Is this a good hospitalist offer?

[guitarguy23]

Hi all, considering a hospitalist position after residency and wondering if I am missing anything I should be thinking about. I have been in talks about the position before the hospitalist group was transitioned to new corporate management. Now, the position actually pays more hourly then it would have.

Pros
--salary seems high; $140 hourly, 15 day shifts/month, 180 shifts/year; $180 for any additional shifts
--flexible schedule; not strictly 7/7, can make it what I as long as 15 shift/month(usually 4/3, 5/2)
--location good; family would be happy, good school system for kids and closer to families
--new group claims to be adding more mid-level support (going from 1-->2 day NPs with 2 physicians)
--census seems appropriate; site visit with ~14-16 patients when I went, that was with only 1 NP too

Cons
--new mgmt; I am unsure how likely they are to follow through on promises for physicians
--not sure if bad but no quality incentive yet? group states they will add after a period of time and NOT reduce hourly rate, but again I am not sure how to be sure
--no 401k match
--small sign-on bonus
--no relocation bonus (working to add negotiate)
--small hospital (~300 beds), limited subspecialty support
--manage ICU patients as part of census (reportedly ~4 per day)

Is there anything I'm missing/should be looking for as a red flag? Job seems good as the hospital is small (~300 beds), when I visited it did not seem super busy. Any thoughts would be appreciated, also, any input regarding what constitutes a "great"hospitalist job would be good! Thanks.

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[PlutoBoy]

Hi all, considering a hospitalist position after residency and wondering if I am missing anything I should be thinking about. I have been in talks about the position before the hospitalist group was transitioned to new corporate management. Now, the position actually pays more hourly then it would have.

Pros
--salary seems high; $140 hourly, 15 day shifts/month, 180 shifts/year; $180 for any additional shifts
--flexible schedule; not strictly 7/7, can make it what I as long as 15 shift/month(usually 4/3, 5/2)
--location good; family would be happy, good school system for kids and closer to families
--new group claims to be adding more mid-level support (going from 1-->2 day NPs with 2 physicians)
--census seems appropriate; site visit with ~14-16 patients when I went, that was with only 1 NP too

Cons
--new mgmt; I am unsure how likely they are to follow through on promises for physicians
--not sure if bad but no quality incentive yet? group states they will add after a period of time and NOT reduce hourly rate, but again I am not sure how to be sure
--no 401k match
--small sign-on bonus
--no relocation bonus (working to add negotiate)
--small hospital (~300 beds), limited subspecialty support
--manage ICU patients as part of census (reportedly ~4 per day)

Is there anything I'm missing/should be looking for as a red flag? Job seems good as the hospital is small (~300 beds), when I visited it did not seem super busy. Any thoughts would be appreciated, also, any input regarding what constitutes a "great"hospitalist job would be good! Thanks.

Look elsewhere.

 

[rokshana]

Hi all, considering a hospitalist position after residency and wondering if I am missing anything I should be thinking about. I have been in talks about the position before the hospitalist group was transitioned to new corporate management. Now, the position actually pays more hourly then it would have.

Pros
--salary seems high; $140 hourly, 15 day shifts/month, 180 shifts/year; $180 for any additional shifts
--flexible schedule; not strictly 7/7, can make it what I as long as 15 shift/month(usually 4/3, 5/2)
--location good; family would be happy, good school system for kids and closer to families
--new group claims to be adding more mid-level support (going from 1-->2 day NPs with 2 physicians)
--census seems appropriate; site visit with ~14-16 patients when I went, that was with only 1 NP too

Cons
--new mgmt; I am unsure how likely they are to follow through on promises for physicians
--not sure if bad but no quality incentive yet? group states they will add after a period of time and NOT reduce hourly rate, but again I am not sure how to be sure
--no 401k match
--small sign-on bonus
--no relocation bonus (working to add negotiate)
--small hospital (~300 beds), limited subspecialty support
--manage ICU patients as part of census (reportedly ~4 per day)

Is there anything I'm missing/should be looking for as a red flag? Job seems good as the hospital is small (~300 beds), when I visited it did not seem super busy. Any thoughts would be appreciated, also, any input regarding what constitutes a "great"hospitalist job would be good! Thanks.

where are you looking that 140/hr seems "high"?

