Heme/Onc Job Offer Discussion

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Interested to hear about inpatient coverage models others see in current positions. Are most positions now consulting only without primary inpatient coverage of patients? Do solid tumor primary services exist outside of academic centers and is there any benefit to having these primary services? Our institution has a primary oncology service and trying to understand if this is a viable model. It is very complex and burdensome on outpatient oncologists to staff even part time and every weekend / after hours when there is no hospitalist coverage.
 
guildsman said:
Interested to hear about inpatient coverage models others see in current positions. Are most positions now consulting only without primary inpatient coverage of patients? Do solid tumor primary services exist outside of academic centers and is there any benefit to having these primary services? Our institution has a primary oncology service and trying to understand if this is a viable model. It is very complex and burdensome on outpatient oncologists to staff even part time and every weekend / after hours when there is no hospitalist coverage.
Click to expand...
Primary service sounds like a nightmare. I can only imagine it if you had 24/7 fellow (or midlevel) coverage, or in niche settings like BMT of course which also typically come with that extra coverage.
 
guildsman said:
Interested to hear about inpatient coverage models others see in current positions. Are most positions now consulting only without primary inpatient coverage of patients? Do solid tumor primary services exist outside of academic centers and is there any benefit to having these primary services? Our institution has a primary oncology service and trying to understand if this is a viable model. It is very complex and burdensome on outpatient oncologists to staff even part time and every weekend / after hours when there is no hospitalist coverage.
Click to expand...
IMO it's not really a sustainable model for solid tumor, but that doesn't mean people don't try it.

In order to make it financially viable (from the physician comp side), you need to have a service that generates 120-150 wRVU weekly at a minimum. That's in the neighborhood of 60-70 patient encounters weekly. But that's only if you expect one person to cover 24/7. If you're going to pay 2 people to cover an inpatient service so that you can provide 24h inpatient coverage, double that number. Outside of major academic cancer centers I'm not sure how many hospitals are seeing 120-150 legitimate inpatient solid tumor patient encounters weekly. If you're turfing your night coverage to the hospitalists anyway, just have them cover the days too and consult as appropriate.
 
guildsman said:
Interested to hear about inpatient coverage models others see in current positions. Are most positions now consulting only without primary inpatient coverage of patients? Do solid tumor primary services exist outside of academic centers and is there any benefit to having these primary services? Our institution has a primary oncology service and trying to understand if this is a viable model. It is very complex and burdensome on outpatient oncologists to staff even part time and every weekend / after hours when there is no hospitalist coverage.
Click to expand...
The inpatient solid tumor 'primary' service is obsolete in community practices. Inpatient care and more importantly care coordination has become too complex.
New grads will run away if there is an inpatient 'primary' service.
Hospitalists can do majority of things.
Most places have only consult service.
It's a recipe for burnout imo.

gutonc said:
IMO it's not really a sustainable model for solid tumor, but that doesn't mean people don't try it.

In order to make it financially viable (from the physician comp side), you need to have a service that generates 120-150 wRVU weekly at a minimum. That's in the neighborhood of 60-70 patient encounters weekly. But that's only if you expect one person to cover 24/7. If you're going to pay 2 people to cover an inpatient service so that you can provide 24h inpatient coverage, double that number. Outside of major academic cancer centers I'm not sure how many hospitals are seeing 120-150 legitimate inpatient solid tumor patient encounters weekly. If you're turfing your night coverage to the hospitalists anyway, just have them cover the days too and consult as appropriate.
Click to expand...
Absolutely agree.
We have 5 days straight 24 hrs coverage. Busy hospital so about 4-7 consults per day, 10-15 follow ups per day. Both heme and onc. APPs help with inpatient work.
 
When I was a fellow we managed inpatient solid tumor services as primary.

As an attending, never again. Unless you're in academics don't take a job with that, it's a recipe for burnout.
 
Plutarch02 said:
When I was a fellow we managed inpatient solid tumor services as primary.

As an attending, never again. Unless you're in academics don't take a job with that, it's a recipe for burnout.
Click to expand...
Most of us did as fellows. Which is why we won't ever do it as attendings.
 
employed setting, what is the average wRVU per patient? (typical setting of general practice). I have been following this forum for a while, I see anywhere between 2 to 2.4 wRUV. Below is the compensation part of an offer (initial one) I received. This is 5 days per week schedule, 20 patients per day with 4-5 new patients among them. Welcome any comments. Too low or average or anything else?
base is 500K, guarantee
anything above guarantee in dollar amount in a true-up
Avg wRVUs per New Patient Visit 2.81
Value of each wRVU for new patient $166.72
Avg wRVUs per Follow-Up Visit 1.93
Value of each wRVU for follow-up $45.00

I calculate 4 new patients and 16 follow up on daily basis (5 days per week and 46 weeks per year) = 2585 + 7100= 9685 wRVU per year.
 
