moving there after fellowship. Haven't really had any luck connecting with any of the groups thus far.
Sorry for late reply as I wanted to do site visit and learn about the job.
so this hospital which I interviewed is a stand alone hospital (call it Hospital A). It's located in a town of 17k population but with in 20 mins, there is a larger town with 100k population. This Hospital A have large network of Primary care, most specialties available and have 100 bed hospital. They previously had 1 oncologist for 3 years (but per admins he was not interested in building up practise, so they lost lot of revenue). Across this hospital, there is another independent hospital (hospital B) and they have 2 oncologist. Than in larger town, there is large heme onc private practice with 5 oncologist ( this group is actually looking to hire 6th oncologist).
They initially offer 800k base with RVU $133 for anything above 6000 RVU with a 3 year commitment. I feel it's a significant work commitment with building up practice. I requested higher base pay to reflect that work. will see if they budge on that. They are open to 3.5/4 day work week as well.
overall this place has low volume for past few years, their annual production was around 4-6k RVU annually, but they feel they lost revenue due to prior oncologist unwillingness to build practice.
Overall work environment is good and I met few docs who lives in metro city and drives every day to work at this small town or few folks have apartment/hotel across hospital for overnight stays
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800k for 6000 RVUs is already extremely good offer fyi I would not expect a higher base or dare I say it you may actually be the first person I’ve ever thought might run into a legit Stark issue.
3.5 day work week and “building up the practice” seem like they are opposite ends of a spectrum, not saying it’s a bad idea.
90 minute commute would be a total non-starter for me though personally
The one caveat I'll give here is that, referral patterns are hard to break. And if this prior oncologist and the hospital more generally, didn't support the need for hem/onc services, that referral base is already mostly lost. Not that it can't be rebuilt, but it is likely going to take more than 3 years to do it.
I was contacted about a job not unlike this about 5 years ago. Hospital wanted to start up a group to compete with the private group in the next town over. Once they realized what they were up against and the fact that it would probably be a 5+ year journey to build that practice, they decided against it.
If it were me, especially with the commute, I would pass on this.
90 minutes commute is a long commute! I assume it is one way?
drreddy7
New Member
Hello everyone,
Wanted to get your thoughts on this offer I received from a metro area in the south.
It’s a growth position and there’s already a lot of demand for an additional oncologist.
They’re offering 450k as a base with 50k as a sign on bonus with 105 per RVU.
The threshold to go to production is 4285 RVUs.
Inpatient consults are 4 weeks per year and you work about 12 days of call per year and 4 weekends total.
Average doc there pulls in more than 7000 RVUs a year.
They’re offering 50k as a sign on bonus.
Will see approximately 18-20 patients per day and it’s a 4 day work week. But can see as much as I would want due to need.
Is there anything else I should negotiate?
Thanks again in advance.
Wanted to get your thoughts on this offer I received from a metro area in the south.
It’s a growth position and there’s already a lot of demand for an additional oncologist.
They’re offering 450k as a base with 50k as a sign on bonus with 105 per RVU.
The threshold to go to production is 4285 RVUs.
Inpatient consults are 4 weeks per year and you work about 12 days of call per year and 4 weekends total.
Average doc there pulls in more than 7000 RVUs a year.
They’re offering 50k as a sign on bonus.
Will see approximately 18-20 patients per day and it’s a 4 day work week. But can see as much as I would want due to need.
Is there anything else I should negotiate?
Thanks again in advance.
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Seems like a fair deal. What are the other docs getting per RVU?
Maximize CME money.
Make sure APPs do not take away your easy follow ups and leave you with only difficult cases. Make sure you have control of your team.
Maximize CME money.
Make sure APPs do not take away your easy follow ups and leave you with only difficult cases. Make sure you have control of your team.
drreddy7
New Member
Everyone there makes the same wRVU and the other physicians I’ve talked to seem genuinely like working for the system.
Thank you for the tips, I’ll definitely keep that in mind.
They’re offering 6k in CME funds.
Do you think I should negotiate the base (guaranteed for 3 years) and the sign on bonus since this is what they initially presented me?
Thank you for the tips, I’ll definitely keep that in mind.
They’re offering 6k in CME funds.
Do you think I should negotiate the base (guaranteed for 3 years) and the sign on bonus since this is what they initially presented me?
