How 'good' can endocrinology be lifestyle and salary wise vs general IM?

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experiment113

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Hi all, just wondering how 'good' can the Endocrinology specialty get lifestyle and salary wise vs general IM? Lets say working in the NE like in NYC or in surrounding areas.
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experiment113 said:
Hi all, just wondering how 'good' can the Endocrinology specialty get lifestyle and salary wise vs general IM? Lets say working in the NE like in NYC or in surrounding areas.
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It varies... like all specialties.
I know people that work mom-fri, 8-5 and no weekends.
money...that too varies, but you really need to bust your butt , though the new billing rules helps...can you make 500k... yeah if you see 35-40 pts a day...
The NE sucks overall for pay... lots of supply and people want to live there...so they don’t have to pay that much... but again rvu based and productive... you can make a lot of money.
Most people go into endocrine because we truly enjoy the subject...no one goes into endo for the money.
 
the salary of $236,000 in medscape, is that the average in PP and seeing 12-15 pts/day, 4 day work, including all the RVU/bonus??
 
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bochaw said:
the salary of $236,000 in medscape, is that the average in PP and seeing 12-15 pts/day, 4 day work, including all the RVU/bonus??
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Having answered the Medscape survey in the past, I can tell you that it's not remotely that granular. The question is basically, where do you work, what kind of practice (academic, community, solo PP, etc) and how much did you make last year?
 
bochaw said:
the salary of $236,000 in medscape, is that the average in PP and seeing 12-15 pts/day, 4 day work, including all the RVU/bonus??
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Well if you do the math
12 pt /day x 4 days a week = 48 pts week
Say you work 46 weeks a year ( 6 weeks pto) then you get 2208 pts a year.

say you get 3 rvu/visit (basically all level 5 visits) them that’s 6624 rvus per year... which frankly is pretty high productivity

if you get $50 per rvu that’s $331,200/year...can you? Yes...will you...eh, depends.
 
How much do you really make per rvu? And I'm seeing salaried docs work four and one half days per week so the total number of patients is lower. Don't forget supervision of mid-levels too.
 
TikiTorches said:
How much do you really make per rvu? And I'm seeing salaried docs work four and one half days per week so the total number of patients is lower. Don't forget supervision of mid-levels too.
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Varies with place, but have heard as low as $45 and as high as $55...which is why I picked $50 in my post .

mans you should make sure it’s wRVU.
 
rokshana said:
Well if you do the math
12 pt /day x 4 days a week = 48 pts week
Say you work 46 weeks a year ( 6 weeks pto) then you get 2208 pts a year.

say you get 3 rvu/visit (basically all level 5 visits) them that’s 6624 rvus per year... which frankly is pretty high productivity

if you get $50 per rvu that’s $331,200/year...can you? Yes...will you...eh, depends.
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All level 5??? That would get audited or insurers may adjust their reimbursement
 
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If you open your own private practice you have stepped outside of the wRVU game. Now you are beholden to the contracted rates with insurance companies. Completely different ball game then.
 
rokshana said:
Well if you do the mathrvu vydrowrvu
12 pt /day x 4 days a week = 48 pts week
Say you work 46 weeks a year ( 6 weeks pto) then you get 2208 pts a year.

say you get 3 rvu/visit (basically all level 5 visits) them that’s 6624 rvus per year... which frankly is pretty high productivity

if you get $50 per rvu that’s $331,200/year...can you? Yes...will you...eh, depends.
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A more typical full time schedule for someone with an established practice might be 20 patients scheduled 4.5 days a week, usually a mix of ~16 old and ~4 new after you've been there for a while. That's 40 minute appointments for news and 20 minute appointments for f/us with an 8 hr day. Assuming an ~80% show rate (so you actually see 16 a day) and 2020 RVU numbers (which are less than 2021, but many employers are still using 2020 for another couple years) with everyone being a level 4 (1.5 wrvu for a 99214, 2.43 wrvu for a 99204), you'd make about 27 wRVU/day.