 

[guitarguy23]

What’s most concerning?

 

[guitarguy23]

where are you looking that 140/hr seems "high"?

What is a decent reference hourly rate that should be high? I’ve seen most hospitalist jobs in my area quote at $115-125/hr?

 

[guitarguy23]

Look elsewhere.

Whats concerning to you about the position? I’m concerned now!

 

[DrMetal]

What is a decent reference hourly rate that should be high? I’ve seen most hospitalist jobs in my area quote at $115-125/hr?

What part of the country? Major metro area?

 

[Raryn]

where are you looking that 140/hr seems "high"?

That's potentially high for a big metro area, especially if he's an employee and not a contractor. If he works 12-hour shifts x 15 shifts a month, it comes out to ~$300k/year, which is well above the average in big cities.

 

[guitarguy23]

Semi-rural town, ~40k population and about 1 hr from large metro town

 

[Raryn]

Semi-rural town, ~40k population and about 1 hr from large metro town

It's not a *bad* pay for a smaller town, but for the described work and the fact it's an employed rather than contractor position, you could potentially do better. But it's also dependent more on local market factors.

 

[pgy0246]

I have an offer with 240k base, and promising another 30-40k (RVU + quality bonus) with an hour driving outside of major metropolitan, smaller hospital (150 beds), should I look elsewhere?

How important is RVU in term of hospitalist offer?

 

[NITRAS]

Always ask if you have to be present for your entire shift, or can you leave.
Do you take calls at night?
How much can people shift shifts if needed? How much moonlighting is available.
Procedures?
What is there in terms of critical care support.
How do the admissions work?
What is their retention like? Our retention is very good, like the majority have been here over 5 years. Most have left to do fellowship. If everyone one there has been there less than 3 years. . .. I'd probably look elsewhere.

The "average" hospitalist will produce like 4200-4400 wRVUs a year. I don't get paid bonus till I hit 3500, but I can count on getting about $15k to $20k a year. Other jobs are majority wRVU's and account for a larger % of their salary.

 

[PlutoBoy]

Whats concerning to you about the position? I’m concerned now!

No 401k, no sub specialties (hospital medicine depends on this), you have to cover the ICU... I could go on.

If they are paying you too much the job probably sucks.

If they cannot retain hospitalists or sub specialists it is for a reason.

Lastly, you are an internist. Leave the ICU to intensivists. It’s not reasonable to run the ICU while fielding calls for docusate. Now, if you have to do it then make sure you can intubate and insert central lines/a-lines.

Look elsewhere.

 

[PlutoBoy]

Semi-rural town, ~40k population and about 1 hr from large metro town

Run.

 

[eimaise]

Hi all, considering a hospitalist position after residency and wondering if I am missing anything I should be thinking about. I have been in talks about the position before the hospitalist group was transitioned to new corporate management. Now, the position actually pays more hourly then it would have.

Pros
--salary seems high; $140 hourly, 15 day shifts/month, 180 shifts/year; $180 for any additional shifts
--flexible schedule; not strictly 7/7, can make it what I as long as 15 shift/month(usually 4/3, 5/2)
--location good; family would be happy, good school system for kids and closer to families
--new group claims to be adding more mid-level support (going from 1-->2 day NPs with 2 physicians)
--census seems appropriate; site visit with ~14-16 patients when I went, that was with only 1 NP too

Cons
--new mgmt; I am unsure how likely they are to follow through on promises for physicians
--not sure if bad but no quality incentive yet? group states they will add after a period of time and NOT reduce hourly rate, but again I am not sure how to be sure
--no 401k match
--small sign-on bonus
--no relocation bonus (working to add negotiate)
--small hospital (~300 beds), limited subspecialty support
--manage ICU patients as part of census (reportedly ~4 per day)

Is there anything I'm missing/should be looking for as a red flag? Job seems good as the hospital is small (~300 beds), when I visited it did not seem super busy. Any thoughts would be appreciated, also, any input regarding what constitutes a "great"hospitalist job would be good! Thanks.

This sounds like a dream job to me. Don't take all the negativity too hard. Hospitalists vary so much in their opinions on jobs I have discovered. I have met some that literally want to get in and get out and grumble the whole time. Others I have met and worked with are passionate about their job, enjoy the full scope of hospital medicine including ICU etc.

