Heme/Onc Job Offer Discussion

[gutonc]

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?

Sounds like "the West" = California here. Also seems a bit predatory, but that may just be me.

You (and we) don't have enough information to answer the question you're asking here about total compensation. What are the %s and how are they valued? What are the median comp #s for pre-partners and partners.

We can use my standard numbers for a comparison. They might not be relevant, but it's something. Let's say 100 pts/wk x46w x2 wRVU/pt = 9200 wRVU/year. My current employed gig (which is rural-ish) would pay me ~$800K for that workload from day 1. My old (urban, HCOL, also employed) job would pay ~$675K for that workload from day 1.

Call in my current job is non-existent, call in my old job was 2 weeknights a month, 4 weekends a year.

In the last 6 months, I've seen 3 patients in the hospital, total. In my old job, hospital coverage was 2-10 patients a day (when you were covering the hospital, which was ~1 week a month). The good docs in the group saw their own patients, the s***heads had the "doc of the day" do it.

5 days a week is unnecessary.

I'm hiring.

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[Ubba]

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?

That seems like low comp these days for 20-25 pts per day x5 days/week. 20-25 pts/day is a moderate to hefty load regardless and that's apart from having to go in before your workday to see your inpatients.

Seems like a lowball unless the partners are truly living the good life.

Edit: Also, are you hiding the percentages to maintain anonymity, or did they actually not tell you these at the interview? Highly suspicious practice if they left these kinds of Qs hanging. There should be no questions after the interview. BTW, most practices in my emails have bases much higher than this place's and the expected pt load is more like 16-20.

 

[whoknows2012]

Seems low unless the rvu bonus is actually much higher than what you wrote there

 

[HemeOncHopeful19]

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?

I do not think I would take a job where the partners work 4 days/week and I work 5 days/week.

I REALLY do not think I would take a job where I might have to be driving around to 3 different hospitals BEFORE my clinic.

That doesn't even make much sense to me. So you build up a patient panel and then when you make partner you... drop it down by 20%?

 

[HemOncCheng]

I do not think I would take a job where the partners work 4 days/week and I work 5 days/week.

I REALLY do not think I would take a job where I might have to be driving around to 3 different hospitals BEFORE my clinic.

That doesn't even make much sense to me. So you build up a patient panel and then when you make partner you... drop it down by 20%?

I agree, this does not make sense that you have a full panel and you use 4 days instead of 5?

 

[solidonc2020]

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?

Sounds like you'll work your a$$ off for subpar pay for "2-3 years," then you'll continue working your a$$ off hopefully for a lot of money.

The call alone (notwithstanding low-ish pay the first few years) would scare me away. But if you go down this route, make sure you are very clear on what exactly the path is to becoming partner. You don't want to suffer through those first few years only to find out the pay isn't what you thought, or they're never actually going to make you partner, or they're being bought out by the academic system nearby before you reach the finish line, etc. There's most likely a boatload of money to be made eventually, but the only guarantee is that you're going to be working, a lot.

I would ask them what exactly has been the path of every new hire over the past 5-10 years. If there are any who left before becoming partner, or others who have been there >2-3 years and are not yet partner, that's info you want to know.

 

[MD46]

Hey Everyone!

I would like to request your insight regarding the choice between the American Board of Internal Medicine (ABIM) and the American Osteopathic Board of Internal Medicine (AOBIM). I am curious to know if there are any notable disparities between these two certification programs in terms of the Continuing Medical Education (CME) requirements, the nature of CMEs, or the frequency of board examinations.

Additionally, I would appreciate any clarifications on whether osteopathic CME is obligatory for ABOIM, or if any form of CME would suffice.

Thank you!

Sounds like you'll work your a$$ off for subpar pay for "2-3 years," then you'll continue working your a$$ off hopefully for a lot of money.

The call alone (notwithstanding low-ish pay the first few years) would scare me away. But if you go down this route, make sure you are very clear on what exactly the path is to becoming partner. You don't want to suffer through those first few years only to find out the pay isn't what you thought, or they're never actually going to make you partner, or they're being bought out by the academic system nearby before you reach the finish line, etc. There's most likely a boatload of money to be made eventually, but the only guarantee is that you're going to be working, a lot.

