Heme/Onc Job Offer Discussion

[FaithSaves]

I mean you haven’t mentioned the most important thing which is how much you’re actually paid - just the minimum guarantee.

But honestly?

Hell %{*}in’ no. That job sounds nuts. On call for your own patients every single weeknight for the rest of time? Even if you wanted a busy $1m a year job it still sounds like a dumb way to set it up.

That was my first thought

Regarding compensation model, I was told there is no RVU threshold to be met. When I asked about the break down, they said it will essentially be the guaranteed + annual bonus (~10%). I clarified and said if there was a $/wRVU bonus in addition to that due to the high volumes. They said there was... but it was "difficult to predict" and could not give me specific numbers. But told me essentially this will be my total sum to expect each year. This is my first offer so I was a little confused. Disappointed they are not 100% transparent with $/wRVU bonus.

I am also concerned with seeing an upwards of 16-20 patients a day just starting out.

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[HemeOncHopeful19]

That was my first thought

Regarding compensation model, I was told there is no RVU threshold to be met. When I asked about the break down, they said it will essentially be the guaranteed + annual bonus (~10%). I clarified and said if there was a $/wRVU bonus in addition to that due to the high volumes. They said there was... but it was "difficult to predict" and could not give me specific numbers. But told me essentially this will be my total sum to expect each year.

 

[gutonc]

That was my first thought

Regarding compensation model, I was told there is no RVU threshold to be met. When I asked about the break down, they said it will essentially be the guaranteed + annual bonus (~10%). I clarified and said if there was a $/wRVU bonus in addition to that due to the high volumes. They said there was... but it was "difficult to predict" and could not give me specific numbers. But told me essentially this will be my total sum to expect each year. This is my first offer so I was a little confused. Disappointed they are not 100% transparent with $/wRVU bonus.

I am also concerned with seeing an upwards of 16-20 patients a day just starting out.

 

[RustBeltOnc]

I've wanted to have a special voice mail that would answer "Hell 2 Da Naw" when someone tries to leave a message "to touch base" about one of the many offers similar to that cited above.

 

[bobsmith]

Hell %{*}in’ no. That job sounds nuts. On call for your own patients every single weeknight for the rest of time? Even if you wanted a busy $1m a year job it still sounds like a dumb way to set it up.

I mean, I have to imagine they cover when people are on vacation and things like that

But do you all get a lot of after hours calls from your patients and your group's patients? We have an nursing advice line that triages most things initially so very few calls actually come to me - maybe once a month?

 

[gutonc]

I mean, I have to imagine they cover when people are on vacation and things like that

But do you all get a lot of after hours calls from your patients and your group's patients? We have an nursing advice line that triages most things initially so very few calls actually come to me - maybe once a month?

Is your triage line 24/7/365? RNs where I live make >$100K and if you're going to ask them to stay up all night to answer patient calls, you're going to pay them more than that. I'm not arguing it's not a good use of resources, just that it's hard to recruit.

TBH, the issue isn't really the volume, the issue is having to be available. I no longer take call, but when I did, I would get anywhere from 0-10 calls a night. Most of them were 5-7p and 5-7a, and most nights were more like 1-2 calls total. But it only takes one 2am call to really ruin your night.

 

[onconc]

Hi, I received an offer from a desirable large metropolitan city in California

Community group practice
No RVU minimum. No partnership track
Guaranteed 500K in Year 1 with 50K sign on bonus
550K in Year 2
570K in Year 3

Work load
M-F work week, no administration day
Very busy area with initial workload of 15-20 patients a day with ramp up to 20-30 over 1-2 years experienced
Each physician takes call for own patients calls after hours Mon-Fri
Weekend coverage is q5. Responsible for 1-2 local hospitals, coverage during the week is covered by the covering physician (q5)

I am concerned with the initial workload straight from fellowship.
With that being said, is this a fair offer?

Is your compensation fixed ? I mean they offer 500k for seeing 15-20 patients. And then they pay 570k to see 20-30 patients ? Even with just basic mathematics, they should be paying $700 or so if your patient load increases from 17 to 25.

I am not even going into the terrible on call situation since others have covered that issue.

 

[bobsmith]

Is your triage line 24/7/365? RNs where I live make >$100K and if you're going to ask them to stay up all night to answer patient calls, you're going to pay them more than that. I'm not arguing it's not a good use of resources, just that it's hard to recruit.

