Maximum compensation pathway offered during first three years as attending?

[aafisahar]

Our nocturnists do week on/off. Definitely not 10/month.

Better pay more money than God for that schedule

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[CCM-MD]

Better pay more money than God for that schedule

$140/h or 305k/year + benefits

 

[Splenda88]

$140/h or 305k/year + benefits

That is ridiculous. Where is that? NY, LA.

 

[CCM-MD]

That is ridiculous. Where is that? NY, LA.

Small city in the SE. Days get $120/h.

 

[Splenda88]

Small city in the SE. Days get $120/h.

This should be the rate in big cities like NY, LA etc...

 

[rokshana]

No it's not... 90+% of nocturnist jobs out there are 7 days on/off. I have spent 5 months looking for 10-12 nights/month nocturnist job with no luck.

lol...funny gutonc said the same thing I did... in fact the exact same thing ( didn’t realize that when I posted) but it’s me that you tell that I’m wrong... but not gutonc....hmmmn.

and I’ve worked as nocturnist... haven’t in the last couple of years mind you... but,yeah,know what the nocturnist market is...at least on the east coast...still have plenty of friends that are still nocturnists.
Yes you can make 500k + working 20 nights a month... because that is equal to TWO jobs.

 

[rokshana]

Small city in the SE. Days get $120/h.

That’s terrible... get $120/ hr in Boston for days...should be higher in some small town in the SE.

 

[CCM-MD]

That’s terrible... get $120/ hr in Boston for days...should be higher in some small town in the SE.

Thats what they pay here. The other crazy thing is, we (intensivists) are not in house overnight. Somehow they still don't have a hard time recruiting.

 

[Splenda88]

lol...funny gutonc said the same thing I did... in fact the exact same thing ( didn’t realize that when I posted) but it’s me that you tell that I’m wrong... but not gutonc....hmmmn.

and I’ve worked as nocturnist... haven’t in the last couple of years mind you... but,yeah,know what the nocturnist market is...at least on the east coast...still have plenty of friends that are still nocturnists.
Yes you can make 500k + working 20 nights a month... because that is equal to TWO jobs.

I guess things have change. I was looking for that kind of setting and I did not see that many. I actually saw one in FL.

I agree 20 nights per month is akin to having 2 FTE. What I wanted to point out is that the typical nocturnist job these days is 7 days on/off. If you don't believe me, you can do a search on the physcian job website like practicelink etc... and you will see that there aren't that many 10-12 nights/month nocturnist jobs out there.

 

[Splenda88]

Thats what they pay here. The other crazy thing is, we (intensivists) are not in house overnight. Somehow they still don't have a hard time recruiting.

I wonder how much they pay intensivists. 350k/yr

 

[CCM-MD]

I wonder how much they pay intensivists. 350k/yr

We get 450-500k in an open ICU working day shifts with q2h night call from home. But I am confident if they could recruit us easily, they would gladly pay 350k.

 

[Splenda88]

We get 450-500k in an open ICU working days with q2h night call from home. But I am confident if they could recruit us easily, they would gladly pay 350k.

Not bad for intensivists. I kind of have an idea where you are based on previous posts, and I am shocked they are able to recruit hospitalists for <300k and nocturnists for <350k.

 

[CCM-MD]

Not bad for intensivists. I kind of have an idea where you are based on previous posts, and I am shocked they are able to recruit hospitalists for <300k and nocturnists for <350k.

2020 MGMA mean is 447k for intensivists so what I am getting is probably average with the night call frequency.

 

[Splenda88]

@CCM-MD

If this is the place I am thinking, I think they have other benefits and incentive that make up for the low base pay because these incentives are another >100k on top of the salary. (another 20% of salary in incentive, 33k+25k/yr student loan repayment).

 

[CCM-MD]

@CCM-MD

If this is the place I am thinking, I think they have other benefits and incentive that make up for the salary because these incentives are another >100k on top of the salary. (another 20% of salary in incentive, 33k+25k/yr student loan repayment).

Turns out there is a bonus of ~10% based on some metrics that I was not aware of. I don't know enough about loan repayment to comment. Maybe it is the same place. But I am not going to say more to maintain some anonymity.

