Advertisement - Members don't see this ad
For an employed position, I would have every factor imaginable specified in the contract. PTO and max call frequency without question.
Heme/Onc Job Offer Discussion
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
For an employed position, I would have every factor imaginable specified in the contract. PTO and max call frequency without question.
So...rural.
Not bad. What are the current wRVU targets and $/wRVU? What is the current median productivity for the group?
And after year 2? Or is this a one time thing?
Holy balls that's a lot.
How many inpatients and how many hospitals are covered? Call should be 1:# Docs. This can vary over time so it's fine if it's not spelled out beyond that. But if there are 8 docs in the group and you're being asked to cover call 1:4, F*** that.
6 weeks is pretty typical for employed. If you think 20 days and 4 days a week of clinic, that's 5 weeks. Definitely get clarity on this from the Business/Ops/Admin director. If you're asking the different docs and not that person, I'm not surprised you got multiple different answers.
Reasonable.
Super low workload. Is this typical for all the docs or just what they're expecting for you to start out at?
There's an out in every contract, don't get hung up on this. And I'm guessing that after 2 years it becomes annual and pretty much "at will".
Honestly not even worth worrying about. If things go sideways, you can get out of this if you need to.
As I mentioned above, PTO should be clearly laid out. Call can vary based on staffing so I'm not surprised it's not spelled out more formally. In my prior position, our contracts said something to the effect of "call is distributed equitably based on the number of physicians in the group. At the time of this contract offer, that number is X, which amounts to Y weeknight and Z weekend calls annually, however the number of physicians in the group may vary over time, changing the frequency of call." In the 11 years I was there, the best it ever got was 1:16, the worst was 1:10. You can see how if the contract said "1:10", but they hired 5 more docs, that would really suck for you, since they could just say "sorry, your call is contracted at 1:10". Again, if there are a bunch of docs in the group that aren't in the call pool, that's a big red flag. But if everyone's in the call pool equitably, you'll have to make do with what there is. If you don't want to do 1:4 (or 1:3 if somebody goes on leave or quits), then join a bigger group.
Agree with most of what GutOnc said.
You usually won't find a group that will promise you 1:X call for the reasons stated. What you do want to avoid (IMO) is joining a group where call is not equally distributed amongst all the docs.
For example in this rural area that is hard to recruit to (the base salary and signing bonus confirms this), you might have an older doc approach management and say "look I am tired of taking call either take me off the call list, reduce it by X or I am going to retire" and then they may take that doc off the call schedule and have you pick up the slack. Another situation might be the head of the group is only 80% clinical / 20% admin so he/she decides they will only do 80% of the call frequency of everybody else, it's up to you whether you think that is "fair" (I probably wouldn't). Now if someone is only part time say .5 FTE then it might make sense for them to take .5 the call of everybody else but that is different IMO.
Regarding the PTO, that should also be mentioned in your contract or at least given to you in writing in a benefits packet for example. One important factor that may explain the discrepancy is that most hospital systems will say "we give XYZ weeks PTO" but then Christmas, New Years, Thanksgiving, Labor Day/Memorial Day etc. all count as "mandatory PTO days" so that reduces the actual number of PTO days you can take whenever you want them. The most comical packet I received once was "we give everyone XYZ PTO days*" and then at the bottom of the page "*Hospitalists do not get PTO"
You also didn't mention the RVU targets or $/RVU, I would assume it is >$90-95/RVU but if it is not that is also a red flag.
Advertisement - Members don't see this ad
job offer isn't very good. Money is mediocre, location is mediocre, we don't know the wrvu rate/threshold, and the uncertainty about call is unacceptable.
you write the "organization is excellent" but it's not excellent if they don't know that in 2024, you need to have this call thing worked out, certainly in community hem onc.
Don't take this job.
you write the "organization is excellent" but it's not excellent if they don't know that in 2024, you need to have this call thing worked out, certainly in community hem onc.
Don't take this job.
RE noncompete, how does one get out of it? Just curious
I have a similar noncompete, a friend of mine had to pay 1 year salary for "violating" (spurious logic, he was shafted) his noncompete
Did your friend give outright give away trade secrets? Use a "buy 2 hours, get the 3rd free" lawyer?
