Heme/Onc Job Offer Discussion

[Ubba]

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Hey all - wanted to run a pure private practice offer by everyone.

- Huge group of 12 oncologists plus rad oncs and gyn oncs.
- See patients out of the local main hospital. Call is 1/10 weeks. Well-supported with RN support overnight for patient calls.
- Financials:
----- Years 1-2: base salary guaranteed in 300K range but no one ever misses this base. RVUs paid in the ~90-100 range. All docs paid same RVUs regardless of seniority.
----- Years 3-5: partnership buy in. No one pays for partnership with money - you pay in with time. So you become a partner year 3 but don't get any partnership revenue years 3-5.

Without partnership revenue, docs make in the ~600K to 1.2 million range depending on how busy you want to be. Partnership revenue adds 100-250K roughly depending on shares owned.

I'm almost shocked at the numbers. When the hospital employed group offered me $685K, I was speechless - but 7 figures seems crazy.

What questions should I be asking? What seems too good to be true?

Thank you.

PPD?

 

[MD46]

Hey all - wanted to run a pure private practice offer by everyone.

- Huge group of 12 oncologists plus rad oncs and gyn oncs.
- See patients out of the local main hospital. Call is 1/10 weeks. Well-supported with RN support overnight for patient calls.
- Financials:
----- Years 1-2: base salary guaranteed in 300K range but no one ever misses this base. RVUs paid in the ~90-100 range. All docs paid same RVUs regardless of seniority.
----- Years 3-4: partnership buy in with time. So you become a partner year 3 but don't get any partnership revenue years 3-4

Without partnership revenue, docs make in the ~600K to 1.1 million range depending on how busy you want to be. Partnership revenue adds 100-250K roughly depending on shares owned.

I'm almost shocked at the numbers. When the hospital employed group offered me $685K, I was speechless - but 7 figures seems crazy.

What questions should I be asking? What seems too good to be true?

Thank you.

Some missing info:

RVU requirement to make base salary once you become partner?

How much is total buy in?

Shares: how many you can or have to buy
Equity buy in?

What is average number for RVUs each doctor doing?

$90-100 per RVU after base?

How many days a week clinic

NP support and to what extent

Vacation time difference between partnership vs not

 

[osprey099]

Hey all - wanted to run a pure private practice offer by everyone.

- Huge group of 12 oncologists plus rad oncs and gyn oncs.
- See patients out of the local main hospital. Call is 1/10 weeks. Well-supported with RN support overnight for patient calls.
- Financials:
----- Years 1-2: base salary guaranteed in 300K range but no one ever misses this base. RVUs paid in the ~90-100 range. All docs paid same RVUs regardless of seniority.
----- Years 3-4: partnership buy in with time. So you become a partner year 3 but don't get any partnership revenue years 3-4

Without partnership revenue, docs make in the ~600K to 1.1 million range depending on how busy you want to be. Partnership revenue adds 100-250K roughly depending on shares owned.

I'm almost shocked at the numbers. When the hospital employed group offered me $685K, I was speechless - but 7 figures seems crazy.

What questions should I be asking? What seems too good to be true?

Thank you.

I guess the biggest question here is how many patients/day and days/week? If the practice is seeing 20/day 5 days/week, those numbers are pretty normal, especially if the physicians own everything (infusion, dispensary, lab, imaging, rad onc, real estate) and doesn't have a MSO like US Onc or AON.

Unfortunately, a lot of these type of practice are deceitful and will sell you the prospect of financial partnership in the future, like 5-6 years down the road, but never intend to make you an equal partner. It is impossible to know their true intentions. The best you can do is look at their track record and see if anyone recently quit or left the practice and try to talk with that person to hear the details.

 

[gutonc]

Hey all - wanted to run a pure private practice offer by everyone.

- Huge group of 12 oncologists plus rad oncs and gyn oncs.
- See patients out of the local main hospital. Call is 1/10 weeks. Well-supported with RN support overnight for patient calls.
- Financials:
----- Years 1-2: base salary guaranteed in 300K range but no one ever misses this base. RVUs paid in the ~90-100 range. All docs paid same RVUs regardless of seniority.
----- Years 3-4: partnership buy in with time. So you become a partner year 3 but don't get any partnership revenue years 3-4

Without partnership revenue, docs make in the ~600K to 1.1 million range depending on how busy you want to be. Partnership revenue adds 100-250K roughly depending on shares owned.

I'm almost shocked at the numbers. When the hospital employed group offered me $685K, I was speechless - but 7 figures seems crazy.

What questions should I be asking? What seems too good to be true?

Thank you.

You've gotten great responses from others here, all of which I agree with.

I'll add that you should ask:
1. What percentage of new docs have NOT made it to the full partner (year 5) stage?
2. What is the median comp for the non-partners, partners and group as a whole (med oncs only)?
3. What are the career stages of the other docs in the group (is there a pending bolus of retirees or a bunch of new docs)?
4. What risks/threats are there for the group being sold in the next 5 years (which would put your partnership at risk)?
5. Why if there are 12 oncologists (soon to be 13) is call 1/10?