Do that 4.5 days a week, 48 weeks a year, you'd make 5832 wRVU a year. The typical wRVU multiplier nationwide (for someone in an established practice) is just more than $50 - I think last I saw was $53 - so you'd make ~$310k in this scenario. More if you work 5 full days a week, have a show rate above 80%, schedule more than 20 patients a day, or mix level 5s in with your 4s (which most of us do). Less in big coastal cities. A lot less in academia. But more once the 2021 changes are considered in full by employers.

Is that likely? Well, the median endocrinologist doesn't make $310k - the median is right around $250k. Why? Because a lot of my colleagues work part time, schedule fewer than 20 patients a day, work in academics, or work for an employer that doesn't pay anywhere near $53/wrvu. Many of these choices are explicitly lifestyle considerations.

Now that said, that's an *established* practice. It takes probably a couple years in one place to be able to produce that consistently. No one is getting a starting pay close to $310k just out of fellowship. I think if I were to stay at my current job for a second year I'd approach that income - but I also schedule 22 patients a day five full days a week.
 
Raryn said:
A more typical full time schedule for someone with an established practice might be 20 patients scheduled 4.5 days a week, usually a mix of ~16 old and ~4 new after you've been there for a while. That's 40 minute appointments for news and 20 minute appointments for f/us with an 8 hr day. Assuming an ~80% show rate (so you actually see 16 a day) and 2020 RVU numbers (which are less than 2021, but many employers are still using 2020 for another couple years) with everyone being a level 4 (1.5 wrvu for a 99214, 2.43 wrvu for a 99204), you'd make about 27 wRVU/day.

Do that 4.5 days a week, 48 weeks a year, you'd make 5832 wRVU a year. The typical wRVU multiplier nationwide (for someone in an established practice) is just more than $50 - I think last I saw was $53 - so you'd make ~$310k in this scenario. More if you work 5 full days a week, have a show rate above 80%, schedule more than 20 patients a day, or mix level 5s in with your 4s (which most of us do). Less in big coastal cities. A lot less in academia. But more once the 2021 changes are considered in full by employers.

Is that likely? Well, the median endocrinologist doesn't make $310k - the median is right around $250k. Why? Because a lot of my colleagues work part time, schedule fewer than 20 patients a day, work in academics, or work for an employer that doesn't pay anywhere near $53/wrvu. Many of these choices are explicitly lifestyle considerations.

Now that said, that's an *established* practice. It takes probably a couple years in one place to be able to produce that consistently. No one is getting a starting pay close to $310k just out of fellowship. I think if I were to stay at my current job for a second year I'd approach that income - but I also schedule 22 patients a day five full days a week.
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You supervise any mid-levels? Thyroid biopsy?
 
TikiTorches said:
You supervise any mid-levels? Thyroid biopsy?
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No to either. Biopsies don’t really make any money - you’d be better off seeing two follow ups during the time it takes to do one. And I make significantly less than $310k right now - just saying that if my schedule was consistently full I wouldn’t be surprised if that’s what I would pull in year 2 and onwards at this job. But I’m changing jobs due to family issues, so not going to do that this year either.
 
Raryn said:
No to either. Biopsies don’t really make any money - you’d be better off seeing two follow ups during the time it takes to do one. And I make significantly less than $310k right now - just saying that if my schedule was consistently full I wouldn’t be surprised if that’s what I would pull in year 2 and onwards at this job. But I’m changing jobs due to family issues, so not going to do that this year either.
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How easy or difficult was it to find a job where you did not have to supervise midlevels? I’m hoping to have the same stipulation when I eventually go job hunting.
 
Just curious, what are your employers doing regarding 2021 E&M wRVU changes? I have heard some are adopting it now but can't pay out the difference until finances are finalized at year end.

Raryn, you are saying your employer isn't adopting new wRVU rates at all for several years? But then what happens to the extra $ they get from Medicare? The dollar amount reimbursed went up significantly - not just RVUs.
 
bronx43 said:
Just curious, what are your employers doing regarding 2021 E&M wRVU changes? I have heard some are adopting it now but can't pay out the difference until finances are finalized at year end.

