Heme/Onc Job Offer Discussion

[gutonc]

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Hi I am currently a 3rd year fellow with a job offer that I'm planning on taking. Anything that i should ask about and how does this offers seem?

Base salary: 525k for first two years.

Seems OK

After two years, base becomes 90% of earnings from previous year with 67$ per RVU over production threshold.

This one sounds terrible, but I'm not sure just how terrible. Let's math it out for a minute.

525 x 0.9 = $472500 as your base in year 3. If they're using an RVU conversion of 67, that works out to a little over 7000 wRVU just to make that base. To get back to your original base, it's over 7500 wRVU. To get to 7500 wRVU in a year, you're going to need 17-18 patients a day. Totally doable. But way underpaid. My current, hospital employed, gig, at 7500 wRVU/y I'm going to get paid a hair under $750K. There are folks out there getting $100-110/wRVU (not counting PP folks getting infusion and ancillary money). $67/wRVU means that someone is skimming a quarter million dollars off you every single year.

4 day work week with 32 patient facing hours

Good

1 admin day

Also good, as long as they don't expect you to be ass in seat in the office.

All physicians are paired 1:1 APP.

Could be good if you get some portion of their productivity credited to you.

1:6 call, APP supports inpatient on weekdays

Weekends not too busy, on average 3-4 hours/day in hospital

Not terrible, not fabulous, but pretty average. I have been very fortunate in my career to go from a 1:15(ish) call to 1:never call. I recognize that my views on what constitutes a "good" call schedule is very biased.

They said the APP’s manage the inbox which sounds really nice.

That sounds cool until you realize how many APPs don't know s*** about f***. I am married to one who is very good and I would have no concerns about managing my inbox. My current APP is pretty good and I feel comfortable with her managing it while I'm on vacation, knowing I'll have some small messes to clean up when I get back. I have worked with dozens of APPs that I wouldn't trust to cat sit for me (I have a cat that hates people and has automatic feeder, waterer and litter box, the only thing you need to do is check them all once a week).

My goal is not necessarily to optimize salary but to have a good work life balance which it seems like having a 1:1 APP would help with. They said you can be as busy as you would like.

I'm a huge fan of work-life balance and have never been about salarymaxxing. But you can easily find a job that will let you do that and make 30-50% more than this job would, with no more work.

One MD there is two years in and sees about 12-15 patients a day.

Based on what you've told us about the comp plan, if he's off the guarantee and on full production, he's making $350-450K with that workload. Not chump change by any measure. But still well below what he should be getting paid.

 

[HemeOncHopeful19]

They said the APP’s manage the inbox which sounds really nice.
My goal is not necessarily to optimize salary but to have a good work life balance which it seems like having a 1:1 APP would help with. They said you can be as busy as you would like. One MD there is two years in and sees about 12-15 patients a day.

If the APP *just* manages the inbox then great

If they see 8 of your patients while doing it and you get no credit for supervising that is money being taken out of your pocket.

I have a triage nurse that manages my inbox and it works great but she doesn’t steal my productivity

 

[juventas]

I've got a somewhat odd offer I would like to run by you guys. I am not a new onc, just haven't really done rvu based work before, usually just chill salary based practices. Didn't get a lot of pay but also not a lot of work.

- Non-academic hospital, based in suburban SoCal
- 520k base
- 4 patient facing days, 1/2 day admin
- 1:3 weekend home call which pays 3k per weekend

- wrvu threshold 6000
--wrvu rate 65 if less than 65% outpatient
--80 if less than 75% outpatient
--90 if greater than 75% outpatient

- they expect >7000 wrvus at least, which corresponds to roughly 16-18 patients per day so they say
- you only cover one hospital at a time, rotating through a few of them with your partners
- some hospitals are busy, like 8-10 inpatient census, although you don't have to see all of them every day, reportedly

This percentage outpatient based wrvu thing is really throwing me for a loop. Sounds like it would be really easy to fall into the 65 wrvu range and virtually impossible to get into the 90. I see a lot of posts here saying 100/wrvu or bust, but if you google search the average SoCal hem/onc total compensation, it's like 550k. 100/wrvu seems like it would be way more than 550k/year.