I would ask them what exactly has been the path of every new hire over the past 5-10 years. If there are any who left before becoming partner, or others who have been there >2-3 years and are not yet partner, that's info you want to know.

This is good advice, happened to me where they didnt make partner as promised after 3yrs. Extended employee track for more years as due to covid expenses changed bla bla, but i was paid less due to sweat equity in the first few years as there was supposedly no buyin. Also they never shared exact partner salaries either.
I was too naive to pick up on redflags and also some area restrictions to begin with due to family.

 

[RustBeltOnc]

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?

These numbers are bad, and the call schedule is bad. Don't do this.

 

[bigboyonc]

Midwest - midsize city

500k
4.5 days/week (I know stupid but they wouldn’t budge)
wRVU target 5000 with $100/wRVU above that
40 days PTO + holidays
Call 1:7 with still working in the AM and rounding in the PM
Seeing ~12-15 patients/day once you ramp up.

Thoughts?

 

[gutonc]

Midwest - midsize city

500k
4.5 days/week (I know stupid but they wouldn’t budge)
wRVU target 5000 with $100/wRVU above that
40 days PTO + holidays
Call 1:7 with still working in the AM and rounding in the PM
Seeing ~15 patients/day once you ramp up.

Thoughts?

What's the employment structure? PP? MSG? Hospital employed?

Other than the 4.5d/wk thing, seems pretty decent to me. With that workload, wRVU target and productivity comp, you're looking at a $600-650K gross without working all that hard.

Questions to ask or things to negotiate on:
1. Can you do <1.0 FTE in order to get 3.5 or 4d a week (if that matters to you)? Or stretch your 4 days an extra hour to cover that extra half day?
2. How rough is the call and how many hospitals do you have to cover?
3. CME money and time?
4. Sign-on/Reloc/Retention?

I might have other questions based on the employment type, but that's what I've got off the top of my head. Overall though, it seems pretty good.

 

[bigboyonc]

What's the employment structure? PP? MSG? Hospital employed? Hospital

Other than the 4.5d/wk thing, seems pretty decent to me. With that workload, wRVU target and productivity comp, you're looking at a $600-650K gross without working all that hard.

Questions to ask or things to negotiate on:
1. Can you do <1.0 FTE in order to get 3.5 or 4d a week (if that matters to you)? Or stretch your 4 days an extra hour to cover that extra half day? Can’t stretch the 4 days, I asked about that.
2. How rough is the call and how many hospitals do you have to cover? Call isn’t bad. There’s a nurse system who take first call. One hospital. Seeing 0-9 patients/day mostly. NP sees patient/does notes during weekdays. Weekends you’re on the own.
3. CME money and time? CME time included in PTO above. 5k
4. Sign-on/Reloc/Retention? 50k

I might have other questions based on the employment type, but that's what I've got off the top of my head. Overall though, it seems pretty good.

 

[RainerMaria]

What's the employment structure? PP? MSG? Hospital employed?

Other than the 4.5d/wk thing, seems pretty decent to me. With that workload, wRVU target and productivity comp, you're looking at a $600-650K gross without working all that hard.

Questions to ask or things to negotiate on:
1. Can you do <1.0 FTE in order to get 3.5 or 4d a week (if that matters to you)? Or stretch your 4 days an extra hour to cover that extra half day?
2. How rough is the call and how many hospitals do you have to cover?
3. CME money and time?
4. Sign-on/Reloc/Retention?

I might have other questions based on the employment type, but that's what I've got off the top of my head. Overall though, it seems pretty good.

Would he likely be crossing bonus threshold territory seeing only 12-15 pts a day? Unless the inpatient consults would pad that.
Back of envelope 46 weeks a year seems to yield 5,000 on the nose.

 

[bigboyonc]

Would he likely be crossing bonus threshold territory seeing only 12-15 pts a day? Unless the inpatient consults would pad that.
Back of envelope 46 weeks a year seems to yield 5,000 on the nose.

It’s actually more like 43 weeks - between PTO and holidays, it ends up being 45-46 days off/year.

