Kaiser Heme/Onc

[blackcadillacs]

Can anyone speak to their own experiences in Kaiser Heme/Onc (or friend/family's experiences too)? I'm interviewing there, and while people rave about the benefits, I don't want to sacrifice QOL now just for the sake of benefits at 65 - so I wanted to make sure the day-to-day experiences are also positive (my current alternative is academia where I know QOL will be better, but lower compensation).

The pay in the norcal groups is 385k/year, but the # of patients per day seems to differ a lot by location (one location told me 10/day, one 12/day, and another 15-16/day) - so I find this confusing.

Specifically, I'm looking for:
- What is your day-to-day life like? E.g. pts/day, are you doing your own procedures, how is balancing inpatient time + clinic time? I know this differs by location, but am curious about all experiences.
- Are you generally happy at your position and don't feel burnt out?
- If you've practiced in other settings too (academia, PP), how does it compare?
- Do you feel like you're competitively compensated for the amount of work you're doing, since it's salaried?
- If you're comfortable sharing, which Kaiser group are you part of? (the northern CA group seems a little bit nicer to me than the southern CA group)
- Anything else you feel is relevant about your job!

Thank you!

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[bobow98]

How many days of clinic a week is it? 4?
12-15 a day for 4 days a week seems pretty chill honestly.

 

[blackcadillacs]

How many days of clinic a week is it? 4?
12-15 a day for 4 days a week seems pretty chill honestly.

Depends on the Kaiser location, some are 4 days, some 5. I think 308k for 4d/week and 385k for full-time 5d/week.

Pts per day also variable by site, one told me 12/day while another told me 15-16 per day.

Just one reason Kaiser seems so odd to me- a less busy site may see 12 pts/day but make the same salary as another site that sees 16/day since I believe the salaries are the same across all Kaisers within a group.

 

[Mehena]

Depends on the Kaiser location, some are 4 days, some 5. I think 308k for 4d/week and 385k for full-time 5d/week.

If you have a choice i.e. not restricted geographically then would avoid 5day oncology clinic by any means neccessary. It'll be too much to handle for a community job. Negotiate for increased salary for 4d/wk clinic gig, if they listen.

 

[HemeOncHopeful19]

The problem with Kaiser and other HMO groups IMO is what happens when that 12-15/d 4d/w suddenly becomes 17-18/d and then oh hey volume is up we need everyone to do 4.5 days while we recruit for our now completely underpaying job and you’re stuck with the golden handcuffs that is their pension plan.

 

[Ubba]

Depends on the Kaiser location, some are 4 days, some 5. I think 308k for 4d/week and 385k for full-time 5d/week.

Pts per day also variable by site, one told me 12/day while another told me 15-16 per day.

Just one reason Kaiser seems so odd to me- a less busy site may see 12 pts/day but make the same salary as another site that sees 16/day since I believe the salaries are the same across all Kaisers within a group.

Man, I know that some people are geographically restricted, but 385k for a 5-day week seems pretty harsh for a subspecialty with 3 added training years. Agree with HOH19 above, this could easily become a trap. Something the finance guys learn is the value of optionality. We aren't taught that lesson in medicine, which is how so many people get lured into systems like KP and become work-mice in the cage.

 

[gutonc]

Drive north about 10 hours and I've got a job for you that would pay you ~$150K more a year for 4d of work seeing those same 16 patients.

 

[HemeOncHopeful19]

Drive north about 10 hours and I've got a job for you that would pay you ~$150K more a year for 4d of work seeing those same 16 patients.

Not to mention less taxes on top of that although still rough where you are.

Slight derail but what do your docs do on that 5th day a week?

When I’ve interviewed at other places they were all still expecting me to be sitting around in the office so it didn’t feel like a true 4 day work week but obviously they wanted to pay me like it was.

 

[honkonc]

Drive north about 10 hours and I've got a job for you that would pay you ~$150K more a year for 4d of work seeing those same 16 patients.

Which area are you referring to? Washington?

 

[blackcadillacs]

The problem with Kaiser and other HMO groups IMO is what happens when that 12-15/d 4d/w suddenly becomes 17-18/d and then oh hey volume is up we need everyone to do 4.5 days while we recruit for our now completely underpaying job and you’re stuck with the golden handcuffs that is their pension plan.

