Lost my job and can't move . . . now what?

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Well better to have this type of data then not. But ya not holding my breath that the supply/demand imbalance will be meaningfully address by our “leadership” no matter what the report finds.
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medgator said:
Even if they did, would it matter? Fox guarding the henhouse
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My feeling as well. I am sure they will put out something nebulous and watered down- everything is ok at the moment, but like in every field, the future is uncertain and there are some concerning trends....
 
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elementaryschooleconomics said:
Just repeating myself on the off chance fresh eyes find this post in the future:

Yes, you probably have heard the counter-argument that "even with the pay cut, you still make more than a Pediatrician"!

In some cases that may be true, and yes, we (as in, doctors) still make more than the average American.

HOWEVER, even if the end result is still "good" compared to the average American (or PCP) salary, a sudden 30-50% cut in salary is never, ever, ever a "good" thing. Ever. Unless you're the employer.

Do not feel bad for being upset at a 50% cut, even though the final number is still "higher than starting PCP salary". That is not the point.
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Here’s my question…
Has the comp in academics gone down by 50%?

If so… that sucks.

If not, one can make the argument that, in addition to resident oversupply, consolidation of PP into academics may also be driving much of this. Not that this is much better, but it is a slightly different mechanism.
 
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Lamount said:
Here’s my question…
Has the comp in academics gone down by 50%?

If so… that sucks.

If not, one can make the argument that, in addition to resident oversupply, consolidation of PP into academics may also be driving much of this. Not that this is much better, but it is a slightly different mechanism.
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Oh that's for sure a significant part of it. Lots of stories around this forum about it.
 
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TheWallnerus said:
This is essentially what Ed Halperin said in his editorial way back when… but then attempted to walk it back in the same editorial by optimistically predicting a hard working, industrious rad onc could get respect. And become a med school dean. LOLOL

If a rad onc gets appointed as a med school dean between now and 2030, the first person to DM me I will Venmo a hundred bucks.

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when he loses interim title please send the $100 dollar to ACRO for me

www.hopkinsmedicine.org

Meet Interim Dean and CEO Theodore DeWeese

DeWeese is taking the helm of Johns Hopkins Medicine and the Johns Hopkins University School of Medicine following the July 1, 2022, retirement of Paul B. Rothman.
www.hopkinsmedicine.org www.hopkinsmedicine.org

1657150149496.png
 
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radiation said:
when he loses interim title please send the $100 dollar to ACRO for me

www.hopkinsmedicine.org

Meet Interim Dean and CEO Theodore DeWeese

DeWeese is taking the helm of Johns Hopkins Medicine and the Johns Hopkins University School of Medicine following the July 1, 2022, retirement of Paul B. Rothman.
www.hopkinsmedicine.org www.hopkinsmedicine.org

View attachment 356947
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I wouldn’t be so confident. Good guy, but certainly academically (which may or may not be important) he or anyone else in this field does not have the gravitas to be dean of Hopkins.
 
jondunn said:
I see palliative Med brought up - but how is the reimbursement? Would it really be better than even a lower paying rad onc job?
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The number of palliative fellowships has been increasing pretty quickly (which the field leadership paints in a positive light since "The field is growing"). I can only hope that demand for Palli docs outstrips supply going forward. But yes, for now it is "stable"

Average Palli salary is around $240k (highly variable based on location, etc), certainly possibly to make $300k if you want to work "hard"

And in general, this is one of those truly-interesting SDN threads and I couldn't help but read the whole thing in one sitting. Feeling a bit grateful I never experienced a half-million salary before so I don't know what I'm missing... nevertheless all of this serves as additional motivation to plan an exit route from medicine (in the employee role)
 
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Entadus said:
The number of palliative fellowships has been increasing pretty quickly (which the field leadership paints in a positive light since "The field is growing"). I can only hope that demand for Palli docs outstrips supply going forward. But yes, for now it is "stable"

Average Palli salary is around $240k (highly variable based on location, etc), certainly possibly to make $300k if you want to work "hard"

And in general, this is one of those truly-interesting SDN threads and I couldn't help but read the whole thing in one sitting. Feeling a bit grateful I never experienced a half-million salary before so I don't know what I'm missing... nevertheless all of this serves as additional motivation to plan an exit route from medicine (in the employee role)
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Welcome to the Rad Onc forum, HPM doc - we are the kings of reminiscing about "the good ol' days" around here.
 
