non-invasive Cardiology starting salaries

[mont43red]

I'm curious what the rough differences are between non-invasive cards starting gigs at hospitals vs private practice.. and what starting salaries would look like in the northeast? For both rural northeast and major hubs like Boston? Everything I see says that area has some of the lowest starting salaries in the nation due to "prestige" but I don't know where it actually is... Thanks!

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[deleted980918]

BWH/Harvards starts 220-240k for noninvasive

PP depends on the setup and location 300-350k range with potential to be in the 450-500k range after 2-3 years

 

[aafisahar]

Outside of Chicago, New York, and LA, 400k is the floor. I signed in the Midwest near a metro area circa 2 million for 410k plus productivity. Average doc salary is around 500-550k after 2 years. It's a 3.5 day clinic with 1 imaging day (read all nukes, echos, and TEEs). Call about 4-6x/month as the new guy.

 

[timpview]

500-650k in my neck of the woods including moderate size metro areas.

I still can’t comprehend how any cardiologist would work for less than 400k. Crazy to me.

 

[deleted980918]

500-650k in my neck of the woods including moderate size metro areas.

I still can’t comprehend how any cardiologist would work for less than 400k. Crazy to me.

None of my peers looking for non-invasive jobs in NYC metro/suburbs (LI, Westchester..etc) is getting more than 350k first 1-2 years. Location kills it

 

[mont43red]

Thanks guys. It seems that with places like NYC and Boston, yes there are more doctors in a small area but also cost of living is so substantially higher so it's surprising to me that those areas have such lower salaries.

 

[mont43red]

500-650k in my neck of the woods including moderate size metro areas.

I still can’t comprehend how any cardiologist would work for less than 400k. Crazy to me.

What is your neck of the woods?

 

[ROBINHO]

Thanks guys. It seems that with places like NYC and Boston, yes there are more doctors in a small area but also cost of living is so substantially higher so it's surprising to me that those areas have such lower salaries.

Comes down to the demand for cardiologist in rural versus urban . The demand in Boston/NYC is low so there is no reason to pay more. If you dont take that contract the next person will take it-because they want to live in NY/ Boston.

Salaries also depends on academic versus private.

Sometimes the salary is not the important thing- call system, clinical load, RVU system etc play a part

Salaries can go from 200 to 600 k depending on what you want. Academics, big cities pay less.

 

[BMW M5]

What is your neck of the woods?

Yea I'd like to know that as well. I'm assuming this salary is average for those that are more than 2 years into practice. If a cardiologist generates 10,000 wRVUs annually at $55 a wRVU, that will equal to $550,000.

 

[disorder]

West Coast: 200-250k academic. 350k-450k PP/group practice.

 

[anonymous0439]

BWH/Harvards starts 220-240k for noninvasive

PP depends on the setup and location 300-350k range with potential to be in the 450-500k range after 2-3 years

How about the next tier of academic institutions- for e.g. BU, Tufts, Lahey, St. Elizabeth’s etc. What is the average starting pay for non-invasive/advanced imaging in these places? What can one expect after 3-5 years of practice?

 

[Scope guy]

550k in midwest

 

[aafisahar]

How about the next tier of academic institutions- for e.g. BU, Tufts, Lahey, St. Elizabeth’s etc. What is the average starting pay for non-invasive/advanced imaging in these places? What can one expect after 3-5 years of practice?

Anything academic is going to pay 40-60% of what you can get in the community.

 

[deleted980918]

Anything academic is going to pay 40-60% of what you can get in the community.

Some of my friends are getting offers with base in the 200-240k range (RVU goal of 7500) in those community locations of major academic places. Obviously with production, u can probably hit 300k but a base in the low 200s are just a disgrace in my opinion.

 

[bronx43]

Some of my friends are getting offers with base in the 200-240k range (RVU goal of 7500) in those community locations of major academic places. Obviously with production, u can probably hit 300k but a base in the low 200s are just a disgrace in my opinion.

Are they actually taking these positions

 

[deleted980918]

Are they actually taking these positions

They aren’t but someone who is geographically limited, restrained by visa requirements or wants the “prestige” always will.