 

[ONC2023]

Hi all - thank you very much for the responses. These are very helpful.

I have a really good hospital employed offer (good vacation time, sub specialization, NP support, salary, etc) so I am basically debating the higher reward/higher risk of private practice versus being paid probably less but being part of a stable hospital group. I'll find out more details as you all describe above.

I'm so so fed up with academic medicine and feeling exploited that the thought of going into private practice and becoming a business owner in a few years feels so, so good. We'll see how brave I am!

PPD?

Apologies, what is PPD?

 

[Ubba]

Hi all - thank you very much for the responses. These are very helpful.

I have a really good hospital employed offer (good vacation time, sub specialization, NP support, salary, etc) so I am basically debating the higher reward/higher risk of private practice versus being paid probably less but being part of a stable hospital group. I'll find out more details as you all describe above.

I'm so so fed up with academic medicine and feeling exploited that the thought of going into private practice and becoming a business owner in a few years feels so, so good. We'll see how brave I am!



Apologies, what is PPD?

Patients per day

 

[ONC2023]

Oh, I see - it sounds like to make my base it's low double digits daily but I am going to push for harder numbers from them next time I speak to them. I don't think they're hiding anything from me - it's just a larger group so they need to talk to collate the data.

 

[gutonc]

Oh, I see - it sounds like to make my base it's low double digits daily but I am going to push for harder numbers from them next time I speak to them. I don't think they're hiding anything from me - it's just a larger group so they need to talk to collate the data.

You don't ask individual docs this information, you ask the business manager or the senior managing partner/medical director. If they can't provide the data by end of business the day after you ask, they're hiding something.

When I was the medical director of an employed community based group, I got monthly reports on productivity for every single doc in my group that included total wRVUs, breakdowns by CPT code and variance from median of the group as a whole for every data point. Somebody is getting paid to collect and analyze this data to make sure that everyone gets paid what they've earned. Find that person and ask them that question.

 

[osprey099]

You don't ask individual docs this information, you ask the business manager or the senior managing partner/medical director. If they can't provide the data by end of business the day after you ask, they're hiding something.

When I was the medical director of an employed community based group, I got monthly reports on productivity for every single doc in my group that included total wRVUs, breakdowns by CPT code and variance from median of the group as a whole for every data point. Somebody is getting paid to collect and analyze this data to make sure that everyone gets paid what they've earned. Find that person and ask them that question.

Agree with this but back when I was interviewing, my experience was that practice managers don't share this information. Maybe they're hiding something but sometimes they just don't feel comfortable revealing financials to someone who hasn't even signed a contract. Additionally, for private practice, there are multiple income sources via billing, drug margin, ancillaries, real estate, etc that it would be hard to provide an exact income given so many variables. This is much easier to do in an employed hospital based model because you're just taking a $/RVU amount above a certain base salary.

In my scenario, my private practice group asked me to provide a number and they told me whether or not every partner beats that income, rather than sharing the nitty gritty details/opening the books. I'm not partner yet so we'll see if they were genuine..

 

[gutonc]

Agree with this but back when I was interviewing, my experience was that practice managers don't share this information. Maybe they're hiding something but sometimes they just don't feel comfortable revealing financials to someone who hasn't even signed a contract. Additionally, for private practice, there are multiple income sources via billing, drug margin, ancillaries, real estate, etc that it would be hard to provide an exact income given so many variables. This is much easier to do in an employed hospital based model because you're just taking a $/RVU amount above a certain base salary.

In my scenario, my private practice group asked me to provide a number and they told me whether or not every partner beats that income, rather than sharing the nitty gritty details/opening the books. I'm not partner yet so we'll see if they were genuine..

A PP group that won't open the books to someone they plan to make "part of the club" is hiding something. Full stop.

 

[osprey099]

A PP group that won't open the books to someone they plan to make "part of the club" is hiding something. Full stop.

I guess as an employee (in my case, 3 years before partnership consideration), you aren't really part of the club yet? If I get offered partnership, obviously I expect to see all the financial details in the books

 

[MD46]

I guess as an employee (in my case, 3 years before partnership consideration), you aren't really part of the club yet? If I get offered partnership, obviously I expect to see all the financial details in the books

I agree with GutOnc , I was in a similar situation where they never opened the books and in reality didnt have any intention to do so.
Realistically if you don't know what you are going to be making as a partner and they aren't transparent even when you ask, that is automatically a red flag.

I interviewed at the some private places where the managing partner sat with me, showed me the numbers of a "random partner" with their details hidden.

All partners had the same base salary, they had a formulae to distribute productivity from ancillaries and real-estate/rent etc as well. Showed final compensation. Hence super transparent.

 

[gutonc]

I agree with GutOnc , I was in a similar situation where they never opened the books and in reality didnt have any intention to do so.
Realistically if you don't know what you are going to be making as a partner and they aren't transparent even when you ask, that is automatically a red flag.

I interviewed at the some private places where the managing partner sat with me, showed me the numbers of a "random partner" with their details hidden.

