Heme onc lifestyle pretty bad

[TexasMed22]

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Interesting article

Which Doctors Have the Best Work-Life Balance? | White Coat Investor

Doctors consistently say a lack of control over their time is a driver of burnout. These specialties, however, have good work-life balance.

www.whitecoatinvestor.com

 

[MifflinDunder]

Are you surprised?

 

[gutonc]

Meh. Disagree on how low hem-onc lies. I suspect the survey data they use has a lot of low-tier academic responders.

I have never worked >45h in a week in my career. And the vast majority of them have been more like 30-35. I can count on one hand the number of Fridays I've worked
My call burden at my old job was 1-2 nights a month and 1 weekend a quarter. I worked there for 7 years before I got stuck with call on a real holiday. That group has since added more docs so the weekend burden is only 3/year. My current job has no call.
I've always had more PTO than I know what to do with.
I am paid fairly well. I could work more and make more, but I'm perfectly happy with where I am.

 

[MD46]

Agree with Gut Onc, I work 4.5 days a week, usually start 830-330 seeing patients, then some Admin stuff, mostly <40hrs a week. Very low call burden , 6 weeks PTO and making 1 mil plus. Pretty good lifestyle if you ask me.

 

[sloh]

This article is terrible haha. It’s being discussed over in the anesthesia sub forums as well and the overwhelming consensus is it’s not accurate

 

[bobsmith]

This might sound a little weird, but I'm actually perfectly OK if everyone else continues to think we have a terrible quality of life

 

[GrassrootMaltan]

Agree with Gut Onc, I work 4.5 days a week, usually start 830-330 seeing patients, then some Admin stuff, mostly <40hrs a week. Very low call burden , 6 weeks PTO and making 1 mil plus. Pretty good lifestyle if you ask me.

May I ask how many patients you see per day and what your $/wRVU number approximately is? Those are very impressive numbers, and I would like to work hard to get there some day as an early career community oncologist, so knowing your numbers would be quite helpful for me (and hopefully others like me). Thank you.

 

[PugsAndHugs]

Agree with Gut Onc, I work 4.5 days a week, usually start 830-330 seeing patients, then some Admin stuff, mostly <40hrs a week. Very low call burden , 6 weeks PTO and making 1 mil plus. Pretty good lifestyle if you ask me.

Wow, HOW?

 

[HemeOncHopeful19]

Agree with Gut Onc, I work 4.5 days a week, usually start 830-330 seeing patients, then some Admin stuff, mostly <40hrs a week. Very low call burden , 6 weeks PTO and making 1 mil plus. Pretty good lifestyle if you ask me.

You and GutOnc definitely have better jobs than most of us but I believe you

 

[gutonc]

You and GutOnc definitely have better jobs than most of us but I believe you

We have jobs on different ends of the spectrum.

IIRC, @MD46 is in a true PP with partnership and infusion revenue and ancillaries and all that. When you have a gig like that, you definitely work hard for the money, but you also get paid well for it.

I have an employed job in a rural CAH. I have a base salary that is solidly 50th %ile for the region and has no money at risk. I also have quality and production bonuses available to me. If I were to see 20 patients a day, 4.5 days a week for 46 weeks a year, I'd be grossing ~$950K. Instead I see 14-18, work 3.5 days a week and gross ~$650K. My partner makes almost $250K working 3 days a week. We both love our jobs and neither of us have any interest in not working (at least for now), so we're more than fine. For me, the marginal gains I would get from an extra $1-200K in gross salary aren't worth the effort.

And to be clear "working hard" doesn't mean "working 12 hour days". I can see 20 patients a day and still go home 20 minutes or so after I walk out of my last room of the day with all my charts closed. Working efficiently makes all the difference.

 

[MD46]

You and GutOnc definitely have better jobs than most of us but I believe you

I plan to retire early, found a job that will allow me to do that and still have good time spent with my 2 and 6 yr old. I travel 2 times a year overseas with family, play in a local sports team for fun, about 2 hrs from a large metropolitan area and international airport. This checked all the boxes for me. I have a FIRE number that I will achieve much sooner than if I had worked in NYC making 350k a year. Every one has their own priorities. I feel blessed to able to get up in the morning and look forward to work which I still enjoy doing. I would pick this field over and over again if I had the choice.

 

[HemeOncHopeful19]

We have jobs on different ends of the spectrum.