Inpatient work also seems quite substantial, although one of the partners says he leaves by 4-5pm every day.

Thanks!

 

[HemeOncHopeful19]

I've got a somewhat odd offer I would like to run by you guys. I am not a new onc, just haven't really done rvu based work before, usually just chill salary based practices. Didn't get a lot of pay but also not a lot of work.

- Non-academic hospital, based in suburban SoCal
- 520k base
- 4 patient facing days, 1/2 day admin
- 1:3 weekend home call which pays 3k per weekend

- wrvu threshold 6000
--wrvu rate 65 if less than 65% outpatient
--80 if less than 75% outpatient
--90 if greater than 75% outpatient

- they expect >7000 wrvus at least, which corresponds to roughly 16-18 patients per day so they say
- you only cover one hospital at a time, rotating through a few of them with your partners
- some hospitals are busy, like 8-10 inpatient census, although you don't have to see all of them every day, reportedly

This percentage outpatient based wrvu thing is really throwing me for a loop. Sounds like it would be really easy to fall into the 65 wrvu range and virtually impossible to get into the 90. I see a lot of posts here saying 100/wrvu or bust, but if you google search the average SoCal hem/onc total compensation, it's like 550k. 100/wrvu seems like it would be way more than 550k/year.

Inpatient work also seems quite substantial, although one of the partners says he leaves by 4-5pm every day.

Thanks!

SoCal might be an area I would say shoot for 90 because nobody is gonna pay you 100.

I agree the % outpatient thing is completely bizarre to the point I want to ask if you’re absolutely sure it works that way? I can’t understand how admin would possibly justify such a system to the docs when you have essentially zero control over how much inpatient work you do. Then again I guess that might explain why they only have 2 docs currently working there…

 

[gutonc]

I've got a somewhat odd offer I would like to run by you guys. I am not a new onc, just haven't really done rvu based work before, usually just chill salary based practices. Didn't get a lot of pay but also not a lot of work.

- Non-academic hospital, based in suburban SoCal
- 520k base
- 4 patient facing days, 1/2 day admin
- 1:3 weekend home call which pays 3k per weekend

- wrvu threshold 6000
--wrvu rate 65 if less than 65% outpatient
--80 if less than 75% outpatient
--90 if greater than 75% outpatient

- they expect >7000 wrvus at least, which corresponds to roughly 16-18 patients per day so they say
- you only cover one hospital at a time, rotating through a few of them with your partners
- some hospitals are busy, like 8-10 inpatient census, although you don't have to see all of them every day, reportedly

This percentage outpatient based wrvu thing is really throwing me for a loop. Sounds like it would be really easy to fall into the 65 wrvu range and virtually impossible to get into the 90. I see a lot of posts here saying 100/wrvu or bust, but if you google search the average SoCal hem/onc total compensation, it's like 550k. 100/wrvu seems like it would be way more than 550k/year.

Inpatient work also seems quite substantial, although one of the partners says he leaves by 4-5pm every day.

Thanks!

I'm not sure I really understand this. Are they saying that if your inpatient production is <65% of your outpatient production, they're only paying you $65/wRVU? And the threshold is 6000? Do they want 6000 total or 6000 outpatient with another 4500 inpatient? Or they want your inpatient production to be 75% of your outpatient? Or do they want 75% of your total productivity to be outpatient? I'm very confused by this.

Are you seeing outpatients after a full clinic day or do you have time blocked for it? I will tell you that I can see 10 outpatients in 2-2.5 hours with level 5 notes done. It would take me 4+ hours to see the same number of inpatients (longer if the hospital and the clinic weren't in the same building) unless I was only billing level 1 follow ups. 10 level 3 OP follow ups is >30 wRVU with G2211. 10 level 1 IP is 10 wRVU (even 10 Level 3 is <25). Inpatient heavy jobs suck on a productivity basis.

 

[juventas]

SoCal might be an area I would say shoot for 90 because nobody is gonna pay you 100.