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Regrading eviCore, if someone has contact info for their recruiter or lead physcian, please PM me.
Having issues discussed on this board :(
 
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A_DeMichele said:
Regrading eviCore, if someone has contact info for their recruiter or lead physcian, please PM me.
Having issues discussed on this board :(
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They often post "opportunities" on the Astro Career Center.
 
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A_DeMichele said:
Regrading eviCore, if someone has contact info for their recruiter or lead physcian, please PM me.
Having issues discussed on this board :(
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Very sorry to hear. Its probably a good idea to pounce on that... there may be more coming and I wouldn't be surprised if even those dry up. There are links on the Evicore website for jobs.

I have found that most peer-to-peers are usually due to poor documentation and it isn't clear that the study is being utilized for an appropriate indication. I spoke with one of the directors last week about a PET scan that was ordered for a head and neck patient. The documentation was not clear that this was specifically to evaluate for recurrence; but rather looked like regular surveillance. It was approved after clarifying... but I'm sure there are people getting PET scans left and right that aren't appropriate. So I can't blame them.

I've tried to order treatments that were kind of out there, like SBRT for a single met in pancreatic cancer. That got denied of course so I said "You got me copper!" But I can get IMRT due to prior RT to the pancreas? So I'll just heat it up.

Only bad experience was when they tried to force us to do 2D treatments for all bone mets..... No.

Good luck
 
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elementaryschooleconomics said:
Just repeating myself on the off chance fresh eyes find this post in the future:

Yes, you probably have heard the counter-argument that "even with the pay cut, you still make more than a Pediatrician"!

In some cases that may be true, and yes, we (as in, doctors) still make more than the average American.

HOWEVER, even if the end result is still "good" compared to the average American (or PCP) salary, a sudden 30-50% cut in salary is never, ever, ever a "good" thing. Ever. Unless you're the employer.

Do not feel bad for being upset at a 50% cut, even though the final number is still "higher than starting PCP salary". That is not the point.
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Perfect timing:

1657511549809.png


So to recap, academic health systems scoop up formerly private practices, salaries to staff that site are significantly reduced, then on the other side we have CMS cuts and inflation.

CMS tries this every year, every year there's pushback, so who knows what will actually happen.

AT BEST, salaries will stay stable, which is functionally a pay cut. At worst, if you think your institution won't send you something on an official looking letterhead either bumping up your RVU target, or decreasing the bonus structure, or something that doesn't make them say "we're passing the cuts on to you" but that's what is actually happening...I have some magic beans to sell you.
 
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elementaryschooleconomics said:
Perfect timing:

View attachment 357079

So to recap, academic health systems scoop up formerly private practices, salaries to staff that site are significantly reduced, then on the other side we have CMS cuts and inflation.

CMS tries this every year, every year there's pushback, so who knows what will actually happen.

AT BEST, salaries will stay stable, which is functionally a pay cut. At worst, if you think your institution won't send you something on an official looking letterhead either bumping up your RVU target, or decreasing the bonus structure, or something that doesn't make them say "we're passing the cuts on to you" but that's what is actually happening...I have some magic beans to sell you.
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I only buy magic beans Elon Musk endorses.
 
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A_DeMichele said:
Regrading eviCore, if someone has contact info for their recruiter or lead physcian, please PM me.
Having issues discussed on this board :(
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Medical students, this is what rock bottom looks like in our field: Stopping clinical practice to work for a company earning less than PCP pay doing peer reviews that routinely deny life saving care to our patients so you don't have to move to rural Iowa.

Lets contrast that with another specialty that used to be comparable to ours: Diagnostic radiology. Rock bottom would be having to take a "nighthawk" position meaning you read studies overnight at home from your literally anywhere in the world with an internet connection for 500k+/year with 20+ weeks of vacation.
 
