Post-Fellowship Offers

[Finishingfellowship2018]

Hey All!

Finally getting closer to finishing this marathon that has been cardiology training (Interventional with structural training) and about to get serious about job search. However, as has been previously routinely addressed on this thread salary information outside of the usual published sources is tough to come by and unfortunately even within my program, seniors have been tight lipped and danced around the question. This remains intriguing to me because the same is not true in most other fields and I do believe its disadvantageous to fellows coming out of training who are strangers to gauging their financial worth within current healthcare market. To that end, I am hoping to get support from the SDN community. I created this new handle to maintain anonymity. My intention was the gather as much information as I can to assist both myself and other fellows who will be starting their job search in the near future.
I would sincerely appreciate your assistance in this endeavor and hopefully serve as a useful resource for this forum.
-Please provide geographically location of offer as specifically as you personally feel comfortable. I.e Southeast or North carolina or Bronx NY...once again whatever is comfortable for you
-Type of specialization: General Cardiology, Interventional, EP, Imaging etc.
-Either post directly to the thread or Just PM me (can create anonymous handle if that makes you comfortable). I will post directly to the thread with breakdown of location and offers
-Current offers and those dating back a few years would be welcome. This include second hand offers. The historical context I believe is beneficial and appreciated
-Please provide as precise a salary as you feel comfortable relaying. other general details of offer I.e call schedule, partnership track if offered, guarantee vs bonus structure, sign on bonus/loan repayment. Once again to your level of comfort.
-My aim is for this thread to be as constructive and beneficial as possible. I know there are usual detractors and naysayers whenever some of these topics arise which is fine. I do plead that whether negative or positive that the comments be constructive.
-I will do my very best to keep this updated and appropriately formated and I hope we all find some benefit. Obviously it is highly dependent on your participation.
-I offer my utmost gratitude in advance!!

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[Finishingfellowship2018]

First response! Please keep then coming, sincerely appreciate your participation

Location: Midwest, medium-large sized city
specialty: Non-Invasive
Offer year: 2017 (3 months prior to fellowship completion)
Salary/package: hospital employed ~400k. Bonus potential. No sign on bonus. 10k annual loan repayment with cap (undisclosed). 5k relocation. Standard benefits package with 401k match
Other details: weekday call 1:7, weekend call 1:6.

 

[epicandprivate]

First response! Please keep then coming, sincerely appreciate your participation

Location: Midwest, medium-large sized city
specialty: Non-Invasive
Offer year: 2017 (3 months prior to fellowship completion)
Salary/package: hospital employed ~400k. Bonus potential. No sign on bonus. 10k annual loan repayment with cap (undisclosed). 5k relocation. Standard benefits package with 401k match
Other details: weekday call 1:7, weekend call 1:6.

Hope this thread takes off and more people contribute!

 

[Phospholipid]

Just curious for those who interviewed for jobs, what is your rate of offers? like.. for example, for 5 interviews you went to, did you get offers from all 5? 4?.

 

[Instatewaiter]

From 2016:
Structural- In Pa, smallish city but large hospital system. $700K. >50K signon bonus.
Academic HF in StL- $185K- 30+ weeks on inpatient service. Not accepted by person
Non-academic HF starting LVAD program in upstate NY- $450K. Accepted. No idea of call schedule

From last year:
Interventional- midwest but desirable city. 1 in 8 call. $450K. Accpeted
Interventional- Academic, Northeast (VT)- $440K. If I remember right somethink like 8-10 weeks vacation

Academic HF northeast (phili)- $250K- was not accepted by the person
Academic HF in midwest- $250K- accepted. person on a visa and only wanted academics
Semi-academic HF in true midwest (KC)- $350K but rapidly increased salary. Included time for research.
Hospital-employed non-academic HF- 1 in 10 call. 6 weeks vacation. $450K. 25K sign on bonus + paid move including packing. Matched 401K up to 6%. 2 weeks inpatient/2 wks outpatient (on outpoatient only works 7 days in 2 weeks). Accepted by person
Hospital employed non-academic HF- $375K. 6 weeks vacation. 25K sign on bonus. Ridiculous retirement package which ramped up (if you stayed for 10 years they would match 17% of your salary). Accepted by person

 

[Finishingfellowship2018]

Awesome! Please keep the posts coming. Incredibly useful info that will provided informal database to fellows!

Thanks again.