All partners had the same base salary, they had a formulae to distribute productivity from ancillaries and real-estate/rent etc as well. Showed final compensation. Hence super transparent.

I always shared our base and median comp with interviewees. The numbers are there, no reason not to be honest with them.

In a PP situation, I would expect to see pre-partner median (assuming it's not just straight base), median partner comp and median comp of the group as a whole.

 

[osprey099]

I always shared our base and median comp with interviewees. The numbers are there, no reason not to be honest with them.

In a PP situation, I would expect to see pre-partner median (assuming it's not just straight base), median partner comp and median comp of the group as a whole.

I wish you were my boss lol. Maybe it's a NE costal thing. People are generally more shady here..

 

[gutonc]

I wish you were my boss lol. Maybe it's a NE costal thing. People are generally more shady here..

That should tell you everything you need to know.

I hope things work out for you, and if they do, I hope that when you're in a position to help recruit new physicians to your group, you are not shady.

 

[onconc]

I interviewed at the some private places where the managing partner sat with me, showed me the numbers of a "random partner" with their details hidden.
Showed final compensation.

Would it be possible to share what those numbers were ? I am curious to know how much a typical "partner" makes in these kinds of groups. Thx

 

[osprey099]

That should tell you everything you need to know.

I hope things work out for you, and if they do, I hope that when you're in a position to help recruit new physicians to your group, you are not shady.

Certainly. There is enough volume and income for everyone to do well. Problem is, human nature is inherently greedy.

 

[MD46]

Would it be possible to share what those numbers were ? I am curious to know how much a typical "partner" makes in these kinds of groups. Thx

This was more than 5 years ago so I dont have exact, depending on the area on average a partner seeing 18-24 patients a day 4-4.5 days a week with 4-6 weeks off in a year should be around 750k-1mil+ range.

 

[IgAddict]

Hello Everybody,

I've been looking into Medonc academic jobs in the south and got 3 offers from NCI CCC's

Base ranging from 260-290 + productivity/academic merit-based compensation that would add up to 10-15% on top of base.

2 to 2.5 half days a week + some inpatient coverage. They expect me to produce around 4400-4800 wRVU's.

Am I being lowballed on the base salary? (This will be my first job out of fellowship)

 

[geniusindisguise]

Hello Everybody,

I've been looking into Medonc academic jobs in the south and got 3 offers from NCI CCC's

Base ranging from 260-290 + productivity/academic merit-based compensation that would add up to 10-15% on top of base.

2 to 2.5 half days a week + some inpatient coverage. They expect me to produce around 4400-4800 wRVU's.

Am I being lowballed on the base salary? (This will be my first job out of fellowship)

I presume you meant 2 to 2.5 days per week?

Not sure about wRVU expectations, but from what I have seen, base salary usually falls in the range of 275-325K so your range seems pretty standard.

 

[HemeOncHopeful19]

Hello Everybody,

I've been looking into Medonc academic jobs in the south and got 3 offers from NCI CCC's

Base ranging from 260-290 + productivity/academic merit-based compensation that would add up to 10-15% on top of base.

2 to 2.5 half days a week + some inpatient coverage. They expect me to produce around 4400-4800 wRVU's.

Am I being lowballed on the base salary? (This will be my first job out of fellowship)

That comes out to around $60/wRVU which is awful but I mean you already knew you were getting that going into Academics.

Why Academics?

 

[gutonc]

Hello Everybody,

I've been looking into Medonc academic jobs in the south and got 3 offers from NCI CCC's

Base ranging from 260-290 + productivity/academic merit-based compensation that would add up to 10-15% on top of base.

Base is mediocre for the location IMO. But academics does like to pay you in "reputation".

2 to 2.5 half days a week + some inpatient coverage. They expect me to produce around 4400-4800 wRVU's.

Using my new and improved 2.4 wRVU/pt outpatient numbers (assuming you can G2211 them all) and all my other prior base assumptions (46wks/y, etc), you will need to see 17-18 patients a day (not counting your inpatient duties) to make your wRVU goals. That's easy to do in community based practice, but in academics, which is notoriously inefficient, poorly staffed with ancillaries and should have trainees to "help" you, 18 patients a day is tough...not impossible, but tough.

What will they pay you if you go over your base productivity? And what are you doing with the rest of your time?

 

[faelivrin]

Is there ever a scenario where $72/wRVU can be justified? Hospital employed, private equity owned (ugh) on the outskirts of a major West Coast city, base $450k + $60k (negotiable) bonus + productivity after. Call 1:9 a week at a time, clinic 4 days/week with average 15 - 18 patients, other standard perks but no dedicated NP, creating new panel and not inheriting one. Onboarding lasts a few months and would consist of a much lighter work load.

When asked about the low wRVU compensation - they waffled and said that there are other incentives/quality measures to make up for it but it has been difficult to get a straight answer and I suspect that most of the physicians in the group don't make much beyond base + bonus logistically speaking and there's no minimum RVU threshold.

Instinct tells me to bail but the location would be really, really good for my kids... I should pass, right? It seems pretty easy to get taken advantage of in this type of setting even if I'm not exactly sure how the exploitation would take place haha.