 

[gutonc]

Would he likely be crossing bonus threshold territory seeing only 12-15 pts a day? Unless the inpatient consults would pad that.
Back of envelope 46 weeks a year seems to yield 5,000 on the nose.

By my math:
15x4.5x2x46 = 6210
6210-5000 = 1210
1210x100 = 121000

You are correct that at 12/d you're pretty much at the 5K/y point. But whenever you're starting a new job (either building or taking over a practice), you tend to have higher billing at the beginning. This is a combination of seeing more new patients in a day than you will later in your career and having to completely un-f*** the disasters you're taking over from the near retirement dinosaurs who haven't had to re-certify their boards ever, so largely still practice 1987 oncology with a smattering of "data" from whichever hot drug rep was in the office last.

I'm a pretty efficient physician and can bang out a 99215-worthy chart in 10 minutes total (visit time + documentation/ordering time) if I know the patient well. But when I started my new job, I had to seriously un-f*** some old/locums/NP craziness which resulted in me billing some of my longest time-based charts ever (I legit billed a 130 min f/u based solely on active time in the chart on a met breast cancer who was on 9th line treatment at year 15 when I met her). I keep track of my own wRVU billing and did an analysis of my charges for the last 6 months. They went from an average of ~2.8wRVU/pt for the first 2 months to a hair above 2.1/pt last month.

 

[gutonc]

It’s actually more like 43 weeks - between PTO and holidays, it ends up being 45-46 days off/year.

In that case, you're more in the $550-600K range. But the take home difference there is pretty minimal,

I'll be honest though, it's surprisingly hard to take that many days off a year. Not bad, just difficult, especially when building a practice.

 

[bigboyonc]

In that case, you're more in the $550-600K range. But the take home difference there is pretty minimal,

I'll be honest though, it's surprisingly hard to take that many days off a year. Not bad, just difficult, especially when building a practice.

Difficult in which way? From what I gather, they have an abundance in consults since they’re kind of the only oncology practice in town. The docs see 3-4 NP/day because they have so many new consults.

 

[gutonc]

Difficult in which way? From what I gather, they have an abundance in consults since they’re kind of the only oncology practice in town. The docs see 3-4 NP/day because they have so many new consults.

I think you misunderstood me. I was saying that taking 9+ weeks of PTO a year is hard. I'm working on it though and I'll tell you how it goes next December. I've only made PTO requests through the end of March, plus a week in June but I'm already at 4 weeks.

 

[bigboyonc]

I think you misunderstood me. I was saying that taking 9+ weeks of PTO a year is hard. I'm working on it though and I'll tell you how it goes next December. I've only made PTO requests through the end of March, plus a week in June but I'm already at 4 weeks.

Gotcha. I can see that. It is a lot. I don’t expect to be able to see enough people to make a sizeable bonus with that much PTO.

 

[gutonc]

Gotcha. I can see that. It is a lot. I don’t expect to be able to see enough people to make a sizeable bonus with that much PTO.

If you do manage to take a full 9 weeks off, that's the 2nd set of calculations I did.

But in any case, I still think the job seems pretty reasonable.

 

[Duke1K]

Opinion on an offer in academia:

Metropolitan high CoL area in California
Assistant Professor
~300K base with ~2000 wRVU minimum (~15 pts a day); +$?/RVU on top (others average $10-30K on top)
10 weeks inpatient
40% clinical, 60% research
$30K signing bonus
$25K discretionary

Thoughts? Other than conference travel/memberships, etc., what things are the discretionary funding used for that isn't typically accounted for (I'm trying to estimate my usage over time)? Anyone with the benefit of hindsight - any specific things I should negotiate for?

 

[osprey099]

Opinion on an offer in academia:

Metropolitan high CoL area in California
Assistant Professor
~300K base with ~2000 wRVU minimum (~15 pts a day); +$?/RVU on top (others average $10-30 on top)
10 weeks inpatient
40% clinical, 60% research
$30K signing bonus
$25K discretionary

Thoughts? Other than conference travel/memberships, etc., what things are the discretionary funding used for that isn't typically accounted for (I'm trying to estimate my usage over time)? Anyone with the benefit of hindsight - any specific things I should negotiate for?

