Job search advice for a Heme/Onc fellow

[HaemOnculus]

Hello everyone, second year heme/onc fellow without a visa requirement here. I am looking for advice about the upcoming job search. Any information would be appreciated. Looking for a private practice or hybrid practice job. Hesitant to consider academia(but open to hearing opinions). My understanding as far as looking for a job would be to consider three main competing things: compensation, location, and work environment. It seems reasonable to expect two of these three aspects of employment when searching. But I am hoping for some guidance:

1. I am not married to any geographic location and I plan on interviewing at several(hopefully 10-15) locations(both rural and urban) to get a feel for different locations as well as different practice environments. Would you consider this disingenuous? I certainly don't want to waste anyone's time or money in interviewing but I want to get a feel for what is possible/available.
2. What are the other things I should consider? I am aware of things such as non-compete clauses, administrative time, AP roles, overnight and weekend coverage, hospital consults, procedures, partnership vs employee, productivity, but what should I ask about these things and what other things should I consider?
3. For anyone that is currently an attending, what has interviews/hiring been like in the time of covid?
4. Any tips for negotiating?
5. I have heard from several people about having a lawyer(familiar with physician contracts) looking over the final contract. What are the things that I should pay special attention to? Does anyone have any anecdotes about bad contracts/clauses?
6. What does a typical job interview day look like, what are some red flags?
7. What are some things that may be different interviewing as a fellow vs interviewing as an established attending?
8. Where should I begin my search, I am aware of NEJM, ASCO/ASH Jobs, Merrit-Hawkins, and Practice Link. I also do plan on cold-calling certain areas that pique my interest. Any other services that I should look into?
9. What else should I consider?
10. Are there any resources out there that may help answer the above?

I apologize for the long post and I truly appreciate your time in energy in responding. Thank you.

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[Mehena]

I'm in the same boat and all are pertinent questions though some have been answered one way or the other in this forum. It will help greatly if recent successful new entrants to the market or the old guard chime in.

 

[HaemOnculus]

Could anyone point me to any resources that may help with the above questions?

 

[QuizzicalApe]

Can touch on at least a few things:
1. This is fine; this is the purpose of interviewing
2. If not at an academic center, what is your relationship with the academic center? Does your practice enroll on clinical trials directly? Do you send people off to trials? If you feel the need, do you have access to academic tumor boards or will you mostly discuss cases with your colleagues? Time off/conference time/discretionary CME funds/etc is also worth asking. Just me brainstorming while a patient is being roomed.

 

[DeezNutz13]

1. This is fine. I figure you will be exhausted after 4-5 and will also have a good picture of what you want at this point and should be able to narrow it down. 15 seems erroneous.
2. how busy are calls? Do you induce leukemics or not? See what specialties are not present if in a smaller area and where do patients go that need them. What's the compensation model. How much do you make per wrvu. is there a wrvu target? # patients per day. How many new pts. How long alloted per pt.
3. I did 5 in person interviews in July. Social distancing as much as possible and masks. Most places want to do zoom calls which is fine but you're going to want to see the place if your signing on.
4. Compare contracts and find what is the going rate for salary, wrvu, call time, clinic time. I hired a contract review lawyer as well who helped clarify details.
6. various interviews with clinic managers, oncs, rad oncs, nurse managers, hospital admin, tours. Lunch and dinner usually. Red flags are high turnover. frequent call. One place tried to make me pay my own way out to interview (didnt go).
7. Is your office nice. How does the practice utilize mid levels. How many patients do you need to see ect. partnership. contract benefits such as signing bonus, moving stipend, tail coverage for malpractice ect
8 in addition to what you listed doccafe

 

[Mehena]

These are all gems and please keep them coming please to empower us.
Also i have found this informative,Master thread for those who have found good jobs

 

[bobsmith]

I found this article incredibly helpful (more for those looking for private practice / community jobs):

https://ascopubs.org/doi/full/10.1200/jop.2006.2.5.252

+ Emphasis on this part:

"Knowing what you want in a position continues to be front and center in finding a good practice match. You should determine as best you can whether your practice philosophy, personal values, and work style are compatible with those of the other physicians in the practice"

There's also a nice breakdown of questions and things to consider at the end of the article

 

[gutonc]

I found this article incredibly helpful (more for those looking for private practice / community jobs):

https://ascopubs.org/doi/full/10.1200/jop.2006.2.5.252

+ Emphasis on this part:


There's also a nice breakdown of questions and things to consider at the end of the article

I ask a version of that question to everyone I pre-interview when I'm hiring for my community-based academish group. Basically, "describe your dream practice environment". It allows me to quickly and easily decide who I should move forward in the interview process.