 

[TAVR4life]

From 2016:
Structural- In Pa, smallish city but large hospital system. $700K. >50K signon bonus.
Academic HF in StL- $185K- 30+ weeks on inpatient service. Not accepted by person
Non-academic HF starting LVAD program in upstate NY- $450K. Accepted. No idea of call schedule

From last year:
Interventional- midwest but desirable city. 1 in 8 call. $450K. Accpeted
Interventional- Academic, Northeast (VT)- $440K. If I remember right somethink like 8-10 weeks vacation

Academic HF northeast (phili)- $250K- was not accepted by the person
Academic HF in midwest- $250K- accepted. person on a visa and only wanted academics
Semi-academic HF in true midwest (KC)- $350K but rapidly increased salary. Included time for research.
Hospital-employed non-academic HF- 1 in 10 call. 6 weeks vacation. $450K. 25K sign on bonus + paid move including packing. Matched 401K up to 6%. 2 weeks inpatient/2 wks outpatient (on outpoatient only works 7 days in 2 weeks). Accepted by person
Hospital employed non-academic HF- $375K. 6 weeks vacation. 25K sign on bonus. Ridiculous retirement package which ramped up (if you stayed for 10 years they would match 17% of your salary). Accepted by person

Does structural really make that much? I heard job market and thus salary were terrible for structural...

 

[bronx43]

But what are the contracts going to look like after the "starting offer?" I've known many people of different specialties who had to leave their positions after 2-3 years or take a big pay cut, because the "guaranteed salary" expired and the new compensation package is NOTHING like the old.

Asking about the eventual compensation structure is much more important than what the initial offer is, unless you're looking to be a nomad and move every few years. So for an employed position (which most cardiologists are nowadays), will there be a recalculation of compensation per wRVU? What is the productivity bonus in terms of dollars per wRVU? What is the productivity bonus cut off in terms of number of wRVU? Is it billed, billable, or collected RVU? Is there a threshold percentile of MGMA at which the hospital system cuts you off?

 

[Finishingfellowship2018]

But what are the contracts going to look like after the "starting offer?" I've known many people of different specialties who had to leave their positions after 2-3 years or take a big pay cut, because the "guaranteed salary" expired and the new compensation package is NOTHING like the old.

Asking about the eventual compensation structure is much more important than what the initial offer is, unless you're looking to be a nomad and move every few years. So for an employed position (which most cardiologists are nowadays), will there be a recalculation of compensation per wRVU? What is the productivity bonus in terms of dollars per wRVU? What is the productivity bonus cut off in terms of number of wRVU? Is it billed, billable, or collected RVU? Is there a threshold percentile of MGMA at which the hospital system cuts you off?

Great point Bronx..that certainly is advise that we fellows should internalize. However, though the compensation structure in medicine is somewhat unique to the field the core aspect of viewing any salary package from a 360 degree perspective is not. You certainly should always go to the negotiation table with your eyes open, appraise the full compensation "package" for what its truly worth and seek the necessary assistance when necessary. Our extensive medical training does not prepare us for these financial realities but it would be in our best interest to stay well informed on these matters. To that end in addition to the initial offer your salient points should definitely also be considered;
1. Will there be a recalculation of compensation per wRVU?
2. What is the productivity bonus in terms of dollars per wRVU?
3. What is the productivity bonus cut off in terms of number of wRVU?
4. Is it billed, billable, or collected RVU?
5. Is there a threshold percentile of MGMA at which the hospital system cuts you off

Future tips to this end will also be quite beneficial to this thread!

Thanks Again!

 

[pandh83]

So I have a question, with these great job offers is it one year contracts with 2nd year contract that might offer less? I know a lot of job offers usually is high but whenever contract rewenal is up for talks the offer is substantially lower.

 

[bronx43]

So I have a question, with these great job offers is it one year contracts with 2nd year contract that might offer less? I know a lot of job offers usually is high but whenever contract rewenal is up for talks the offer is substantially lower.

This is often the case with employed positions. The first year "guaranteed salary" is purely to lure you in, and they hope that once you are entrenched in a certain location/lifestyle, you will have no option but to take their offer for a much more financially stringent set up. In fact, what employers often do is that they "move up" the money from future years to the first year so that they can front load the salary to make it more attractive. Then, after that, they offer you below what you generate so that they can come out even or ahead. Unfortunately, there's not much you can do about it other than move to a new place every 1-2 years, but that isn't sustainable. This is what happens to fields as the government cuts outpatient reimbursement while maintaining inpatient reimbursement for certain codes... it puts the power entirely within the hands of the hospital system, and we all lose out. This is THE REASON why fields need to protect themselves and not overtrain, since the only thing protecting you is the limit on the supply of the commodity (you). But unfortunately, the people in charge of those decisions usually have incentive to pump out more trainees.