 

[gutonc]

Is there ever a scenario where $72/wRVU can be justified? Hospital employed, private equity owned (ugh) on the outskirts of a major West Coast city, base $450k + $60k (negotiable) bonus + productivity after. Call 1:9 a week at a time, clinic 4 days/week with average 15 - 18 patients, other standard perks but no dedicated NP, creating new panel and not inheriting one. Onboarding lasts a few months and would consist of a much lighter work load.

When asked about the low wRVU compensation - they waffled and said that there are other incentives/quality measures to make up for it but it has been difficult to get a straight answer and I suspect that most of the physicians in the group don't make much beyond base + bonus logistically speaking and there's no minimum RVU threshold.

Instinct tells me to bail but the location would be really, really good for my kids... I should pass, right? It seems pretty easy to get taken advantage of in this type of setting even if I'm not exactly sure how the exploitation would take place haha.

Missing something here. If there's no RVU threshold or target, where does the $72/wRVU number come from?

A little quick math here using my updated assumptions:
18pts/d x4d/wk 46w x 2.2wRVU = 7300 wRVU/y. Using the 450K number, that works out to ~$62/wRVU, not $72. At $72/wRVU, you need 6250 wRVU to make your nut. I'm just trying to figure out if they even know what they're doing.

The way they've set up the pay structure seems intentionally opaque, so good job picking up on that. I'd like to see an actual productivity structure laid out in writing before signing.

That said, $450-500K for what seems like a reasonable workload in a place you want to be isn't all that bad of a gig. I'm not sure I'd pick up and move across the country for this job, but if it's already where you are or where you want to be, there are worse jobs out there.

 

[faelivrin]

Missing something here. If there's no RVU threshold or target, where does the $72/wRVU number come from?

A little quick math here using my updated assumptions:
18pts/d x4d/wk 46w x 2.2wRVU = 7300 wRVU/y. Using the 450K number, that works out to ~$62/wRVU, not $72. At $72/wRVU, you need 6250 wRVU to make your nut. I'm just trying to figure out if they even know what they're doing.

The way they've set up the pay structure seems intentionally opaque, so good job picking up on that. I'd like to see an actual productivity structure laid out in writing before signing.

That said, $450-500K for what seems like a reasonable workload in a place you want to be isn't all that bad of a gig. I'm not sure I'd pick up and move across the country for this job, but if it's already where you are or where you want to be, there are worse jobs out there.

Sorry, made a typo - there's no minimum RVU threshold for year 1 only. I will update my post once I verify the wRVUs covered by the base salary - I want to say it's in the 6200 range and that's where the $72 figure came from but I'm double checking.

Also edited to add that the 60k is an quality bonus that everybody gets - there doesn't seem to be a sign on per se.

 

[gutonc]

Sorry, made a typo - there's no minimum RVU threshold for year 1 only. I will update my post once I verify the wRVUs covered by the base salary - I want to say it's in the 6200 range and that's where the $72 figure came from but I'm double checking.

That makes a lot more sense. So for that amount of work (let's use my 6250 number), you cover your base at 15.5 pts a day. Which is a totally reasonable and sustainable workload. And if you're getting $510K for that, it's a decent gig. And if you want to work harder, seeing an average of 20 patients a day (assuming they do actually pay you for that), brings your pre-bonus base to ~$580K. So not terrible.

I would caution you to ignore the "everyone gets it" bonus when making these kinds of decisions. Focus on the money you're "guaranteed" to get based on your contract and enjoy the bonus if it actually shows up.

 

[solidonc2020]

That makes a lot more sense. So for that amount of work (let's use my 6250 number), you cover your base at 15.5 pts a day. Which is a totally reasonable and sustainable workload. And if you're getting $510K for that, it's a decent gig. And if you want to work harder, seeing an average of 20 patients a day (assuming they do actually pay you for that), brings your pre-bonus base to ~$580K. So not terrible.

I would caution you to ignore the "everyone gets it" bonus when making these kinds of decisions. Focus on the money you're "guaranteed" to get based on your contract and enjoy the bonus if it actually shows up.

I would agree that pre-bonus base of ~580k for seeing 20 patients/day and 4 days/week isn't "terrible" but it's definitely below the national market. There are lots of jobs where that volume pays ~850k+ that are still in good locations. You have to see what the other options are specifically in the location you're looking for though. If that's the best available in the area and the location is important, you're going to be making more than enough money to be happy, just not as much as you would elsewhere.

ETA: gutonc and I are saying the same thing, just adding additional perspective.

 

[gutonc]

I would agree that pre-bonus base of ~580k for seeing 20 patients/day and 4 days/week isn't "terrible" but it's definitely below the national market. There are lots of jobs where that volume pays ~850k+ that are still in good locations. You have to see what the other options are specifically in the location you're looking for though. If that's the best available in the area and the location is important, you're going to be making more than enough money to be happy, just not as much as you would elsewhere.

ETA: gutonc and I are saying the same thing, just adding additional perspective.