I'm interviewing for my first job out of residency right now but have been moonlighting as a hospitalist for the last several months. Many of the smaller hospitals ask for their hospitalists to cover the ICU. I happen to love the ICU and doing procedures, etc, so I asked on every job interview if I would be able to manage ICU patients. 300 beds is not that small in my opinion. I interviewed at hospitals with 50 beds. I currently moonlight in two 80 bed hospitals. And not having a 401k match is not a deal breaker. Most importantly, the location is good and your family would be happy. The salary is also good I would argue for that set up. If you think you'd be happy there, take the job. What's the worst that's going to happen? You hate it and leave in 1 year. Make sure you interview at a few places though so you can compare.

 

[CDI]

Semi-rural town, ~40k population and about 1 hr from large metro town

Ah hell nah.

 

[CDI]

Is there anything I'm missing/should be looking for as a red flag? Job seems good as the hospital is small (~300 beds), when I visited it did not seem super busy. Any thoughts would be appreciated, also, any input regarding what constitutes a "great"hospitalist job would be good! Thanks.

Flexible schedule
Round & go
No procedures, No codes, No ICU
PTO
Paid holidays
401k match
Pension plan
Sign on bonus

My first year with 15 shifts/month = 180 shifts for the year:

$315k

This includes federal holidays paid out AND PTO paid out.

It does NOT take into account my 401k employer match, pension plan, or bonus.

 

[fasteddie911]

Seem pretty decent to me. Location and pay seem good. I'm sure you can find a higher paying position but at what cost? Often you'll only stay at your first attending job a few years, so I wouldn't worry to much about the longterm outlook. The group seems new too so it's hard to say how it'll be over time. ICU doesn't seem like a big issue, I've rotated at hospitals like that and it seemed fine if you feel comfortable with it. I think there's just things you won't know until you actually start working, what you like and don't like etc. Depends on what other options you have as well.

 

[DaTruMD]

Flexible schedule
Round & go
No procedures, No codes, No ICU
PTO
Paid holidays
401k match
Pension plan
Sign on bonus

My first year with 15 shifts/month = 180 shifts for the year:

$315k

This includes federal holidays paid out AND PTO paid out.

It does NOT take into account my 401k employer match, pension plan, or bonus.

How does one find a job like this?

 

[rokshana]

This sounds like a dream job to me. Don't take all the negativity too hard. Hospitalists vary so much in their opinions on jobs I have discovered. I have met some that literally want to get in and get out and grumble the whole time. Others I have met and worked with are passionate about their job, enjoy the full scope of hospital medicine including ICU etc.

I'm interviewing for my first job out of residency right now but have been moonlighting as a hospitalist for the last several months. Many of the smaller hospitals ask for their hospitalists to cover the ICU. I happen to love the ICU and doing procedures, etc, so I asked on every job interview if I would be able to manage ICU patients. 300 beds is not that small in my opinion. I interviewed at hospitals with 50 beds. I currently moonlight in two 80 bed hospitals. And not having a 401k match is not a deal breaker. Most importantly, the location is good and your family would be happy. The salary is also good I would argue for that set up. If you think you'd be happy there, take the job. What's the worst that's going to happen? You hate it and leave in 1 year. Make sure you interview at a few places though so you can compare.

no THIS sounds like the dream job

Flexible schedule
Round & go
No procedures, No codes, No ICU
PTO
Paid holidays
401k match
Pension plan
Sign on bonus

My first year with 15 shifts/month = 180 shifts for the year:

$315k

This includes federal holidays paid out AND PTO paid out.

It does NOT take into account my 401k employer match, pension plan, or bonus.

 

[CDI]

no THIS sounds like the dream job

I was giving an example of the ideal things to look for.

My current job has all of the above I had mentioned, except for the round & go part. We are technically 7 on 7 off, but people have managed 3/4 week schedules. I average about 3 extra shifts a month.

Our patient population tends to be sick, you wind up needing to stay the full shift in the hospital.

I work directly in the middle of and up to 20 mins outside a major city. (Forgot to include proximity to major city in the list.)