I agree the % outpatient thing is completely bizarre to the point I want to ask if you’re absolutely sure it works that way? I can’t understand how admin would possibly justify such a system to the docs when you have essentially zero control over how much inpatient work you do. Then again I guess that might explain why they only have 2 docs currently working there…

It literally says "The applicable incentive rate shall be based on the percentage of Physician’s total monthly wRVUs that are generated through outpatient clinic services."

I'm not sure I really understand this. Are they saying that if your inpatient production is <65% of your outpatient production, they're only paying you $65/wRVU? And the threshold is 6000? Do they want 6000 total or 6000 outpatient with another 4500 inpatient? Or they want your inpatient production to be 75% of your outpatient? Or do they want 75% of your total productivity to be outpatient? I'm very confused by this.

Are you seeing outpatients after a full clinic day or do you have time blocked for it? I will tell you that I can see 10 outpatients in 2-2.5 hours with level 5 notes done. It would take me 4+ hours to see the same number of inpatients (longer if the hospital and the clinic weren't in the same building) unless I was only billing level 1 follow ups. 10 level 3 OP follow ups is >30 wRVU with G2211. 10 level 1 IP is 10 wRVU (even 10 Level 3 is <25). Inpatient heavy jobs suck on a productivity basis.

The threshold is 6000 total. It's percentage of total wrvu. If <65% of total production is clinic, then they are only paying 65/wrvu.

Seeing outpatients after/before full clinic day. I believe it is consultation role only, not as primary team.



I'm going to negotiate for a flat wrvu structure. What do you think I should aim for? Just 80/wrvu? Because of the base pay/ call stipend, the first 570k is essentially at 95/wrvu, which seems reasonable.

 

[HemeOncHopeful19]

It literally says "The applicable incentive rate shall be based on the percentage of Physician’s total monthly wRVUs that are generated through outpatient clinic services."




The threshold is 6000 total. It's percentage of total wrvu. If <65% of total production is clinic, then they are only paying 65/wrvu.

Seeing outpatients after/before full clinic day. I believe it is consultation role only, not as primary team.



I'm going to negotiate for a flat wrvu structure. What do you think I should aim for? Just 80/wrvu? Because of the base pay/ call stipend, the first 570k is essentially at 95/wrvu, which seems reasonable.

If I were going to consider this job I would want details on exactly how many RVUs and the % of inpatient/outpatient for each doc dating back like 5 years, apparently on a monthly basis.

To answer your other question, honestly? I would negotiate for 90/RVU. It’s no secret Onc makes its money in outpatient care, but IMO in an employed setup if you are set up such that <65% of your productivity comes from outpatient that is an administration and management failure not a physician problem. They are trying to write your contract such that if they screw up their side of the equation you get punished - for example you say 1:3 call but what happens when someone quits and now you’re 1:2 call and admin drags its feet on hiring someone? How does that affect your “outpatient %”?

Now whether or not you can actually negotiate that is a different story but that is the perspective you should be thinking from.

 

[gutonc]

The threshold is 6000 total. It's percentage of total wrvu. If <65% of total production is clinic, then they are only paying 65/wrvu.

OK, this wording makes sense to me. I'm with @HemeOncHopeful19 that I'd want to see some real numbers for the past 3-5 years (careful going back too far since that may be biased by things that are irrelevant to the practice as it is now). Median inpatients/d, median outpatients/d, median wRVU/day (all on a per physician basis).

But 75% of 6000 wRVU is only 4500, which works out to roughly 10-12 patients a day on average in the outpatient setting. If you're not seeing that many people, they didn't really need to hire you. How long of a guarantee do you have and if you make productivity during the guarantee period, do you get the greater of the 2 amounts?

Seeing outpatients after/before full clinic day. I believe it is consultation role only, not as primary team.

Doesn't really matter that much, but make sure you'r enot primary (or at least only primary on chemo-specific admits). Work is work and 8-10 inpatients a day on top of a full clinic day sucks donkey nards.