I can say that while that base may be below national market, for my region it's a hair above median. And since the OP says he's "outskirts of a West Coast city", we're in the same region.

I agree that there are plenty of jobs out there that will pay more for the same work. But quite a few that will pay less (which is how you get a median...MATH!) as well. So I don't think the pay itself is a dealbreaker, just the squirrely-ness of the employer in describing it.

 

[faelivrin]

I can say that while that base may be below national market, for my region it's a hair above median. And since the OP says he's "outskirts of a West Coast city", we're in the same region.

I agree that there are plenty of jobs out there that will pay more for the same work. But quite a few that will pay less (which is how you get a median...MATH!) as well. So I don't think the pay itself is a dealbreaker, just the squirrely-ness of the employer in describing it.

Thank you and to @solidonc2020 - this has given me a lot of peace of mind. I know that there's more money to be made in the Midwest and South but I have family obligations that tie me to a highly desirable HCOL area for at least a few years. I'll keep looking around but it's nice to know that this type of offer may not be pure daylight robbery and that the lack of transparency is the bigger red flag here.

In salary based positions, how are conscientious people willing to work hard screwed over? Co-workers randomly closing clinics, selecting easier consults, not seeing their own consults from the hospital, etc?

 

[faelivrin]

I would agree that pre-bonus base of ~580k for seeing 20 patients/day and 4 days/week isn't "terrible" but it's definitely below the national market. There are lots of jobs where that volume pays ~850k+ that are still in good locations. You have to see what the other options are specifically in the location you're looking for though. If that's the best available in the area and the location is important, you're going to be making more than enough money to be happy, just not as much as you would elsewhere.

ETA: gutonc and I are saying the same thing, just adding additional perspective.

Is that possible near bigger Texas cities like Dallas and Houston?

 

[gutonc]

Thank you and to @solidonc2020 - this has given me a lot of peace of mind. I know that there's more money to be made in the Midwest and South but I have family obligations that tie me to a highly desirable HCOL area for at least a few years. I'll keep looking around but it's nice to know that this type of offer may not be pure daylight robbery and that the lack of transparency is the bigger red flag here.

I don't know which "West Coast City" you're near, but I'm aware of offers in several markets that fit that description and your offer is not far from the mark for a hospital employed position.

In salary based positions, how are conscientious people willing to work hard screwed over? Co-workers randomly closing clinics, selecting easier consults, not seeing their own consults from the hospital, etc?

The biggest problem is not having a productivity incentive. If the person generating 4000 wRVUs a year is making the same money as the one generating 8000, that's a problem. When you provide a floor compensation and reward productivity, you generally get better behavior.

 

[MD46]

Is that possible near bigger Texas cities like Dallas and Houston?

I remember 6 or so years back Abilene TX with US Oncology, after partner were making 600k plus range, before that was like 300s though.

 

[solidonc2020]

Is that possible near bigger Texas cities like Dallas and Houston?

I’m sure it is with Texas Oncology. I never interviewed with them to know the details, though.

 

[whatup2016]

Midwest. Smallish town. ~250k.
Next closest with >1 mil in metro area is about an hour away.
Closest actual large city about 2-3 hrs.

500k base
100/wRVU above 5k wRVU
5% quality bonus

 

[gutonc]

Midwest. Smallish town. ~250k.
Next closest with >1 mil in metro area is about an hour away.
Closest actual large city about 2-3 hrs.

500k base
100/wRVU above 5k wRVU
5% quality bonus

Seems decent. What’s the median productivity and comp of the group currently? Are you building a new practice or taking over from a departing doc?

5k wRVU is only 12-13 patients per day. If you’re taking over a practice, you’ll make this in the first year without issue. If you’re building your own practice, it might take a year or two depending on the setting.

401k match? Call?

Overall, if the location and practice environment work for you, it’s not a bad gig

 

[whatup2016]

Seems decent. What’s the median productivity and comp of the group currently? Are you building a new practice or taking over from a departing doc?

5k wRVU is only 12-13 patients per day. If you’re taking over a practice, you’ll make this in the first year without issue. If you’re building your own practice, it might take a year or two depending on the setting.

401k match? Call?

Overall, if the location and practice environment work for you, it’s not a bad gig

Call every 7 weeks. During the week have APP assistance.
New practice but up to base at least within the first 6 months.
Match 50% of up to 6%

 

[MD46]

Midwest. Smallish town. ~250k.
Next closest with >1 mil in metro area is about an hour away.
Closest actual large city about 2-3 hrs.

500k base
100/wRVU above 5k wRVU
5% quality bonus

Pretty decent, make sure enough volume to make base at least. Can ask other colleagues

Also signon, moving allowance and vacation you can usually negotiate more than base or rvu rate.

 

[Ubba]

5k wRVU is only 12-13 patients per day. If you’re taking over a practice, you’ll make this in the first year without issue. If you’re building your own practice, it might take a year or two depending on the setting.