For academic, that base pay is pretty good, assuming you are a fresh grad. For some context, my academic fellowship institution has been actively looking for new grads to take the bait, offering <200k starting.

 

[Duke1K]

For academic, that base pay is pretty good, assuming you are a fresh grad. For some context, my academic fellowship institution has been actively looking for new grads to take the bait, offering <200k starting.

That's gotta be for an instructorship position; if not, your institution is getting away with highway robbery - even purely onc early phase trialists with 80% protected time make more at our institution than that

 

[HemOncCheng]

That's gotta be for an instructorship position; if not, your institution is getting away with highway robbery - even purely onc early phase trialists with 80% protected time make more at our institution than that

I agree, I know MDA offer much than 200K for the base to start.

 

[HemeOncHopeful19]

I agree, I know MDA offer much than 200K for the base to start.

Even the VA pays 300

 

[whoknows2012]

Opinion on an offer in academia:

Metropolitan high CoL area in California
Assistant Professor
~300K base with ~2000 wRVU minimum (~15 pts a day); +$?/RVU on top (others average $10-30K on top)
10 weeks inpatient
40% clinical, 60% research
$30K signing bonus
$25K discretionary

Thoughts? Other than conference travel/memberships, etc., what things are the discretionary funding used for that isn't typically accounted for (I'm trying to estimate my usage over time)? Anyone with the benefit of hindsight - any specific things I should negotiate for?

What’s the inpatient census like during those 10 weeks? Two clinic days per week? Do you have anyway to get the actual $/wRVU as that would be hugely important to determine your likely compensation about the base…

 

[Duke1K]

What’s the inpatient census like during those 10 weeks? Two clinic days per week? Do you have anyway to get the actual $/wRVU as that would be hugely important to determine your likely compensation about the base…

Census is ~20-25 with a co-management hospitalist model. No expectation to do clinic during inpatient weeks, but some keep a half day or two.
Two full clinic days a week.
No idea about the $/RVU, but the top earner will make $40K above the base including some QI bonuses; I think most people probably make $15K on top and some do the minimum. Being academia, advancement isn't really tied to RVU, and an additional couple $10K pre-tax is not really that substantive (I think generally people make more from "moonlighting" uncovered shifts). However, maximizing RVU may be better for negotiation purposes (part of the salary is fixed to an academic pay scale based on title, and the other part is negotiated with the Chair each year), so if you can prove you are a high RVU generator based on historical performance, I'm guessing you can ask for more.

 

[gutonc]

Opinion on an offer in academia:

Metropolitan high CoL area in California
Assistant Professor
~300K base with ~2000 wRVU minimum (~15 pts a day); +$?/RVU on top (others average $10-30K on top)
10 weeks inpatient
40% clinical, 60% research
$30K signing bonus
$25K discretionary

Thoughts? Other than conference travel/memberships, etc., what things are the discretionary funding used for that isn't typically accounted for (I'm trying to estimate my usage over time)? Anyone with the benefit of hindsight - any specific things I should negotiate for?

I'm not in academia or CA, but that seems like a pretty decent offer overall.

The "discretionary" thing is kind of odd IMO. Is that a one time only thing and you're expected to use that pot of money for all CME, travel, etc for as long as you're with the institution? I mean, if you're planning to bounce after 4 or 5 years, it seems reasonable. If you're going to be a lifer, it works out to ~$1K/y or less. I'd get some clarity on how long that's intended to last, what it's typically used for and what other support there is for CME and other things later on.

I agree that getting a number on the wRVU is important, but also that at this level of productivity, you're unlikely to be clinically busy enough to make it that much of an issue.

What are you doing for your 60% research time? Clinical trials? Bench research? What kind of support is there for that side of your job including scientific writing and biostats help (assuming clinical research)? Are you expected to bring in outside funding to help cover some of this? How protected is the time?

 

[Duke1K]

I'm not in academia or CA, but that seems like a pretty decent offer overall.

The "discretionary" thing is kind of odd IMO. Is that a one time only thing and you're expected to use that pot of money for all CME, travel, etc for as long as you're with the institution? I mean, if you're planning to bounce after 4 or 5 years, it seems reasonable. If you're going to be a lifer, it works out to ~$1K/y or less. I'd get some clarity on how long that's intended to last, what it's typically used for and what other support there is for CME and other things later on.