I doubt the base matters because it's par for the RVU calculation. You should easily break the base. Is the RVU true up monthly, quarterly, or q6 months? You should clarify that. I think monthly or quarterly is the best. But what happens if you take a leave of absence for 1 month after switching over to RVU early? Do you go that month without getting paid? That may be rough.
More sign on bonus is usually better than less sign on.
6k CME seems quite fair. Most places give 5k.
Do you get your own nurse?
Agree that the numbers are reasonable. As for the true up, a monthly report out and Q3-6 month true up is typical for the situations I'm aware of. Many places will just continue to pay out the base and then adjust up or down on the schedule. That's the one (and only one) upside I see to doing the RVU adjustments annually. It smooths out the bumps for when you take 2-4 weeks off.
Agree with this.
One caveat to this is that there are some areas of the country (like where I am), where nurses make well north of $100K. So hiring a RN for every doc can be prohibitively expensive and cut into your potential income. You should definitely have RN support and someone else who can do all of the other stuff that you don't need a nurse to do.
Pickles360
Full Member
Hey all, I'm starting out as a new attending later in the summer. I’m sticking with the program I trained at so I have some idea of the ins and outs and the day to day. What would you recommend to a new attending on the best way to avoid potential pitfalls and start out strong. I’m obviously both excited and nervous, but just don't want to hurt anyone
I'm three years out from fellowship, in the beginning it's a lot of learning the system, since you trained there that will come more naturally. It's ok to look up uptodate/LLMs/NCCN while fellow is presenting and will give you confidence to have the data in front of you. Difficult cases it's always a good idea to utilize tumor boards and present patients with several options.
1. Don't be afraid to look things up. In fact, you should be very afraid if you think you know everything and don't look anything up. I'm almost 15 years out and I look things up (UTD, OE, NCCN, primary literature) multiple times a day.
2. Oncology is actually pretty easy. Taking care of people with cancer is pretty hard Not everybody's cancer reads the book. Not everybody in front of you is right for the "correct" treatment. Remember that the person in front of you is what matters, not you.
3. Ask what matters to your patients. We get so hung up on PFS and OS (because it's what we measure and test, not because it's what's actually important) that we often forget to even consider QOL and time toxicity of treatments, let alone ask about it. Not everyone wants to be a professional patient.
I’ll add since you’re seemingly staying in Academics and presumably will now be supervising fellows… remember that you are in the big boy/girl pants now and the patients are ultimately your total responsibility.
In fellowship your mindset may be “we need to sign off on as many patients as early as possible to get the list down” whereas as an attending it needs to be “are we still meaningfully contributing to this patient’s care.” Similarly trust but verify and don’t assume that your 2nd or 3rd year fellow won’t miss anything important.
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Anyone have percentile numbers for non infusion hem/onc wRVUs by AAMC?
@gutonc
@gutonc
Are you asking for just the E/M wRVU data? I don't have access to any of the big ones these days, and definitely not AAMC. Last data I saw from MGMA (either 2024 or 2025 data) for West region, 50th %ile was around 4700-4800.
Much appreciated
I am interested to know this as well. Any updates?
That sounds a LOT busier than 4d/week 10-15 patients… kinda missed an important detail lol
None yet. waiting for some one to reach out, also have asked a few other people. If you are interested as well, will update you once I get more info
What are you trying to figure out? Like gross revenues, profits? I find not many partners really understand the numbers very well. Most of the drugs will be gobbled up by PBMs and forced to mail order pharmacies
I think this is the biggest issue under the current insurance system. Without contracts, you're going to need to send most of those prescriptions out anyway.
I have worked for 2 large health systems with in-house specialty pharmacies and in both settings, easily half, if not more, of the oral antineoplastic prescriptions I write wind up being sent somewhere else for insurance reasons anyway.
Totally agreed with you. After much back and forth with this hospital, I ended up signing with them. They added additional benefits including call pay, medical directorship stipend, increase vacation time etc. Total comp is approx $1.2-1.3M which was too good to let go for me.
Yes it's one way. It's really long and boring commute and probably they paying extra $$$ for that.
Due to stark law issue, they added additional comp for call day coverage (from home, need to be available by phone), directorship stipend etc to make total comp attractive for me.
well initially, it was a non-starter for me too and I just went for an interview from a friend's request but after hearing their final offer, I couldn't let it go and end up signing with them.
And that's the kind of money they'd need to attract anyone to that position IMO. Good job on sticking to your guns and making it work well for you. I hope the position works out.