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Moonbeams said:
Medical students, this is what rock bottom looks like in our field: Stopping clinical practice to work for a company earning less than PCP pay doing peer reviews that routinely deny life saving care to our patients so you don't have to move to rural Iowa.

Lets contrast that with another specialty that used to be comparable to ours: Diagnostic radiology. Rock bottom would be having to take a "nighthawk" position meaning you read studies overnight at home from your literally anywhere in the world with an internet connection for 500k+/year with 20+ weeks of vacation.
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That’s geographic restriction. Kids, parents and spouses’ job make moving very difficult, 5 years into a job.
 
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Moonbeams said:
Medical students, this is what rock bottom looks like in our field: Stopping clinical practice to work for a company earning less than PCP pay doing peer reviews that routinely deny life saving care to our patients so you don't have to move to rural Iowa.

Lets contrast that with another specialty that used to be comparable to ours: Diagnostic radiology. Rock bottom would be having to take a "nighthawk" position meaning you read studies overnight at home from your literally anywhere in the world with an internet connection for 500k+/year with 20+ weeks of vacation.
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Rads is well off rock bottom at this point, in addition, while we have no bottom in sight
 
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RickyScott said:
Huge difference is that there was never contracting demand in rads.
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I think there was fear of ai, overtraining etc but you're right, if anything it's gone 180 from rad onc and you see plenty of growth in all the nuc med imaging/radiotracers, increasing use of LDCT for lung etc
 
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medgator said:
I think there was fear of ai, overtraining etc but you're right, if anything it's gone 180 from rad onc and you see plenty of growth in all the nuc med imaging/radiotracers, increasing use of LDCT for lung etc
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Lot of growth in mri as well
 
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A_DeMichele said:
bump - looking for Cigna/eviCore connections, please
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Also if anybody has direct (or at significant) experiences of what it’s actually like to work for them and how “sustainable” the positions are. Not that long ago it seemed like the reviewers were all older/semi retired types and I recognized them from prior peer to peers but I’ve been making note recently and honestly “looking up” them up (nothing crazy, we get their name so just Google “Dr x radiation oncology”) and every single one is not only young or at least nowhere near retirement age but in doing so I also realized that I almost never get the same one twice anymore. Is this just my random experience or the case for you all as well? If so any idea if the actual job is only offered for short periods of time or if people quickly leave on their own (hopefully because they found a permanent clinical job or were just seeking extra flexibility while I don’t know taking care of a newborn).

Also not sure if random luck but recently it’s literally been like the reviewer is trying to help me get approval (for example the other day he said “the easiest way for me to get this approved is if any of these indications exist … you stated that he has a hip replacement but I noticed in PSH it states bilateral, is this the case?”). I’ve had similar experiences where they say essentially “I agree with your clinical assessment and judgement but for me to get this approved I really need you tell me about x, y, or z” and he redirected my focus to what I assume are the indications set forth my the policy. It seemed like he was staring at a bunch of boxes and trying to get me to just explicitly state one to get it approved as quickly and easily as possible.

Now that I think about it, maybe that’s why they don’t appear to last long?!?
 
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JumpingShip said:
Also if anybody has direct (or at significant) experiences of what it’s actually like to work for them and how “sustainable” the positions are. Not that long ago it seemed like the reviewers were all older/semi retired types and I recognized them from prior peer to peers but I’ve been making note recently and honestly “looking up” them up (nothing crazy, we get their name so just Google “Dr x radiation oncology”) and every single one is not only young or at least nowhere near retirement age but in doing so I also realized that I almost never get the same one twice anymore. Is this just my random experience or the case for you all as well? If so any idea if the actual job is only offered for short periods of time or if people quickly leave on their own (hopefully because they found a permanent clinical job or were just seeking extra flexibility while I don’t know taking care of a newborn).

Also not sure if random luck but recently it’s literally been like the reviewer is trying to help me get approval (for example the other day he said “the easiest way for me to get this approved is if any of these indications exist … you stated that he has a hip replacement but I noticed in PSH it states bilateral, is this the case?”). I’ve had similar experiences where they say essentially “I agree with your clinical assessment and judgement but for me to get this approved I really need you tell me about x, y, or z” and he redirected my focus to what I assume are the indications set forth my the policy. It seemed like he was staring at a bunch of boxes and trying to get me to just explicitly state one to get it approved as quickly and easily as possible.

