Is this a good job offer? Hospitalist

[the_teej]

Hi, planning to go into hospitalist medicine. Got a job offer in SE region, mid-sized city for mid 2023 I’m seriously considering.

-Salary 262k base. No RVU component but may be transitioned in 1-2 years. Lets for now say no
-20k quality, basically checking boxes
-10k “experience” so wont get that any time soon
-3k CME
-1.5k for boards
-6% match 401k.
-30k signon bonus, 5k relocation
-malpractice covered.
- “full benefits” dont know if i missed anything.

The job-
Days, 7on 7 off, 7am-7pm. Must be in house whole time.
-20pts on average to round, may get overflow admissions if admitting physician overwhelmed
- closed ICU. Great specialty and ancillary support
- no procedures.
-supposed 1wk PTO and 5 day CME time/yr

I do love the area, but am worried i am getting taken advantage of a bit. The pt load with possible admissions makes me worried ill be workin hard for (currently) no RVU compensation.

What do you all think? Im currently in talks with other hospitals, but haven’t visited them or got offers yet.

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[chessknt]

Hi, planning to go into hospitalist medicine. Got a job offer in SE region, mid-sized city for mid 2023 I’m seriously considering.

-Salary 262k base. No RVU component but may be transitioned in 1-2 years. Lets for now say no
-20k quality, basically checking boxes
-10k “experience” so wont get that any time soon
-3k CME
-1.5k for boards
-6% match 401k.
-30k signon bonus, 5k relocation
-malpractice covered.
- “full benefits” dont know if i missed anything.

The job-
Days, 7on 7 off, 7am-7pm. Must be in house whole time.
-20pts on average to round, may get overflow admissions if admitting physician overwhelmed
- closed ICU. Great specialty and ancillary support
- no procedures.
-supposed 1wk PTO and 5 day CME time/yr

I do love the area, but am worried i am getting taken advantage of a bit. The pt load with possible admissions makes me worried ill be workin hard for (currently) no RVU compensation.

What do you all think? Im currently in talks with other hospitals, but haven’t visited them or got offers yet.

Do you have # of shifts per year? Assuming it is 26*7-7 (for your week off)=175*12 (in house hours)=2100 hrs/yr for 282 salary (not going to count benefits since that is pretty similar most employed places)=134/hr. Ignore the other crap (sign on CME etc) since this is the crux of the job. I think this would be pretty blah for the SE which traditionally reimburses better than other areas. It is even more blah when they hold 8% of it hostage to whatever they define as quality.

Now let's compare your billing at 20 pt census to see how it compares because that is important too. I agree that an average of 20 seems heavy and that means that you could go way over that for it to be the average. I would conservatively ballpark average wRVU/encounter for a hospitalist to be somewhere around 1.5ish with no procedures. that is 30 wRVU/day *25 weeks=5250 wRVU which comes out to about $53/wRVU and this is likely significantly undershooting your production at that census load. MGMA 2021 data puts median hospital-employed hospitalist comp at 71.60/wRVU which makes your job look like it is underperforming, however total comp in South median is at 324 (which is actually close to yours accounting for benefits).

So what does this mean? It means they are conjuring up a number that looks competitive in accordance with the Stark nonsense but are making you do 20% more work to get it than the average job in that area. They probably wont negotiate anything on your pay structure but arguing for a productivity incentive of the median unit rate over the median regionally-adjusted wRVU total would be one strategy to try to capture value if you are being overworked. They wont go for it though.

 

[Splenda88]

Not a bad offer if the 20k is basically "guaranteed'.

However, I believe you should counter by asking for 290k and settle for 280k, 2 wks PTO and 10k relocation.

 

[medstudent2IM]

The 2 major drawbacks of that job posting are
1: Rounding on 20 patients and then also being on the hook for admission simultaneously. This is just a lot of patients day-to-day and not something I'd want.
2: Having to be in house for full 12 hours of your shift.

The salary is just blah. I wouldn't be taking this job.

 

[zegrated]

Not great. 20 pts a day plus admissions is a recipe for burnout, especially if you aren't getting an RVU kicker on top of that base salary. Also needing to be in house the whole time sounds horrible.