 

[blahblah56]

550k in midwest

As a new graduate?

 

[Scope guy]

As a new graduate?

yes

 

[Mighty_MD]

I'm graduating in June and signed a contract for an general invasive cardiology position in the Midwest for a guaranteed 2-year base of 550k. I would move to a production model of $63/wrvu in my third year or sooner if I'm productive. The offer would have been the same regardless of whether I was invasive or non-invasive. Basically, they were looking for a non-invasive cardiologist but I asked if I could do diagnostic right and left heart caths and they agreed to that. I had two other offers that were slightly better for 563k and 568k, which I didn't take due to personal and geographical reasons. The lowest offer I received was for 500k.

I would say 550k is right about 50th percentile in salary for a general cardiologist based on physician compensation surveys and so is $62-63/wrvu if you're paid based upon production. I kind of made sure to let them know I was aware of that during the negotiations so I wouldn't get low ball offers. There is nothing wrong with expecting fair market value (i.e. 50th percentile reimbursement) as a new graduate. It's only fair.

 

[deleted980918]

I'm graduating in June and signed a contract for an general invasive cardiology position in the Midwest for a guaranteed 2-year base of 550k. I would move to a production model of $63/wrvu in my third year or sooner if I'm productive. The offer would have been the same regardless of whether I was invasive or non-invasive. Basically, they were looking for a non-invasive cardiologist but I asked if I could do diagnostic right and left heart caths and they agreed to that. I had two other offers that were slightly better for 563k and 568k, which I didn't take due to personal and geographical reasons. The lowest offer I received was for 500k.

I would say 550k is right about 50th percentile in salary for a general cardiologist based on physician compensation surveys and so is $62-63/wrvu if you're paid based upon production. I kind of made sure to let them know I was aware of that during the negotiations so I wouldn't get low ball offers. There is nothing wrong with expecting fair market value (i.e. 50th percentile reimbursement) as a new graduate. It's only fair.

How Midwest is this job, location wise? Because where I am at in the NE, it’s $40-45/wRVU?

 

[timpview]

How Midwest is this job, location wise? Because where I am at in the NE, it’s $40-45/wRVU?

$40/rvu ?? Ouch. That’s our NP rate (though they only hit about 3k rvus)…

But You could be fairly busy at 9k rvus and still not hit 400k. Crazy.

 

[gutonc]

Hello Mighty_MD! Congrats on the job. $62-63/wRVU is a good rate. Enjoy!

Is $60/wRVU really a good deal in cards? Because if it is, y'all are getting seriously hosed. Median cards productivity is in the 10K wRVU/yr range. Are you really working that hard for $5-600K?

I make that same money in a non-procedural IM specialty (hospital employed) and only work about half that hard and never have to go in after dark.

 

[CCM-MD]

And this post is how we know that you have got to be completely full of s***.

Is $60/wRVU really a good deal in cards? Because if it is, y'all are getting seriously hosed. Median cards productivity is in the 10K wRVU/yr range. Are you really working that hard for $5-600K?

I make that same money in a non-procedural IM specialty (hospital employed) and only work about half that hard and never have to go in after dark.

Actually he isn’t. 2020 Median MGMA wRVU is ~$65 for non-invasive cardiology. Median number of wRVUs is ~8000.

Oncology is a major anomaly and is ~$100 per wRVU at the MGMA median. Onc is ridiculous with its essential kickbacks for chemo prescriptions.

 

[bronx43]

And this post is how we know that you have got to be completely full of s***.

Is $60/wRVU really a good deal in cards? Because if it is, y'all are getting seriously hosed. Median cards productivity is in the 10K wRVU/yr range. Are you really working that hard for $5-600K?

I make that same money in a non-procedural IM specialty (hospital employed) and only work about half that hard and never have to go in after dark.

Not every specialty has huge kick backs for overpriced chemo and immunotherapy. We have some meager infusions in rheum but the profit margins aren't close to what it is for oncology, and barely factor into compensation per RVU calculations.