Question re: private practice. The group I am joining, which owns ancillary services, told me that my salary was RVU based including percentage of APP RVU's. They gave me super detailed info on the RVU part, including median RVUs, $/RVU, etc. Several of the attendings also explicitly told me their compensation last year, so they were very transparent in that regard.
They also mentioned - without much detail - that within the limits of Stark laws there is something based on ancillary service; however, this was the most nebulous part of the entire compensation plan. It seems like this is not limited to partners and all associates, including newly-hired ones, get this.
Can I ask if anyone has seen examples of how this works in reality?
They also mentioned - without much detail - that within the limits of Stark laws there is something based on ancillary service; however, this was the most nebulous part of the entire compensation plan. It seems like this is not limited to partners and all associates, including newly-hired ones, get this.
Can I ask if anyone has seen examples of how this works in reality?
I think this is what you're asking about, I AM NOT A LAWYER, but general conceptual example based on my understanding:
You can't get paid $XYZ bonus based on the # of PET/CTs you personally order (anti-kickback)
You can get paid a % of the total profits from imaging (+ other ancillaries) ordered by ALL physicians, possibly scaled relative to the RVUs you generated seeing patients (so in theory a doc who sees more patients will order more imaging but it isn't directly related to ordering the scans) but NOT scaled to the relative amount of imaging studies you ordered.
(Alternatively in theory working directly for a hospital system, they would charge 2-3x for said PET/CT what your private group will be able to negotiate, and then bake some of that money into the $/RVU structure while pumping most of it into the system)
I am not.
Happens all the time. If I have one spot open and 4 people interview for it, I can only offer one of them a job.
part of total recruitment cost to the employer.
I’d like to collect some thoughts on a job offer. Northeast major city suburb, 580k guarantee for year 1-2, 400k guarantee for year 3 and beyond. $90 per wRVU. $7 in each wRVU APP generates. Call 1:7. One office and hospital location. 4 days a week. Thank you
These numbers are decent-ish compared to the job offers I’ve gotten out in the Midwest. But the questions I’d have are:
1) How many patients a day do you have to see to make your base? Is it $90 per RVU for all patients below and above the base?
2) What are the physicians in the group currently making once their base drops in year 3? A base of $400 is very low for full time hospital employed, so I would want to make sure I can rise above it easily.
3) Also what’s the signing bonus?
I’d love to hear what people think about the $90/RVU. That seems to be the lowest base that’s acceptable. I had one place offer $77, and I gave an immediate no.
1). $90 per wRVU below and above the minimum floor salary. The more you see, the more you make.
2). I don’t know how much more they make, but they keep telling me that they have more referrals than they can handle. Won’t be a problem to build up the practice
3). 50k sign on bonus and relocation assistance
At a 580000 base at $90/RVU, that’s 6444 RVU’s to make that base. At 2.4 RVU’s per visit over 46 weeks with 4 days per week, that’s 14.6 patients a day for 4 days a week, which seems pretty good.
My one criticism of the offer is that is basically identical to my private practice job offer except my offer has equity buy in (no cash, just time in the practice). This is the perennial hospital vs PP dilemma - and maybe you have no interest in PP - but if I was going to a hospital employed position, I’d want something to make up for the absence of eventual ownership like a higher $/RVU, more support in clinic, better EMR, less call, higher bonus, more subspecialization, etc. (I do have a lower base than you, but it’s easy enough to hit $580K at $90/RVU).
Is support in clinic/the EMR good? Do you take first call on overnight patient calls or is there a nurse triage?
My one criticism of the offer is that is basically identical to my private practice job offer except my offer has equity buy in (no cash, just time in the practice). This is the perennial hospital vs PP dilemma - and maybe you have no interest in PP - but if I was going to a hospital employed position, I’d want something to make up for the absence of eventual ownership like a higher $/RVU, more support in clinic, better EMR, less call, higher bonus, more subspecialization, etc. (I do have a lower base than you, but it’s easy enough to hit $580K at $90/RVU).
Is support in clinic/the EMR good? Do you take first call on overnight patient calls or is there a nurse triage?