IIRC, @MD46 is in a true PP with partnership and infusion revenue and ancillaries and all that. When you have a gig like that, you definitely work hard for the money, but you also get paid well for it.

I have an employed job in a rural CAH. I have a base salary that is solidly 50th %ile for the region and has no money at risk. I also have quality and production bonuses available to me. If I were to see 20 patients a day, 4.5 days a week for 46 weeks a year, I'd be grossing ~$950K. Instead I see 14-18, work 3.5 days a week and gross ~$650K. My partner makes almost $250K working 3 days a week. We both love our jobs and neither of us have any interest in not working (at least for now), so we're more than fine. For me, the marginal gains I would get from an extra $1-200K in gross salary aren't worth the effort.

And to be clear "working hard" doesn't mean "working 12 hour days". I can see 20 patients a day and still go home 20 minutes or so after I walk out of my last room of the day with all my charts closed. Working efficiently makes all the difference.

For some reason I thought MD46 was hospital employed in the DMV area maybe I’m thinking of someone else.

I think the unique thing about your setup is the hospital being willing to let you work 3.5 days per week, which I have not found to be common even when I’ve looked in the Midwest.

Meanwhile I am currently struggling with convincing the old timers in my group that there is no glory or Medicare “workaholic bonus adjustment” for working until 6PM

 

[MD46]

You are correct, I was in DMV area 1.5yrs ago and came to Mid west in a multispecialty private setup. Couldn't be happier! Here most partners do 4 days a week and some even less. I am currently 4.5 but I want to make more money at this time

 

[gutonc]

I think the unique thing about your setup is the hospital being willing to let you work 3.5 days per week, which I have not found to be common even when I’ve looked in the Midwest.

I'm technically 4d/week. But I blocked the last 3h of my schedule on Tuesdays 2 years ago for a meeting series that was cancelled a year ago and have just left it that way. Nobody seems to care and I'm not going to bring it up anytime soon.

 

[TexasMed22]

Anyone else heard of folks working 3.5 days a week? What kind of compensation hit does this entail? Seems like a wonderful life lol

 

[gutonc]

Anyone else heard of folks working 3.5 days a week? What kind of compensation hit does this entail? Seems like a wonderful life lol

At the job I left before coming here, 4d was FT. That is pretty common in employed community jobs. Roughly 1/3 of the docs there worked <1.0 FTE (including me most of my time there). Some had other non-clinical FTE (admin, teaching, research, informatics) and others just chose to not work FT.

The way the money worked there was, you work 0.8 FTE, your base is 80% of the FT base and your wRVU target was 80% as well. Employer contribution to retirement and bennies was 80% too.

Call sharing was 100% though (which wasn't too bad since call was 1-2 weeknights a month and 3-4 weekends a year). You will need a large group to pull this off. We had 5 offices with ~15 docs (varied over the years) and the call pool was everyone. If you're in an office of 3 people, this may be harder to make work, which I suspect is why it's not super common. I will say that the organization I work for now also has a fair number of PT docs but it's the same situation where they're sharing call among a dozen or more physicians.

Honestly, it doesn't hurt to ask when you interview. I wouldn't make it the first question and I'd definitely try to suss out the culture of the place first. But the worst they can say is "no".

 

[HemeOncHopeful19]

At the job I left before coming here, 4d was FT. That is pretty common in employed community jobs. Roughly 1/3 of the docs there worked <1.0 FTE (including me most of my time there). Some had other non-clinical FTE (admin, teaching, research, informatics) and others just chose to not work FT.

The way the money worked there was, you work 0.8 FTE, your base is 80% of the FT base and your wRVU target was 80% as well. Employer contribution to retirement and bennies was 80% too.

Call sharing was 100% though (which wasn't too bad since call was 1-2 weeknights a month and 3-4 weekends a year). You will need a large group to pull this off. We had 5 offices with ~15 docs (varied over the years) and the call pool was everyone. If you're in an office of 3 people, this may be harder to make work, which I suspect is why it's not super common. I will say that the organization I work for now also has a fair number of PT docs but it's the same situation where they're sharing call among a dozen or more physicians.

Honestly, it doesn't hurt to ask when you interview. I wouldn't make it the first question and I'd definitely try to suss out the culture of the place first. But the worst they can say is "no".