This is how I feel as well. If the volume increases, you're stuck with the same salary with 0 room for negotiation bc of the bureaucracy that is Kaiser... then if you quit, you don't get access to any retirement benefits which are the reason so many sign up. So then you made a lower salary for x years for no reason since you didn't get the retirement benefits anwyay..

I remember explicitly asking one Kaiser doctor about whether they felt adequately compensated for their work since it's salaried (compared to what they might make if RVU-based). And their answer... "oh I don't like thinking about that RVU stuff, that's why I like Kaiser, it's salaried and I just don't have to think about it." I wonder how many Kaiser doctors have that mentality? I'm sure some have crunched the numbers and realized it'ss worth it for them, but that mentality was concerning to me, like you didn't even entertain what you might make with the same workload at a different setting?

 

[blackcadillacs]

Drive north about 10 hours and I've got a job for you that would pay you ~$150K more a year for 4d of work seeing those same 16 patients.

Haha I wish! I've read about your job on other threads and it sounds great. I'm geographically restricted and trying to select the best of my options.

 

[sloh]

This is how I feel as well. If the volume increases, you're stuck with the same salary with 0 room for negotiation bc of the bureaucracy that is Kaiser... then if you quit, you don't get access to any retirement benefits which are the reason so many sign up. So then you made a lower salary for x years for no reason since you didn't get the retirement benefits anwyay..

I remember explicitly asking one Kaiser doctor about whether they felt adequately compensated for their work since it's salaried (compared to what they might make if RVU-based). And their answer... "oh I don't like thinking about that RVU stuff, that's why I like Kaiser, it's salaried and I just don't have to think about it." I wonder how many Kaiser doctors have that mentality? I'm sure some have crunched the numbers and realized it'ss worth it for them, but that mentality was concerning to me, like you didn't even entertain what you might make with the same workload at a different setting?

I used to work for Kaiser. I can confirm most "just don't think about it." Ignorance is bliss.

 

[gutonc]

Which area are you referring to? Washington?

Oregon

 

[gutonc]

Not to mention less taxes on top of that although still rough where you are.

Slight derail but what do your docs do on that 5th day a week?

When I’ve interviewed at other places they were all still expecting me to be sitting around in the office so it didn’t feel like a true 4 day work week but obviously they wanted to pay me like it was.

We are expected to “be available” and check our InBasket a couple of times a day.

Urgent stuff goes to whoever is in the office that day and the rest can wait.

 

[blackcadillacs]

I used to work for Kaiser. I can confirm most "just don't think about it." Ignorance is bliss.

ooh could you please comment on your experience there (are you in heme/onc)? What you liked, didn't like? Despite what I said above, I'm still considering taking a job there bc of geographic reasons and I found one location that seems quite chill compared to the other more hardcore locations I've interviewed at.

 

[MD46]

ooh could you please comment on your experience there (are you in heme/onc)? What you liked, didn't like? Despite what I said above, I'm still considering taking a job there bc of geographic reasons and I found one location that seems quite chill compared to the other more hardcore locations I've interviewed at.

If you wanted to work harder, is there an rvu based productivity model or something similar?

 

[sloh]

ooh could you please comment on your experience there (are you in heme/onc)? What you liked, didn't like? Despite what I said above, I'm still considering taking a job there bc of geographic reasons and I found one location that seems quite chill compared to the other more hardcore locations I've interviewed at.

I'm PM&R. Things I didn't like were the lack of autonomy and flexibility with my schedule, having to schedule vacations way in advance which couldn't overlap with other colleagues in my department, having to tend to inbox messages (uncompensated). The inbox message responsibilities are a huge headache for a lot of the outpatient specialties at Kaiser.

If you wanted to work harder, is there an rvu based productivity model or something similar?

No RVU based productivity. Pretty much get paid the same based off how many years you've been there. Get a bonus every year if your patient satisfaction scores are good.

This is a good summary of what it is like working for Kaiser. It's written by an ophthalmologist but can apply to most outpatient specialties.

Why I Left Kaiser (and Why You Might Want To) - OphthoQuestions

One of our colleagues explains why leaving Kaiser Permanente was the right career move for her.

www.ophthoquestions.com

"The first myth I’d like to debunk is “Kaiser’s starting salary is significantly higher than one would make in private practice.” Kaiser is actually paying their ophthalmologists 40% less than what they should make. And Kaiser does not allow for negotiation of compensation.