TBH, the issue isn't really the volume, the issue is having to be available. I no longer take call, but when I did, I would get anywhere from 0-10 calls a night. Most of them were 5-7p and 5-7a, and most nights were more like 1-2 calls total. But it only takes one 2am call to really ruin your night.

I'll just count my blessings and consider myself lucky

 

[gutonc]

I'll just count my blessings and consider myself lucky

It's a pretty good gig from that perspective at least.

 

[FaithSaves]

I mean, I have to imagine they cover when people are on vacation and things like that

But do you all get a lot of after hours calls from your patients and your group's patients? We have an nursing advice line that triages most things initially so very few calls actually come to me - maybe once a month?

Yes. The only time when you are free from weekday coverage for your own patients is when you are on vacation. The other physicians in the group also cover their own patients during week days.

When you are "on call", you cover the new hospital consults for one week at a time, q5 weeks.

Regarding weeknight coverage for your own patients - I tried asking what is the call volume like overnight on weekdays and if there was nursing support.

The physician told me the call was "manageable and not too bad". The nurse said there was a secretary line but said patients will want to speak with their doctors I assume calls will inevitable come to the MD.

 

[FaithSaves]

Is your compensation fixed ? I mean they offer 500k for seeing 15-20 patients. And then they pay 570k to see 20-30 patients ? Even with just basic mathematics, they should be paying $700 or so if your patient load increases from 17 to 25.

I am not even going into the terrible on call situation since others have covered that issue.

Yes compensation is fixed from what I am gathering. They told me there was a wRVU bonus however that it was "difficult to predict" and could not give me specific numbers. In the contract there was no mention of the wRVU bonus. Only the guaranteed fixed rate noted above and a sign on bonus for first year. So I presume likely no additional compensation

This discussion has been enlightening. I had significant concerns already while interview, but kept getting reassured how I was a great fit and people would "help out if things get too busy". Felt uneasy about the salary break down. But just from that call schedule alone, I can't imagine still having to be available after hours even when I'm not on call.

 

[onconc]

Yes compensation is fixed from what I am gathering. They told me there was a wRVU bonus however that it was "difficult to predict" and could not give me specific numbers. In the contract there was no mention of the wRVU bonus. Only the guaranteed fixed rate noted above and a sign on bonus for first year. So I presume likely no additional compensation

This discussion has been enlightening. I had significant concerns already while interview, but kept getting reassured how I was a great fit and people would "help out if things get too busy". Felt uneasy about the salary break down. But just from that call schedule alone, I can't imagine still having to be available after hours even when I'm not on call.

I will just offer one other data point.

After a couple of years ramping up, seeing 25+ patients is not terribly bad IF you have a good support system in office. Like good support medical staff and good EMR and good admin support. I myself see more than 25, many weeks 35 even. I do work 55 +/- hours a week or so. And have family and kids. But I cannot imagine doing this if my support medical and admin staff was not there. And also I get paid solely on RVU with no base floor. So compensation is (kind of) linearly proportional to how many patients I see.

Also I have a supportive spouse (who also has demanding job) and extensive home help staff so that I can focus all my time at home with spouse and kids and my hobbies. And yes, I do have time for hobbies.

 

[osprey099]

Sounds like a very low-ball offer. 20+ patients from the get go? Call every night? No RVU bonus? No partnership track? Highest state tax in the US?

Gotta pay me at least 1 million to even consider that position

 

[bobsmith]

Yes compensation is fixed from what I am gathering. They told me there was a wRVU bonus however that it was "difficult to predict" and could not give me specific numbers. In the contract there was no mention of the wRVU bonus. Only the guaranteed fixed rate noted above and a sign on bonus for first year. So I presume likely no additional compensation

I mean, this is the core problem. You are correct to presume that if it is not in the contract, it does not exist - how else would you be able to hold them to it?

 

[checkpointinhibitor]

Hi, I received an offer from a desirable large metropolitan city in California

Community group practice
No RVU minimum. No partnership track
Guaranteed 500K in Year 1 with 50K sign on bonus
550K in Year 2
570K in Year 3

Work load
M-F work week, no administration day
Very busy area with initial workload of 15-20 patients a day with ramp up to 20-30 over 1-2 years experienced
Each physician takes call for own patients calls after hours Mon-Fri
Weekend coverage is q5. Responsible for 1-2 local hospitals, coverage during the week is covered by the covering physician (q5)

I am concerned with the initial workload straight from fellowship.
With that being said, is this a fair offer?

what you need to know to understand whether you are paid fairly is productivity in comparison to compensation.
Know what the median RVUs are generated there by the group and what is the $/wRVU rate.
you will have to clarify your compensation structure better for us to give you a more nuanced answer.