To be fair the worst they can say is “we’re going with someone else” if they think you’re coming off as lazy or not wanting to work. Which I know is a red flag by itself and “oh you didn’t wanna work there anyway” but you also don’t want to rob yourself of any opportunities unnecessarily IMO. I may be paranoid but I feel like I lost out on a job opportunity (prob would not have taken it) possibly because I asked every single doc what time they got to work and what time they left everyday and maybe it came off wrong.

I think a better way to ask would be to ask “so you have X docs, are all of them full time or are some part time?” I tend to think working part time is the kinda thing places are more open to once you’ve worked there a few years and proved yourself to be someone productive they don’t want to lose. Easier to do as GutOnc who had a proven track record of experience and leadership taking his current job compared to a fresh new fellow grad

 

[gutonc]

To be fair the worst they can say is “we’re going with someone else” if they think you’re coming off as lazy or not wanting to work. Which I know is a red flag by itself and “oh you didn’t wanna work there anyway” but you also don’t want to rob yourself of any opportunities unnecessarily IMO. I may be paranoid but I feel like I lost out on a job opportunity (prob would not have taken it) possibly because I asked every single doc what time they got to work and what time they left everyday and maybe it came off wrong.

I think a better way to ask would be to ask “so you have X docs, are all of them full time or are some part time?” I tend to think working part time is the kinda thing places are more open to once you’ve worked there a few years and proved yourself to be someone productive they don’t want to lose. Easier to do as GutOnc who had a proven track record of experience and leadership taking his current job compared to a fresh new fellow grad

Yeah, that's definitely true. Although I would argue that if work-life balance is a "must have" for a job, you aren't going to want to work at a place where everyone else is working 5.5 days a week anyway.

But this is why this should be part of the negotiation process once you have an offer, not a question you ask everyone on your first interview day. You also need to be able to read the room and recognize who, where and when to ask.

 

[MifflinDunder]

I posted about this before

M

Thread 'Inbox management and other lifestyle questions'

Feb 18, 2024

Incoming fellow. I made the mistake of joining the multiple physician Facebook groups and found these comments about the heme-onc lifestyle (can delete if this isn't allowed on sdn).

The world today has moved very fast in Oncology, I spend 1 hour every night reviewing the latest data and still cannot keep up. The other half of my free time is fighting for scans and chemotherapy drugs that people need. And during my workout time, I try to answer all patient messages can be 50-100 a day.
We are in the hospital AFTER seeing 20 dying humans in clinic. And answering 50-100 MyChart messages...

• MifflinDunder
• Replies: 72
• Forum: Hematology / Oncology

• 

These are the most recent posts from the same forum, and plenty more about the same topic if you search there.

1. I’m a Hemonc fellow, and it’s been extremely busy lately. My in-basket is constantly flooded, there are multiple patient calls, and during inpatient months I’m in the hospital almost 12 hours a day. Many patient prefer me to discuss results of all imaging on phone only, because ‘when you could do it on phone then why you want me to come all the way’. They are nice patients, just exhausted with what they are going through.
By the time I get home, I’m exhausted and end up being snappy with my kids. Each day the first thing I remember when i wake up is how horrible i was with kids yesterday and then cycle repeats.
Does the routine eventually get better. Im trying to be a better person at home, hiring help etc. but does the routine eventually get better. Do i get to select the workload after fellowship.
2. Hi. I am onc first yr attending. Almost same expectations from patient. I let my nurse to convey the normalish results with patient Almost never call them unless there is very concerning finding and needs starting treatment within a week or so. Setting expectations is important. Cancer patients are like babies, so even if you call them everyday they would still be not very satisfied because that is the nature of disease. You have to decide how soon you want to get burnt out. Also pls dint be harsh on yourself, journey has not even started for you. Can feel you as I just transitioned from fellow to attending and learning the art slowly. My 2 cents.

Yes, the first one is a fellow, though it’s hardly surprising that it’s not viewed as a lifestyle specialty. It takes every element of outpatient medicine and intensifies them exponentially, and no other specialty in medicine is called the "primary -ologist". Regardless of the job we pick, there are aspects inherent to the field that are anti-lifestyle.

 

[HemeOncHopeful19]

I posted about this before

M

Thread 'Inbox management and other lifestyle questions'

Feb 18, 2024

Incoming fellow. I made the mistake of joining the multiple physician Facebook groups and found these comments about the heme-onc lifestyle (can delete if this isn't allowed on sdn).

