Job red flags

[NeuroAP86]

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How bad does it look leaving 2 jobs within 2 years? I really do not want to do this but my hand might be forced. I would ideally wait 6 months before looking for something else. Here is a bit of background regarding this situation:

I decided to leave my first job out of training (private practice) roughly 1 year due to multiple reasons (awful commute, several partners quit with more call and covid related pay cuts/reduced volume). I took a job in academics closer to home. Most aspects of this job I like including mostly outpatient and teaching residents/fellows/medical students but there are some big issues that came up. Shortly after starting, COVID related pay cuts were announced for all physicians and moving to productivity compensation which is an issue as the no show rate can be quite high.

Another issue is related to inpatient coverage at an outside hospital. On the surface, this looked great as I was being paid extra to do this but I quickly realized why this was the case. This is a VERY HIGH volume/acuity situation (8-10+ consults daily and total lists of 20-30+ patients) and it is only me with a mid level provider (also new). The others also doing this coverage feel the same as I do regarding high volume and acuity. It has been discussed with administration but not much has changed. I am very worried that this and the fact that we are moving to RVU model with the ongoing COVID related issues, I won't be able to hit my targets. I also want to be able to practice my subspecialty area in addition to general neurology but this is not happening so far (I was told I would get some of this time including procedures like EMG/EEG/botox).

I am quite aware leaving too many jobs is a red flag but given what I stated above and some of these issues stemming from COVID, would these be reasonable excuses to any jobs I interview for in the future? I am trying to make the best decision going forward.

 

[robellis]

If you’re seeing a ton of patients wouldn’t it be very easy to hit RVU targets and make a lot of money?

 

[NeuroAP86]

If you’re seeing a ton of patients wouldn’t it be very easy to hit RVU targets and make a lot of money?

I should have clarified that. The contract work service does not count towards our RVUs for the year and paid a flat fee as our hospital gets paid X amount (not disclosed to us) for coverage provided to this outside hospital. I guess its like a locum type of situation.

Basically we are seeing high volumes when are not paid by RVU and the rest of my time spent in clinic just seeing consults with no procedures with high show rates that have gotten worse with the ongoing pandemic (>30%).

 

[robellis]

I should have clarified that. The contract work service does not count towards our RVUs for the year and we are paid per day as a flat fee as our hospital gets paid a certain fee (not disclosed to us) for covering 2 weeks a month by this community hospital.

Basically we are seeing high volumes when are not paid by RVU and the rest of my time spent in clinic just seeing consults with no EMG or botox with high show rates that have gotten worse with the ongoing pandemic (previously 30% but probably as high at 50% now)

yeah you’re in a tough position I think leaving is reasonable if things don’t significantly change

 

[NeuroAP86]

yeah you’re in a tough position I think leaving is reasonable if things don’t significantly change

Thanks for the response. Would <1 year really look bad given that I left my previous job at 1 year? It is so frustrating that I can't seem to find the best situation that I can see myself staying for a long period of time. I was not sure about the first job but I was certain this one would be much better long term option.

 

[robellis]

People change jobs all the time I wouldn’t sweat it and do what’s best for you

 

[Neurologo]

It is typical for new grads to change jobs first 2-3 years because they don't know what to look for in job selection or the job turns out to be not what they were expecting after they start. As long as you are not switching jobs simply because you cannot handle average to high production, then you should be fine. I am not sure about the first job you quit although you mentioned increased calls and work load as one of the reasons for quitting. But the second job would be unfair if the compensation for that additional inpatient coverage is not $1600-2000 per day (typical locum pay). The RVU based pay for your clinic work is reasonable given the current COVID situation. You should expect to get in proportion to what you produce.

I know another MS guy working his ass off in a university hospital as his first job being the only MS doc covering the MS clinic and building up an infusion center as well as covering busy inpatient service with minimal office staff support and yet making ridiculous $180k per year. I tell him he should be making $380k - 480k minimum for that amount of work in private practice. I even offered him to join my group. I don't think he believes my numbners or he thinks working in an "academic center" is worth slaving his health away with little left in his savings. Yet he is stressed and feels overwhelmed daily. To each his own.