 

[Nocturnist]

Not in the 'hospitalist world'

Totally is in the nocturnists world.
My job is 10 shifts a month.
Most I've interviewed for and heard about are 12 shifts a month. The minority were 7 on/7 off. Those gigs are a vestige of less progressive, frankly ****tier programs that dont properly recognize the value and hardship of being a dedicated full time nocturnist. I consider those jobs to be 1.5x FTE, and expect them to pay accordingly.

 

[Nocturnist]

Hey everyone,

I had a quick question regarding job prospects as a first-year private practice subspecialty internal medicine attending. I understand that compensation depends on many factors, including but not limited to, partnership, location, volume, compensation model, days/week, etc, but I’m curious what your opinions on the pathways that will lead to the highest possible salary after training. Is cardiology or GI more lucrative, keeping into consideration saturation concerns such as oversupply of interventionalists in cardiology after training, please support your answer with anecdotal evidence of salaries you have seen for first year attending salary.

The reason I ask is because I will have a hefty student loan debt burden at the completion of my training. My spouse and I will have a combined debt burden of $1.1 Million upon completion of fellowship training. Yes I have made financial mistakes in the past when I was a student (expensive undergrad, expensive masters, expensive medical school, for both spouse and myself). Spouse going into pediatrics and wants to do subspecialty training so I am expecting realistically 150k after tax for their income. Location does not matter, days/week does not matter, and honestly satisfaction with my work environment does not matter as this would be a temporary position as I work to build a sizable nest egg and pay off debt. My goal would to work as hard as possible, even if that includes 120 hr weeks in order to pay off our debt. Eventually, I would transition to a work environment and location that I desired, but this would be at least several years down the line. How can I maximize my income in internal medicine?

Thanks for any insight,
Sall

Hey everyone,

I had a quick question regarding job prospects as a first-year private practice subspecialty internal medicine attending. I understand that compensation depends on many factors, including but not limited to, partnership, location, volume, compensation model, days/week, etc, but I’m curious what your opinions on the pathways that will lead to the highest possible salary after training. Is cardiology or GI more lucrative, keeping into consideration saturation concerns such as oversupply of interventionalists in cardiology after training, please support your answer with anecdotal evidence of salaries you have seen for first year attending salary.

The reason I ask is because I will have a hefty student loan debt burden at the completion of my training. My spouse and I will have a combined debt burden of $1.1 Million upon completion of fellowship training. Yes I have made financial mistakes in the past when I was a student (expensive undergrad, expensive masters, expensive medical school, for both spouse and myself). Spouse going into pediatrics and wants to do subspecialty training so I am expecting realistically 150k after tax for their income. Location does not matter, days/week does not matter, and honestly satisfaction with my work environment does not matter as this would be a temporary position as I work to build a sizable nest egg and pay off debt. My goal would to work as hard as possible, even if that includes 120 hr weeks in order to pay off our debt. Eventually, I would transition to a work environment and location that I desired, but this would be at least several years down the line. How can I maximize my income in internal medicine?

Thanks for any insight,
Sally

Anecdotal evidence here:
I'm a nocturnist working 55-60 hours a week in the northeast for the past 5 years. I've made 600k last year. If you only lived on your spouse's salary (150k net is very reasonable) and used your entire income towards your debt, you could be completely debt free in under 3 years. In this time frame you could be maxing out both your retirement accounts, instead of that 1.1m ballooning to 1.3m during fellowship.

 

[CCM-MD]

Anecdotal evidence here:
I'm a nocturnist working 55-60 hours a week in the northeast for the past 5 years. I've made 600k last year. If you only lived on your spouse's salary (150k net is very reasonable) and used your entire income towards your debt, you could be completely debt free in under 3 years. In this time frame you could be maxing out both your retirement accounts, instead of that 1.1m ballooning to 1.3m during fellowship.

20 night shifts per month?

 

[Nocturnist]

Yup, combination of somewhere around 16-20 nights a month plus some shorter 'oh crap look how backed up the ED is' admit shifts plus a few percent of that from quality/productivity bonus

 

[wamcp]

Anecdotal evidence here:
I'm a nocturnist working 55-60 hours a week in the northeast for the past 5 years. I've made 600k last year. If you only lived on your spouse's salary (150k net is very reasonable) and used your entire income towards your debt, you could be completely debt free in under 3 years. In this time frame you could be maxing out both your retirement accounts, instead of that 1.1m ballooning to 1.3m during fellowship.