The world today has moved very fast in Oncology, I spend 1 hour every night reviewing the latest data and still cannot keep up. The other half of my free time is fighting for scans and chemotherapy drugs that people need. And during my workout time, I try to answer all patient messages can be 50-100 a day.
We are in the hospital AFTER seeing 20 dying humans in clinic. And answering 50-100 MyChart messages...

• MifflinDunder
• Replies: 72
• Forum: Hematology / Oncology

• 

These are the most recent posts from the same forum, and plenty more about the same topic if you search there.

1. I’m a Hemonc fellow, and it’s been extremely busy lately. My in-basket is constantly flooded, there are multiple patient calls, and during inpatient months I’m in the hospital almost 12 hours a day. Many patient prefer me to discuss results of all imaging on phone only, because ‘when you could do it on phone then why you want me to come all the way’. They are nice patients, just exhausted with what they are going through.
By the time I get home, I’m exhausted and end up being snappy with my kids. Each day the first thing I remember when i wake up is how horrible i was with kids yesterday and then cycle repeats.
Does the routine eventually get better. Im trying to be a better person at home, hiring help etc. but does the routine eventually get better. Do i get to select the workload after fellowship.
2. Hi. I am onc first yr attending. Almost same expectations from patient. I let my nurse to convey the normalish results with patient Almost never call them unless there is very concerning finding and needs starting treatment within a week or so. Setting expectations is important. Cancer patients are like babies, so even if you call them everyday they would still be not very satisfied because that is the nature of disease. You have to decide how soon you want to get burnt out. Also pls dint be harsh on yourself, journey has not even started for you. Can feel you as I just transitioned from fellow to attending and learning the art slowly. My 2 cents.

Yes, the first one is a fellow, though it’s hardly surprising that it’s not viewed as a lifestyle specialty. It takes every element of outpatient medicine and intensifies them exponentially, and no other specialty in medicine is called the "primary -ologist". Regardless of the job we pick, there are aspects inherent to the field that are anti-lifestyle.

This is a benefit of being in PP and not using Epic. Personally I think this is the new/future niche for PP. It used to be PP was the best way to make the most money and get paid fairly, but nowadays in 340B era hospitals have so much money that you can’t access in PP there is more parity unless you’re in a desirable location (morally bankrupt system IMO but it’s the cards we’re dealt). Instead I think PP will be the way you have more control and can say no to some of the pointless BS that comes along with hospital employment to maintain your sanity

I have a nurse assigned to me that helps handle all this stuff. I make like 1-3 patient calls a week. I’m not sure I’ve ever sent a patient a message through our EMR and I’d have to ask her to show me how to (and I’m tech savvy just never had to look into it).

Our EMR does not give them access until I sign off on labs/imaging, and if I see something I think is going to freak them out I just don’t sign it until I meet with them. There is no administrator pestering me that I didn’t sign every lab or image within XYZ hours.

If they’re getting a scan they should have a visit set up 2-4 days later. “I want to meet with you in case something bad shows up, and I don’t want to jinx it by scheduling a phone call I am superstitious!”

I have colleagues that do phone visits. We don't get paid for phone visits. I don’t do phone visits.

Agree there is an overwhelming amount of labs

 

[gutonc]

Thanks for that perspective. I'm applying for jobs now and I'm completely avoiding EPIC. Even if I have armies of NP/MAs handling mychart, I can't be that available, especially in a primary -ologist field that orders the most labs and scans in medicine.

You do you but I think that's kind of a silly metric for choosing a job. Epic is the worst EMR out there, except for all the others. Epic is not the issue. Support is.

I've said it before and I'll say it again. It's all about setting expectations up front and setting hard boundaries when necessary. I'm pretty busy (less so since I brought on a partner) and I get maybe a dozen patient calls/MyCharts a week...total. Half of them get forwarded to my RN (or pharmacy, or schedulers, or whoever) to deal with and the rest take up maybe 15 minutes of my week. That is all down to setting expectations and boundaries. Anything requiring more than 2 sentences gets a visit. I don't do phone visits but will do virtual since they pay the same as in person. If I'm doing significant work, I'm getting paid for it.

 

[TexasMed22]

A fellow explaining to an attending with more than a decade of experience what their specialty is/isn't never gets old 🙂

 

[bobsmith]

This would be fine if heme/onc was like any other outpatient specialty, which it very obviously isn't. I appreciate your thoughts but it is what it is.