 

[FaithSaves]

what you need to know to understand whether you are paid fairly is productivity in comparison to compensation.
Know what the median RVUs are generated there by the group and what is the $/wRVU rate.
you will have to clarify your compensation structure better for us to give you a more nuanced answer.

Hi, I had mentioned this in the subsequent posts - In the contract, the total compensation structure stated is the guaranteed fixed rate noted above in my original post.

I asked them about $/wRVU bonus but they had said it was "difficult to predict" and would not give me specific numbers. In the contract there was no mention of the wRVU bonus. So I presume it likely did not exist and all I would be getting is that fixed rate for total comp

 

[gutonc]

Hi, I had mentioned this in the subsequent posts - In the contract, the total compensation structure stated is the guaranteed fixed rate noted above in my original post.

I asked them about $/wRVU bonus but they had said it was "difficult to predict" and would not give me specific numbers. In the contract there was no mention of the wRVU bonus. So I presume it likely did not exist and all I would be getting is that fixed rate for total comp

It's "difficult to predict" because it's imaginary. Assume that you're getting paid those flat rates and that's all there is. If you're happy with that, and fine with the (what I consider excessive) workload, then go for it.

Let's do the gutonc compensation math here though...and let's look at a year 3 comp/workload example:
25 encounters/d
5d/wk
46wk/y (assume 6w PTO just for comparison's sake, it's the number both my last and current contract were based on)
That's 5750 encounters/y @ ~2 wRVU/encounter (again, a reasonable assumption, I'm currently at 1.96wRVU/pt since starting my new job in June)
So now you're looking at 11,500 wRVU/year, which is a 90th %ile gig
If I was moving that much meat at my current job, my annual gross would be a hair shy of $1M. At the Year 3 base salary, you're getting paid <$50/wRVU which is family medicine material. For oncology it should be in the $80-110 range.

 

[osprey099]

It's "difficult to predict" because it's imaginary. Assume that you're getting paid those flat rates and that's all there is. If you're happy with that, and fine with the (what I consider excessive) workload, then go for it.

Let's do the gutonc compensation math here though...and let's look at a year 3 comp/workload example:
25 encounters/d
5d/wk
46wk/y (assume 6w PTO just for comparison's sake, it's the number both my last and current contract were based on)
That's 5750 encounters/y @ ~2 wRVU/encounter (again, a reasonable assumption, I'm currently at 1.96wRVU/pt since starting my new job in June)
So now you're looking at 11,500 wRVU/year, which is a 90th %ile gig
If I was moving that much meat at my current job, my annual gross would be a hair shy of $1M. At the Year 3 base salary, you're getting paid <$50/wRVU which is family medicine material. For oncology it should be in the $80-110 range.

Is your current gig employed position or private practice? $1m for 11,500 RVUs sounds pretty low

 

[gutonc]

Is your current gig employed position or private practice? $1m for 11,500 RVUs sounds pretty low

Employed. But that was kind of my point. Even at an employed gig with base + productivity (vs true PP), I'd make almost twice what this job is offering. For a true fully production based PP job, that kind of work should be well north of a million.

I will also never have any interest in working that hard.

 

[onconc]

Is your current gig employed position or private practice? $1m for 11,500 RVUs sounds pretty low

How much should 11,500 RVUs be getting compensated for in your opinion ?

 

[osprey099]

How much should 11,500 RVUs be getting compensated for in your opinion ?

In full disclosure, I'm still "just" a PGY6 fellow.

The community hospital employed places I interviewed at would be 600-700k for 20/day 5 days per week. For the private practice place I signed with, im getting paid very low in the first 3 years as an employee, but partners there all make 1m+ seeing 20/day 5 days per week.

However, I'm located in desirable Northeast coastal location so my numbers may be lower than most places

 

[TexasMed22]

In full disclosure, I'm still "just" a PGY6 fellow.