I'm going to negotiate for a flat wrvu structure. What do you think I should aim for? Just 80/wrvu? Because of the base pay/ call stipend, the first 570k is essentially at 95/wrvu, which seems reasonable.

Yes, the fact that they're going to pay you less for exceeding your base productivity (which my old job did too) is BS.

All that said, this is just a stupid setup. Let's say you hustle your ass off and make 10K wRVU in a year, but only 6400 of them are outpatient. Are they seriously going to punish you for exceeding your base AND expanding the number of patients your clinic manages (since many/most inpatients convert to outpatients in a non-tertiary setting)?

 

[juventas]

If I were going to consider this job I would want details on exactly how many RVUs and the % of inpatient/outpatient for each doc dating back like 5 years, apparently on a monthly basis.

To answer your other question, honestly? I would negotiate for 90/RVU. It’s no secret Onc makes its money in outpatient care, but IMO in an employed setup if you are set up such that <65% of your productivity comes from outpatient that is an administration and management failure not a physician problem. They are trying to write your contract such that if they screw up their side of the equation you get punished - for example you say 1:3 call but what happens when someone quits and now you’re 1:2 call and admin drags its feet on hiring someone? How does that affect your “outpatient %”?

Now whether or not you can actually negotiate that is a different story but that is the perspective you should be thinking from.

Thanks for the perspective. Will have to get that data out of them.

OK, this wording makes sense to me. I'm with @HemeOncHopeful19 that I'd want to see some real numbers for the past 3-5 years (careful going back too far since that may be biased by things that are irrelevant to the practice as it is now). Median inpatients/d, median outpatients/d, median wRVU/day (all on a per physician basis).

But 75% of 6000 wRVU is only 4500, which works out to roughly 10-12 patients a day on average in the outpatient setting. If you're not seeing that many people, they didn't really need to hire you. How long of a guarantee do you have and if you make productivity during the guarantee period, do you get the greater of the 2 amounts?

Doesn't really matter that much, but make sure you'r enot primary (or at least only primary on chemo-specific admits). Work is work and 8-10 inpatients a day on top of a full clinic day sucks donkey nards.

Yes, the fact that they're going to pay you less for exceeding your base productivity (which my old job did too) is BS.

All that said, this is just a stupid setup. Let's say you hustle your ass off and make 10K wRVU in a year, but only 6400 of them are outpatient. Are they seriously going to punish you for exceeding your base AND expanding the number of patients your clinic manages (since many/most inpatients convert to outpatients in a non-tertiary setting)?

Yeah, I am definitely starting to see how stupid it is.

 

[sloh]

Yes, the fact that they're going to pay you less for exceeding your base productivity (which my old job did too) is BS.

Pretty much always a red flag and a job.

 

[jafeel]

Community Practice, base would be 600k and sign on 50k. However the thing that's getting me is their wRVU expectation is 8000 and after that it'd be ~$90/RVU exceeding that. It's a 4 day workweek position but I feel like that wRVU threshold is a bit high to expect of a new grad right? I'll be taking over the practice of one of the retired docs so it's not like I have to build a new panel but if I'm doing the math right that'd be

8000 wRVU expectation / (4day week x 48 weeks a year x 2.2 avg wRVU per pt encounter)= which would come out to ~19 pts a day. Is my math right and is that feasible as a new grad?

 

[HemeOncHopeful19]

Community Practice, base would be 600k and sign on 50k. However the thing that's getting me is their wRVU expectation is 8000 and after that it'd be ~$90/RVU exceeding that. It's a 4 day workweek position but I feel like that wRVU threshold is a bit high to expect of a new grad right? I'll be taking over the practice of one of the retired docs so it's not like I have to build a new panel but if I'm doing the math right that'd be

8000 wRVU expectation / (4day week x 48 weeks a year x 2.2 avg wRVU per pt encounter)= which would come out to ~19 pts a day. Is my math right and is that feasible as a new grad?