I agree that getting a number on the wRVU is important, but also that at this level of productivity, you're unlikely to be clinically busy enough to make it that much of an issue.

What are you doing for your 60% research time? Clinical trials? Bench research? What kind of support is there for that side of your job including scientific writing and biostats help (assuming clinical research)? Are you expected to bring in outside funding to help cover some of this? How protected is the time?

Discretionary funding should theoretically be a one-time pot for educational or work-related expenses not covered by grant or other funding. It is small over a 20-30 year career, but this can be re-supplied/re-negotiated when running out. Chair said it was a simple ask and it'll be replenished; mentor advised that you can't trust anything not in the contract. Others have said the offer letter is like a prenup - basics are covered, but everything else is based on trust and reciprocity.

I go to at least three major conferences a year; accounting for airfare, hotel, transportation, registration fees, membership and incidentals - this would probably be ~$7500 a year. Then MOC fees (assuming I keep up with three...doubtful) will be ~$500, +journal publication fees, etc. - it just seems like I'll burn the discretionary amount in a few years. At the same time, it seems unreasonable to ask for a tenfold increase here.

Research is clinical/translational without significant bench time and mostly trials, with decent biostats/trial support but not as flush as behemoths like MDA (no dedicated CRC support). Salary is 100% clinical revenue so no expectation for outside funding, and even some discouragement for grants with protected time (e.g. K awards) because of this. Protected time is of course not truly protected at all - heavy in-basket work, doc-to-docs, "curbsides" for your area of expertise, etc. There are experienced practice RNs who handle some of this but they're stretched thin, covering four other attendings each and their 2 clinic days.

Anything to ask for in terms of clinical support? I've never worked with a scribe and I actually enjoy writing clinic notes - should I ask for one, or is this presumptuous as a first year attending?

 

[osprey099]

That's gotta be for an instructorship position; if not, your institution is getting away with highway robbery - even purely onc early phase trialists with 80% protected time make more at our institution than that

Welcome to northeast "desirable" city locations...

 

[gutonc]

Discretionary funding should theoretically be a one-time pot for educational or work-related expenses not covered by grant or other funding. It is small over a 20-30 year career, but this can be re-supplied/re-negotiated when running out. Chair said it was a simple ask and it'll be replenished; mentor advised that you can't trust anything not in the contract. Others have said the offer letter is like a prenup - basics are covered, but everything else is based on trust and reciprocity.

I go to at least three major conferences a year; accounting for airfare, hotel, transportation, registration fees, membership and incidentals - this would probably be ~$7500 a year. Then MOC fees (assuming I keep up with three...doubtful) will be ~$500, +journal publication fees, etc. - it just seems like I'll burn the discretionary amount in a few years. At the same time, it seems unreasonable to ask for a tenfold increase here.

Yeah, I'm with your mentor on this. Assume that $25K is all you're getting as long as you work there unless your contract states it will be replenished or renegotiated QX years. That may be all you're going to get out of them, but worth asking for a formal reassessment timeline.

Research is clinical/translational without significant bench time and mostly trials, with decent biostats/trial support but not as flush as behemoths like MDA (no dedicated CRC support). Salary is 100% clinical revenue so no expectation for outside funding, and even some discouragement for grants with protected time (e.g. K awards) because of this. Protected time is of course not truly protected at all - heavy in-basket work, doc-to-docs, "curbsides" for your area of expertise, etc. There are experienced practice RNs who handle some of this but they're stretched thin, covering four other attendings each and their 2 clinic days.

Biggest concern here is when somebody leaves (because they will). Now all of a sudden they're going be all "Hey Dr. Duke1K, we know you're a lymphoma specialist, but as you know, Dr. Smith, our melanoma specialist is leaving, so we need you to cover his patient panel while we recruit for his replacement, it should be easy for you to manage, since they both end in -oma, they're basically the same diseases" and now you're doing 3+ days of clinic a week. And "while we recruit" means "12-24 months". This kind of stuff tends to get dumped on the new folks most places and is a huge cause of burnout in early stage "clinical investigator" physicians. It's a good reason to find yourself some outside funding of some sort so you can truly protect at least some of that time.