You and me are living proof of the nocturnist path to FI

Took us 21 months post residency to crush 340k in loans, with aftertax income, while putting 100k to tax deferred accounts at the same time, even while spouse was not yet done with fellowship. Was doing 55hr week avg

 

[Nocturnist]

I guess things have change. I was looking for that kind of setting and I did not see that many. I actually saw one in FL.

I agree 20 nights per week is akin to having 2 FTE. What I wanted to point out is that the typical nocturnist job these days is 7 days on/off. If you don't believe me, you can do a search on the physcian job website like practicelink etc... and you will see that there aren't that many 10-12 nights/month nocturnist jobs out

You won't see any advertisements on TV for Ferrari, either.

Great nocturnist jobs dont need to advertise- they fill quickly and stay filled.

There's a great deal of selection bias here. Crappy jobs that advertise and keep advertising on practicelink do so because they can't be filled and have a high turnover.

it may mean you have to find the the great nocturnist jobs yourself by networking and emailing your CV to department directors, but they are definitely out there.

 

[Osteoth]

You won't see any advertisements on TV for Ferrari, either.

Great nocturnist jobs dont need to advertise- they fill quickly and stay filled.

There's a great deal of selection bias here. Crappy jobs that advertise and keep advertising on practicelink do so because they can't be filled and have a high turnover.

it may mean you have to find the the great nocturnist jobs yourself by networking and emailing your CV to department directors, but they are definitely out there.

Best ways to network into a good job?

 

[Splenda88]

You won't see any advertisements on TV for Ferrari, either.

Great nocturnist jobs dont need to advertise- they fill quickly and stay filled.

There's a great deal of selection bias here. Crappy jobs that advertise and keep advertising on practicelink do so because they can't be filled and have a high turnover.

it may mean you have to find the the great nocturnist jobs yourself by networking and emailing your CV to department directors, but they are definitely out there.

I am glad that there are these nocturnist jobs out there (10-12 nights/month). Just signed a hospitalist contract today since I could not find such job. I will try to network in the 2-yr of my contract so I could land a job like that someday.

 

[Nocturnist]

Best ways to network into a good job?

Be prepared to kiss alot of frogs and have patience.

Pick a radius around where you've settled down that is acceptable to you and Google every hospital in that area. Google the recruiter and/or hospitalist director and send them your resume.

The Ferraris of nocturnist jobs won't have an opening today, but when they do- there's a good chance they'll contact you first before putting a shingle up on practicelink.

Also do you have any connections from residency or prior colleagues that can put in a good word for you? A 'hey I've worked with this guy and they're a great hospitalist' is worth more to a hospitalist group director than anything else on your CV.

 

[chessknt]

Best ways to network into a good job?

Obviously you email your CV to random hospitals that have no advertisement for a position asking for 10 shifts a month 600k a year full benefits including fully funded 401k and no noncompete, non-negotiable or your unique nocturnist skills will be lost to their competitor. A 'good' hospital will see this immense value and hire you.

 

[Splenda88]

You and me are living proof of the nocturnist path to FI

Took us 21 months post residency to crush 340k in loans, with aftertax income, while putting 100k to tax deferred accounts at the same time, even while spouse was not yet done with fellowship. Was doing 55hr week avg

That is remarkable!

How long have you been out of residency? What's your average salary during these years?

Honestly, if one is not passionate about card/GI, don't do it for the money. These guys/gals work 55-60 hrs/wk to make 450-500k. You can make close to that as hospitalist/nocturnist working these hours. For instance, if I work 18 shifts per month (52-54 hrs/wk) based on the contact I just signed, my salary will be a little bit over 400k/year.

I will see if I can become FI in 10 yrs (1.5-2 mil in 401k, IRA, index etc and ~1 mil in real estate). Hope medicine does not explode (aka medicare for all) w/in those 10 yrs.

 

[Nocturnist]

I am glad that there are these nocturnist jobs out there (10-12 nights/month). Just signed a hospitalist contract today since I could not find such job. I will try to network in the 2-yr of my contract so I could land a job like that someday.

Curious, where are you geographically? Do you mind sharing some of the details of your contract?

 

[Splenda88]

Curious, where are you geographically? Do you mind sharing some of the details of your contract?

SE of the US. Contract $150/hr (hospitalist). If I cover night, $175/hr. 7 on/off. 35k sign on. No RVUs or incentive bonus. Average census 16-18 and 1-2 admits/day. W2 job.