Question regarding the above: I've been presented options that claim to end up more or less in this ballpark if desired by the incoming physician, and for approximately the base mentioned above (assuming leadership doesn't change expectations and demands once in practice). Do most oncologists feel that this is too light a load in a sense, and that it makes sense for a grad to envision eventually seeing 18-20 ballpark, or do some find that the low-mid teens is a nice balance?

Speaking about PPs and system-employed, not academic.

Of course, depends on personal goals (retirement age, kids' college, etc.), but I'm curious especially to hear from those who at least factor QOL into career structure.

 

[gutonc]

Question regarding the above: I've been presented options that claim to end up more or less in this ballpark if desired by the incoming physician, and for approximately the base mentioned above (assuming leadership doesn't change expectations and demands once in practice). Do most oncologists feel that this is too light a load in a sense, and that it makes sense for a grad to envision eventually seeing 18-20 ballpark, or do some find that the low-mid teens is a nice balance?

Speaking about PPs and system-employed, not academic.

Of course, depends on personal goals (retirement age, kids' college, etc.), but I'm curious especially to hear from those who at least factor QOL into career structure.

I think a lot of this comes down to the culture of the institution/practice and sometimes even a particular site.

I personally have no issues with someone having QOL as a priority when choosing a job. What does bother me is when that impacts QOL of other people in the practice. If you want to only see 14-15 patients a day, I'm cool with that. But you also need to share the load of the practice in an equitable way.

 

[whatup2016]

Pretty decent, make sure enough volume to make base at least. Can ask other colleagues

Also signon, moving allowance and vacation you can usually negotiate more than base or rvu rate.

90k sign on and moving together.
40 days between PTO and CME.
+ holidays

 

[gutonc]

90k sign on and moving together.
40 days between PTO and CME.
+ holidays

That all looks pretty good. If you like the location and the other docs in the group, I'd go for it.

 

[MD46]

90k sign on and moving together.
40 days between PTO and CME.
+ holidays

Looks good. Nice amount of PTO CME
Solid Signon, make sure no more than a couple of years pay back ( means if you leave after 2yrs you keep signon)

Good luck! 👍🏼

 

[ONC2023]

Hi all

I finally have my decision down to two offers that I really like, and I think I now have all the needed details I didn't when I posted about these jobs before.

JOB 1:
Model: Hospital-employed.
Sites: One clinic. One 350-bed hospital. Both are side-by-side, so it makes my day very easy.
Specialization: Single-organ system of my choice (I can choose GI or GU or thoracic, up to me, and I like all of these). Solid tumor only.
Call: 1 in 11 weeks evenly divided between all oncologists/hematologists. If I have complex heme overnight, there's a heme attending I can always reach out to. All outpatient calls go to triage nurse first.
Compensation: pure salary + quality bonuses/incentives (closing charts, etc). The bonuses are almost always given (>95% of the time).
-- Years 1 and 2: $500K + $75K bonuses for years 1 and 2 = $575K.
-- Years 3: $600K + 90K bonuses.
-- Salary is automatically adjusted to some MGMA baseline every 2-3 years (baseline is somewhere 60-70% percentile)
Bonuses: $55K.
Retirement: They do retirement matching and their own contributions that, roughly, equally $20K a year from their end.
Schedule: 4 day work week. 1 hour new patient visits. 30 minute follow-ups.
Vacation: Total of 40 days off, which includes vacations and hospital holidays.
Tumor Boards/trials/surgery: They have virtually everything you need on site, including disease specific tumor boards, clinical trials, surgical oncologists, etc. When you need more support, there are academic sites 2 hours away in multiple directions.
Support: RN and MA in clinic. I do supervise an NP who sees follow-ups, but the NP sees patients separately from my schedule so it's more patients.
EMR: Epic, thank god.

JOB 2:
Model: Private practice.
Sites: One clinic. One 700 bed hospital. They are located 15-20 minutes or so.
Specialization: I get to pick a few organ sites of my choosing, whatever I want. Solid tumor only.
Call: 1 in 12 weeks. Divided equally between all oncologists. Overnight calls from patients go to triage nurse first.
Compensation: There are three sources.
-- pure productivity. Each RVU equal to $90. The median RVU of the physicians there is 7200, which translates to 650K. Most make 6000-9000 with one outlier above and one outlier below.
-- APP supervision: when I get busy and if I want an NP, I get some fraction of APP revenue. This is variable depending on the oncologist but is on average ~5K a month, which adds about $60K a year.
-- partnership: I become a partner year 6. There is no buy-in. You become a partner through time there. People have become partners successfully and the only things that have stopped partnership recently are egregious problems with physician behavior. They told me no plans to sell the practice.
-- overall, if I make assumptions, once you ramp up year 2-3, comp = 650K (from RVUs) + $60K from APP supervision = $710K. Partnership profit is variable and can be low 6 figures (100K or so).
Base: There is some base around $350K which translates to approximately 3900 RVUs for the first two years.
Retirement: They do retirement matching and their own contributions. Probably a bit less than job 1.
Schedule: 4.5 day work week.
Vacation: Total of 37 days off, which includes vacations and hospital holidays. Vacation same for everyone there, and it increases over time as you're there (they add 2 days every 2 years to vacation)
Tumor Boards/trials/surgery: They have trials but I have to work with pathologists, surgery, etc at the local hospital and not part of the clinic of course. It's not an integrated health system like above.
Support: RN and MA and then get NP when busy enough.
EMR: Not EPIC, unfortunately. The hospital has Cerner I believe.