Raryn, you are saying your employer isn't adopting new wRVU rates at all for several years? But then what happens to the extra $ they get from Medicare? The dollar amount reimbursed went up significantly - not just RVUs.
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My employer pays me a % collections, so I'm getting the increased money flowing to me. That said, I have a number of friends whose employment is wRVU based - and they're staying on the 2020 RVU scales for now.

Basically, while Medicare reimbursement went up for E&M codes, commercial payors mostly haven't followed *yet*. And the Medicare RVU multiplier did go down a bit, though not as much as was originally projected. Since RVU calculations are payor agnostic, if they started giving everyone credit based on the 2021 RVUs, the docs would be getting more money from all payors, while the clinic is only making more money from Medicare.

The folks I know working on wRVUs have been told that's not feasible for now, so they're having their contracts forcibly amended more or less to continue to use the 2020 scales for the time being. They've been told that commercial payors are expected to adjust their scales over the next year or two, and that it would be reevaluated then. I assume the clinics/hospitals are pocketing the extra money from Medicare. I think that's unfair, but it's also likely temporary.

TaroBubbleTea said:
How easy or difficult was it to find a job where you did not have to supervise midlevels? I’m hoping to have the same stipulation when I eventually go job hunting.
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Very easy in the two markets that I've looked for jobs. Very few endocrine clinics in either metro area even employ midlevels, and the ones that did already had the owner of the practice supervising them.

I would assume that it's market dependent though and in some areas Endocrine PA/NPs are more common.
 
Raryn said:
My employer pays me a % collections, so I'm getting the increased money flowing to me. That said, I have a number of friends whose employment is wRVU based - and they're staying on the 2020 RVU scales for now.

Basically, while Medicare reimbursement went up for E&M codes, commercial payors mostly haven't followed *yet*. And the Medicare RVU multiplier did go down a bit, though not as much as was originally projected. Since RVU calculations are payor agnostic, if they started giving everyone credit based on the 2021 RVUs, the docs would be getting more money from all payors, while the clinic is only making more money from Medicare.

The folks I know working on wRVUs have been told that's not feasible for now, so they're having their contracts forcibly amended more or less to continue to use the 2020 scales for the time being. They've been told that commercial payors are expected to adjust their scales over the next year or two, and that it would be reevaluated then. I assume the clinics/hospitals are pocketing the extra money from Medicare. I think that's unfair, but it's also likely temporary.



Very easy in the two markets that I've looked for jobs. Very few endocrine clinics in either metro area even employ midlevels, and the ones that did already had the owner of the practice supervising them.

I would assume that it's market dependent though and in some areas Endocrine PA/NPs are more common.
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Hospitals want money. Bean counters love mid-levels. All the liability is on the doc.
 
TikiTorches said:
Hospitals want money. Bean counters love mid-levels. All the liability is on the doc.
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However endocrine isn’t a big money maker..and many time is a revenue negative division...so not a lot of push per se for midlevels to try to get into the field...and we tend to utilize them for specific areas...diabetes management and potentially hypothyroidism.
 
rokshana said:
However endocrine isn’t a big money maker..and many time is a revenue negative division...so not a lot of push per se for midlevels to try to get into the field...and we tend to utilize them for specific areas...diabetes management and potentially hypothyroidism.
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Yes exactly when a field isn't a huge money maker that's when admin likes to hire mid-level to generate more revenue. Costs much less than another doc
 
TikiTorches said:
Yes exactly when a field isn't a huge money maker that's when admin likes to hire mid-level to generate more revenue. Costs much less than another doc
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I’m not sure what you are trying to prove here... you have had 2 Pt acting endocrinologists say that mid levels and the need to supervise mid levels in endocrinology is not that big an issue...yet you keep harping on hospitals wanting to replace endocrinologists with midlevels...why?

are mid levels an issue in endocrine? Sure...they are an issue with every aspect of medicine... but let’s face it ...many physicians considered endocrine perplexing to them... what do you think a less educated and trained midlevel is going to think? And why would they choose to work more and get paid less than say being a cards or ortho midlevel?

many of the mid levels in endocrine are typically type 1 themselves or have a family member and have an interest in working with diabetes pts.

there are enough issues with practicing as an endocrinologist...an army of midlevels trying to take my job is low on the list.
 