 

[Nocturnist]

Obviously you email your CV to random hospitals that have no advertisement for a position asking for 10 shifts a month 600k a year full benefits including fully funded 401k and no noncompete, non-negotiable or your unique nocturnist skills will be lost to their competitor. A 'good' hospital will see this immense value and hire you.

You laugh but that's practically how I landed the side gig I currently moonlight at. I was moonlighting at a hospital I wasn't too happy at, so I sent my resume to around a dozen other hospitals, got a call back from all of them and interviewed at about half.

This one hospital offered me a per diem gig for $1500 for a 12 hour shift. I'd be the only nocturnist on at night and was told I'd be expected to do about 8 admits myself and staff about 8 with the housestaff. I respectfully told them this is the lowest rate I've come across in the northeast, and that it sounded like way too much work for one nocturnist.

About a year later I get a call back from the same hospital-my comment made them do some market research, after which they realized how poorly their rates kept up with the competition. they were able to get the budget approved to increase staffing from 1 to 2 nocturnist a night, increase their moonlighting rate by $50/hr, and provide more mid-level support. Closed ICU, no cross coverage and housestaff handle rapids and codes. So they asked me if I'd reconsider? I said heck yes, after a couple months there, quit my other side gig and never looked back. It went from one of the worst offers I've heard about to one of the most sustainable, well paying gigs.

Sometimes the good gigs aren't open. Sometimes they become good gigs if you give them some time.
Kiss some frogs and have patience.

 

[Nocturnist]

SE of the US. Contract $150/hr (hospitalist). If I cover night, $175/hr. 7 on/off. 35k sign on. No RVUs or incentive bonus. Average census 16-18 and 1-2 admits/day. W2 job.

Are we talking apples and oranges here?

I think you're referring to day hospitalist, I'm talking strictly nocturnist. 7 on/off is in fact the standard for days, while 10-12 a month is more common for nights. $150 for days/$175 for nights is a very good rate.

At $175/hr a night times 20 shifts a month, you're looking at $504k a year not including any bonuses.

 

[Splenda88]

Are we talking apples and oranges here?

I think you're referring to day hospitalist, I'm talking strictly nocturnist. 7 on/off is in fact the standard for days, while 10-12 a month is more common for nights. $150 for days/$175 for nights is a very good rate.

At $175/hr a night times 20 shifts a month, you're looking at $504k a year not including any bonuses.

I was initially looking for a nocturnist position, but when I could not find a 10-12 nights/month nocturnist, I started to dabble into the hospitalist world because there is no way I can work 15 night shifts on average. Therefore, I settle for hospitalist position because 15 day shifts is more manageable than 15 nights IMO.

 

[Nocturnist]

I was initially looking for a nocturnist position, but when I could not find a 10-12 nights/month nocturnist, I started to dabble into the hospitalist world because there is no way I can work 15 night shifts on average. Therefore, I settle for hospitalist position because 15 day shifts is more manageable than 15 nights IMO.

And this hospital wouldnt entertain offering you a a 0.66 or 0.75 FTE nocturnist position? Their hourly rate is on point. Seems a little whack they'd pass on a nocturnist they were willing to hire just because you don't want to do 15 nights a month.

 

[Splenda88]

And this hospital wouldnt entertain offering you a a 0.66 or 0.75 FTE nocturnist position? Their hourly rate is on point. Seems a little whack they'd pass on a nocturnist they were willing to hire just because you don't want to do 15 nights a month.

They would not. I proposed 12 nights and they said it's easier with scheduling to have someone 7 on/off.

 

[thumbz]

Nocturnists in my shop are $180/hr, 10 hour shifts, 12 shift minimum per month, ample opportunity to pick up as many extras as you want. BFE in the northwest. Admit 6-8 per shift, solo coverage from 0200-0600. Swings in house until 0200. That's on the non academic side, on the academic side we don't have true nocturnists.

Edit: closed ICU, no procedures, full subspecialty support

 

[Splenda88]

Nocturnists in my shop are $180/hr, 10 hour shifts, 12 shift minimum per month, ample opportunity to pick up as many extras as you want. BFE in the northwest. Admit 6-8 per shift, solo coverage from 0200-0600. Swings in house until 0200. That's on the non academic side, on the academic side we don't have true nocturnists.