Every single post from that other link I quoted are real life attendings that you can message directly. Anyway, believe what you want.

You’re right, I don’t know what I’m talking about. Heme/onc is a great lifestyle specialty. Just set your boundaries and you’re good to go. Go for it.

Well if you're going to cherry pick the complainers, why can't we also cherry pick those of us that have repeatedly responded to your messages explaining that it IS possible to set boundaries

As I've mentioned to you previously many times:

For what it's worth, I don't think that this is an all or nothing thing - (i.e., I don't think that to be a good oncologist, you have to let it take over your life). And then similarly, I don't think some people are destined to love their job just because they love patient care, and then others are doomed to hate it.

I think it's a skill to balance how much you let it take over your life, and just like any other skill, it requires some degree of practice and patience to get better at it over time.

For example, I remember when I started my first attending job, I would sometimes get a page / call / message about a patient while I was hanging out with my family / friends and then I would just be totally distracted as I thought (and then unproductively perseverated) about the situation for far too long, sometimes even after I had made a decision and there was nothing else to be done.

Luckily, as time has gone on and I've gotten more comfortable making decisions, this happens less frequently. It also is something I've chosen to work on - if I recognize something is going to distract me (and sometimes my partner can tell better than I can!), I try to decide right then whether I'm going to spend time doing it right away, or truly decide to put it out of my mind to work on it / think about it at some other time.

(Luckily, most things that we deal with do not require our urgent attention!)

Definitely agree with this. At my initial visit with pretty much all new patients that are not just one-and-done consults (and especially for active oncology patients), we go over expectations for our clinic, response times, what the after hours advice line does, etc.

ALL messages from our patients go to my staff first to screen / triage - I never see things like straightforward scheduling questions, clarifications on where to go for labs, or requests for paperwork; if something is needed (like my signature on something), my staff is trained to do the initial work first.

The other benefit of this setup is that if I clear my inbox at the end of the day on Friday, my patient messages box will stay empty until Monday morning, since my office staff are only checking their inbox during business hours. So even if I do log in on Sunday night to look something up / prep something for Monday, I don't get stressed / distracted by a bunch of inbox patient messages

We also make this very clear when they establish care with us, and I have yet to hear anybody complain that this is unreasonable

I've mentioned this before (probably in response to one of your messages, actually), but I think this is something that can be worked on. One does not have to forego boundaries just because it's cancer, and I do believe we can be good oncologists while also setting appropriate boundaries that allow us to have sustainable careers.

 

[bobsmith]

You do you but I think that's kind of a silly metric for choosing a job. Epic is the worst EMR out there, except for all the others. Epic is not the issue. Support is.

I've said it before and I'll say it again. It's all about setting expectations up front and setting hard boundaries when necessary. I'm pretty busy (less so since I brought on a partner) and I get maybe a dozen patient calls/MyCharts a week...total. Half of them get forwarded to my RN (or pharmacy, or schedulers, or whoever) to deal with and the rest take up maybe 15 minutes of my week. That is all down to setting expectations and boundaries. Anything requiring more than 2 sentences gets a visit. I don't do phone visits but will do virtual since they pay the same as in person. If I'm doing significant work, I'm getting paid for it.

I've agreed with you before and I'll agree with you again.

 

[gutonc]

This would be fine if heme/onc was like any other outpatient specialty, which it very obviously isn't. I appreciate your thoughts but it is what it is.

You are right. It's way better than the rest of them (at least the IM options). If rheum and allergy weren't so boring, they'd probably be up there, but just typing Rheum and Allergy puts me to sleep.

I feel bad that your mentors and fellowship experience have been so bad that you're coming out to your first attending job so jaded and with a misconception of what you have ahead of you. I hope you have a better experience than you're anticipating.

 

[Plutarch02]

It's a high acuity field, there's a degree of familiarity you gain with working with very sick people but it doesn't necessarily ever get comfortable. That said in any general heme onc practice you will have the iron deficiency anemias, mild leukocytosis/erythrocytosis, or leukopenia consults that feel like going back to elementary school and serve a necessary purpose of lowering your stress level. I think if you find the right balance of acuity and genetics/benign heme you can make it more of a lifestyle. The inpatient emergencies though can make you feel like a critical care doctor at times (CVA Hgb SS, acute chest syndromes, TTP, APML etc)

 

[HemeOncHopeful19]

Bump to survey the group, would really appreciate some feedback that I can take to some of the old timers in our group.