Exactly ! We as consultant specialists need to hold our ground in salary negotiations. That's how the MGMA and %ile salary will increase.
I think INOVA, VCS, Frederick Health, MedStar are hiring
Bonemarrow1990
New Member
Hi all. I am graduating next yr and started looking at jobs. Geographical preference is OK and Tampa, FL because of family. Got an offer from hospital based system in OKC with a flat RVU rate of $100/RVU for each RVU above 5500, with a base salary of 500 K for the first three years. After that its completely RVU based. 4-4.5 days a week clinic. Call schedule is 1:6, and you get RVUs from the call.
I am currently in the process of interviewing with some Tampa based/close to Tampa clinics. From what I understand most of the practices offer on average 450 K base salary with RVUs of $50-60/RVU.
I am looking for a job that offers a balance of decent life and pay. Not planning on seeing 30 patients a day.
Trying to make a realistic comparison between these two and if I should take the first offer.
I am currently in the process of interviewing with some Tampa based/close to Tampa clinics. From what I understand most of the practices offer on average 450 K base salary with RVUs of $50-60/RVU.
I am looking for a job that offers a balance of decent life and pay. Not planning on seeing 30 patients a day.
Trying to make a realistic comparison between these two and if I should take the first offer.
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At $100/wRVU, you will make roughly $250/pt seen on average. Do the math from there.
At 15 pts a day, 4 days a week, 46 weeks a year (these are my base assumptions for all jobs to help smooth out the noise between offers), that's around $650K. Bump it to 20 a day and you're in the $850K range. At 25 a day you're over $1M. See 20 a day and only work 3-3.5d a week and you're still well north of $700K. See 15 a day for 4.5 days for the same amount of money.
It's also worth noting that, while this all seems like crazy ass Monopoly money when you're coming from $65-75K/yr as a fellow, the marginal gains going from $650-750K are often not worth the extra work required to get there.
What is the average total comp at the Tampa jobs? And what is the RVU goal to get the $50/RVU? That seems very low for Florida
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Does it matter? That's 10K wRVU to get to $500K. F*** that nonsense.
Seriously... the audacity to offer $50 per wRVU. F*** that nonsense too !! I wonder who falls for such lowball offers. Might as well be a hospitalist and work 6 months a year.
My apologies. Not for director job. Doc would be apart of group with mentorship to eventually become director
Does anyone have any experience working for Intermountain in the Colorado area. Good organization to work for? I'm hesitating to apply because you have to cover 4 hospitals when you're on call.
I do not personally, but know a couple of people who do and like their jobs. IMH is also a pretty well thought of for it's physician-focused policies and allowing for good work-life balance.
My first job (where I worked for 12 years) had coverage for 7 hospitals when I first started (we later relinquished privileges at 2 of them). It could have theoretically been a nightmare, but in general it was pretty chill. I can count on one hand the number of times I had to go to more than 2 hospitals on any given day while I was on call. That's definitely something worth asking more than one of the current docs about.
FWIW I cover 4 in PP and like GutOnc said usually only have to go to 1 or 2 on a daily basis but I would be very VERY hesitant to cover 4 hospitals for an employed job personally. It may just be you have to accept some downside to get a job in Colorado though
New third year fellow starting the job search and considering rural jobs specifically. I've been looking at employed postings with at least one other experienced doc, definitely not thinking of a solo gig. Does anyone with much more experience have any insights about what to look for in rural jobs specifically for a first job?
Thanks
Thanks
I am at an employed rural CAH job. I was solo for the first 2+ years I was here and now have a partner. I would not do solo again for sure, especially as a new grad.
Things I would want to know:
- What local support (surgical and med subspecialties, IR, Rad Onc) will you have?
- If affiliated with a larger healthcare organization, how easy is it to ship people to the mothership when needed. If not affiliated, how hard is transferring patients?
- What significant competition is there in the area (either another local group/doc or nearby that people are willing to drive to).
- Call and inpatient coverage? (I don't take call and most of my inpatient visits are social. I wouldn't do it any other way.)
- How much of the base comp is "at risk"? Is this fully salaried? Production incentive? While I am generally a fan of production based compensation, a rural job may limit how much work you can do, especially when new. I wouldn't want to be forced to only eat what I can kill in a market where there may not be much hunting to be done.
CMS proposes increases to Medicare hospital outpatient department payment rates, site-neutral and 340B changes | AHA News
The Centers for Medicare & Medicaid Services July 2 issued a proposed rule that would increase Medicare hospital outpatient prospective payment system rates by a net 2.4% in calendar year 2027 compared to 2026.