The metrics by which a Kaiser physician is evaluated against are somewhat unintuitive. This is because all specialties use the same metrics, be it ophthalmology or neurology or neurosurgery. One such metric is a patient satisfaction score (MPS score). This number comes from a patient satisfaction survey in which only 5 questions out of a 25-question survey pertains to physician performance. We all know that surveys are prone to survey bias, but Kaiser uses this MPS score as a physician performance score.

I often jokingly compare the Kaiser environment to socialism to my non-Kaiser friends. There is some truth to this. Although Kaiser does not push its providers to sell premium lenses or perform costly procedures, there is also no incentive to perform. One can be a mediocre physician and get the same salary as an overachieving physician, so there is less motivation to do more than mediocre. Just as one cannot negotiate the salary, incentive pay and annual increases are also predetermined with no room for negotiation."

 

[schpooner]

To go against the grain here, I just started at KP NorCal and it's been pretty good for me, so far.

Things I liked about academia that I get to keep: subspecialization, working in a big center with lots of resources/experienced colleagues, sub-sub specialized tumor boards, working with trainees, ability to do research(lots of access to cool data), not counting beans.

On the other hand, I didn't love the idea of subsisting on grants, or being beholding to P&T committees to justify my existence in academia long term, doing projects/meetings that I wasn't interested in as an early career person. On the PP side, I also didn't want to ever argue with an insurance rep or "peer to peer" or figure out what kind of coverage my pt had before coming up with a plan which is more common in PP. I also didn't want to have to spend time/brain space advertising myself, getting referrals etc.

KP has a good system that works for some people, not as much for others. I think many folks here have trained to "shut off" the part of the brain that calculates RVUs, and we get paid decently especially compared to academia, so there's not a lot of grumbling. If you want to make more there's certainly ways to do so, but (IMO) you work much harder for it.

The 12-15 pts a day thing is real, at least for me. That's simply what my matrix looks like, I couldnt add more if I wanted to. WHile I see patients 5 days a week I have about 2-3 half days each week of functional admin time, which I can use to catch up. In total I probably see about as many patients as my mentor in academia, just over 5 days instead of 2.5, though I Have much less APP/trainee support. I can see the argument about feeling like a cog in a machine or whatever, but it hasn't really bothered me yet, because I enjoy taking care of my patients and I see that as an end in itself, and then I get to go home and hang out with my family. Maybe I'll change my tune in a few years, but it's been as billed for me so far.

PM me if anyone wants to learn more!

 

[HemeOncHopeful19]

To go against the grain here, I just started at KP NorCal and it's been pretty good for me, so far.

Things I liked about academia that I get to keep: subspecialization, working in a big center with lots of resources/experienced colleagues, sub-sub specialized tumor boards, working with trainees, ability to do research(lots of access to cool data), not counting beans.

On the other hand, I didn't love the idea of subsisting on grants, or being beholding to P&T committees to justify my existence in academia long term, doing projects/meetings that I wasn't interested in as an early career person. On the PP side, I also didn't want to ever argue with an insurance rep or "peer to peer" or figure out what kind of coverage my pt had before coming up with a plan which is more common in PP. I also didn't want to have to spend time/brain space advertising myself, getting referrals etc.

KP has a good system that works for some people, not as much for others. I think many folks here have trained to "shut off" the part of the brain that calculates RVUs, and we get paid decently especially compared to academia, so there's not a lot of grumbling. If you want to make more there's certainly ways to do so, but (IMO) you work much harder for it.

The 12-15 pts a day thing is real, at least for me. That's simply what my matrix looks like, I couldnt add more if I wanted to. WHile I see patients 5 days a week I have about 2-3 half days each week of functional admin time, which I can use to catch up. In total I probably see about as many patients as my mentor in academia, just over 5 days instead of 2.5, though I Have much less APP/trainee support. I can see the argument about feeling like a cog in a machine or whatever, but it hasn't really bothered me yet, because I enjoy taking care of my patients and I see that as an end in itself, and then I get to go home and hang out with my family. Maybe I'll change my tune in a few years, but it's been as billed for me so far.

PM me if anyone wants to learn more!

Are you in the office 5 days a week or are those 2-3 half days spent at the “home office”?