The community hospital employed places I interviewed at would be 600-700k for 20/day 5 days per week. For the private practice place I signed with, im getting paid very low in the first 3 years as an employee, but partners there all make 1m+ seeing 20/day 5 days per week.

However, I'm located in desirable Northeast coastal location so my numbers may be lower than most places

In jobs like the one you are taking, is there an option once you are a partner to scale back after a few years? Like after 5 years could you decide to go to 4 days a week and take a pay cut?

 

[HemeOncHopeful19]

In jobs like the one you are taking, is there an option once you are a partner to scale back after a few years? Like after 5 years could you decide to go to 4 days a week and take a pay cut?

You can prob make $6-700ish seeing 18-20 per day 4d per week at most PP jobs per my second hand contacts. Good luck finding that in most employed jobs.

 

[gutonc]

You can prob make $6-700ish seeing 18-20 per day 4d per week at most PP jobs per my second hand contacts. Good luck finding that in most employed jobs.

My current (employed) gig would be ~$650K for that workload.

 

[osprey099]

In jobs like the one you are taking, is there an option once you are a partner to scale back after a few years? Like after 5 years could you decide to go to 4 days a week and take a pay cut?

Im not sure but probably yes. My understanding is that once you're a partner in private practice, you can basically do whatever you want cause it's your business, as long as most/all of the other partners are in agreement

 

[onconconconconc]

I will just offer one other data point.

After a couple of years ramping up, seeing 25+ patients is not terribly bad IF you have a good support system in office. Like good support medical staff and good EMR and good admin support. I myself see more than 25, many weeks 35 even. I do work 55 +/- hours a week or so. And have family and kids. But I cannot imagine doing this if my support medical and admin staff was not there. And also I get paid solely on RVU with no base floor. So compensation is (kind of) linearly proportional to how many patients I see.

Also I have a supportive spouse (who also has demanding job) and extensive home help staff so that I can focus all my time at home with spouse and kids and my hobbies. And yes, I do have time for hobbies.

Would you be willing to elaborate on the type of support that you have to achieve these volumes? How often does your schedule get derailed by difficult conversations and emergencies?
Am working similar hours with much lower volumes and am wondering what proportion is my own inefficiency versus insufficient staff support.

 

[bobsmith]

Im not sure but probably yes. My understanding is that once you're a partner in private practice, you can basically do whatever you want cause it's your business, as long as most/all of the other partners are in agreement

You make choose to work less / different hours but your share of the overhead may be the same

 

[Ubba]

The fairest approach would probably be to have a graduated $/wrvu scheme because - as a general rule - those who generate the most billings contribute the most to the economy of scale.

 

[gutonc]

The fairest approach would probably be to have a graduated $/wrvu scheme because - as a general rule - those who generate the most billings contribute the most to the economy of scale.

I proposed this type of comp plan in my prior medical director life. It was approved without question by "the powers that be". We structured it so that a physician producing the median wRVU for the group would have gotten a ~5% increase from their prior base salary (which was 90% of the docs). We then ramped the $/wRVU up by $10 for every 1000 wRVU produced annually. So, if the base (as an example) was 5000 wRVU and paid out at $75/wRVU, for the next 1000 wRVU, you got $85/wRVU, for the the next 1000, $95, etc. But here was the catch...it wasn't 5000x75+(1000x85)+(1000x95) etc, once you hit the next level, you got all of your wRVUs compensated at the higher level, so if you hit 7000, they were all paid out at $95/wRVU (again...rough example numbers).

The physicians completely s*** their pants when I presented this saying that we were trying to cut their pay, despite providing models of their new pay based on prior year's productivity (again, most of them making 5-30% more for the same workload) and then showed them what 10-40% higher productivity (at 10% intervals) looked like for them.

At the time I left the group, most of the docs were making 15-50% less with the comp plan they ultimately approved compared to the one I originally proposed. They seems happy with this for...reasons. A few of them finally realized what they'd given up on and apologized for being such dumf***s.

That comp plan has only gotten worse.

 

[anonperson]

I proposed this type of comp plan in my prior medical director life. It was approved without question by "the powers that be". We structured it so that a physician producing the median wRVU for the group would have gotten a ~5% increase from their prior base salary (which was 90% of the docs). We then ramped the $/wRVU up by $10 for every 1000 wRVU produced annually. So, if the base (as an example) was 5000 wRVU and paid out at $75/wRVU, for the next 1000 wRVU, you got $85/wRVU, for the the next 1000, $95, etc. But here was the catch...it wasn't 5000x75+(1000x85)+(1000x95) etc, once you hit the next level, you got all of your wRVUs compensated at the higher level, so if you hit 7000, they were all paid out at $95/wRVU (again...rough example numbers).