And $60 for cards is not bad considering the fact that a lot of the wRVUs come from reading echos and ECGs which don't have huge technical fees to make it very profitable for hospital systems. Cards reimbursement has really been slashed over the past 15 years.

 

[VA Hopeful Dr]

Not every specialty has huge kick backs for overpriced chemo and immunotherapy. We have some meager infusions in rheum but the profit margins aren't close to what it is for oncology, and barely factor into compensation per RVU calculations.

And $60 for cards is not bad considering the fact that a lot of the wRVUs come from reading echos and ECGs which don't have huge technical fees to make it very profitable for hospital systems. Cards reimbursement has really been slashed over the past 15 years.

Echos don't? Then why do they cost $1500 each?

 

[deleted980918]

Not every specialty has huge kick backs for overpriced chemo and immunotherapy. We have some meager infusions in rheum but the profit margins aren't close to what it is for oncology, and barely factor into compensation per RVU calculations.

And $60 for cards is not bad considering the fact that a lot of the wRVUs come from reading echos and ECGs which don't have huge technical fees to make it very profitable for hospital systems. Cards reimbursement has really been slashed over the past 15 years.

Makes wonder why so many cardiologists are still working and taking calls into their 70s if the reimbursement were so good 15 years ago and they invested a little.

 

[bronx43]

Echos don't? Then why do they cost $1500 each?

Medicare pays like $200 for a complete TTE, and $130 is technical component. And the overhead isn't low with echos considering equipment and echo tech salary. I'm sure hospitals charge $1500, but I don't know that any insurers are actually paying that. I would bet big players like UHC barely pay higher than Medicare. When I was in a private group and collected part of the technical component, it surprised me how little we actually get. Some of these ancillaries barely break even...

Chemo, on the other hand, adds up to 7 figures easy for each oncologist of pure profit. There's also billable infusion CPT codes on top of that.

 

[HemeOncHopeful19]

Makes wonder why so many cardiologists are still working and taking calls into their 70s if the reimbursement were so good 15 years ago and they invested a little.

They either

a) did not invest much
b) did not invest wisely (FOTM stuff such as putting tons of money into Crypto today)
c) three ex-wives

In the 80s-90s there wasn't as much of a reason to be "smart" with your money before two decades of death by a thousand cuts

 

[Scope guy]

Is $60/wRVU really a good deal in cards? Because if it is, y'all are getting seriously hosed. Median cards productivity is in the 10K wRVU/yr range. Are you really working that hard for $5-600K?

I make that same money in a non-procedural IM specialty (hospital employed) and only work about half that hard and never have to go in after dark.

good for you. Your RVU conv of 100$ is reflective of the fees that chemo brings in and downstream revenue from imaging, labs, etc. All good things come to an end, so may be in the next few years, we will see this coming down. GI, cards, nephro have had incredible cost cuts in the last 15 years already

 

[cards67]

Medicare pays like $200 for a complete TTE, and $130 is technical component. And the overhead isn't low with echos considering equipment and echo tech salary. I'm sure hospitals charge $1500, but I don't know that any insurers are actually paying that. I would bet big players like UHC barely pay higher than Medicare. When I was in a private group and collected part of the technical component, it surprised me how little we actually get. Some of these ancillaries barely break even...

Chemo, on the other hand, adds up to 7 figures easy for each oncologist of pure profit. There's also billable infusion CPT codes on top of that.

That's for private practice, it's closer to $500+ for hospital-based. Part of the reason practices have sold to hospitals. Maybe not chemo money but without it I don't think gen cards couldn't collect much more $/rvu than primary care. One hospital group I know says their highest earner is their echo guy.

 

[bronx43]

good for you. Your RVU conv of 100$ is reflective of the fees that chemo brings in and downstream revenue from imaging, labs, etc. All good things come to an end, so may be in the next few years, we will see this coming down. GI, cards, nephro have had incredible cost cuts in the last 15 years already

It’s mainly chemo buy and bill - honestly the biggest racket in medicine. The rheumatologists who push infusions aggressively (over oral or SC dmards) can literally see 12-15 patients a day and pull 500k. I have witnessed this first hand.