 

[schpooner]

In my group we have variable set up for amount of time we are able to do remote clinic- some folks are off site up to 4 days a week. I'm 1 day/week (for now). Inpatient time is very light, and consult only.
The rest of the admin time can be mixed- some we want people to be on site to deal with emergencies (one is a functional backup position to help with urgent tasks, though we have great APPs to cover infusion center stuff and procedures).

I'm learning this set up is highly dependent based on the specific location though so YMMV!

 

[MD46]

To go against the grain here, I just started at KP NorCal and it's been pretty good for me, so far.

Things I liked about academia that I get to keep: subspecialization, working in a big center with lots of resources/experienced colleagues, sub-sub specialized tumor boards, working with trainees, ability to do research(lots of access to cool data), not counting beans.

On the other hand, I didn't love the idea of subsisting on grants, or being beholding to P&T committees to justify my existence in academia long term, doing projects/meetings that I wasn't interested in as an early career person. On the PP side, I also didn't want to ever argue with an insurance rep or "peer to peer" or figure out what kind of coverage my pt had before coming up with a plan which is more common in PP. I also didn't want to have to spend time/brain space advertising myself, getting referrals etc.

KP has a good system that works for some people, not as much for others. I think many folks here have trained to "shut off" the part of the brain that calculates RVUs, and we get paid decently especially compared to academia, so there's not a lot of grumbling. If you want to make more there's certainly ways to do so, but (IMO) you work much harder for it.

The 12-15 pts a day thing is real, at least for me. That's simply what my matrix looks like, I couldnt add more if I wanted to. WHile I see patients 5 days a week I have about 2-3 half days each week of functional admin time, which I can use to catch up. In total I probably see about as many patients as my mentor in academia, just over 5 days instead of 2.5, though I Have much less APP/trainee support. I can see the argument about feeling like a cog in a machine or whatever, but it hasn't really bothered me yet, because I enjoy taking care of my patients and I see that as an end in itself, and then I get to go home and hang out with my family. Maybe I'll change my tune in a few years, but it's been as billed for me so far.

PM me if anyone wants to learn more!

I am 🫤 confused
But hey, if it works for you and pays well 👍🏼

I rather have a rvu model which I can utilize to see more patients make more money and when I want to wind down I can.

Also little bit more autonomy on my schedule. I can change around my starting time, ending time as long as it aligns with supporting staff etc

 

[honkonc]

To go against the grain here, I just started at KP NorCal and it's been pretty good for me, so far.

Things I liked about academia that I get to keep: subspecialization, working in a big center with lots of resources/experienced colleagues, sub-sub specialized tumor boards, working with trainees, ability to do research(lots of access to cool data), not counting beans.

On the other hand, I didn't love the idea of subsisting on grants, or being beholding to P&T committees to justify my existence in academia long term, doing projects/meetings that I wasn't interested in as an early career person. On the PP side, I also didn't want to ever argue with an insurance rep or "peer to peer" or figure out what kind of coverage my pt had before coming up with a plan which is more common in PP. I also didn't want to have to spend time/brain space advertising myself, getting referrals etc.

KP has a good system that works for some people, not as much for others. I think many folks here have trained to "shut off" the part of the brain that calculates RVUs, and we get paid decently especially compared to academia, so there's not a lot of grumbling. If you want to make more there's certainly ways to do so, but (IMO) you work much harder for it.

The 12-15 pts a day thing is real, at least for me. That's simply what my matrix looks like, I couldnt add more if I wanted to. WHile I see patients 5 days a week I have about 2-3 half days each week of functional admin time, which I can use to catch up. In total I probably see about as many patients as my mentor in academia, just over 5 days instead of 2.5, though I Have much less APP/trainee support. I can see the argument about feeling like a cog in a machine or whatever, but it hasn't really bothered me yet, because I enjoy taking care of my patients and I see that as an end in itself, and then I get to go home and hang out with my family. Maybe I'll change my tune in a few years, but it's been as billed for me so far.

PM me if anyone wants to learn more!

how is comp for you? same as the 308/385 quoted above?

 

[schpooner]

how is comp for you? same as the 308/385 quoted above?

Yeah, exactly. Kaiser doesn't really do a lot of negotiation- starting salary for all med oncs is the same (and doesnt account for COL unfortunately... Vallejo pays the same as San Francisco, etc).
The "functional" total take home is a little more with a few internal bonuses, and of course it's hard to calculate how much the benefits are worth to you.