When I considered the added benefits of my employer 401k contribution (correction from my prior post, it’s an employer automatic contribution, not a match) + pension plan growth + avg expected bonus, it works out to ~$350k/yr working 180 shifts.

As you could imagine it was difficult pursuing a fellowship when I saw those numbers, especially since I never really found my calling with any particular specialty to begin with.

It was also the first and only place I interviewed at, and hopefully is the last.

 

[CDI]

How does one find a job like this?

Would have to look for a large managed care organization where they rely on preventive care over simply seeing more patients in the hospital.

The outpatient docs are incentivized to keep people out the hospital, and keep costs down - so they see the heavy numbers while inpatient docs just see the sick patients but less of them overall.

 

[jacksparrow82]

Hi all, considering a hospitalist position after residency and wondering if I am missing anything I should be thinking about. I have been in talks about the position before the hospitalist group was transitioned to new corporate management. Now, the position actually pays more hourly then it would have.

Pros
--salary seems high; $140 hourly, 15 day shifts/month, 180 shifts/year; $180 for any additional shifts
--flexible schedule; not strictly 7/7, can make it what I as long as 15 shift/month(usually 4/3, 5/2)
--location good; family would be happy, good school system for kids and closer to families
--new group claims to be adding more mid-level support (going from 1-->2 day NPs with 2 physicians)
--census seems appropriate; site visit with ~14-16 patients when I went, that was with only 1 NP too

Cons
--new mgmt; I am unsure how likely they are to follow through on promises for physicians
--not sure if bad but no quality incentive yet? group states they will add after a period of time and NOT reduce hourly rate, but again I am not sure how to be sure
--no 401k match
--small sign-on bonus
--no relocation bonus (working to add negotiate)
--small hospital (~300 beds), limited subspecialty support
--manage ICU patients as part of census (reportedly ~4 per day)

Is there anything I'm missing/should be looking for as a red flag? Job seems good as the hospital is small (~300 beds), when I visited it did not seem super busy. Any thoughts would be appreciated, also, any input regarding what constitutes a "great" hospitalist job would be good! Thanks.

This doesn't seem too bad in my opinion. I've been a hospitalist for over 7 years now. There are so many variables to consider here that it's really hard to compare one job to the next.
My first position was not as good as you describe above in terms of pay and number of shifts. I was paid a base salary which worked out to about $110/hr, but we didn't have to stay in the hospital the whole shift. I got significant RVU and quality bonuses. I was hitting around 230k-270k most years. However, we were required to do 200 shifts/year and the hospital was BUSY. Lot's and lot's of admission when on call and our census was frequently above 18 each.
Now I work at a different hospital an hour outside of town. It's a small hospital. Much less busy. However, very little specialist support. It pays much better per hour, but it's a drive here. We have to respond to codes and manage the ICU alone on certain weekends (which we never did at my old job). We're not required to do procedures, but have to rely on the ER doc or a surgeon to help if a procedure is required. I'm making a lot more money and under less stress, but there are trade offs. You really need to do decide what's important to you.
I don't like the no 401k match, but that's becoming more common these days unfortunately. This hospital is actually getting taken over by TeamHealth next month. The new company is going to require 12 hour shifts no leaving early, not sure we'll be "allowed" to leave early yet. Pay will be $150/hr for moonlighters. No 401k match. This hospital has a high census during winter months (over 20-25 each most days).

In my opinion, the best hospitalist jobs are those that allow for flexible schedules (not a rigid 7 on/7 off) and allow you to leave when you're done rounding if you're not on call. Being on call too frequently is not good, but neither is being on call infrequently. The downside to being on call too infrequently is not admitting any of your own patients, which makes discharge summaries and family conversations more difficult because you don't know them as well. I think being on call every 2 days is probably about the right mix. Another big factor for me is code blues and ICU management. We have enough to deal with on the regular medical/telemetry floors. If you can avoid code blues and ICU calls, your day will be much more pleasant. Outside of those big factors, the average daily census is very important. When my census goes above the 16-18 range, I really feel it. A 401k match is nice, but sometimes it comes at the expense of a better hourly rate or RVU bonus rate, etc.
The bottom line is how pleasant the work is, how much you're paid in a year, and how much free time you get away from work. Maximize those 3 things and you'll be pleased with your job.