Anything to ask for in terms of clinical support? I've never worked with a scribe and I actually enjoy writing clinic notes - should I ask for one, or is this presumptuous as a first year attending?

Asking for the tools you need to do your job is never presumptuous, but it's going to be hard to know what tools you really need at this point in your career. I personally find scribes pointless, but lots of people love them, so if you think that will be you, ask now. Good RN and MA support is invaluable in your clinic. If your RN is overworked already, make sure you have a good MA dedicated to you who can take on some of the clinical stuff that doesn't need a nurse. A lot of places will tell you only a nurse can do certain things, but wasting RN pay on disability paperwork is stupid.

 

[WildflAuer]

Hi all. Received an offer from coastal NE suburbia (my ideal location with great commute from husband's job).

Large multispecialty private practice
Taking over a busy largely benign/indolent hematology clinic. No APP support but otherwise full personal staff. Minimal call.
334K base (based on 25% percentile of 2019 MGMA - I did ask if this could be increased to reflect 2021 MGMA data at 388K. TBD) - 3-year guaranteed. $96/wRVU. No threshold wRVU - my total revenue is subtracted by my direct expenses (401K match funds, health insurance, malpractice insurance - we estimated would be around $111K if I maxed out 401k) AND my base salary, and then I keep 50%, which is to be paid out at 1 year. Potential for partnership at 1 year, at which time transitions to productivity model only with no base salary and I keep 100% of my net earnings less the above mentioned and some practice overhead (I don't have this number but the practice physicians do own the buildings and there is potential to buy a new one soon).
No signing or other bonuses.
Clinic 4 days/week. For first year, 3 weeks paid vacation (including holidays) and 5 days CME time - more flexibility with partnership.

Is this a reasonable offer?
If I transition to another practice in 3-5 years, will this experience hurt my prospects (while I am hoping I can stay in community heme I am realistic about what I can find)?
@gutonc thoughts?

 

[onconc]

Hi all. Received an offer from coastal NE suburbia (my ideal location with great commute from husband's job).

Large multispecialty private practice
Taking over a busy largely benign/indolent hematology clinic. No APP support but otherwise full personal staff. Minimal call.
334K base (based on 25% percentile of 2019 MGMA - I did ask if this could be increased to reflect 2021 MGMA data at 388K. TBD) - 3-year guaranteed. $96/wRVU. No threshold wRVU - my total revenue is subtracted by my direct expenses (401K match funds, health insurance, malpractice insurance - we estimated would be around $111K if I maxed out 401k) AND my base salary, and then I keep 50%, which is to be paid out at 1 year. Potential for partnership at 1 year, at which time transitions to productivity model only with no base salary and I keep 100% of my net earnings less the above mentioned and some practice overhead (I don't have this number but the practice physicians do own the buildings and there is potential to buy a new one soon).
No signing or other bonuses.
Clinic 4 days/week. For first year, 3 weeks paid vacation (including holidays) and 5 days CME time - more flexibility with partnership.

Is this a reasonable offer?
If I transition to another practice in 3-5 years, will this experience hurt my prospects (while I am hoping I can stay in community heme I am realistic about what I can find)?
@gutonc thoughts?

I feel it depends on what is a realistic target for 2nd year (and later) total RVUs. Secondly, once you start to own buildings and other equipment etc, then the potential for tax writeoffs is huge. And that will impact your take home pay even if gross compensation doesn't increase.

 

[HemeOncHopeful19]

Hi all. Received an offer from coastal NE suburbia (my ideal location with great commute from husband's job).

Large multispecialty private practice
Taking over a busy largely benign/indolent hematology clinic. No APP support but otherwise full personal staff. Minimal call.
334K base (based on 25% percentile of 2019 MGMA - I did ask if this could be increased to reflect 2021 MGMA data at 388K. TBD) - 3-year guaranteed. $96/wRVU. No threshold wRVU - my total revenue is subtracted by my direct expenses (401K match funds, health insurance, malpractice insurance - we estimated would be around $111K if I maxed out 401k) AND my base salary, and then I keep 50%, which is to be paid out at 1 year. Potential for partnership at 1 year, at which time transitions to productivity model only with no base salary and I keep 100% of my net earnings less the above mentioned and some practice overhead (I don't have this number but the practice physicians do own the buildings and there is potential to buy a new one soon).
No signing or other bonuses.
Clinic 4 days/week. For first year, 3 weeks paid vacation (including holidays) and 5 days CME time - more flexibility with partnership.