Feasible yes
Comfortable? Maybe not

But you can answer your question reasonably well by asking how many RVUs the doc you’re replacing did the past two years

Agree 8000 for 600k is pretty mediocre

 

[gutonc]

Feasible yes
Comfortable? Maybe not

Agreed. I'd ask for a minimum 2y guarantee. You're right that you're looking at 70-75 patients a week to make that number. That's not too hard to do in year 4+, but a rough ask for a new grad.

Agree 8000 for 600k is pretty mediocre

They're paying you $75/wRVU for the first 8k and then giving you the real money? F*** that. I mean, it's better than my last job which paid $85/wRVU for the first 5K and then docked you $10/wRVU for each 1000 beyond that. But it's still BS. $90+/wRVU across the board or GTFO.

 

[MotoMD]

anyone here in socal? I'm currently around 500k as a base with bonus no rvu structure

 

[hushhush88]

anyone here in socal? I'm currently around 500k as a base with bonus no rvu structure

is this private practice or hospital employed?

 

[ECOG0Energy]

No RVU in California probably means Kaiser.

 

[gutonc]

No RVU in California probably means Kaiser.

And nobody works for Kaiser for the base salary. They do it for location, predictability of the BS (because there's BS in every job but at Kaiser, you know what it is and can learn to deal with it quickly) and for the retirement package.

 

[sloh]

What's the typical annual income for a Kaiser hematologist oncologist after they make partner In Southern California? How about Northern California?

 

[tj0413]

Still looking FYI for all who are interested.

Job is for Director of Cancer program

If anyone looking, I know someone hiring in Ohio.
700-1M salary. 4 day work week 10-15 patients per day

still available if anyone is looking!

 

[CluvK]

Hi, I’m considering a Hem/Onc job offer with Kaiser in Northern California and would appreciate some input on whether the terms are reasonable:

• 5 days/week, full-day clinic (8 AM–5 PM)
• Average 13–15 patients/day
• General Hem/Onc
• ~$500K base salary, no RVU-based compensation, typical Kaiser benefits packages
• Typical Kaiser administrative responsibilities/expectations
• 3 weeks of vacation initially
• Limited control over my schedule, although the team/department seems very supportive

For those familiar with Hem/Onc jobs, how does this compare with typical offers?

Thank you.

 

[HemeOncHopeful19]

Good lord why does anyone work for Kaiser

Even ignoring literally every other detail I cannot imagine EVER taking a full time job in Medicine that gives 3 weeks vacation. Even residency gave me 4! That is just insulting IMO and I am offended for anyone given that offer after 10 years of education and training to treat cancer patients.

For comparison I am partner track in PP and my group gives me 6 weeks even on partner track.

 

[gutonc]

Hi, I’m considering a Hem/Onc job offer with Kaiser in Northern California and would appreciate some input on whether the terms are reasonable:

• 5 days/week, full-day clinic (8 AM–5 PM)
• Average 13–15 patients/day
• General Hem/Onc
• ~$500K base salary, no RVU-based compensation, typical Kaiser benefits packages
• Typical Kaiser administrative responsibilities/expectations
• 3 weeks of vacation initially
• Limited control over my schedule, although the team/department seems very supportive

For those familiar with Hem/Onc jobs, how does this compare with typical offers?

Thank you.

5 full days a week? Nope. 4 max
3 weeks vacation? Nope, 6 or GTFO
Kaiser comp is what it is. And what it is, is mediocre. To get the real benefit of working for Kaiser (the pension, or whatever they call it now), you have to be a lifer. And those golden handcuffs can cut pretty deep for a lot of people.

 

[bobow98]

5 full days a week? Nope. 4 max
3 weeks vacation? Nope, 6 or GTFO
Kaiser comp is what it is. And what it is, is mediocre. To get the real benefit of working for Kaiser (the pension, or whatever they call it now), you have to be a lifer. And those golden handcuffs can cut pretty deep for a lot of people.

Hard agree
4 d/wk
6wk vacay minimum
the one day to decompress and do the things in your life that remind you that you are human is invaluable (even though it's admin day and you have to check your messages and such).