Pro Tip: There are no "right" answers here, but there is one absolutely wrong one, and that's to not be able to answer concisely and thoughtfully.

 

[Mehena]

I ask a version of that question to everyone I pre-interview when I'm hiring for my community-based academish group. Basically, "describe your dream practice environment". It allows me to quickly and easily decide who I should move forward in the interview process.

Pro Tip: There are no "right" answers here, but there is one absolutely wrong one, and that's to not be able to answer concisely and thoughtfully.

gutonc, what is the interview process like in the current Covid climate compared to pre-pandemic? Phone --> Zoom--> in person -->offer

 

[gutonc]

gutonc, what is the interview process like in the current Covid climate compared to pre-pandemic? Phone --> Zoom--> in person -->offer

Pretty much. I have always done a pre-interview initial phone call for every CV I get. I basically do my own personal interview of them and give a run-down of what the job/practice entails. After that was an interview with the full group. This takes 2 days, even when done via Zoom. Now, we're bringing people out if they and we are interested after the virtual interview process and focus on the office/site we're hiring them for. Our usual interview process has candidates visiting 5-7 different campus sites over the 2 days, which we're obviously trying to avoid these days.

This is my first round of interviews since the pandemic, so I haven't gotten to the offer stage yet, but that's about how it's going to go.

 

[gutonc]

Hello everyone, second year heme/onc fellow without a visa requirement here. I am looking for advice about the upcoming job search. Any information would be appreciated. Looking for a private practice or hybrid practice job. Hesitant to consider academia(but open to hearing opinions). My understanding as far as looking for a job would be to consider three main competing things: compensation, location, and work environment. It seems reasonable to expect two of these three aspects of employment when searching. But I am hoping for some guidance:

1. I am not married to any geographic location and I plan on interviewing at several(hopefully 10-15) locations(both rural and urban) to get a feel for different locations as well as different practice environments. Would you consider this disingenuous? I certainly don't want to waste anyone's time or money in interviewing but I want to get a feel for what is possible/available.

You've gotten a fair number of good answers here, but I'll add some thoughts.

First and foremost, 10-15 is 2-5X too many places to interview at. You do you, But that's way too much.

2. What are the other things I should consider? I am aware of things such as non-compete clauses, administrative time, AP roles, overnight and weekend coverage, hospital consults, procedures, partnership vs employee, productivity, but what should I ask about these things and what other things should I consider?

You've got a pretty good list. Ask about the comp plan and how it's determined. Base, productivity, etc. Call schedule and expectations.

3. For anyone that is currently an attending, what has interviews/hiring been like in the time of covid?

It blows.

4. Any tips for negotiating?

Ask for what you want. You won't get what you don't ask for and you can't know what they're willing to give unless you request. Understand that they may be limited in what/how then can budge.

6. What does a typical job interview day look like, what are some red flags?

See #3 above. It's all a hot mess right now.

A lack of honest answers, or inconsistent answers should make you pay attention. But note that you will meet people during your interview day who don't know what the **** they're talking about, so don't hesitate to ask clarifying questions of "the boss".

I talk to people that interview with my group a minimum of 3 times. One in the pre-interview stage, a formal interview during the interview day, and then a follow-up phone conversation (in-person if they're local and pre-lockdown). Not to mention all the emails and conversations they have with my admin staff. Do NOT be afraid to ask questions. The only true red flag in this process is when people aren't willing to answer your questions.

 

[HaemOnculus]

Hello all,

Just signed a new job. I want to thank everyone for their advice in the interview and employment process. Once again this place continues to offer sage advice. I wanted to share the list of considerations that I used on the interview trial to evaluate positions. These were compiled from this site as well various recruiter and society websites. I hope it helps someone in the future:


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Location/practice

Date/time

Interviewer(contact info)

Size of group
-How long has each physician been with the group?
-Practice growing or did someone leave?
-Have any physicians left the group in the last 5 years?
-Why did they leave? Would you mind if I spoke with them?