Hi everyone! Hoping for some feedback on a Job offer, I personally think it sounds good but this is the first contract I've been offered so would appreciate some advice from those with more experience.

3 year contract that automatically renews, adjustments made every 2-3 years to maintain market competitiveness

Base salary: 465k
Target RVU: ~5000
productivity: $90/RVU over Target
Quality incentive that can be upwards of $50k/yr in bonuses (with quality incentive, average $/RVU is estimated to go up to 106 from 90)

Incentives:
25k signing bonus at start
25k/yr x 4 years student loan repayment
4k/yr CME

With incentives and salary/RVU bonus, estimated year 1 pay is around $600k and estimated to be around 800k within a few years

Gig:
-A Location i want to be in
-hospital employed
-4 to 4.5 days/wk in clinic, average 18 patients per day. docs here seem very happy
-1 in 6 week hospital call, 2 docs on inpatient service at a time, alternating every other night call during that week. hospital is attached to clinic
-all on site support services including pharmacy, navigators, etc. and they are currently hiring more mid-level support
-36 days vacation/sick days per year

1 year non-compete clause.

Again, I think this sounds like a fantastic offer but really just wanted to ask if there's anything else I should be looking for or concerned about here.
 
folfoxizalamableucel said:
Hi everyone! Hoping for some feedback on a Job offer, I personally think it sounds good but this is the first contract I've been offered so would appreciate some advice from those with more experience.

3 year contract that automatically renews, adjustments made every 2-3 years to maintain market competitiveness

Base salary: 465k
Target RVU: ~5000
productivity: $90/RVU over Target
Quality incentive that can be upwards of $50k/yr in bonuses (with quality incentive, average $/RVU is estimated to go up to 106 from 90)

Incentives:
25k signing bonus at start
25k/yr x 4 years student loan repayment
4k/yr CME

With incentives and salary/RVU bonus, estimated year 1 pay is around $600k and estimated to be around 800k within a few years

Gig:
-A Location i want to be in
-hospital employed
-4 to 4.5 days/wk in clinic, average 18 patients per day. docs here seem very happy
-1 in 6 week hospital call, 2 docs on inpatient service at a time, alternating every other night call during that week. hospital is attached to clinic
-all on site support services including pharmacy, navigators, etc. and they are currently hiring more mid-level support
-36 days vacation/sick days per year

1 year non-compete clause.

Again, I think this sounds like a fantastic offer but really just wanted to ask if there's anything else I should be looking for or concerned about here.
Click to expand...
Aside from the non-compete, it seems pretty decent to me. And if it's in a place you want to live, I'd go for it.
 
HemOncCheng said:
employed setting, what is the average wRVU per patient? (typical setting of general practice). I have been following this forum for a while, I see anywhere between 2 to 2.4 wRUV. Below is the compensation part of an offer (initial one) I received. This is 5 days per week schedule, 20 patients per day with 4-5 new patients among them. Welcome any comments. Too low or average or anything else?
base is 500K, guarantee
anything above guarantee in dollar amount in a true-up
Avg wRVUs per New Patient Visit 2.81
Value of each wRVU for new patient $166.72
Avg wRVUs per Follow-Up Visit 1.93
Value of each wRVU for follow-up $45.00

I calculate 4 new patients and 16 follow up on daily basis (5 days per week and 46 weeks per year) = 2585 + 7100= 9685 wRVU per year.
Click to expand...
Last year, my overall average wRVU/pt was 2.32, so the range is reasonable and I use 2.2 when doing the math for people since it's conservative. The averages given above are basically 992X4 so also pretty reasonable.

What I'm curious about is the differential wRVU values for new and f/u patients. Are they really paying 3.7X/wRVU for new patients compared to follow ups? If so, that's a really interesting way to incentivize seeing new patients. I have worked with physicians before who would refuse to see more than 2 new patients a day so they could pad their numbers with more, possibly unnecessary, follow ups (weekly tox checks for people on Q6w pembro, monthly follow ups on long-term tamoxifen/AI patients, etc). We tried a number of ways to incentivize seeing more new patients, but this one never crossed my mind.
 
gutonc said:
Last year, my overall average wRVU/pt was 2.32, so the range is reasonable and I use 2.2 when doing the math for people since it's conservative. The averages given above are basically 992X4 so also pretty reasonable.