TikiTorches said:
Yes exactly when a field isn't a huge money maker that's when admin likes to hire mid-level to generate more revenue. Costs much less than another doc
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Endos make low enough a salary that it’s actually not a huge diff over a midlevel. I don’t think admin are tripping over themselves trying to hire a NP (who are limited to DM) for $130k when they can hire a board certified endo for $230k.
 
bronx43 said:
Endos make low enough a salary that it’s actually not a huge diff over a midlevel. I don’t think admin are tripping over themselves trying to hire a NP (who are limited to DM) for $130k when they can hire a board certified endo for $230k.
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I saw from other posts you are in rheum. What about midlevel encroachment in rheum? As someone interested in thinking about applying rheum this year, can I DM you a few questions regarding the career outlook?
 
TaroBubbleTea said:
I saw from other posts you are in rheum. What about midlevel encroachment in rheum? As someone interested in thinking about applying rheum this year, can I DM you a few questions regarding the career outlook?
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Midlevels in rheumatology are mostly driven by the physician owned single specialty groups. Infusions are becoming an endangered species at this point and greedy private practice docs are scambling to keep up their bottom line by loading up on midlevels. This process is somewhat mitigated in hospital employed positions, though it’s unclear for how long...
 
bronx43 said:
Midlevels in rheumatology are mostly driven by the physician owned single specialty groups. Infusions are becoming an endangered species at this point and greedy private practice docs are scambling to keep up their bottom line by loading up on midlevels. This process is somewhat mitigated in hospital employed positions, though it’s unclear for how long...
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Can private practice them easily clear >300k? What is the average/median salary for 1 FTE hospital employed position ?
 
blue.jay said:
Can private practice them easily clear >300k? What is the average/median salary for 1 FTE hospital employed position ?
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If you do full time 5 days a week, then I would think 300k is easily doable, if not higher. Average salaries are lower since most ppl don’t do 5 days. Most of us do 4 or 4.5 at most.
 
bronx43 said:
If you do full time 5 days a week, then I would think 300k is easily doable, if not higher. Average salaries are lower since most ppl don’t do 5 days. Most of us do 4 or 4.5 at most.
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Do you think it’s worth pursuing rheum fellowship nowadays? I think I wouldn’t mind primary care, but I really like the idea of being a specialist.
 
bronx43 said:
Pm me
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I tried but it says I cannot since it says "This member limits who may view their full profile." Additionally, I tried to PM you and it says I cannot. Maybe if you start the convo on your end?
 
TaroBubbleTea said:
Do you think it’s worth pursuing rheum fellowship nowadays? I think I wouldn’t mind primary care, but I really like the idea of being a specialist.
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Well, if others are interested...

A big part of whether you should pursue rheumatology, in my opinion, depends on where you ultimately want to end up. The issue with rheumatology is that our diseases are very rare, which means that demand is fairly inelastic and can easily be saturated in locations that are considered "desirable." Unfortunately, more and more tier 2/3 cities are now desirable, and you're left with a situation where you have to go to the boonies to get decent patient population.

If you want to be in a metropolitan area, then it would mean that you are going to be mired in less-than-ideal patient referrals. I'm not talking fibromyalgia - those patients are actually fine. I'm talking about the poorly coping sufferer of the human condition, who by sheer statistical probability, has a positive ANA and mildly elevated ESR. These will be the bane of your existence, which is made infinitely worse if you work for a health system that inevitably abides by the "customer is always right" mentality. The one major difference between rheumatology and most other specialties is that when rheumatology becomes saturated in a city, the job becomes outright intolerable (in my opinion). If you're already older and established, then saturation doesn't hurt you in the same way. But, if you're trying to establish yourself, then best of luck.

Rheumatologists of old were a rare commodity, and had their pick of real diseases to treat. Now, this isn't the case across most regions. Young, unestablished rheumatologists are scraping the bottom of the barrel to make their RVUs. Honestly, if you ask me to pick between PCP in a metro vs rheumatology... I'd pick PCP in a heartbeat. I may still do that.