 

[KatsuCurry]

In my group we have variable set up for amount of time we are able to do remote clinic- some folks are off site up to 4 days a week. I'm 1 day/week (for now). Inpatient time is very light, and consult only.
The rest of the admin time can be mixed- some we want people to be on site to deal with emergencies (one is a functional backup position to help with urgent tasks, though we have great APPs to cover infusion center stuff and procedures).

I'm learning this set up is highly dependent based on the specific location though so YMMV!

Appreciate the responses you've given so far! They've been very helpful!

How often are you on in-patient service? What does that look like for you?

Do you have to take any call, and what does that look like?

 

[osprey099]

Can anyone explain Kaiser's pension plan? Specifically, how many years do you need to be with them to obtain their pension? And what are the other exclusive benefits working for Kaiser?

 

[tomsuntom]

To go against the grain here, I just started at KP NorCal and it's been pretty good for me, so far.

Things I liked about academia that I get to keep: subspecialization, working in a big center with lots of resources/experienced colleagues, sub-sub specialized tumor boards, working with trainees, ability to do research(lots of access to cool data), not counting beans.

On the other hand, I didn't love the idea of subsisting on grants, or being beholding to P&T committees to justify my existence in academia long term, doing projects/meetings that I wasn't interested in as an early career person. On the PP side, I also didn't want to ever argue with an insurance rep or "peer to peer" or figure out what kind of coverage my pt had before coming up with a plan which is more common in PP. I also didn't want to have to spend time/brain space advertising myself, getting referrals etc.

KP has a good system that works for some people, not as much for others. I think many folks here have trained to "shut off" the part of the brain that calculates RVUs, and we get paid decently especially compared to academia, so there's not a lot of grumbling. If you want to make more there's certainly ways to do so, but (IMO) you work much harder for it.

The 12-15 pts a day thing is real, at least for me. That's simply what my matrix looks like, I couldnt add more if I wanted to. WHile I see patients 5 days a week I have about 2-3 half days each week of functional admin time, which I can use to catch up. In total I probably see about as many patients as my mentor in academia, just over 5 days instead of 2.5, though I Have much less APP/trainee support. I can see the argument about feeling like a cog in a machine or whatever, but it hasn't really bothered me yet, because I enjoy taking care of my patients and I see that as an end in itself, and then I get to go home and hang out with my family. Maybe I'll change my tune in a few years, but it's been as billed for me so far.

PM me if anyone wants to learn more!

Hi there,

I am currently in private practice and I am considering moving to Kaiser Norcal. I am definitely earning a lot of money at my current job maybe 30-40% more than I would at Kaiser, and I have a scribe who helps me write my notes and put in orders. But the downside is that there is a lot more stress about running my practice and keeping up the patient volume, competition with other providers, treating patients who don't need to see me (e.g. platelet 140) because I can't turn away patient referrals, not being an expert in any disease, having to go to the hospital for consults every day after clinic.

I read your previous post about what it's like working at Kaiser and I was wondering if you still enjoying working there? You mentioned you have 2-3 half day clinics for administrative time, is that included in a 1.0 FTE job? Do you ever find they give you more and more work to do without paying you more, and it's hard to leave because of the golden handcuffs?

 

[hushhush88]

I am considering accepting an offer from Kaiser coming out of fellowship.
Starting salary is $400k.
Would love to hear from attendings if they continue to still be happy working there.

 

[gutonc]

I am considering accepting an offer from Kaiser coming out of fellowship.
Starting salary is $400k.
Would love to hear from attendings if they continue to still be happy working there.

I'm not at Kaiser, so take this with a grain of salt. I know a lot of people who do work there though.

If you want a generally quiet pace, decent (but not great) pay and a baller pension if you can stick it out there, Kaiser is a good place to be. The downside of course is that sometimes you're going to be "asked" (forced) to work harder because you're short handed but you won't get compensated for it. You're also largely forced to work within a limited (but data driven and constantly updated) formulary which some people don't like, but others appreciate.

What I will say is that I know more people who have gone to Kaiser and stayed at Kaiser than have gone to Kaiser and left for reasons other than relocating to a place where Kaiser doesn't exist.

Also, if you're at all interested in population-based or outcomes research, Kaiser's patient data is pretty much unparalleled in the US.