The physicians completely s*** their pants when I presented this saying that we were trying to cut their pay, despite providing models of their new pay based on prior year's productivity (again, most of them making 5-30% more for the same workload) and then showed them what 10-40% higher productivity (at 10% intervals) looked like for them.

At the time I left the group, most of the docs were making 15-50% less with the comp plan they ultimately approved compared to the one I originally proposed. They seems happy with this for...reasons. A few of them finally realized what they'd given up on and apologized for being such dumf***s.

That comp plan has only gotten worse.

I'm shocked they turned down a structure that would have paid all of the rvus at the higher threshold rate. That's a huge financial incentive to hustle a bit more and honestly would make people feel fairly paid for the extra work.

 

[gutonc]

I'm shocked they turned down a structure that would have paid all of the rvus at the higher threshold rate. That's a huge financial incentive to hustle a bit more and honestly would make people feel fairly paid for the extra work.

I'm not...physicians can be really stupid. They all figured it out once it was too late.

 

[solidonc2020]

My current (employed) gig would be ~$650K for that workload.

Same for me in the employed gig I’m waiting for a contract to sign, although would be closer to $700k but that took some negotiating.

 

[Teleblockop]

Just received this offer and was hoping to get some feedback if I should pursue.

Hospital employed position in NYC metro area. Function as community oncologist, no track for partnership
5 day work week (no admin time). Call q5 weeks. Cover consults from 2 inpatient hospitals
Yr 1: Base salary 315K + $50/wRVU >5000 wRVUs + sign on bonus of 30K
Yr.3: Base increases to 330K + $50/wRVU >5000wRVUs
Bonus of 7.5% of base salary added on at end of year

What are you all's thoughts about this offer?

 

[Mehena]

I wish I knew the NYC market well enough to provide valuable information. However, $50/wRVU seems like a laughable conversion rate for oncology, and it's quite low. I am located in a less congested area in the mid-Atlantic corridor, and my RVU is more than double that amount. Even considering the luxury of living and working in New York City, such a significant difference should not exist.

These are other concerns:

1) A 5-day workweek and a call schedule of every 5 weeks.
2) The 5000 RVU threshold seems a bit high.

Good luck.

 

[Ubba]

Just received this offer and was hoping to get some feedback if I should pursue.

Hospital employed position in NYC metro area. Function as community oncologist, no track for partnership
5 day work week (no admin time). Call q5 weeks. Cover consults from 2 inpatient hospitals
Yr 1: Base salary 315K + $50/wRVU >5000 wRVUs + sign on bonus of 30K
Yr.3: Base increases to 330K + $50/wRVU >5000wRVUs
Bonus of 7.5% of base salary added on at end of year

What are you all's thoughts about this offer?

Sounds like a churn & burn model.

 

[FaithSaves]

I wish I knew the NYC market well enough to provide valuable information. However, $50/wRVU seems like a laughable conversion rate for oncology, and it's quite low. I am located in a less congested area in the mid-Atlantic corridor, and my RVU is more than double that amount. Even considering the luxury of living and working in New York City, such a significant difference should not exist.

These are other concerns:

1) A 5-day workweek and a call schedule of every 5 weeks.
2) The 5000 RVU threshold seems a bit high.

Good luck.

Is 5000 RVU threshold difficult to attain for a first year?
I'm also applying to NYC area as well. Anyone know what is the expected $/wRVU in NYC?

 

[HemeOncHopeful19]

Just received this offer and was hoping to get some feedback if I should pursue.

Hospital employed position in NYC metro area. Function as community oncologist, no track for partnership
5 day work week (no admin time). Call q5 weeks. Cover consults from 2 inpatient hospitals
Yr 1: Base salary 315K + $50/wRVU >5000 wRVUs + sign on bonus of 30K
Yr.3: Base increases to 330K + $50/wRVU >5000wRVUs
Bonus of 7.5% of base salary added on at end of year

What are you all's thoughts about this offer?