 

[HemeOncHopeful19]

5 full days a week? Nope. 4 max
3 weeks vacation? Nope, 6 or GTFO
Kaiser comp is what it is. And what it is, is mediocre. To get the real benefit of working for Kaiser (the pension, or whatever they call it now), you have to be a lifer. And those golden handcuffs can cut pretty deep for a lot of people.

I heard they recently did away with or substantially altered the pension for new docs without much input from the rank and file.

 

[gutonc]

I heard they recently did away with or substantially altered the pension for new docs without much input from the rank and file.

In that case, Im not sure how they're going to keep recruiting paying trash wages with crap working conditions in HCOL/VHCOL areas.

 

[sloh]

I heard they recently did away with or substantially altered the pension for new docs without much input from the rank and file.

I worked for Kaiser the first year out of residency, and their pension structure is so complicated to understand that most physicians just end up throwing up their hands and taking it based on faith that the pension structure will work out and is worth it. And yeah, I also heard that pension is worse now since they made changes to the terms. You really shouldn't take a job with Kaiser, regardless of specialty, unless it's truly your only option or you're looking for a mommy track position.

 

[hemonc27]

Hi, I’m considering a Hem/Onc job offer with Kaiser in Northern California and would appreciate some input on whether the terms are reasonable:

• 5 days/week, full-day clinic (8 AM–5 PM)
• Average 13–15 patients/day
• General Hem/Onc
• ~$500K base salary, no RVU-based compensation, typical Kaiser benefits packages
• Typical Kaiser administrative responsibilities/expectations
• 3 weeks of vacation initially
• Limited control over my schedule, although the team/department seems very supportive

For those familiar with Hem/Onc jobs, how does this compare with typical offers?

Thank you.

I'm also curious about jobs in Northern California/Bay Area.

Looking at the postings, most places are hiring. It seems like Kaiser pays the most (500k), but it's also Kaiser. That said, they're kind of feigning academic, now with supposed research opportunities? At the same time, I'm reading/hearing mixed things about the major academic centers themselves, and it's a bit confusing to know how that applies, for instance, to a freestanding infusion center in the East Bay. Everyone is trying to expand and build out clinics/infusion, and there are some 'community academic jobs' that pay 400k for 4 full days, but might be the worst of both worlds. Does anyone think that there's a benefit in being at one academic satellite vs another (i.e., Stanford vs UCSF)? Feels like they're using the academic logo as an excuse to pay less. Thinking it wouldn't be a bad way to start my career and then pivot out after I've gained some experience, maybe it'd grant me some flexibility.

Different question, but kind of to add to the weirdness here, I'm also told that UC faculty may be unionizing, and there's more turnover now due to the health system (and low pay, especially for SF), but I'm not sure how true that is for satellites. Does anyone on the inside know more about this?

 

[Tigermt]

I'm in a saturated north east community based private practice backed by one oncology. We have around 50 heme/onc docs spread throughout 15 offices. My location as 3 med oncs and we are in a close proximity to several large hospital symptoms.

I just made 4 years with the practice and have some concerns regarding partnership. The initial contract does not have specific details regarding partnership. To make partner, one must have and maintain the median RVU threshold for partners (which is around 9000) for 2 years in order to be considered for partnership. I am at around 6000 and do not think it is possible to reach 9000 given the competition of the nearby hospitals. There are many non partners in the group. At this point, I may never make partner. I guess my question to the group; is this a common scenario where an MD does not make partner for over several years? Would it be reasonable to ask for a raise in my base salary knowing I will not make partner anytime soon? I am at $400,000 since starting in 2022 (average for my area in the north east). Thank you

 

[HemeOncHopeful19]

I'm in a saturated north east community based private practice backed by one oncology. We have around 50 heme/onc docs spread throughout 15 offices. My location as 3 med oncs and we are in a close proximity to several large hospital symptoms.