Is this a reasonable offer?
If I transition to another practice in 3-5 years, will this experience hurt my prospects (while I am hoping I can stay in community heme I am realistic about what I can find)?
@gutonc thoughts?

Sounds like there is some fishyness but in the NE you might just take what you can get.

So basically you “keep half” so essentially ~$50/RVU in year 1? That’s mediocre but in the grand scheme not a dealbreaker I suppose.

The weird thing to me is that it sounds like your “partnership” pay is

$96/RVU - (overhead, 401k match, insurance, etc.)

In a good hospital employed job you might just get $96/RVU period without subtracting all that stuff out.

How much was the person you’re taking over for making?

 

[WildflAuer]

Sounds like there is some fishyness but in the NE you might just take what you can get.

So basically you “keep half” so essentially ~$50/RVU in year 1? That’s mediocre but in the grand scheme not a dealbreaker I suppose.

The weird thing to me is that it sounds like your “partnership” pay is

$96/RVU - (overhead, 401k match, insurance, etc.)

In a good hospital employed job you might just get $96/RVU period without subtracting all that stuff out.

How much was the person you’re taking over for making?

His salary is "classified" so they were unable to tell me. His hem/onc partners are hospital-leased, essentially, so they have a different compensation structure. He himself told me he makes more than they do. That's the most I got. Practice told me his RVUs were ~5800 last year (of note, he's retiring so I'm not sure if this is scaling back).

 

[HemeOncHopeful19]

His salary is "classified" so they were unable to tell me. His hem/onc partners are hospital-leased, essentially, so they have a different compensation structure. He himself told me he makes more than they do. That's the most I got. Practice told me his RVUs were ~5800 last year (of note, he's retiring so I'm not sure if this is scaling back).

That keeps getting weirder tbh. You’re going to be the only Oncologist in the group on your specific compensation plan?

 

[whoknows2012]

Base seems low. That’s not far off from a base being offered by some academic and academic affiliated hospital positions (know of one in particular in nyc metro 325-350 base 90-100/rvu, with specialization)

 

[WildflAuer]

That keeps getting weirder tbh. You’re going to be the only Oncologist in the group on your specific compensation plan?

Exactly! He was very senior and carved quite a niche for himself.

 

[WildflAuer]

Base seems low. That’s not far off from a base being offered by some academic and academic affiliated hospital positions (know of one in particular in nyc metro 325-350 base 90-100/rvu, with specialization)

Thank you. I agree, especially if they are trying to shoot for 25% percentile MGMA data for base. The compensation factor seems acceptable, and I'm assuming the 50% take away the first year is equal to the practice buy-in.

 

[HemeOncHopeful19]

Thank you. I agree, especially if they are trying to shoot for 25% percentile MGMA data for base. The compensation factor seems acceptable, and I'm assuming the 50% take away the first year is equal to the practice buy-in.

The compensation factor is reasonable but IMO not when you subtract out a bunch of stuff.

5800x96 = 550k which is fair for a full 4d/week I guess.

If you subtract out the 110k like you estimated then 440k is starting to sound a bit worse, unless there is something else that we’re missing which could be possible.

 

[WildflAuer]

The compensation factor is reasonable but IMO not when you subtract out a bunch of stuff.

5800x96 = 550k which is fair for a full 4d/week I guess.

If you subtract out the 110k like you estimated then 440k is starting to sound a bit worse, unless there is something else that we’re missing which could be possible.

That productivity is based on only 15 pts/day, which I think I'll be surpassing pretty quickly, but your point is a good one -- 50% of my net proceeds the first year goes toward practice buy-in, fine, but how much more can I realistically make as a partner if I'm no longer giving back 50% of my net but am instead paying for overhead in addition to personal costs? I think I need to call back the CEO to clarify those salary deductions.