Would be very careful taking a 340b job and pay very close attention to this new proposal if I were a 3rd year fellow
Can you explain this like we're five? All of our graduating fellows chose hospital-employed positions to focus on a disease site, and so they could avoid being a generalist.CMS proposes increases to Medicare hospital outpatient department payment rates, site-neutral and 340B changes | AHA News
The Centers for Medicare & Medicaid Services July 2 issued a proposed rule that would increase Medicare hospital outpatient prospective payment system rates by a net 2.4% in calendar year 2027 compared to 2026.www.aha.org
Would be very careful taking a 340b job and pay very close attention to this new proposal if I were a 3rd year fellow
340b systems have massive mark-up on drugs particularly infusion drugs which have been enormously profitable over the past decade as they qualify for the program based on treating indigent patients in the bad part of town while buying out practices / facilities in the suburbs (read: well insured) part of town. This has been a huge driver for the very hot job market we’ve had as a field over the past 5 years or so.
CMS is proposing essentially a ~40% cut to reimbursement for 340b program drugs which (IMO) will have a substantial impact to how hospitals want to pay and treat their employed Med Oncs
ELI5 version: CMS wants to massively cut how much money they pay hospitals for cancer care so hospitals may not treat their Med Oncs very well anymore
CMS proposes increases to Medicare hospital outpatient department payment rates, site-neutral and 340B changes | AHA News
The Centers for Medicare & Medicaid Services July 2 issued a proposed rule that would increase Medicare hospital outpatient prospective payment system rates by a net 2.4% in calendar year 2027 compared to 2026.
Would be very careful taking a 340b job and pay very close attention to this new proposal if I were a 3rd year fellow
If payments drop,
Does that drop affect ASP?
Because 4% margins on a 10k ASP vs the same percent on a 6k ASP would be a big change overall for EVERY practice.
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I don’t believe so because the way I understand ASP is based on price you pay the drug company not the price CMS pays you for the drug.
Inflation reduction act CMS negotiations of drug prices is projected to affect ASP in a big way though. Very uncharted waters ahead, anyone interviewing with PP if you ask and they aren’t aware of this or brush it off is a red flag IMO
Starting in January 2028, Medicare will transition reimbursement for selected Part B oncology drugs from the standard ASP-based model to an administratively set Maximum Fair Price (MFP). Because this negotiated MFP will be significantly lower, the standard add-on percentage that independent practices rely on to cover fixed operational costs will shrink drastically. Industry projections already estimate that independent oncology practices administering just four of these negotiated drugs could face $12 billion to $19 billion in aggregate reimbursement reductions over the coming years.
The even larger issue is the impending commercial market spillover, which is going to be an operational nightmare. As MFP data inevitably drags down the overall ASP, commercial payers are fully expected to adopt those lowered benchmark rates for their own reimbursement schedules. However, pharmaceutical manufacturers are under no legal obligation to extend those same MFP discounts to independent practices for their commercial patient volume. This creates a highly dangerous scenario where community practices could end up completely underwater—paying standard commercial acquisition costs while being reimbursed at MFP-deflated rates. If a private practice's leadership isn't already aggressively strategizing around this and renegotiating payer contracts right now, it is an absolute red flag.
The even larger issue is the impending commercial market spillover, which is going to be an operational nightmare. As MFP data inevitably drags down the overall ASP, commercial payers are fully expected to adopt those lowered benchmark rates for their own reimbursement schedules. However, pharmaceutical manufacturers are under no legal obligation to extend those same MFP discounts to independent practices for their commercial patient volume. This creates a highly dangerous scenario where community practices could end up completely underwater—paying standard commercial acquisition costs while being reimbursed at MFP-deflated rates. If a private practice's leadership isn't already aggressively strategizing around this and renegotiating payer contracts right now, it is an absolute red flag.
Does this mean employed HemOnc docs' salaries will also start going down over the next few years?
Nobody knows, that’s why I just said people should be paying attention. AHA lobby is strong so maybe it will be neutered but it is pretty low hanging fruit for payment reform IMO
Edit: Base is ok I guess
Otherwise Terrible
$67/RVU is awful
1:1 APP is a trap unless they give you credit for APP RVUs (they won’t)
Base is ok depending on volume
4 day work week is ok
1:6 call is ok