Advertisement - Members don't see this ad
for New England area, what’s the average dollar value for each wRVU? Maybe I can negotiate something over $90/wRVU
You’re not gonna be able to negotiate that number as a new hire to be honest, it’s something your group as a collective unit would need to negotiate.
Alright guys, want to run this gig by the group for a new fellowship grad.
Mid atlantic urban area
Private practice, 3 year partnership track. 4 partners total. Partners each made 700-800k over the last 5 years, split profits equally. Good relationship with the hospital system in which they work, recently renewed a 10 year lease. Im assured there are no plans to sell.
2-3 new patients per day, 12 follow ups. 3.5 clinic days, 0.5 hospital day. 1 admin day. Split weekend call equally, average 2 or so consults per day on weekends. 5 weeks PTO, 5 sick days. Good benefits with 401k match. 2 NPs and triage RNs.
salary fixed 325k first year, 350k second year, 375k third year. Partner thereafter, pro rata buy in over a few years (though salary still expected to increase from starting base). All current partners have been there since graduating fellowship. 2 other people have tried, 1 was let go (apparently was "not a good fit" and the other took a gig across town closer to home, though they wanted to make him partner)
Non-compete present, but inconsequential (limited to a geographic distance that wouldnt affect future employment opportunities).
Thoughts?
Mid atlantic urban area
Private practice, 3 year partnership track. 4 partners total. Partners each made 700-800k over the last 5 years, split profits equally. Good relationship with the hospital system in which they work, recently renewed a 10 year lease. Im assured there are no plans to sell.
2-3 new patients per day, 12 follow ups. 3.5 clinic days, 0.5 hospital day. 1 admin day. Split weekend call equally, average 2 or so consults per day on weekends. 5 weeks PTO, 5 sick days. Good benefits with 401k match. 2 NPs and triage RNs.
salary fixed 325k first year, 350k second year, 375k third year. Partner thereafter, pro rata buy in over a few years (though salary still expected to increase from starting base). All current partners have been there since graduating fellowship. 2 other people have tried, 1 was let go (apparently was "not a good fit" and the other took a gig across town closer to home, though they wanted to make him partner)
Non-compete present, but inconsequential (limited to a geographic distance that wouldnt affect future employment opportunities).
Thoughts?
Last edited:
For New England area I think it is acceptable. Depends on the city, if good schools, close to major metro or a suburb of major metro, easy airport access then very fair.
This would be unacceptable for midwest.
Also, $7/wRVU for APP is too low. Should be higher but that may be difficult to get. That's essentially the price of your license shared by APP which generates revenue for the hospital.
I either would have 20-30% $/wRVU or not have APP supervision at all.
I know of many places which pay fixed APP stipend of about 40-50K per year.
I know of PCPs who have APP supervision stipends of 20K per year.
So yes, that is a very poor offer for APP supervision.
Brief thoughts:
I don't necessarily think this group is terrible/malignant but it comes off more as a "hey this is how we've been doing things for the past 10-20 years and we don't see a reason to change with the times"
Pros: 700-800k for 3.5 clinic days / 0.5 hospital days and 15 patients per day is probably fair
Cons: Basically everything else...
- 3 year partner track (should be 2 years at most, I bet in a decade will be all 1 year tracks if PP still exists)
- 325k/350k/375k track is terrible
- What are you paying a buy-in for when you've already paid in a ton over the above 3 years? You mentioned they recently "renewed a lease" so what exactly do they own that you will be purchasing a share of?
- Q4 call not my cup of tea unless the money is great
- If the non-compete is inconsequential then there isn't any reason for it to exist in the first place
I concur with your thoughts.
Why do they do 3.5 days of clinic only with PP?
If you own a PP then you need to maximize revenue and minimize the cost.
What happens to the place when the partner is not working? Is it just empty office for 2.5 days per week or it's shared?
I think it is very inefficient from business standpoint.
QOL is good but ultimately, you don't hit 7 figures working in PP and still have 3 year track for partnership and then still prorata increase? I am confused. What is the point of getting paid so little if the ceiling is going to be 700-800K?
If location desirable, numbers work out, get good feeling from the group. then go for it.