Affiliated hospitals/practices

Primary or consultative

EMR/ is it integrated

Office flow(people running behind?, how many MA/practice nurses, understaffed?)

How are AP’s utilized?

Patient demographics, languages spoken?

Internal Tumor boards or curbside partners/consultants

where do patients go to for second opinions(surgery, radiation, medical, pathology)?
-What is the culture of communication between specialties?

Clinical trials(required?)

Wait time to see new patients?

Administrative time

On call
-how busy?
-Weekday/overnight
-Weekends
-Call split evenly?

Will I be coming into an established patient load or have build my own?

Vacation time

CME/Conference time/funds

Benefits Package
-insurance
-moving stipend
-retirement plan,
-signing bonus
-tail coverage
-PSLF/loan repayment assistance

Non-compete Clause(Distance, language(from which office))

Procedures required

Who gets referred out, where? ie Leukemics

Employee vs partnership(path to partnership, defined or not)

Satellite offices(now or planned in future?)

Termination clause

Malpractice insurance(occurrence based vs claims based)

Minimum Contract time

Salary/compensation structure

How is productivity gaged/compensation model
-RVU target
-How much per RVU
-How is salary growth determined (what is the pathway for moving forward in the practice?)
-Number of patients expected per day

*how many are new patients/follow ups/ time allotted for new/follow-ups


Bonus
- formula for determining the incentive/bonus
- how is my performance measured. what are they looking for me to contribute (mainly RVUs, practice building, program building)?


What is the track record for offering partnership (if private practice)?
- terms for joining a partnership (if it's a private practice - time to partnership, cost for buy-in, what exactly does the buy-in purchase?)
- how does the group measure productivity (i.e. kill what you eat, shared productivity models?) - i.e. am I competing with my colleagues?
- terms for leaving (i.e. malpractice tail coverage, buy-out, how is outstanding A/R handled, what amount of notice is required when leaving the practice?)


Red flags?

 

[onchopeful1]

Do places usually pay for you to interview? i.e. flights, car rental, hotels, etc.? I would think so at this point but I haven't had people mention it thus far and not sure how to bring it up?

 

[gutonc]

Do places usually pay for you to interview? i.e. flights, car rental, hotels, etc.? I would think so at this point but I haven't had people mention it thus far and not sure how to bring it up?

They ****ing better

 

[HaemOnculus]

Do places usually pay for you to interview? i.e. flights, car rental, hotels, etc.? I would think so at this point but I haven't had people mention it thus far and not sure how to bring it up?

Make sure to save your receipts!

 

[onchopeful1]

disclaimer: I have very little experience on what’s the “norm” in heme/onc.

Midwest city
Don’t know pay for sure but was told by recruiter that it’d be in the realm of 450.
3 clinic days/week (all with fellows). NC 40 mins and follow up 20 mins.
On call about 4 months a year. Fellows take first call.
Can block off some clinic time when on consults (sounds like 1-2 hrs/day)
Malignant heme is separate so at least I won’t have to deal with that, which is great.


The timing for patients in clinic seems really low… and with fellows, feel like you’d need more time. Where I’m training we have 1 hr for NC and 30 for follow-ups, which seems much more manageable.

Thoughts?

 

[Mehena]

Don’t know pay for sure but was told by recruiter that it’d be in the realm of 450.

Is the "recruiter" employed by the hospital or outside? The outside recrutiers are always in the habit of upselling the job and find out from the source.

3 clinic days/week (all with fellows).

Is this a pure academic job or hybrid? The salary is very good for academia and fair for hybrid for 3 days of clinic. Although i doubt you can draw $450K when you start getting paid with wRVU. Unless you expect some kind of grant or funding from academic pursuits, the inpatient consult billings are not going to make the difference.

NC 40 mins and follow up 20 mins.

You should be fine. Could negotiate to tack on exta minutes. Even at pure academic setting, you won't have fellows or trainees daily or even monthly. If anything they could speed things up, so I wouldn't worry too much about it.

On call for 2 weeks every 6 weeks (including weekends). Getting 3-5 new consults/day in the hospital. Fellows take first call.