If I assume I make between 6000-7500 RVUs per year, that comes out to 540K to 675K. This does not include possible APP supervision, which I am reluctant to make assumptions about, but can add $60K a year. The big thing is that I am not including revenue sharing starting year 6, which seems like a risky thing to assume is guaranteed.

I really like the safety of job 1 (clear salary, with increase based on MGMA guaranteed every 2 years and built into contract), but I do love the idea of becoming a partner. I feel very lucky to have both of these options, and would love any thoughts.

 

[solidonc2020]

Hi all

I finally have my decision down to two offers that I really like, and I think I now have all the needed details I didn't when I posted about these jobs before.

JOB 1:
Model: Hospital-employed.
Sites: One clinic. One 350-bed hospital. Both are side-by-side, so it makes my day very easy.
Specialization: Single-organ system of my choice (I can choose GI or GU or thoracic, up to me, and I like all of these). Solid tumor only.
Call: 1 in 11 weeks evenly divided between all oncologists/hematologists. If I have complex heme overnight, there's a heme attending I can always reach out to. All outpatient calls go to triage nurse first.
Compensation: pure salary + quality bonuses/incentives (closing charts, etc). The bonuses are almost always given (>95% of the time).
-- Years 1 and 2: $500K + $75K bonuses for years 1 and 2 = $575K.
-- Years 3: $600K + 90K bonuses.
-- Salary is automatically adjusted to some MGMA baseline every 2-3 years (baseline is somewhere 60-70% percentile)
Bonuses: $55K.
Retirement: They do retirement matching and their own contributions that, roughly, equally $20K a year from their end.
Schedule: 4 day work week. 1 hour new patient visits. 30 minute follow-ups.
Vacation: Total of 40 days off, which includes vacations and hospital holidays.
Tumor Boards/trials/surgery: They have virtually everything you need on site, including disease specific tumor boards, clinical trials, surgical oncologists, etc. When you need more support, there are academic sites 2 hours away in multiple directions.
Support: RN and MA in clinic. I do supervise an NP who sees follow-ups, but the NP sees patients separately from my schedule so it's more patients.
EMR: Epic, thank god.

JOB 2:
Model: Private practice.
Sites: One clinic. One 700 bed hospital. They are located 15-20 minutes or so.
Specialization: I get to pick a few organ sites of my choosing, whatever I want. Solid tumor only.
Call: 1 in 12 weeks. Divided equally between all oncologists. Overnight calls from patients go to triage nurse first.
Compensation: There are three sources.
-- pure productivity. Each RVU equal to $90. The median RVU of the physicians there is 7200, which translates to 650K. Most make 6000-9000 with one outlier above and one outlier below.
-- APP supervision: when I get busy and if I want an NP, I get some fraction of APP revenue. This is variable depending on the oncologist but is on average ~5K a month, which adds about $60K a year.
-- partnership: I become a partner year 6. There is no buy-in. You become a partner through time there. People have become partners successfully and the only things that have stopped partnership recently are egregious problems with physician behavior. They told me no plans to sell the practice.
-- overall, if I make assumptions, once you ramp up year 2-3, comp = 650K (from RVUs) + $60K from APP supervision = $710K. Partnership profit is variable and can be low 6 figures (100K or so).
Base: There is some base around $350K which translates to approximately 3900 RVUs for the first two years.
Retirement: They do retirement matching and their own contributions. Probably a bit less than job 1.
Schedule: 4.5 day work week.
Vacation: Total of 37 days off, which includes vacations and hospital holidays. Vacation same for everyone there, and it increases over time as you're there (they add 2 days every 2 years to vacation)
Tumor Boards/trials/surgery: They have trials but I have to work with pathologists, surgery, etc at the local hospital and not part of the clinic of course. It's not an integrated health system like above.
Support: RN and MA and then get NP when busy enough.
EMR: Not EPIC, unfortunately. The hospital has Cerner I believe.

If I assume I make between 6000-7500 RVUs per year, that comes out to 540K to 675K. This does not include possible APP supervision, which I am reluctant to make assumptions about, but can add $60K a year. The big thing is that I am not including revenue sharing starting year 6, which seems like a risky thing to assume is guaranteed.

I really like the safety of job 1 (clear salary, with increase based on MGMA guaranteed every 2 years and built into contract), but I do love the idea of becoming a partner. I feel very lucky to have both of these options, and would love any thoughts.

Nice job getting pretty much all the details and comparing the two. Here are the major differences I see.