Imaging and labs have been cut beyond all recognition. If it goes much lower then those become financial losers. Only centers with high enough throughput can eek out a small margin to make it worthwhile.

 

[bronx43]

That's for private practice, it's closer to $500+ for hospital-based. Part of the reason practices have sold to hospitals. Maybe not chemo money but without it I don't think gen cards couldn't collect much more $/rvu than primary care. One hospital group I know says their highest earner is their echo guy.

Oh you’re right. The facility fee does add on a significant amount. I recall seeing numbers for joint ultrasounds for hospital based and it was multiple times higher than what I got in pp.

 

[deleted980918]

It will be ok. No one is starving. You can’t squeeze any more water out of a dry sponge.

An avg salary of 450-500k is by no means a small amount and is a upper middle class anywhere in this country.

 

[timpview]

Not sure why everyone is riled up at heme onc guy.

He’s right. We even have a poster here confirming he’s a cardiologist making $40/rvu.

In general, Cardiologists are underpaid and need to better understand their value. Obviously the market is the market and if a hospital can get a cardiologists to accept $40/rvu than they will..

But, unless you’re really really geographically constrained than you should keep an open mind and know your value. You’re also hurting your profession and colleagues by accepting such terms.

But it’s important for fellows to see what’s out there.

In general a great job will be $70-80+/rvu (75% plus mgmt). $60/rvu is prob near 50%. If your total package is <600k than you should probably keep looking imo.

 

[BMW M5]

Not sure why everyone is riled up at heme onc guy.

He’s right. We even have a poster here confirming he’s a cardiologist making $40/rvu.

In general, Cardiologists are underpaid and need to better understand their value. Obviously the market is the market and if a hospital can get a cardiologists to accept $40/rvu than they will..

But, unless you’re really really geographically constrained than you should keep an open mind and know your value. You’re also hurting your profession and colleagues by accepting such terms.

But it’s important for fellows to see what’s out there.

In general a great job will be $70-80+/rvu (75% plus mgmt). $60/rvu is prob near 50%. If your total package is <600k than you should probably keep looking imo.

I plan to finish an IC fellowship in June of 2023 and with the little homework I’ve done, I doubt any IC can find a job for more than 450K in a major city such as DFW or Houston. I’ve heard of offers for >600K in smaller towns with 1:6 STEMI call (~ 2 hours outside of either). Probably higher salary in the South TX region. Subtract 50-100K for general cardiology.

I don’t know if such offers still exist in the midwest. Clearly not the case everywhere else…

Assuming 10K wRVU at $60/wRVU. That’s $600K -which I agree should be what is expected.

 

[bronx43]

Not sure why everyone is riled up at heme onc guy.

He’s right. We even have a poster here confirming he’s a cardiologist making $40/rvu.

In general, Cardiologists are underpaid and need to better understand their value. Obviously the market is the market and if a hospital can get a cardiologists to accept $40/rvu than they will..

But, unless you’re really really geographically constrained than you should keep an open mind and know your value. You’re also hurting your profession and colleagues by accepting such terms.

But it’s important for fellows to see what’s out there.

In general a great job will be $70-80+/rvu (75% plus mgmt). $60/rvu is prob near 50%. If your total package is <600k than you should probably keep looking imo.

Idk that it’s a “geographic constraint” issue as much as a “need to live in a metro” issue. What you’re describing is basically the metro/rural arbitrage where any specialty can theoretically find a gig 1-2 hours outside a metropolitan area and increase their comp per rvu by $10-20. Even if someone is constrained by family or spouse’s job, one can always commute that distance… yet most don’t cuz commuting sucks.

The market, therefore, is already in equilibrium- since the vast majority of docs don’t want to commute yet want to live where the suburbs look like HGTV specials. They want to be able to eat organic at Whole Foods, go shop at a mall with Nordstrom’s, or have dinner at the hot new gastro pub.
If docs actually started leaving and taking rural positions and the bigger city employers increased pay, those same docs would flock back to their metropolitan havens begging for jobs which would then drive the pay back down.