That is great setting to prevent quick burnout.

 

[thumbz]

That is great setting to present quick burnout.

Yeah, I definitely work at a lifestyle work/life balance shop which is nice. You can make money hand over fist picking up a ton of extra work if you want too, but once the burnout sets in people have ample opportunity to cut back to a more sustainable pace.

 

[wamcp]

That is remarkable!

How long have you been out of residency? What's your average salary during these years?

Honestly, if one is not passionate about card/GI, don't do it for the money. These guys/gals work 55-60 hrs/wk to make 450-500k. You can make close to that as hospitalist/nocturnist working these hours. For instance, if I work 18 shifts per month (52-54 hrs/wk) based on the contact I just signed, my salary will be a little bit over 400k/year.

I will see if I can become FI in 10 yrs (1.5-2 mil in 401k, IRA, index etc and ~1 mil in real estate). Hope medicine does not explode (aka medicare for all) w/in those 10 yrs.

I’ve posted this in other threads too:

finished residency 2017. Worked as a day hospitalist with lots of crap moonlighting at an academic center for one year, got garbage 100/hr pay. Then switched jobs to community hospitals, since 2018 been a nocturnist doing 50hr work week avg (mix of overnights and 8-10 hr long admitter shifts) generating 550k/yr. My base nocturnist pay is ~170/hr. Moonlighting in the healthsystem pays $200-300/hr, the highest i have ever encountered anywhere (it is crazy because the intensivists get $200/hr to moonlight in their unit...less than or on par with us)
However I have cut back since end of last year due to

1) kids

2) market trading returns that pushed my investments into seven figures

3) postcovid moonlighting shifts are drying up anyway

4) wife completed fellowship in 2020 and now is getting attending pay.

You got the right mindset that a lot of other people in medicine are acting willfully ignorant or blissfully naive. Medicine is at high risk of further downward spiral from:

1) decreasing government reimbursement, through acts of congress like medicare age expansion or M4A type shifts

2) private equity takeovers, to enhance profit they will drive physician pay down and compel physicians to do more for less

3) further midlevel expansion and encroachment

4) residency spot expansions due to 1) and 2)

5) hospital system consolidations. In its mature form, look no further than the boston area where i did academic hospitalist for a year. Community hospitals integrated into the academic system forced all physician compensation to the same level with no bargaining power left to the docs. 100/hr pay is the norm.

Thus, those pursuing 3 yr IM and then 3 yr fellowship hoping for lucrative 500k procedure heavy income over a 30 yr career are probably going to be disappointed. It is better to grab your gains NOW over the short term and get to FI before finding that out at the end of fellowship.

 

[Prehealth1011]

SE of the US. Contract $150/hr (hospitalist). If I cover night, $175/hr. 7 on/off. 35k sign on. No RVUs or incentive bonus. Average census 16-18 and 1-2 admits/day. W2 job.

Are these the typical rates you’ve seen or did you get these rates because it’s a w2 job ?
I’m an incoming IM resident still trying to figure out if fellowships are worth it

 

[Splenda88]

Are these the typical rates you’ve seen or did you get these rates because it’s a w2 job ?
I’m an incoming IM resident still trying to figure out if fellowships are worth it

This is not typical, but they are out there if you are ok to live in small cities (50k-100k population). It's more like $110-125/hr for hospitalist and $125-150/hr for nocturnist. Fellowship worth it only if you are passionate about it IMO.

As I said, I can make 400k/yr working 52 hrs/wk on average.

 

[wamcp]

You won't see any advertisements on TV for Ferrari, either.

Great nocturnist jobs dont need to advertise- they fill quickly and stay filled.

There's a great deal of selection bias here. Crappy jobs that advertise and keep advertising on practicelink do so because they can't be filled and have a high turnover.

it may mean you have to find the the great nocturnist jobs yourself by networking and emailing your CV to department directors, but they are definitely out there.

We hired a day hospitalist at our site this year when one of our guys announced retirement. Our position never had a chance to be advertised. New hire is a graduating resident. It was because the resident had done a rotation at a separate community site within our health system, in the icu as an elective, and thoroughly impressed the icu director who recommended them. All word of mouth.