The schedule sound like more of a job of oncology hospitalist or malignant heme /BMT. In the longterm,the frequency and duration could take a huge toll on you for academic center as the cases can be more complex and involved. You still have to round and cosign notes and approve plan for the other active consult patients' right? so give or take ~10 patients.

 

[onchopeful1]

Is the "recruiter" employed by the hospital or outside? The outside recrutiers are always in the habit of upselling the job and find out from the source.

Is this a pure academic job or hybrid? The salary is very good for academia and fair for hybrid for 3 days of clinic. Although i doubt you can draw $450K when you start getting paid with wRVU. Unless you expect some kind of grant or funding from academic pursuits, the inpatient consult billings are not going to make the difference.

You should be fine. Could negotiate to tack on exta minutes. Even at pure academic setting, you won't have fellows or trainees daily or even monthly. If anything they could speed things up, so I wouldn't worry too much about it.

The schedule sound like more of a job of oncology hospitalist or malignant heme /BMT. In the longterm,the frequency and duration could take a huge toll on you for academic center as the cases can be more complex and involved. You still have to round and cosign notes and approve plan for the other active consult patients' right? so give or take ~10 patients.

Thanks so much for the response.
Hospital recruiter.
I believe it’s guaranteed salary because it’s seen as an academic position but just very clinical heavy. They’ve had a lot of turn over so it’s academic but they don’t have a lot of staff faculty. So I probably would have fellows in every clinic.
Malignant Heme/BMT is totally separate. So I’d be on call for onc consult service only. And during consult weeks, I can block off some clinic time. All in all I don’t think it’s actually that bad … just concerned about having fellows everywhere, allll the time as I get my footing as a heme/onc doc.
Also don’t know if I want to be on call especially for 4 months in a year— though fellows will take first call so at least I won’t have to deal with the countless “my temp is 99.8 and I know that’s not a fever, but it’s high for me, what should I do”questions.

 

[onchopeful1]

Any other feedback? @gutonc, etc.

 

[HemeOncHopeful19]

I’m still in fellowship but IMO, they have a lot of turnover because $450k for running essentially a q3w (including 1/3 of all weekends?) inpatient service is a crappy job. Try to figure out where the people that left went and go interview there.

I doubt you will find too many attending jobs that give 1hr for new patients.

 

[gutonc]

Any other feedback? @gutonc, etc.

Job sounds terrible.

 

[bobsmith]

I believe it’s guaranteed salary because it’s seen as an academic position but just very clinical heavy. They’ve had a lot of turn over so it’s academic but they don’t have a lot of staff faculty. So I probably would have fellows in every clinic.
Malignant Heme/BMT is totally separate. So I’d be on call for onc consult service only. And during consult weeks, I can block off some clinic time. All in all I don’t think it’s actually that bad … just concerned about having fellows everywhere, allll the time as I get my footing as a heme/onc doc.
Also don’t know if I want to be on call especially for 4 months in a year— though fellows will take first call so at least I won’t have to deal with the countless “my temp is 99.8 and I know that’s not a fever, but it’s high for me, what should I do”questions.

Highlighted the red flags for you

 

[bobow98]

I’m still in fellowship but IMO, they have a lot of turnover because $450k for running essentially a q3w (including 1/3 of all weekends?) inpatient service is a crappy job. Try to figure out where the people that left went and go interview there.

I doubt you will find too many attending jobs that give 1hr for new patients.

Actually that's pretty normal to have 1 hr for new patients. Follow ups at most shops are 15 minutes however. So you can expect to be seeing 15-18 easily in a 8-5pm schedule with a 1 hr lunch break.

 

[gutonc]

Actually that's pretty normal to have 1 hr for new patients. Follow ups at most shops are 15 minutes however. So you can expect to be seeing 15-18 easily in a 8-5pm schedule with a 1 hr lunch break.

1h for a new pt is pretty standard. I do 30 min for boring benign heme patients and some of my colleagues do 45. 15 min follow ups unless it's a scan review or a treatment change. I typically see 20-ish in a day but could see more if I wanted to be busier.

 

[MD46]

45mins new onc, 30mins new heme unless leukemia lymphoma myeloma.
15min followup.
Easily do 20-25 a day.
( built upto this in 5 years)