 

[MD46]

“largely benign/indolent hematology clinic”
Not going to get as many RVUs if you continue this route.

 

[whoknows2012]

This doesn’t sound like such a good deal. Do you have other options in the desired area?

 

[WildflAuer]

This doesn’t sound like such a good deal. Do you have other options in the desired area?

I have interviewed and am touring/awaiting offers for a pracademics hematology role as well as a single-specialty PP (heme + onc unfortunately). Both are new positions but with quite a commute for me and husband. Hopefully more details soon.

 

[TexasMed22]

Today I learned there are people who enjoy benign heme

 

[gutonc]

Today I learned there are people who enjoy benign heme

There are a few freaks out there. We try not to talk about it.

 

[WildflAuer]

There are a few freaks out there. We try not to talk about it.

I try to keep it under wraps but some times it shows! 🤷‍♀️

How unreasonable is this offer? What else should I clarify/ask the practice manager/CEO?

 

[gutonc]

Hi all. Received an offer from coastal NE suburbia (my ideal location with great commute from husband's job).

Large multispecialty private practice
Taking over a busy largely benign/indolent hematology clinic. No APP support but otherwise full personal staff. Minimal call.
334K base (based on 25% percentile of 2019 MGMA - I did ask if this could be increased to reflect 2021 MGMA data at 388K. TBD) - 3-year guaranteed. $96/wRVU. No threshold wRVU - my total revenue is subtracted by my direct expenses (401K match funds, health insurance, malpractice insurance - we estimated would be around $111K if I maxed out 401k) AND my base salary, and then I keep 50%, which is to be paid out at 1 year. Potential for partnership at 1 year, at which time transitions to productivity model only with no base salary and I keep 100% of my net earnings less the above mentioned and some practice overhead (I don't have this number but the practice physicians do own the buildings and there is potential to buy a new one soon).
No signing or other bonuses.
Clinic 4 days/week. For first year, 3 weeks paid vacation (including holidays) and 5 days CME time - more flexibility with partnership.

Is this a reasonable offer?
If I transition to another practice in 3-5 years, will this experience hurt my prospects (while I am hoping I can stay in community heme I am realistic about what I can find)?
@gutonc thoughts?

I think there are a few questions that still need to be answered here.
- Is it really reasonable to be seeing 16-20 classical heme patients a day in this practice?
- What does a partnership buy-in look like from a financial perspective on both ends (what will it cost you and what will you get from it)?
- Are they willing to adjust the base/guarantee and $/wRVU to post-pando numbers? If not, why not?
- If it's a true PP, what portion of the infusion revenue are you, and the rest of the partners, expected to get?

I do think that the base is on the lower side, but not completely unreasonable. The same can be said for the $wRVU numbers. The holdbacks for the "benefits" seem a little excessive IMO. Either they need to just cover that (and adjust the base/production appropriately) or just make it "eat what you kill" (after a 1-2y guarantee based on the group's median compensation) and then pay out the "benefits" from that. In this comp plan as outlined, it seems like somebody is trying to have it both ways...and that somebody won't be you.

 

[HemeOncHopeful19]

There are a few freaks out there. We try not to talk about it.

Freaks is a bit strong... I think the term you're looking for is

 

[gutonc]

Freaks is a bit strong... I think the term you're looking for is

I stand by my statement.

 

[Mir2zapine]

SW, sort of a communiversity or in gutonc's words, "academic-ish" system
Days negotiable but starting out likely 4-4.5d/week to build panel, will also staff a satellite clinic 1-2d/week
$470k 2-year guarantee
Once it makes financial sense, I move to a 60%/40% model where I keep 60% of all wRVUs and 40% goes into a pool which includes other med oncs, surg oncs, rad oncs, gyn onc, and the malignant heme folks who do the same, these are then distributed to everyone evenly. Range for med oncs $650k-1.1m with median ~$850k
1wRVU=$110
Call is 1 week every 10w which includes a very mild inpatient service (3-4 patients) and consults. Overnight, APPs cover between 5-10p and then we cover the rest. Average 0-3 calls/night typically. No malignant heme/transplant (they take separate call).
Thoughts?