As a practice owner, I don't care how many jobs a candidate had before. All I care is that he is a good or excellent neurologist (clinical knowledge) who truly wants the best for his patients and is not afraid to work hard or at least be content with getting paid according to his production if he wants to limit his work load. Sloppy notes, poor communication or social skill, being late, wanting to get paid more than what he actually produce are the real red flags that actually matter greatly.

 

[Sushirolls]

Keep it simple that the previous jobs changed the terms of the job after you started, and it wasn't something you agreed to.

Go get your next one. Better yet if you want EMG/EEG/Botox, go open your own practice.

Neurology, like Psychiatry, I don't understand why most don't just open their own practice?

 

[sharkbaitwhohaha]

Keep it simple that the previous jobs changed the terms of the job after you started, and it wasn't something you agreed to.

Go get your next one. Better yet if you want EMG/EEG/Botox, go open your own practice.

Neurology, like Psychiatry, I don't understand why most don't just open their own practice?

uhhhh.... I know why most people don't open their own practice. It is the +300K in educational debt and not wanting to tack on another several hundred thousand as a small business loan.

 

[Sushirolls]

Loans aren't necessary.

Student loans is +/- an issue.

 

[NeuroAP86]

It is typical for new grads to change jobs first 2-3 years because they don't know what to look for in job selection or the job turns out to be not what they were expecting after they start. As long as you are not switching jobs simply because you cannot handle average to high production, then you should be fine. I am not sure about the first job you quit although you mentioned increased calls and work load as one of the reasons for quitting. But the second job would be unfair if the compensation for that additional inpatient coverage is not $1600-2000 per day (typical locum pay). The RVU based pay for your clinic work is reasonable given the current COVID situation. You should expect to get in proportion to what you produce.

I know another MS guy working his ass off in a university hospital as his first job being the only MS doc covering the MS clinic and building up an infusion center as well as covering busy inpatient service with minimal office staff support and yet making ridiculous $180k per year. I tell him he should be making $380k - 480k minimum for that amount of work in private practice. I even offered him to join my group. I don't think he believes my numbners or he thinks working in an "academic center" is worth slaving his health away with little left in his savings. Yet he is stressed and feels overwhelmed daily. To each his own.

As a practice owner, I don't care how many jobs a candidate had before. All I care is that he is a good or excellent neurologist (clinical knowledge) who truly wants the best for his patients and is not afraid to work hard or at least be content with getting paid according to his production if he wants to limit his work load. Sloppy notes, poor communication or social skill, being late, wanting to get paid more than what he actually produce are the real red flags that actually matter greatly.

I am making no where near this which is one of the reasons I feel it is unfair given how high the pay can be when you are generating high RVUs for inpatient coverage.

The first job was more due to location/commute rather than anything else but all the other issues started to build up and it didn’t seem like a great long term option. As a matter of fact, that group lost another 3 neurologists after I left for various reasons. We were also underpaid after talking to other neurologists in the are working for different groups.

 

[Neurogeneral]

People change jobs. It’s part of life - especially for the newer generation. Gone are the days of joining a practice and staying the course no matter what til retirement. And neurology is in demand. So employers can be somewhat eager/desperate to hire.

Having said that, the COVID related cuts will not last forever. Your salary and RVUs could recover in short time especially as there appears to be light at the end of the tunnel.

I also think you need to be more careful about selecting your next job. Try to find out exact details and being more direct with that. Get concrete assurances (possibly in writing) that you will be able to do EMG, EEG, etc. Also, If your compensation vs. workload expectations don’t line up for your current local market, you may have to look in another city/locale to get exactly what you are looking for.

 

[NeuroAP86]

People change jobs. It’s part of life - especially for the newer generation. Gone are the days of joining a practice and staying the course no matter what til retirement. And neurology is in demand. So employers can be somewhat eager/desperate to hire.

Having said that, the COVID related cuts will not last forever. Your salary and RVUs could recover in short time especially as there appears to be light at the end of the tunnel.

I also think you need to be more careful about selecting your next job. Try to find out exact details and being more direct with that. Get concrete assurances (possibly in writing) that you will be able to do EMG, EEG, etc. Also, If your compensation vs. workload expectations don’t line up for your current local market, you may have to look in another city/locale to get exactly what you are looking for.

Thanks for the advice! Having gone through the process on two occasions, I am much more aware of what I need to ask and have clearly written out in terms of assurances for the jobs duties.

I really do hope the market picks up soon as most of the postings in my area are not very desirable.