Now that I think about it, maybe that’s why they don’t appear to last long?!?
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Easiest job to get out there now... I know of a few people that have used it as a stop gap until they can find their next perm job. Some never end up leaving. Make 6 figures working from home
 
medgator said:
Easiest job to get out there now... I know of a few people that have used it as a stop gap until they can find their next perm job. Some never end up leaving. Make 6 figures working from home
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Do you personally know why some never end up leaving, especially if perhaps their intention was initially temporary? Is it just the flexibility/work from home aspect or is it (I can’t believe I’m saying this!) not as bad as they had anticipated? If so in what regard?

Also if it is so easy to get why is the poster above struggling to obtain a position and asking for connections? Is that the only way to get a more favorable position within the company?

A_DeMichele: if you don’t mind, can you let us know if you’ve applied through the posted positions and not heard back or what your experience has been in general seeking such a position?
 
JumpingShip said:
Do you personally know why some never end up leaving, especially if perhaps their intention was initially temporary? Is it just the flexibility/work from home aspect or is it (I can’t believe I’m saying this!) not as bad as they had anticipated? If so in what regard?
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Some have gotten burned out on the clinical side, some blacklisted by practices around them. If you are geographically restricted and want employment after leaving the only practice around, sometimes it may be your only option
 
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Does anyone have rough details on evicore/cigna jobs? Do they expect you to be available at unusual hours to accommodate for different time zones of p2p? What kind of salary do they offer? Sorry if this has been discussed elsewhere, I'm just curious what the actual QoL would be that someone planning to do it temporarily will end up doing it as a perm gig
 
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jondunn said:
I make 900-1 mill yearly but live like I make much less.

I’ve posted again and again about how it’s only a matter of time until my community shop gets taken over, like every community shop should expect. The location is prime for takeover

As an aside - if I lived in Austin Texas, I would consider my time limited. You WILL be taken over

As they say in the departed - ‘we’re all on our way out. Act accordingly’


I’m on the lookout for a good private group PSA setup with a major hospital - that’s the best long term setup IMO
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Apologies for bumping one of the most depressing threads in history, but interested in the group's thoughts:

Is there a critical mass for a private group that makes it difficult for a hospital to just scrap the PSA and force an employed model? With one physician it seems to happen all the time, and stories on this thread indicated numerous 3-5 person groups were given ultimatums, but haven't heard of that as much with the 20-25 physician groups. Obviously no real data on it, but interested in anecdotes.

Though I could imagine a @TheWallnerus - style 3-axis graph that modeled a pretty good guess. Axes being Number of Physicians, Desirability of Location, and Likelihood of Takeover.

The obvious extremes are one physician in a very desirable location (easy to replace -> high likelihood) vs the hypothetical 25 doctor group in Nowhere, USA (hard to replace -> low likelihood).
 
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DireMoose said:
Apologies for bumping one of the most depressing threads in history, but interested in the group's thoughts:

Is there a critical mass for a private group that makes it difficult for a hospital to just scrap the PSA and force an employed model? With one physician it seems to happen all the time, and stories on this thread indicated numerous 3-5 person groups were given ultimatums, but haven't heard of that as much with the 20-25 physician groups. Obviously no real data on it, but interested in anecdotes.

Though I could imagine a @TheWallnerus - style 3-axis graph that modeled a pretty good guess. Axes being Number of Physicians, Desirability of Location, and Likelihood of Takeover.

The obvious extremes are one physician in a very desirable location (easy to replace -> high likelihood) vs the hypothetical 25 doctor group in Nowhere, USA (hard to replace -> low likelihood).
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I have seen it happen with both big and small groups.
 
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DireMoose said:
Apologies for bumping one of the most depressing threads in history, but interested in the group's thoughts:

Is there a critical mass for a private group that makes it difficult for a hospital to just scrap the PSA and force an employed model? With one physician it seems to happen all the time, and stories on this thread indicated numerous 3-5 person groups were given ultimatums, but haven't heard of that as much with the 20-25 physician groups. Obviously no real data on it, but interested in anecdotes.