Oh, and PCPs are starting to, if not already out-earning younger rheumatologists due to the impending extinction of infusions.
 
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bronx43 said:
Well, if others are interested...

A big part of whether you should pursue rheumatology, in my opinion, depends on where you ultimately want to end up. The issue with rheumatology is that our diseases are very rare, which means that demand is fairly inelastic and can easily be saturated in locations that are considered "desirable." Unfortunately, more and more tier 2/3 cities are now desirable, and you're left with a situation where you have to go to the boonies to get decent patient population.

If you want to be in a metropolitan area, then it would mean that you are going to be mired in less-than-ideal patient referrals. I'm not talking fibromyalgia - those patients are actually fine. I'm talking about the poorly coping sufferer of the human condition, who by sheer statistical probability, has a positive ANA and mildly elevated ESR. These will be the bane of your existence, which is made infinitely worse if you work for a health system that inevitably abides by the "customer is always right" mentality. The one major difference between rheumatology and most other specialties is that when rheumatology becomes saturated in a city, the job becomes outright intolerable (in my opinion). If you're already older and established, then saturation doesn't hurt you in the same way. But, if you're trying to establish yourself, then best of luck.

Rheumatologists of old were a rare commodity, and had their pick of real diseases to treat. Now, this isn't the case across most regions. Young, unestablished rheumatologists are scraping the bottom of the barrel to make their RVUs. Honestly, if you ask me to pick between PCP in a metro vs rheumatology... I'd pick PCP in a heartbeat. I may still do that.

Oh, and PCPs are starting to, if not already out-earning younger rheumatologists due to the impending extinction of infusions.
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Oh, that’s quite depressing. What region of the country in particular are you referring too, or do you mean most major cities?
 
TaroBubbleTea said:
Would you apply to rheumatology again knowing what you know now? Or do you think primary care is a better option in the current climate of medicine?
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I would not do rheumatology. I would do heme onc knowing what I know now.
Between rheumatology and primary care in a metro area, I would probably just do primary care. In a rural area, you can probably still have a decent career as the sole rheumatologist.
 
bronx43 said:
I would not do rheumatology. I would do heme onc knowing what I know now.
Between rheumatology and primary care in a metro area, I would probably just do primary care. In a rural area, you can probably still have a decent career as the sole rheumatologist.
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Why heme onc?
 
bronx43 said:
Endos make low enough a salary that it’s actually not a huge diff over a midlevel. I don’t think admin are tripping over themselves trying to hire a NP (who are limited to DM) for $130k when they can hire a board certified endo for $230k.
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Hospital hires endo at over 350k with bonuses etc and saddles them with two mid-levels
 
rokshana said:
Varies with place, but have heard as low as $45 and as high as $55...which is why I picked $50 in my post .

mans you should make sure it’s wRVU.
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The endo I know has negotiated this rate that includes bonuses. And yes it is a rural area. I think she actually makes more than this. It is at Lehigh valley in east Stroudsburg Pennsylvania. Supervisor of two np. And is now medical director to allow for the increased salary.
 
TikiTorches said:
The endo I know has negotiated this rate that includes bonuses. And yes it is a rural area. I think she actually makes more than this. It is at Lehigh valley in east Stroudsburg Pennsylvania. Supervisor of two np. And is now medical director to allow for the increased salary.
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Not saying there aren’t jobs like that out there, but they are not the average endo job.

there was a recent survey of endocrinologists done and salary can widely range… someone makes $900k as an endo…but im certainly not going to say that that is typical.
 
Do Endocrinologists practice general IM as well after fellowship ?
 
psyche1 said:
Do Endocrinologists practice general IM as well after fellowship ?
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Some do… many times its older endos that were doing both…but most go into endo because of the subject matter and are not really interested in doing general medicine.

personally, I still do some hospitalist work on occasion…but there is a reason… local hospital or covid surge…but that was because I was a hospitalist for a couple of years between residency and fellowship.
 
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