- Hospital employed vs private practice. Are you someone who wants to be a business owner who has more control over the whole operation but has to also deal with more administrative headaches? Would you rather go to work, do your job, collect your paycheck, and not deal with hiring/firing, budgets, possible buyouts, reimbursement challenges, etc? Are you okay with being a little more "on your own" in terms of not being in a big system with the support and integration that offers? There's a huge distinction between the two and I think most people either get excited about stepping into a business like that or get anxious about the added responsibility on top of being a clinician. Not sure which is you.
- The employed job doesn't offer productivity bonus, so your income is capped to a degree. However, the compensation isn't bad overall and you'll make more there most likely over the first few years compared to the other while you ramp up. Are they going to push you to start double booking? Seeing all of the APP patients? There's some risk in getting overworked relative to pay compared to "eat what you kill" with the private group.
- Do you want to be an expert in one field, or like the idea of a little more variety?
- What are the locations of each? If they're not in the same city, where would you rather live?
- I wouldn't discount the fact that the first is 4 days vs 4.5 days. 4.5 days is really 5 days.

I think one way to look at this as well is what are the chances you leave either job in the next 3 years? If there's a >50% chance you'll leave within 3 years, you were better off taking the hospital employed job, with the caveat that you are now a single organ disease specialist who may be a little more limited in terms of the next job. The private group offers some long-term payoff if it works out that you stay 6+ years. Will you feel trapped trying to eventually get to partner?

I would probably end up choosing based off geography, gut feel for the group, and whether I wanted to be part of a small business or not. Good luck.

 

[RustBeltOnc]

Both are mediocre in regards to effort/dollar ratio. Option one is somewhat better. Sinking six years into any private practice starting 2024 in hope of a future pay off is not such great idea.

 

[ShuperNewbie]

Agreed. Most of the partnership tracks I've seen are 2-4 years. Six seems a little superfluous

 

[ONC2023]

Thank you all.

- Hospital employed vs private practice. Are you someone who wants to be a business owner who has more control over the whole operation but has to also deal with more administrative headaches? Would you rather go to work, do your job, collect your paycheck, and not deal with hiring/firing, budgets, possible buyouts, reimbursement challenges, etc? Are you okay with being a little more "on your own" in terms of not being in a big system with the support and integration that offers? There's a huge distinction between the two and I think most people either get excited about stepping into a business like that or get anxious about the added responsibility on top of being a clinician. Not sure which is you.

I would probably end up choosing based off geography, gut feel for the group, and whether I wanted to be part of a small business or not.

Yes, this resonates with me - beyond the specifics of compensation, I'm deciding if I want to be in private practice. If I felt confident I could consistently break my hospital employed salary at PP, I think I would choose PP. And compensation excluded, the location of both places is equal to me.

Both are mediocre in regards to effort/dollar ratio. Option one is somewhat better. Sinking six years into any private practice starting 2024 in hope of a future pay off is not such great idea.

Agreed. Most of the partnership tracks I've seen are 2-4 years. Six seems a little superfluous

Oh that's helpful. Does it change your opinions at all that there's no buy-in: I become a revenue-sharing partner by virtue of being there for five years. I don't have to buy into the practice.

As for the hospital job, I thought the pay was great at $690K at year 3! Maybe the academic salaries of NYC have skewed my vision of what's good.

 

[RustBeltOnc]

Both jobs are pretty lame. #1 is less lame. "Adjusted to MGMA" means, we will try to not pay you.
And no, you won't be truly "specializing" and will have to hustle to prioritize access.

And you will be seeing hem, in some context, some of the time.

 

[HemOncCheng]

Both jobs are pretty lame. #1 is less lame. "Adjusted to MGMA" means, we will try to not pay you.
And no, you won't be truly "specializing" and will have to hustle to prioritize access.

And you will be seeing hem, in some context, some of the time.

what will be a not so lame offer? RUV based with base either way, Just want to know if you can share a hypothetical example.

 

[gutonc]

Both jobs are pretty lame. #1 is less lame. "Adjusted to MGMA" means, we will try to not pay you.
And no, you won't be truly "specializing" and will have to hustle to prioritize access.

And you will be seeing hem, in some context, some of the time.

Not knowing what the location is, I don't think that Job 1 is lame at all. Employed, guaranteed salary with pretty low workload and bonuses that get you close to $700K? Unless the location is horrible, sign me up.

Now, Job #2 seems pretty weaksauce. Any PP job that is fully production based should start where this one seems to top out and go up from there pretty easily. $1M a year should not be that hard to get to in a job like this. Seems like it might be harder than it should be and someone's skimming (or you're not getting all the information you seem to have).

To @ONC2023, the big question is, which are you more concerned about? The floor or the ceiling? Job #1 has a pretty high floor but a low ceiling. Job #2 has a very low floor, but the potential for a higher ceiling. Which one are you more concerned about?

FWIW, when I do some quick math on Job #1 (46 weeks x 4d/wk x14 patients a day x 2.2wRVU/encounter), I get <6000wRVU. Round the comp to $600K and you're getting over $100/wRVU in that job.

I also think it's important to recognize the marginal utility of an extra $100K when going from 600-700 (compared to 50-100 for instance) and how hard you will have to work for that difference. Also...arguing about compensation at these levels is a 0.1% problem.