I just made 4 years with the practice and have some concerns regarding partnership. The initial contract does not have specific details regarding partnership. To make partner, one must have and maintain the median RVU threshold for partners (which is around 9000) for 2 years in order to be considered for partnership. I am at around 6000 and do not think it is possible to reach 9000 given the competition of the nearby hospitals. There are many non partners in the group. At this point, I may never make partner. I guess my question to the group; is this a common scenario where an MD does not make partner for over several years? Would it be reasonable to ask for a raise in my base salary knowing I will not make partner anytime soon? I am at $400,000 since starting in 2022 (average for my area in the north east). Thank you

It’s a common scenario in a bull**** situation sure

 

[whoknows2012]

I'm in a saturated north east community based private practice backed by one oncology. We have around 50 heme/onc docs spread throughout 15 offices. My location as 3 med oncs and we are in a close proximity to several large hospital symptoms.

I just made 4 years with the practice and have some concerns regarding partnership. The initial contract does not have specific details regarding partnership. To make partner, one must have and maintain the median RVU threshold for partners (which is around 9000) for 2 years in order to be considered for partnership. I am at around 6000 and do not think it is possible to reach 9000 given the competition of the nearby hospitals. There are many non partners in the group. At this point, I may never make partner. I guess my question to the group; is this a common scenario where an MD does not make partner for over several years? Would it be reasonable to ask for a raise in my base salary knowing I will not make partner anytime soon? I am at $400,000 since starting in 2022 (average for my area in the north east). Thank you

400k for 4 yrs doesn’t sound great. Is that all base? Any bonus? Sounds like a ****ty deal (9k rvus!)

Starting salary for new grads at my academic site is 325 with bonus fwiw

 

[Warderino92]

Hello, starting the job hunting process and wanted to review one of my offers.

Southern medium size city with a smaller but international airport.
Hospital employed
Approx 16 patients per day after ramp up
90/wRVU
~450k base, wRVU up to base are calculated at 90 still and then continue past base at 90.
Quality metrics goal gives additional 10/wRVU for effective 100/wrvu
Unlimited vacation time (obviously eats away at production after awhile)
Inpatient roughly q6 weeks shared with another attending, census 20-40 and split between the two physicians with each holding the pager alternating nights while on call.

Seems like a good job for someone coming out of fellowship, anything I should ask about/look into more?

 

[ECOG0Energy]

Hello, starting the job hunting process and wanted to review one of my offers.

Southern medium size city with a smaller but international airport.
Hospital employed
Approx 16 patients per day after ramp up
90/wRVU
~450k base, wRVU up to base are calculated at 90 still and then continue past base at 90.
Quality metrics goal gives additional 10/wRVU for effective 100/wrvu
Unlimited vacation time (obviously eats away at production after awhile)
Inpatient roughly q6 weeks shared with another attending, census 20-40 and split between the two physicians with each holding the pager alternating nights while on call.

Seems like a good job for someone coming out of fellowship, anything I should ask about/look into more?

That's a LOT of bs consults and social work. Do you have an NP to help you?

 

[Warderino92]

That's a LOT of bs consults and social work. Do you have an NP to help you?

From what I was told there was no inpatient APP

 

[soccerusa]

From what I was told there was no inpatient APP

I do not think this is a good job. There are much more desirable places to live paying > 90/RVU without requiring that kind of inpatient time or at least supporting it much better.

 

[gutonc]

Hello, starting the job hunting process and wanted to review one of my offers.

Southern medium size city with a smaller but international airport.
Hospital employed
Approx 16 patients per day after ramp up
90/wRVU
~450k base, wRVU up to base are calculated at 90 still and then continue past base at 90.
Quality metrics goal gives additional 10/wRVU for effective 100/wrvu
Unlimited vacation time (obviously eats away at production after awhile)
Inpatient roughly q6 weeks shared with another attending, census 20-40 and split between the two physicians with each holding the pager alternating nights while on call.

Seems like a good job for someone coming out of fellowship, anything I should ask about/look into more?

I didn't have a census of 40 when I was a fellow and we had a leukemia service, BMT service and sarcoma service for inpatient chemo. What kind of crazy ass hospital (that's not MDACC or MSKCC) is this that has 40 oncology inpatients at a time? That right there is a terrible job, regardless of the rest of it.