Source: currently a hospitalist in a mid size southern city with base >280k, plus RVU bonus, quality, CME, etc. I see ~16 per day including admissions. We can leave the hospital if not on call.

 

[Splenda88]

Not great. 20 pts a day plus admissions is a recipe for burnout, especially if you aren't getting an RVU kicker on top of that base salary. Also needing to be in house the whole time sounds horrible.

Source: currently a hospitalist in a mid size southern city with base >280k, plus RVU bonus, quality, CME, etc. I see ~16 per day including admissions. We can leave the hospital if not on call.

I am glad hospitalists starting to understand that they are in demand and they dont have to put up with BS.

Given the way the market is right now, no hospitalist should be making less than 280k/yr and have more than 18 encounters per day

 

[collegestud2013]

Hi, planning to go into hospitalist medicine. Got a job offer in SE region, mid-sized city for mid 2023 I’m seriously considering.

-Salary 262k base. No RVU component but may be transitioned in 1-2 years. Lets for now say no
-20k quality, basically checking boxes
-10k “experience” so wont get that any time soon
-3k CME
-1.5k for boards
-6% match 401k.
-30k signon bonus, 5k relocation
-malpractice covered.
- “full benefits” dont know if i missed anything.

The job-
Days, 7on 7 off, 7am-7pm. Must be in house whole time.
-20pts on average to round, may get overflow admissions if admitting physician overwhelmed
- closed ICU. Great specialty and ancillary support
- no procedures.
-supposed 1wk PTO and 5 day CME time/yr

I do love the area, but am worried i am getting taken advantage of a bit. The pt load with possible admissions makes me worried ill be workin hard for (currently) no RVU compensation.

What do you all think? Im currently in talks with other hospitals, but haven’t visited them or got offers yet.

Not a great a offer. I would keep looking unless they're willing to negotiate some parts of the compensation, especially the RVU part. The only good parts of the job seems that it's 100% day shifts, good subspecialty support, there's a decent signon/relocation bonus, and 1 week PTO. They might be able to get away with such an offer if the job is in a highly desirable location.

1) 20 rounding patients (without admissions) is reasonable nowadays for a 12 shift if you have great ancillary/subspecialty support. But if you have to help with admissions routinely on top of that, this will probably make it busier than most people like (and without an RVU bonus you won't get any more for your work).

2) You have to stay in house for 12 hrs for every single shift. At many other places you are able to leave early on your rounding shifts and take call from home, and only have to stay in house the whole time for admitting or night shifts (which should be only the minority of your shifts unless you're the full time nocturnist)

3) $262 + $20k = $282k for 20 or more rounding patients per shift is pretty low pay for southeast. Assuming you're doing the standard 182 shifts per year that comes with a 7on/7off schedule; if you get 1 week PTO and so are only doing 175 shifts it still comes out to $134/hr, which is somewhat low for the volume you're seeing. And that's assuming you get all $20k of the quality bonus. If you can, ask the current hospitalists to see if getting the $20k is really as easy as "checking boxes." And quality bonus cutoffs are subject to change at any time as the employer sees fit. For the volumes and shifts they're quoting you should be getting at least $310-320k.

4) Sounds like there's no RVU bonus right now. You should be very careful about signing up for a job without an RVU bonus unless there's also a hard census cap in your contract. Otherwise the 20 patients that they tell you now, could turn into 24-26 patients if the hospital gets busier or there is some sort of understaffing issue, and you won't get compensated any more for seeing extra patients. However, if they can offer a decent RVU pay on top of the base when you start (instead of waiting 1-2 years to transition to it) then you could re-consider.

 

[Osteoth]

Not great. 20 pts a day plus admissions is a recipe for burnout, especially if you aren't getting an RVU kicker on top of that base salary. Also needing to be in house the whole time sounds horrible.

Source: currently a hospitalist in a mid size southern city with base >280k, plus RVU bonus, quality, CME, etc. I see ~16 per day including admissions. We can leave the hospital if not on call.

What’s your total comp?