Do any of your groups (particularly PP) have any extended / late hours for infusion or imaging? If so do you have an MD on site?

Do you typically rotate who has to hang back for stragglers in infusion finishing up late and how late do they typically run?

Our group pretty routinely has infusion finish up between 530-6 and we have a physician on site until then. We talked about hiring more docs and when I brought up infusion space some of the old timers suggested we do extended hours or have infusion open on Saturdays…

 

[gutonc]

Bump to survey the group, would really appreciate some feedback that I can take to some of the old timers in our group.

Do any of your groups (particularly PP) have any extended / late hours for infusion or imaging? If so do you have an MD on site?

Do you typically rotate who has to hang back for stragglers in infusion finishing up late and how late do they typically run?

Our group pretty routinely has infusion finish up between 530-6 and we have a physician on site until then. We talked about hiring more docs and when I brought up infusion space some of the old timers suggested we do extended hours or have infusion open on Saturdays…

Not PP, but my old group had infusion running 7:30a - 6:30p M-F plus 8a-3p on weekends at one site of 5 (now expanded to 3 sites). Physician not on site but available by phone after 5:30p and APP on site on the weekends.

I will also say that you can probably get some significant improvement out of your infusion scheduling to better utilize chair time. That same place bought an (expensive) scheduling solution that was able to smooth out the schedule and get ~20% more infusion appointments (lots of non-oncology and supportive care) scheduled without adding hours.

 

[HemeOncHopeful19]

Not PP, but my old group had infusion running 7:30a - 6:30p M-F plus 8a-3p on weekends at one site of 5 (now expanded to 3 sites). Physician not on site but available by phone after 5:30p and APP on site on the weekends.

I will also say that you can probably get some significant improvement out of your infusion scheduling to better utilize chair time. That same place bought an (expensive) scheduling solution that was able to smooth out the schedule and get ~20% more infusion appointments (lots of non-oncology and supportive care) scheduled without adding hours.

Appreciate the response as always, would greatly appreciate anyone else willing to chime in (or PM if not wanting to post publicly for some reason).

Were these all hospital based practices where there might’ve been an attached ER or inpatient unit? Our group currently requires a doc to be on site because of the medmal boogeyman. Similar with our imaging which sometimes schedules up to 630-7pm… “in case someone slips off a table.”

 

[gutonc]

Appreciate the response as always, would greatly appreciate anyone else willing to chime in (or PM if not wanting to post publicly for some reason).

Were these all hospital based practices where there might’ve been an attached ER or inpatient unit? Our group currently requires a doc to be on site because of the medmal boogeyman. Similar with our imaging which sometimes schedules up to 630-7pm… “in case someone slips off a table.”

They were not all hospital based and prior to the CMS rule change a couple of years ago, we did need to have someone onsite while infusions were going on. CMS changed their rules for supervision though so that's no longer the case. They changed the policy after that went live (and we got nursing buy-in). Where I am now, it is hospital based and any significant reaction gets a RRT call and the whole team comes running, including the hospitalist.

I don't think they'd be at any higher (or lower) medmal risk by having someone onsite or not. But I can understand the reason for keeping it that way.

 

[stillpremed]

We have jobs on different ends of the spectrum.

IIRC, @MD46 is in a true PP with partnership and infusion revenue and ancillaries and all that. When you have a gig like that, you definitely work hard for the money, but you also get paid well for it.

I have an employed job in a rural CAH. I have a base salary that is solidly 50th %ile for the region and has no money at risk. I also have quality and production bonuses available to me. If I were to see 20 patients a day, 4.5 days a week for 46 weeks a year, I'd be grossing ~$950K. Instead I see 14-18, work 3.5 days a week and gross ~$650K. My partner makes almost $250K working 3 days a week. We both love our jobs and neither of us have any interest in not working (at least for now), so we're more than fine. For me, the marginal gains I would get from an extra $1-200K in gross salary aren't worth the effort.

And to be clear "working hard" doesn't mean "working 12 hour days". I can see 20 patients a day and still go home 20 minutes or so after I walk out of my last room of the day with all my charts closed. Working efficiently makes all the difference.

Gosh I haven’t been to this forum in years congrats on the new job!