 

[GrassrootMaltan]

Hello, starting the job hunting process and wanted to review one of my offers.

Southern medium size city with a smaller but international airport.
Hospital employed
Approx 16 patients per day after ramp up
90/wRVU
~450k base, wRVU up to base are calculated at 90 still and then continue past base at 90.
Quality metrics goal gives additional 10/wRVU for effective 100/wrvu
Unlimited vacation time (obviously eats away at production after awhile)
Inpatient roughly q6 weeks shared with another attending, census 20-40 and split between the two physicians with each holding the pager alternating nights while on call.

Seems like a good job for someone coming out of fellowship, anything I should ask about/look into more?

Not a good job, unfortunately. 20-40 inpatient census is just absolutely terrible. Usually it is between 0 and 5 in most places.

 

[gutonc]

Not a good job, unfortunately. 20-40 inpatient census is just absolutely terrible. Usually it is between 0 and 5 in most places.

On a bad week in my last job we'd have 1 or 2 patients on our service (inpatient chemo and EOL transition was the only thing the hospitalists wouldn't manage) and maybe 5 or 6 consults between 2 hospitals that we could sign off on after 2 visits.

 

[ECOG0Energy]

From what I was told there was no inpatient APP

Even with an NP, I would pass. Inpatient oncology in 2026 is almost entirely scut work and pointless.

 

[HemeOncHopeful19]

I was reading him saying 20-40 census as 20-40 active consults not “these patients are on my admitting service” did he ever clarify?

 

[Warderino92]

I was reading him saying 20-40 census as 20-40 active consults not “these patients are on my admitting service” did he ever clarify?

Correct, they said it’s majority consults mixed with a handful of primary patients admitted for inpatient chemo only.

 

[HemeOncHopeful19]

a handful of primary patients admitted for inpatient chemo only.

 

[gutonc]

I was reading him saying 20-40 census as 20-40 active consults not “these patients are on my admitting service” did he ever clarify?

Doesn't matter. 20-40 patients you have to at least chart round on, in addition to your 20+ in the clinic that day? Have to actually see more than 4 or 5 of them? F*** that noise. That's an extra 2+ hours of work for crap compensation.

 

[CAres2019]

So inpatient consults also yield wRVU... so given that case, isn't it favorable to have high volume inpatient consults?

 

[gutonc]

So inpatient consults also yield wRVU... so given that case, isn't it favorable to have high volume inpatient consults?

Nope.

In an hour, I can see 4 99125s in clinic, which yields 12.52 wRVU.

In the same period of time in the hospital, depending on how far apart the patients are physically located, who else is trying to do whatever with them when I show up, how many family members are in the room or they ask if they can call, and how long it takes me to find an unused computer to document on, I can see 1 or 2 inpatient follow ups (3 if I'm lucky) and those are mostly going to be 99232, maybe 99233 if I'm lucky. So, best case scenario, that's getting me 7.2 wRVU, more likely 4-5 in the same hour.

Add on the fact that you're going to be seeing these people before clinic, during lunch and after clinic, which is going to stretch your 8-9h day out to 11-12 hours.

So, no, high volume inpatient consults is a bad setup and a path to burnout if you're doing it on top of clinic. High volume clinic is a great setup to make money (assuming production based pay).

 

[bobsmith]

Everyone is trying to expand and build out clinics/infusion, and there are some 'community academic jobs' that pay 400k for 4 full days, but might be the worst of both worlds. Does anyone think that there's a benefit in being at one academic satellite vs another (i.e., Stanford vs UCSF)? Feels like they're using the academic logo as an excuse to pay less. Thinking it wouldn't be a bad way to start my career and then pivot out after I've gained some experience, maybe it'd grant me some flexibility.

Yes, my take on this is these "hybrid" positions can often be the worst of both worlds at a lot of centers.

If it's academic pay for community-type/amount of work, it's complete nonsense and you should really have some strong reason for pursuing work specifically at an academic center and some long-term plan for what you would want your career to look like and how they're going to get you there, rather than just using it as positioning for your next job (which is probably already available to you now)