Though I could imagine a @TheWallnerus - style 3-axis graph that modeled a pretty good guess. Axes being Number of Physicians, Desirability of Location, and Likelihood of Takeover.

The obvious extremes are one physician in a very desirable location (easy to replace -> high likelihood) vs the hypothetical 25 doctor group in Nowhere, USA (hard to replace -> low likelihood).
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I don’t think I’ve heard of a PSA being yanked in favor of employment for any group >10 MDs. With numbers do indeed come protection. You will never get such high numbers in rural or even light suburban locales.

As a solo MD with a PSA at a hospital in an undesirable location, this happened to me. And I have been on the other end too where I was the employed MD coming in to squeeze out the PSA guys (two guys).
 
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If the group is unified and the state allows enforcement of non-competes, it'd be very difficult to force out a 20 person group. Especially in a less desirable area. I've seen it happen with diagnostic rads, but much of that can be done remotely, with short term locum coverage for stuff like IR.
 
The real question is, with continued downward pressure on reimbursement, when does the pay/benefit/business management hassle of a group PSA setup dip below unity with the pay/benefit/loss of autonomy hassle of becoming employed? That's when you'll start seeing PSA groups asking to become employed. Of course, then, the employed salaries will decrease in kind. Nothing escapes supply and demand dynamics.
 
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TheWallnerus said:
I don’t think I’ve heard of a PSA being yanked in favor of employment for any group >10 MDs. With numbers do indeed come protection. You will never get such high numbers in rural or even light suburban locales.

As a solo MD with a PSA at a hospital in an undesirable location, this happened to me. And I have been on the other end too where I was the employed MD coming in to squeeze out the PSA guys (two guys).
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What is the clinic volume at which you would rather be employed vs. independent? Is there one?

I have seen a couple very attractive employment offers in less desirable areas that are obviously digging into technical to pay you out as you would bill substantially less on your own. The fear is that when your contract is up, you are at their mercy as to what will happen to your salary on the contract renewal.
I also know some rad oncs who prefer to remain independent no matter what despite only being able to collect 300-400 or so from a low volume clinic whereas the hospital would have to pay 500+ to staff it with an employee.

The other annoying factor with employment are the standard benefits. 401k match is great, and 6 weeks of paid locums coverage is really worth about 90k or so (so your total comp is probably valued at least 100k above your salary when comparing to net collections from PSA), but you lose the flexibility of managing your own retirement vehicles and tax advantages of an LLC. Additionally, virtually all hospital systems have standardized PTO policies for all employed doctors. If you want to make less money and take more vacation (or vice versa), that is not an option unless you have a PSA and pay your own vacation coverage.
 
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Moonbeams said:
What is the clinic volume at which you would rather be employed vs. independent? Is there one?

I have seen a couple very attractive employment offers in less desirable areas that are obviously digging into technical to pay you out as you would bill substantially less on your own. The fear is that when your contract is up, you are at their mercy as to what will happen to your salary on the contract renewal.
I also know some rad oncs who prefer to remain independent no matter what despite only being able to collect 300-400 or so from a low volume clinic whereas the hospital would have to pay 500+ to staff it with an employee.

The other annoying factor with employment are the standard benefits. 401k match is great, and 6 weeks of paid locums coverage is really worth about 90k or so (so your total comp is probably valued at least 100k above your salary when comparing to net collections from PSA), but you lose the flexibility of managing your own retirement vehicles and tax advantages of an LLC. Additionally, virtually all hospital systems have standardized PTO policies for all employed doctors. If you want to make less money and take more vacation (or vice versa), that is not an option unless you have a PSA and pay your own vacation coverage.
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Probably because at the end of the day that tax favored 350-400 in a PSA is probably about the same or less than 500 upfront. But this is all useless, at the end of the day most are employed and those that aren’t will be soon enough.
 
Moonbeams said:
What is the clinic volume at which you would rather be employed vs. independent? Is there one?

