job offers (advanced CHF)

[throwaway1939]

graduating ahft fellow this year

I've narrowed my job search to these two, want to hear everyone else's thoughts.

job #1 - hospital employed, privademics coastal-ish south, vad + txp, 400k + 30k sign on, "partner" after 3 years, 450k + production/metrics (must hit >6500 RVUs to get full bonus), potential is 550k-600kish, 4 weeks vacay, escalates to 6 weeks. the chf group is young; all 2-6 years out of fellowship, total of 6 CHF docs I think. does a decent number of txps (>20) and vads (>50). Epic EMR. 50% general cards, 50% heart failure, 8-10 weeks inpatient rounding which counts as call as well, hospitalist/intensivist coverage overnight, so mostly would be donor call and recs from home, can do own rights, 3-4 imaging/TEEs days a month. 3 surgeons, all experienced, one close to retirement. ~4 million catchment area

job #2 - hospital employed in the midwest, DT-VAD only (newer program, entering second year), 2 current CHF docs, general cards helps with CHF call. 500k to start, 50k sign-on bonus, partners supposedly make >750k after 2 years with seemingly no RVU target, 6 weeks vacay to start, escalates to 8 after 2 years. all docs contribute to RVU pool and then divvied up to set the salary for the entire group. they did 10 vads first year, 15 vads this year, transplant eligible patients go to nearby academic center. 12 weeks inpatient rounding with gen cards picking up the last 18 weeks that's uncovered currently with CHF docs as backup for severe cases, consult only service. do rights for the group (2-3 days/month dedicated cath lab time), read own echoes, tees, nukes and 7-8 imaging/TEE days a month. Epic emr. 2 vad surgeons who want to implant aggressively from my interviews with them, both in their early 40s. location is mid/large sized city in the midwest (ca 2.5 million metro area). group ultimately wants to have 4-5 CHF docs.

leaning towards job #2 even though it doesn't have transplant, but a bit hesitant to join a new program, fwiw, administration seems to be very supportive of growing a vad program. seems like a better QOL overall even though has more inpatient time, get more time away from clinic with imaging/dedicated cath lab time.

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[ROBINHO]

Job#2
What is the average RVU of the HF docs ?
When an LVad patient gets admitted who covers ? Hospitalist ? And when a general cardiologist is on inpatient who sees those patients ? What about if an LVad patient calls in middle of night - who takes that call when HF doc not on call overnight. And what is the support like HF Rn? APP? How many LVad coordinators?
HF is very involving and you are subject to burn out. Sometimes making sure you have appropriate support is more important than salary. Sometimes there may be caveats like if there is an LVad admission, the HF doc needs to come in or take those calls and you need to figure out how often that happens. Vad surgeons wanting to be aggressive is good but also means more work.

My questions are focused on job 2 because you are leaning towards that.

 

[cards67]

Hard to compare on the surface, I'll take your word on what felt better to you. As to your concerns about stability, who knows what the future holds, for anywhere really. Surgeons may leave, insurance changes, admin changes, etc. IMO, go off the information you have now and re-evaluate if/when things change. I agree that support and non-rvu bs work is something to pay attention to, not just salary.

 

[perita]

Hi everyone, I am graduating HF this year but willing to do General. I started looking for jobs without any location restriction.
So the two jobs that I am leaning to regarding are one that pays 650K hospital base and another one with a group that pays 500K with a group that will pay 650K once you make partner after 3 years.
Since this is my first job, the way I see it is why take a job that pays 500K with the promise to make 650K in the future. What about if I leave after the three year. I will better serve if I take the 650K job and even If I leave after three years I have already made 450K more. I know that are some other things that I have to take into considerations but if everything else is about the same between the two , I think it is a no brainer to take the first one unless I am missing something in regards about being a partner of group compare to being hospital employ. Am I?

 

[timpview]

It’s your last sentence.

Corporate medicine is always the devil you know. Not a lot of illusions there. You take a decent paycheck and answer to your boss. You know your place.

If a private opportunity exists obviously you could get equally or more screwed over by partners.. though the possibility of having more autonomy and a higher income ceiling theoretically exists.

The post tax money difference isn’t nearly as crucial as all the other factors that go into it imo.. so I wouldn’t get too caught up on that.