What I'm curious about is the differential wRVU values for new and f/u patients. Are they really paying 3.7X/wRVU for new patients compared to follow ups? If so, that's a really interesting way to incentivize seeing new patients. I have worked with physicians before who would refuse to see more than 2 new patients a day so they could pad their numbers with more, possibly unnecessary, follow ups (weekly tox checks for people on Q6w pembro, monthly follow ups on long-term tamoxifen/AI patients, etc). We tried a number of ways to incentivize seeing more new patients, but this one never crossed my mind.
Click to expand...
We used to get a multiplier for a new pt seen *provided* the patient was seen back within 3 months. The multiplier applied to both of those visits and was to incentivize us to see patients and to keep them in the system.
 
gutonc said:
Last year, my overall average wRVU/pt was 2.32, so the range is reasonable and I use 2.2 when doing the math for people since it's conservative. The averages given above are basically 992X4 so also pretty reasonable.

What I'm curious about is the differential wRVU values for new and f/u patients. Are they really paying 3.7X/wRVU for new patients compared to follow ups? If so, that's a really interesting way to incentivize seeing new patients. I have worked with physicians before who would refuse to see more than 2 new patients a day so they could pad their numbers with more, possibly unnecessary, follow ups (weekly tox checks for people on Q6w pembro, monthly follow ups on long-term tamoxifen/AI patients, etc). We tried a number of ways to incentivize seeing more new patients, but this one never crossed my mind.
Click to expand...
Thanks @gutonc. Yes, that is their intention to incentivize seeing new patients according to two MDs I interviewed with. I did not ask what happened in the past (such as what you mentioned that daily list was padded with unnecessary follow ups).

What will be a reasonable dollar value for each wRVU in employed setting (ball-park)? I know there is regional variation. What I gathered in this forum as job offers were discussed in the past was $90-100/wRVU. I was told by one of my local attending that rule of thumb is $100/wRVU.

The offer (compensation portion only) I listed out above is only $77/wRVU on weighted basis (given 4 new patients and 16 follow-ups daily). In another way, the annual production based on 4 new patients and 16 follow-ups daily, 5 days a week and 46 weeks, is 9685 wRVU, translating into ~$968K if each wRVU is $100. However, using the metrics from the offer to calculation the 9685 wRVU only translating into ~$751K. I appreciate any feedback/input.

Thanks
 
randomhemoncpd said:
We used to get a multiplier for a new pt seen *provided* the patient was seen back within 3 months. The multiplier applied to both of those visits and was to incentivize us to see patients and to keep them in the system.
Click to expand...
We tried the multiplier idea too, but the docs I was trying to lead at the time killed it off. We were going to increase total wRVU paid for an average of >2 new patients/clinic day over the year. So if you saw an average of >2 new patients daily (basically just one extra patient over that number in the course of a year) and totaled 5000 wRVU for the year, you'd actually get paid for 6000 wRVU. Admin was fine with it but the docs were convinced that they'd be losing money with that comp plan, despite doc-by-doc modeling/reporting of current volumes and comp plan vs current volumes with new comp plan and increased volumes with new comp plan, showing that nobody would make less money and everyone would make more, some by 40%.

I don't work there anymore. A bunch of really smart people too stubborn to get out of their own way. At least 4 of them have asked me to come back, recognizing what they lost.
 
HemOncCheng said:
Thanks @gutonc. Yes, that is their intention to incentivize seeing new patients according to two MDs I interviewed with. I did not ask what happened in the past (such as what you mentioned that daily list was padded with unnecessary follow ups).

What will be a reasonable dollar value for each wRVU in employed setting (ball-park)? I know there is regional variation. What I gathered in this forum as job offers were discussed in the past was $90-100/wRVU. I was told by one of my local attending that rule of thumb is $100/wRVU.

The offer (compensation portion only) I listed out above is only $77/wRVU on weighted basis (given 4 new patients and 16 follow-ups daily). In another way, the annual production based on 4 new patients and 16 follow-ups daily, 5 days a week and 46 weeks, is 9685 wRVU, translating into ~$968K if each wRVU is $100. However, using the metrics from the offer to calculation the 9685 wRVU only translating into ~$751K. I appreciate any feedback/input.

Thanks
Click to expand...
Yes, $90-100 wRVU is kind of the "standard".

The numbers this group is offering seem a little off.
 