May I clarify something here?
1) does this mean you get no RVU bonus structure above this base?
2) And you are still expected to buy in the group?
This has two huge red flags for me. First, you’re going to be making academic level salaries for three years. Second, you’re going to lose out on three years of earnings potential AND then STILL have to buy into the practice.
My private practice offer has base with RVU structure and buy in through time in the practice (no cash buy in). It’s not in a traditionally desirable part of the country, but non-partners are making 700-800K.
This job would be a pass for me unless I’m missing something.
I mean I would be perfectly fine making $800k seeing 15 patients working 4 days a week (they’re probably seeing more than 15 but what do I know)
I don’t think just because you’re a PP group you should automatically have to work 5 days a week seeing 30 patients a day… groups that stay that way are going to have trouble finding new partners from the younger generations.
I actually think this will be a decent niche for PP groups moving forward where you don’t have to work yourself to the bone and still make good money, the bigger upside is not having a hospital nurse manager tell you how to do your job.
Last edited:
I know the inside deets of pretty much every practice in the mid Atlantic. If you want to DM me which practice this is, I'm happy to share what I know.
The fact that there were 2 prior employees who did not make partner is a full on red flag. No need to look any further than that and whatever reason they give you is baloney.
The private practice im with is 3yr partnership track, similar base as above (slightly higher) and have a buy-in at the end of 3 years.
The differences are our group owns the building they're in and all of the infusion/lab/etc. Also everyone including partners are seeing 25/day 5 days a week. And the ceiling is well over $1 million
Are the profits something on top of the $800K?
for estimation, how much wRVU nowadays per patient visit?
I think with current numbers and the G2211 modifier, 2.4 is reasonable for a generalist practice. Going to be lower for benign heme and higher for BMT/Cellular Therapy jobs.
Questions regarding private practice: has anyone heard of a distinction between the group practice and the real estate holdings affiliated with the practice? The practice I’m joining has a contract that references both the group practice and a separate company that owns the real estate. The owners of the first are not the same as the owners of the second.
Usually in these situations the older partners own the real estate and rent it out to the group.
Often they won’t offer a path to real estate ownership (which in my mind means unequal partnership) nowadays which I’m not a big fan of.
You should absolutely ask about this situation and it’s a bit suspect that they didn’t volunteer it IMO, but I always ask so I don’t know if people would have volunteered it to me otherwise.
Advertisement - Members don't see this ad
I joined a private practice that has separate buy-in for the practice and then separate buy-in for the real-estate. This is on top of a 3 year sweat equity as employee. They volunteered this information to me when I asked about partnership. I was told the real estate buy-in is a no-brainer but I will likely require a bank loan for the upfront cost. The practice buy-in on the other hand, is less than 100k and more reasonable.
So you have a 3 year sweat equity
Then you buy into the practice (which owns what? CT scanners?)
AND you buy into the building for 6-7 figures?!
Yep, sounds really terrible on paper. But I did my research and believe things will work out in the long run. Nobody has ever been denied partner and there are people ahead of me who should make partner and a new hire after me.
Buy-in is for the furniture/infusion chairs, dispensary from what I'm told.
The real estate partners own the entire building. Hopefully it's not 7 figure buy-in but could be high 6 figure. Regardless, I'm told I'll need a bank loan for this.
Hey all -
Can I get some input on whether this RVU set up seems reasonable for a pure productivity based job: flat $90/RVU (same for all physicians, both partners and non-partners).
Doing some GutOnc math, if I see 17 patients a day for 4 days a week at 2.4 RVU/patient for 46 weeks a year, that’s $675000.
Putting aside all other issues like partnership, APP supervision, call, etc - is this reasonable compensation for 17 patients a day, 4 clinic days with 6 weeks vacation a year?
$90/RVU does seem low but it’s a pretty low cost area. They’re renegotiating the RVU with insurance right now.
Can I get some input on whether this RVU set up seems reasonable for a pure productivity based job: flat $90/RVU (same for all physicians, both partners and non-partners).
Doing some GutOnc math, if I see 17 patients a day for 4 days a week at 2.4 RVU/patient for 46 weeks a year, that’s $675000.