I have seen a couple very attractive employment offers in less desirable areas that are obviously digging into technical to pay you out as you would bill substantially less on your own. The fear is that when your contract is up, you are at their mercy as to what will happen to your salary on the contract renewal.
I also know some rad oncs who prefer to remain independent no matter what despite only being able to collect 300-400 or so from a low volume clinic whereas the hospital would have to pay 500+ to staff it with an employee.

The other annoying factor with employment are the standard benefits. 401k match is great, and 6 weeks of paid locums coverage is really worth about 90k or so (so your total comp is probably valued at least 100k above your salary when comparing to net collections from PSA), but you lose the flexibility of managing your own retirement vehicles and tax advantages of an LLC. Additionally, virtually all hospital systems have standardized PTO policies for all employed doctors. If you want to make less money and take more vacation (or vice versa), that is not an option unless you have a PSA and pay your own vacation coverage.
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"remain independent" is important as they're probably at a point where dumping money into retirement is most important. Not so for new grads. In any case, for me as a single doc, I transitioned from PSA to employed as there was a pretty large difference in salary. IOW, they're paying me more than prof collections, which I also don't have to pay to collect. Obv, I could also consider trying for an RVU-based PSA.
 
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Independent docs tend to be happier than employed docs at the macro level. Obviously can differ at the micro level based on local factors.

There is value to happiness and autonomy, which I think prevents many PSA groups from exploring employment, even if the salary potential is higher in their area.
 
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Mandelin Rain said:
Independent docs tend to be happier than employed docs at the macro level. Obviously can differ at the micro level based on local factors.

There is value to happiness and autonomy, which I think prevents many PSA groups from exploring employment, even if the salary potential is higher in their area.
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Based on my own non-randomized, retrospective data, the risk of MD happiness is significantly higher for independent practice vs employment (HR 383.2, 95% C.I.: 171.9-596.4)
 
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Threads like this will continue to pop up, increasing in frequency and numbers. We have only gotten “just the tip” of what is coming to screw us. This is the way. Those who continue to confuse weather with climate, willfully deceiving or unknowingly ignorant, are in for a rude awakening!
 
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elementaryschooleconomics said:
I'm sorry this happened to you.

To echo @TheWallnerus - by "lost your job" you mean the salary and benefit terms of your previous arrangement, but you have been made an offer to stay in the same place working the same job, but for different (presumably less) salary and benefits?

The answer is obvious, if painful. Accept the new terms for now. If it is truly unsustainable in the long run, then begin to look elsewhere. But look elsewhere from a position of strength...which is being employed, even if it's not what it once was.

The consolidation of formerly private practice jobs into the Academic Medical Center borg marches on.
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I've seen this happen with lots of corporate medical hospitals consolidation.
 
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Ray D. Ayshun said:
"remain independent" is important as they're probably at a point where dumping money into retirement is most important. Not so for new grads. In any case, for me as a single doc, I transitioned from PSA to employed as there was a pretty large difference in salary. IOW, they're paying me more than prof collections, which I also don't have to pay to collect. Obv, I could also consider trying for an RVU-based PSA.
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The RVU-based compensation models generally suck across the board. They will usually offer you $55/wRVU or some joke that is way below their actual revenue per wRVU (which should be around 70). Letting the hospital control payouts for productivity is suboptimal -- better to get paid with high fixed salary up to a point, after which bill-and-collect is the better way to get paid per service than $X per wRVU.

For instance, in a very busy top 5% clinic, if you can collect $1M that sounds great compared to a $700k salary. However if you do the math, the net on the PSA would be $1M - $50k billing - $30k insurances - $40k FICA/medicare - $100k vacation coverage = $780k net. Vs. $700k employment + paid insurances and time off + 20k retirement match = $720k. 60k differential, 35k after tax. Almost a wash in the end?

So you'd need to collect about 40% over your employment offer for it to be financially worth it. Seems like a lot. You'll be able to shelter a bit more from taxes likely, but there's only so much you can write off as a professional. Maybe be conservative and say 30%, that's still a lot. Am I completely off here?
 