 

[wamcp]

SE of the US. Contract $150/hr (hospitalist). If I cover night, $175/hr. 7 on/off. 35k sign on. No RVUs or incentive bonus. Average census 16-18 and 1-2 admits/day. W2 job.

Good pay rates, higher than mine. Closed icu?
Hope the location is decent, if so, maybe it will turn out to be a unicorn type job

 

[Splenda88]

Good pay rates, higher than mine. Closed icu?
Hope the location is decent, if so, maybe it will turn out to be a unicorn type job

Open ICU with intensivist support, no codes, no procedures. Location is not ideal. I gotta execute that 10-yr plan. I guess that's the price I gotta pay.

 

[wamcp]

Nocturnists in my shop are $180/hr, 10 hour shifts, 12 shift minimum per month, ample opportunity to pick up as many extras as you want. BFE in the northwest. Admit 6-8 per shift, solo coverage from 0200-0600. Swings in house until 0200. That's on the non academic side, on the academic side we don't have true nocturnists.

Edit: closed ICU, no procedures, full subspecialty support

Nice, good compensation and 10 hr shifts can’t be beat. What’s BFE stand for?

 

[thumbz]

Nice, good compensation and 10 hr shifts can’t be beat. What’s BFE stand for?

Bum ****, Egypt - also known as the middle of no where.

I personally use it to refer to small communities that most people don't want to live in. I don't think there are any real cutoffs for size or amenities so everyone draws the line a little differently.

 

[Nocturnist]

They would not. I proposed 12 nights and they said it's easier with scheduling to have someone 7 on/off.

Damn, that's cold!

At my main job I can dictate how many shifts I want between 0.5-1.5 FTEs. I could work less, but I'd have to bring my own malpractice and won't qualify for benefits under 0.5.
At my moonlighting gig I've seen several folks do 0.16 or 0.33 FTEs or any version of a hybrid day/swing/night they can dream of. They'll gladly wait to hire the right candidate but once they do they'll give them any schedule they need to keep them happy. Turnover is nonexistant.

 

[VA Hopeful Dr]

That is remarkable!

How long have you been out of residency? What's your average salary during these years?

Honestly, if one is not passionate about card/GI, don't do it for the money. These guys/gals work 55-60 hrs/wk to make 450-500k. You can make close to that as hospitalist/nocturnist working these hours. For instance, if I work 18 shifts per month (52-54 hrs/wk) based on the contact I just signed, my salary will be a little bit over 400k/year.

I will see if I can become FI in 10 yrs (1.5-2 mil in 401k, IRA, index etc and ~1 mil in real estate). Hope medicine does not explode (aka medicare for all) w/in those 10 yrs.

That seems a bit low for both cards and GI.

 

[Splenda88]

That seems a bit low for both cards and GI.

How much do you think they make? It's what I have seen in CiM.

 

[chessknt]

How much do you think they make? It's what I have seen in CiM.

If you wanna look at 90th percentile nocturnist and compare that to 90th percentile cards/gi you’re looking at close to seven figures without a doubt more if they work like a dog like some of the jobs posters here. There truly is no comparison.

 

[Splenda88]

If you wanna look at 90th percentile nocturnist and compare that to 90th percentile cards/gi you’re looking at close to seven figures without a doubt more if they work like a dog like some of the jobs posters here. There truly is no comparison.

These posters are working 50 hrs/wk and make 400k... That is not working like dog IMO.

Based on previous post, @VA Hopeful Dr works ~36 hrs and make 300k/yr. I am saying do GI/card if you are passionate about them because you can make 450k/yr working the hrs card/GI work. Of course card/GI do not deals with some of the bs IM/FM docs have to deal with.

 

[chessknt]

These posters are working 50 hrs/wk and make 400k... That is not working like dog IMO.

@VA Hopeful Dr works ~36 hrs and make 300k/yr. That's why I am saying, do GI/card if you are passionate about them because you can make 450k/yr working the hrs card/GI work. Of course card/GI do not deals with some of the BS IM/FM docs have to deal with.

It isn’t just about not dealing with bs. GI can do an egd in about 5 minutes if no samples are needed and generate 2 rvus. A left heart cath can generate 12+ rvu in 30-45 minutes. The only gi making 450/yr work for a hospital. Pp guys running their own offices or who have their own procedure suites to dip the facility fee are making multiples of that.

mgma 90th for cards ep is 1.1 million. Gi is 885. Hospitalist is 445.