Just be careful, and try to understand the real reason behind the administration’s new pts wRVU decision. Make sure there’s no hidden or nefarious motive. I tend to be a doubting Thomas 🙂
If they’re hiring a bunch of new APPs at the same time, there’s a real chance you’ll end up doing the hardest part,establishing care, managing the initial heavy lift and then the patient gets handed off. You’ll only get pulled back in when things go south, or when there’s a difficult conversation to be had. The admin gets to show increased patient volume at year-end, but I’m not sure that actually translates into anything meaningful for your bottom line in terms of time spent, stress, and dollars gained.
Also, if you’re consistently seeing 5 new pts, your panel probably won’t be able to sustain that volume by year 3 or beyond.
 
Mehena said:
Just be careful, and try to understand the real reason behind the administration’s new pts wRVU decision. Make sure there’s no hidden or nefarious motive. I tend to be a doubting Thomas 🙂
If they’re hiring a bunch of new APPs at the same time, there’s a real chance you’ll end up doing the hardest part,establishing care, managing the initial heavy lift and then the patient gets handed off. You’ll only get pulled back in when things go south, or when there’s a difficult conversation to be had. The admin gets to show increased patient volume at year-end, but I’m not sure that actually translates into anything meaningful for your bottom line in terms of time spent, stress, and dollars gained.
Also, if you’re consistently seeing 5 new pts, your panel probably won’t be able to sustain that volume by year 3 or beyond.
Click to expand...
Thanks @Mehena for the insightful input. They have 6 MDs and 6 APPs and they are trying to expand into 8 MDs as the hospital is opening a new clinic in addition to current one. I tried to ask for some details about how new patients and follow ups are handled between MD and APP. I was offered that MD and APP alternates the patient follow up visits (by MD discretion). New patients only see MD. I will try to get some more clarify.

Can I get some clarify about this "if you’re consistently seeing 5 new pts, your panel probably won’t be able to sustain that volume by year 3 or beyond." Does it mean that I will burn out by consistently seeing 5 new patients per day after 3 years, which I can image? Or patient panel will be much more than 20 patients by seeing 5 new patients per day for 3 years given all of the follow-ups needed for treated and undertreatment patients, and etc. Of course, I do not have any practical experience of ramp-up from a fellow's perspective graduating next year.
 
HemOncCheng said:
Thanks @Mehena for the insightful input. They have 6 MDs and 6 APPs and they are trying to expand into 8 MDs as the hospital is opening a new clinic in addition to current one. I tried to ask for some details about how new patients and follow ups are handled between MD and APP. I was offered that MD and APP alternates the patient follow up visits (by MD discretion). New patients only see MD. I will try to get some more clarify.

Can I get some clarify about this "if you’re consistently seeing 5 new pts, your panel probably won’t be able to sustain that volume by year 3 or beyond." Does it mean that I will burn out by consistently seeing 5 new patients per day after 3 years, which I can image? Or patient panel will be much more than 20 patients by seeing 5 new patients per day for 3 years given all of the follow-ups needed for treated and undertreatment patients, and etc. Of course, I do not have any practical experience of ramp-up from a fellow's perspective graduating next year.
Click to expand...
Your patient panel will be too big if you constantly see 5 new patients per day.

Which means you will end up having to let the midlevels see them, which will make the hospital a boatload (yachtload?) of money, not you. Alternating visits with a midlevel is NOT a good deal for the MD unless you get credit for the RVUs they produce seeing YOUR patient.

I would probably pass on this job man just the fact that they are playing games with the $/RVU amount for news vs follow ups is a major red flag IMO that they will always be playing games with you and it’s just a matter of whether or not you recognize it down the road.
 
HemeOncHopeful19 said:
Your patient panel will be too big if you constantly see 5 new patients per day.

Which means you will end up having to let the midlevels see them, which will make the hospital a boatload (yachtload?) of money, not you. Alternating visits with a midlevel is NOT a good deal for the MD unless you get credit for the RVUs they produce seeing YOUR patient.

I would probably pass on this job man just the fact that they are playing games with the $/RVU amount for news vs follow ups is a major red flag IMO that they will always be playing games with you and it’s just a matter of whether or not you recognize it down the road.
Click to expand...
I totally agree. I was very suspicious at the beginning that they only value follow up visit at that low dollar amount per wRVU
 
You must log in or register to reply here.

Similar threads

D
Heme/Onc Job at the VA?
Replies
6
Views
3K
gutonc
gutonc
P
Malignant Heme Job Question
Replies
7
Views
2K
gutonc
gutonc
S
Didn't match Heme/Onc
Replies
3
Views
2K
flowers
F
I
  • Locked
Choosing rad onc over heme onc
Replies
18
Views
3K
gutonc
gutonc
C
How will an 18-month clinical/18-month research heme-onc fellowship impact job prospects
Replies
9
Views
2K
HemOncCheng
HemOncCheng
Top