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Moonbeams said:
The RVU-based compensation models generally suck across the board. They will usually offer you $55/wRVU or some joke that is way below their actual revenue per wRVU (which should be around 70). Letting the hospital control payouts for productivity is suboptimal -- better to get paid with high fixed salary up to a point, after which bill-and-collect is the better way to get paid per service than $X per wRVU.

For instance, in a very busy top 5% clinic, if you can collect $1M that sounds great compared to a $700k salary. However if you do the math, the net on the PSA would be $1M - $50k billing - $30k insurances - $40k FICA/medicare - $100k vacation coverage = $780k net. Vs. $700k employment + paid insurances and time off + 20k retirement match = $720k. 60k differential, 35k after tax. Almost a wash in the end?

So you'd need to collect about 40% over your employment offer for it to be financially worth it. Seems like a lot. You'll be able to shelter a bit more from taxes likely, but there's only so much you can write off as a professional. Maybe be conservative and say 30%, that's still a lot. Am I completely off here?
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The math IMO is pretty fair. Our overhead (pro fees only) year to year varies some, but ranges from ~15-20%.

However, there is a variable of freedom you have as a pro fee billing physician though (especially a busy one). You don't have to worry about a contract re-negotiation. You don't have to sit on committees you don't want to. You can use more advantageous 401K and cash balance defined benefit contribution plans as tax shelter and select your own funds within those tax havens (though you mentioned that). You don't have to "apply" to get a vacation week.

Of course there are more hassles (more meetings with accountants, more figuring out your own coverage, etc)....but the road to lack of autonomy and IMO a lot of physician frustration is paved by "well the money is the same, I'll just be employed" and that slippery slope starts. For now in rad onc many don't have that option, but if the numbers look within about 100K of each other, I'm taking non employed every time with one major caveat - it is a busy practice. You must generate enough of of your own revenue.
 
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BobbyHeenan said:
The math IMO is pretty fair. Our overhead (pro fees only) year to year varies some, but ranges from ~15-20%.

However, there is a variable of freedom you have as a pro fee billing physician though (especially a busy one). You don't have to worry about a contract re-negotiation. You don't have to sit on committees you don't want to. You can use more advantageous 401K and cash balance defined benefit contribution plans as tax shelter and select your own funds within those tax havens (though you mentioned that). You don't have to "apply" to get a vacation week.

Of course there are more hassles (more meetings with accountants, more figuring out your own coverage, etc)....but the road to lack of autonomy and IMO a lot of physician frustration is paved by "well the money is the same, I'll just be employed" and that slippery slope starts. For now in rad onc many don't have that option, but if the numbers look within about 100K of each other, I'm taking non employed every time with one major caveat - it is a busy practice. You must generate enough of of your own revenue.
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I'm not really seeing a change in autonomy in transitioning from PSA to employed. Corporate let's me do my thing. The autonomy issues I have are a product of our medical system, which is independent of how I'm paid.
 
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Ray D. Ayshun said:
I'm not really seeing a change in autonomy in transitioning from PSA to employed. Corporate let's me do my thing. The autonomy issues I have are a product of our medical system, which is independent of how I'm paid.
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I have had 3 hospital jobs.

The one affiliated with the big center had least autonomy.

The most recent has the most autonomy, even more than my freestanding life.

Big picture: single specialty freestanding has most autonomy, employed at hospital has least, but at individual level, there are many very autonomous hospital employed docs, and constrained freestanding docs.
 
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RealSimulD said:
I have had 3 hospital jobs.

The one affiliated with the big center had least autonomy.

The most recent has the most autonomy, even more than my freestanding life.

Big picture: single specialty freestanding has most autonomy, employed at hospital has least, but at individual level, there are many very autonomous hospital employed docs, and constrained freestanding docs.
Click to expand...

How is everyone defining autonomy: is this in terms of billing, or in terms of treating the way you want to treat (or both?)
 
Lamount said:
How is everyone defining autonomy: is this in terms of billing, or in terms of treating the way you want to treat (or both?)
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Autonomy to me is treating how I want, when I want, and making my own schedule (within reason) but there are lots of ways to define it that I am probably not even aware of with different tiers of importance
 
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