315k / 5000 RVU = $63/RVU (with a nice beefy upgrade to $66/RVU after 2 years, lol) then $50/RVU after that.

Smells like garbage to me.

 

[gutonc]

315k / 5000 RVU = $63/RVU (with a nice beefy upgrade to $66/RVU after 2 years, lol) then $50/RVU after that.

Smells like garbage to me.

Yup, the math is crap on this job. I recognize that NYC pays poorly compared to other places, but this is an embarrassment.

Also, 5 days a week? For this kind of money? Get f****d.

Bonus of 7.5% of base salary added on at end of year

Why not just increase the base by 7.5% then? Or is this contingent on meeting a set of either fungible, or impossible, (or both) benchmarks that assures they won't have to pay it out?

Is 5000 RVU threshold difficult to attain for a first year?

That averages out to 11 patients a day for the above mentioned 5 day week, 14 a day for a more typical 4 day week (I've outlined my general assumptions on workload and wRVU/pt elsewhere, you can look it up if you don't trust me). So it's not a ridiculous goal by any means. it's not the goal here that's ridiculous, it's the productivity "bonus" that's a joke.

I'm also applying to NYC area as well. Anyone know what is the expected $/wRVU in NYC?

I can't say for certain, but any employer there is definitely getting well over $100/wRVU you generate so $50 is an insult.

 

[checkpointinhibitor]

Just received this offer and was hoping to get some feedback if I should pursue.

Hospital employed position in NYC metro area. Function as community oncologist, no track for partnership
5 day work week (no admin time). Call q5 weeks. Cover consults from 2 inpatient hospitals
Yr 1: Base salary 315K + $50/wRVU >5000 wRVUs + sign on bonus of 30K
Yr.3: Base increases to 330K + $50/wRVU >5000wRVUs
Bonus of 7.5% of base salary added on at end of year

What are you all's thoughts about this offer?

This is laughable. I wouldn't even reply to the offer and waste my time.
This is lower middle class money for NYC.
NYC and other larger cities all have a churn and burn model IMO. Have a friend who signed few years ago in one of 'semi-academic' NYC jobs for 300K around 2016.
This is insulting to any oncologist and I don't know how someone woudl want to work there unless they are secondary income earner in their family and spouse is doing much better on other job/gig.

 

[RustBeltOnc]

This is one of the worst offers I've seen, ever. This includes the era when there was an excess of oncologists in many areas.

 

[onconc]

Would you be willing to elaborate on the type of support that you have to achieve these volumes? How often does your schedule get derailed by difficult conversations and emergencies?
Am working similar hours with much lower volumes and am wondering what proportion is my own inefficiency versus insufficient staff support.

A scribe to take care of transcription is a big part. He (the scribe) works with me throughout the day. He is great !
Other than that, the admin mostly helps in staying out of the way; and also gives preferences to most suggestions I make. I mean suggestions regarding processes in the hospital.
At the risk of sounding braggy, I would also say that I consider myself a very efficient person. I have good executive function skills.

 

[HemeOncHopeful19]

A scribe to take care of transcription is a big part. He (the scribe) works with me throughout the day. He is great !
Other than that, the admin mostly helps in staying out of the way; and also gives preferences to most suggestions I make. I mean suggestions regarding processes in the hospital.
At the risk of sounding braggy, I would also say that I consider myself a very efficient person. I have good executive function skills.

I’m curious what time do you get to work and what time do you get home? You mentioned you work 55hrs a week, do you end up charting at home every night?

I interviewed with a busy group once and they said “I get home around 6-7 and see my kids before bed” - no thanks homie. I’m all down to work hard while I’m there though. One of those dudes had two scribes, though. You may be missing out!

 

[onconc]

I’m curious what time do you get to work and what time do you get home? You mentioned you work 55hrs a week, do you end up charting at home every night?

I interviewed with a busy group once and they said “I get home around 6-7 and see my kids before bed” - no thanks homie. I’m all down to work hard while I’m there though. One of those dudes had two scribes, though. You may be missing out!

Oh wow, 2 scribes. That is utopia.

My hours are 7 to 5. And then I work like half an hour at home on and off. My kids sleep late. So I get several hours with them everyday. And with house staff being present, I don't do any house chores at all; except cook (tending to the oven; no cleaning etc). But yes, I understand your concern about coming home late. And I take some calls or charting once in a while at home. So my total hours are between 50 and 55; closer to 50 most weeks.