 

[timpview]

Guess it depends on your definition of a “metropolitan” area.

Out west, I know for a fact that I could make more than 500-600k in Denver, Salt Lake City, Seattle, Portland, Phoenix and I’m pretty confident I would figure out how in LA and the Bay Area over time.

I have a hard time imagining I would make less than that in any Midwest “metropolitan” area besides Chicago… similar in the South.

To me “rural” is where I’m trying to hit 7 figures.

 

[bronx43]

Guess it depends on your definition of a “metropolitan” area.

Out west, I know for a fact that I could make more than 500-600k in Denver, Salt Lake City, Seattle, Portland, Phoenix and I’m pretty confident I would figure out how in LA and the Bay Area over time.

I have a hard time imagining I would make less than that in any Midwest “metropolitan” area besides Chicago… similar in the South.

To me “rural” is where I’m trying to hit 7 figures.

I don’t know that the exact metropolitan really matters or even the income. We were talking about comp per rvu, which is a better comparison since the amount of work is flexible. I would rather make less with higher comp per rvu than vice versa.

The general point I’m trying to make is that docs pay a premium to live in metropolitan areas which I define as 1M+ population. I know many docs who will never live in a city of 50k no matter what the pay differential is.

Certainly your point is well taken that no cardiologist should settle for 40s/rvu but that big city market is already in equilibrium. That’s just what docs prioritize, because like I said, if people leave those jobs and pay increases then they’ll flock right back thus pushing the incomes back down.

 

[deleted980918]

The thing is there are more to it than just the salary.
Many people I know chose the lower pay in major cities due to family ties and spouse career.

Have a kid? Having grandparents nearby that baby sits, that’s at least 50k/yr in childcare saving

Spouse work in tech or business? Their pay difference going to a rural area is another 100-200k/yr depending on what they do

All these add up. Suddenly that 300k/yr noninvasive job in Manhattan is effectively 500k taking all things together.

 

[bronx43]

The thing is there are more to it than just the salary.
Many people I know chose the lower pay in major cities due to family ties and spouse career.

Have a kid? Having grandparents nearby that baby sits, that’s at least 50k/yr in childcare saving

Spouse work in tech or business? Their pay difference going to a rural area is another 100-200k/yr depending on what they do

All these add up. Suddenly that 300k/yr noninvasive job in Manhattan is effectively 500k taking all things together.

Sure those would be big factors. But beyond that, even if people had spouses with flexible jobs or parents that live in more rural parts of the country, most people would prefer to live in metro areas.

The appeal of the luxuries and amenities of larger cities is just too much to forgo for younger generation of doctors. And honestly this is a HUGE boon for big city admins.

 

[blahblah56]

How are you all finding these jobs? Online via Indeed, PracticeLink, JAMA/NEJM? Or are you using recruiters?

Also, do you usually have to go through the entire interview process before finding out the details about salary, benefits, etc, or do they tell you early on? I’m single, have no major family commitments, and at this point in my life, I’m open to living anywhere for a few years

 

[Jimson Weed]

How are you all finding these jobs? Online via Indeed, PracticeLink, JAMA/NEJM? Or are you using recruiters?

Also, do you usually have to go through the entire interview process before finding out the details about salary, benefits, etc, or do they tell you early on? I’m single, have no major family commitments, and at this point in my life, I’m open to living anywhere for a few years

I've just been sending emails to employers I am potentially interested in working with once I am done training. They have all been pretty open about starting compensation, relocation allowance, etc.

 

[blahblah56]

Is it reasonable to be interviewing for multiple jobs at a time? Or is it better to interview/reject an offer and then move on to the next?

 

[Scope guy]

Is it reasonable to be interviewing for multiple jobs at a time? Or is it better to interview/reject an offer and then move on to the next?

the process is very slow, until contract is signed, nuthin is guaranteed. you have to keep seeking options esp if you have specific timeline(finish fellowship and transition)