Putting aside all other issues like partnership, APP supervision, call, etc - is this reasonable compensation for 17 patients a day, 4 clinic days with 6 weeks vacation a year?
$90/RVU does seem low but it’s a pretty low cost area. They’re renegotiating the RVU with insurance right now.
Yes, if you can make >500k even before partnership, that is generally a very good gig.
You don’t renegotiate the $/RVU with insurance you renegotiate it with your employer. If this is PP it makes no sense.
Either you are confused or someone is blowing smoke up your butt.
Also, no, $90/RVU is not reasonable compensation in 2024 IMO. Especially if partners are making the same (what is the point of making partner)? It COULD be reasonable… depending on all those factors that you said to put aside.
Also I think GutOnc’s math may not apply to PP but he could correct me. I believe in PP you cannot add the G2211 mod if you are giving chemo on the same day, whereas in hospital employed practice you can?
Last edited:
In private practice, we don't go by RVU. Compensation is based on medical billing and drug margin, then add ancillary stuff like lab, imaging, research, etc. As an employee in pp, you generally don't get paid via production only. You're likely to get a set salary and maybe a production bonus.
I believe that is true, but can't confirm since I'm in an employed position. Without the G2211 and on 2023 CMS values, I would use 2.2 wRVU/pt as my number.
Would be interested in getting an opinion on a medical oncology following offer.
Location: Coast town in NE, non-metro but desirable location
Hospital employed with a base salary of $375k for 4000 RVU. The compensation over RVU target is $73. 4 day work week.
This seems low to me but it is in a location I am interested in with limited other options in the surrounding area.
Appreciate any insight!
Location: Coast town in NE, non-metro but desirable location
Hospital employed with a base salary of $375k for 4000 RVU. The compensation over RVU target is $73. 4 day work week.
This seems low to me but it is in a location I am interested in with limited other options in the surrounding area.
Appreciate any insight!
If NE is Northeast and by that you mean NY/Bos/Philly metro areas, then probably about as good as you're going to get in an employed position.
If NE is New England and it's NOT Boston metro, that's not great. Or even good.
If NE is Nebraska, you're getting totally ****ed.
Also, they're basically charging you $93.75/wRVU for your base but then only paying you 78% of that amount for any additional work you do. That's complete crap.
Thank you!
It’s Northeast but not metro area. It felt like a fairly poor offer but I appreciate the confirmation.
What kinds of compensation can you expect in the NY/NJ/PA area for employed roles?
Academic 250-300. Hybrid/community 325-400
To be more specific, community with ~8000 wRVU.
Trying to figure out how much of a paycut i should expect if I moved from where I’m at right now (mid-size rural city in Midwest, closest city is about 1 hr but closest large international airport is 2-3 yrs).
Would need more specifics but feel like if you make a per rvu incentive that would net you around 500k. Maybe more
Advertisement - Members don't see this ad
If INTL airport is what you care about I would look in an hour radius around Atlanta or Dallas rather than NYC
Community practice, small town Midwest. 2 hours from international airport. $500k base. Productivity pay beyond 5000 wRVUs at $100/wRVU. 5 days CME, 30 days vacay. Can expect to see 15-18 pts per day. 4.5 days a week. Call is shared and so 1:3 but told is relatively light. Is this on par with the compensation for HemOnc these days or low?
So considering your vacation time, you see 18 patients a day which brings to average productivity of 9K wRVUs per year = 900K. That’s reasonable I think. You can try to negotiate initial base up to 600-650, that would give you some extra income for first 2 years until you build your practice. TBH - 4.5 days per week is not really 4.5 days per week. They end up being 5 days a week. Try to negotiate 4 days a week only and you choose to work the 5th day.
Otherwise, just pure productivity base, it’s decent. Look at how much your partners work, what is your control over your schedule.
Otherwise, just pure productivity base, it’s decent. Look at how much your partners work, what is your control over your schedule.
1:3 call is pretty brutal IMO - what does your clinic look like when you're on call?
The pay/RVU is reasonable.
The pay/RVU is reasonable.
Full clinic when on call. The other physicians say they get around 3-4 consults on average the entire week they are on call.