 

[QuizzicalApe]

there is no amount of money available to a hospital or to god and all his angels that would make me willing to be on call every week

 

[Ubba]

Can someone please describe what good scribes can do that make attending life easier? I'm looking for ways to maximize efficiency once done with training and do understand that one gets what one pays for.

 

[HemOncCheng]

Can someone please describe what good scribes can do that make attending life easier? I'm looking for ways to maximize efficiency once done with training and do understand that one gets what one pays for.

I guess dictation works for most time?

 

[solidonc2020]

Can someone please describe what good scribes can do that make attending life easier? I'm looking for ways to maximize efficiency once done with training and do understand that one gets what one pays for.

I actually think scribes will be obsolete in the next couple of years due to AI. There are several companies with impressive "ambient" AI scribing where it listens to the patient encounter and drafts notes similar to a scribe. Large health systems are piloting or already using them now.

 

[gutonc]

I actually think scribes will be obsolete in the next couple of years due to AI. There are several companies with impressive "ambient" AI scribing where it listens to the patient encounter and drafts notes similar to a scribe. Large health systems are piloting or already using them now.

I personally hate reading scribed/dictated notes, and I can only hope the AI generated ones won't be any worse. There's a bunch of useless stream of consciousness BS in most of them that makes it hard to figure out WTF is going on.

My notes are generally pared down to communicate important information to myself, colleagues and billers/coders. I can finish a 99215 note with free-texted (not templated) medicolegally bulletproof information in 2-3 minutes. I don't see how a scribe (AI or otherwise) is going to improve on that for me. For people who can't type for s***, I guess it might be helpful, but for the people who ramble endlessly about random stuff with their scribes in the room, or Dragon on, and then don't edit it later (which pretty much negates the time benefit of dictation/scribing) their notes are going to be just as useless.

 

[solidonc2020]

I personally hate reading scribed/dictated notes, and I can only hope the AI generated ones won't be any worse. There's a bunch of useless stream of consciousness BS in most of them that makes it hard to figure out WTF is going on.

My notes are generally pared down to communicate important information to myself, colleagues and billers/coders. I can finish a 99215 note with free-texted (not templated) medicolegally bulletproof information in 2-3 minutes. I don't see how a scribe (AI or otherwise) is going to improve on that for me. For people who can't type for s***, I guess it might be helpful, but for the people who ramble endlessly about random stuff with their scribes in the room, or Dragon on, and then don't edit it later (which pretty much negates the time benefit of dictation/scribing) their notes are going to be just as useless.

I agree. When entering fellowship I thought it would be a dream to have a scribe at my eventual job, but what I've learned is there's generally a revolving door in terms of the scribes used at our academic center. Maybe 10-20% of them are great, and the others are not helpful (bloat in the notes, incorrect medical decision-making, etc). The good ones are there a year then move on to med school or something else, then the time/effort you've put into training them is gone. I will be starting my job in July 2024 and had no interest in negotiating for a scribe when I feel I can be pretty efficient on my own.

From what I've heard, the newer AI softwares are being designed to "learn" from your own prior notes and generate their notes based on your style and prior documentation. That sounds promising for someone who will be seeing a relatively focused group of patients (GU oncology for me), at least compared to a pre-med who is just typing as fast as they can in the room with minimal baseline knowledge. I'm cautiously optimistic but we'll see what happens.

 

[Mir2zapine]

Hi all - I have a job offer from a PP in the West that I interviewed at 2 weeks ago.

Metro area ~500k pop, only other onc practice in town is the academic medical center

2-3 year prepartnership track:
Base of $310k + % of RVUs which start from 0 (unclear what the RVU percentage is but total comp during these years is typically $375-450k)
Work 5 days/week seeing 20-25 pts/day; 1 weekday call Q2weeks; 1 weekend call Q2months; no acute leuks, TTP, etc. (basically most heme/onc emergencies), cover 3 community hospitals, round on your own patients in the AM if they're admitted and need to be seen

Partnership track after 2-3 years:
Base of $410k + higher % of RVUs which start from 0 (they said total comp typically doubles) + profit sharing on top of all this
Work 4 days/week seeing 20-25 patients; same call as above

The 5 days/week and rounding in the hospital (seems like every day?) scare me. Thoughts on this or anything else?