Post-fellowship offers

[DoctaK]

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Hi all, there was a thread about this a few years ago but I thought it would be helpful to post this. It would be enormously useful to hear information about the job market as I get closer to finishing fellowship. Honest information about offers and salary has been hard to come by so I thought we could make this a resource so people applying for their first post-fellowship positions can get a barometer for the types of offers out there. Here is the information that I think would be helpful:

-Please provide geographic location of offer as specifically as you feel comfortable: i.e southeast or North Carolina or Bronx NY
-Type of position and specialization: Academic/non-academic, General Cardiology, Interventional, EP, Imaging, Heart Failure, etc. Would be especially interested to hear about non-academic HF positions.
-Current offers and those dating back a few years would be welcome, including second-hand offers of friends/colleagues
-Please provide as precise a salary as you feel comfortable relaying + other details like call schedule, partnership track if offered, guarantee vs bonus structure, sign on bonus/loan repayment, to your level of comfort
-Either post directly to the thread or PM me--I will post directly to the thread with breakdown of location and offers

I would sincerely appreciate any contributions! Thank you in advance!

 

[Phospholipid]

These thread has helped me a lot in the past, and hope to contribute back.

Graduating after 1 yr Interventional Fellowship

1) Private Practice in Phoenix, 350k/yr, keep 50% of net collections, cover 4 hospitals. 10k relocation, no sign on bonus
2) Private Practice in Phoenix, 410k/yr, keep 40% of net collections after 1-2 yrs, cover 2-3 hospitals, 10k relocation, no sign on bonus
3) Private Practice in WA, Cover 2 hospitals, 350k, didn't really understand their reimbursement after base salary, combined sign on bonus/education loan repayment of 60k
4) I accepted a hospital employed position, in Pacific Northwest, 570k/yr base salary, RVU based tier system. 20k sign on bonus, 50k loan repayment over 5 yrs, 10k relocation

From my experience, the need for Interventionalist is pretty good, however, expect to do a lot of general cardiology.

 

[pbrocks15]

These thread has helped me a lot in the past, and hope to contribute back.

Graduating after 1 yr Interventional Fellowship

1) Private Practice in Phoenix, 350k/yr, keep 50% of net collections, cover 4 hospitals. 10k relocation, no sign on bonus
2) Private Practice in Phoenix, 410k/yr, keep 40% of net collections after 1-2 yrs, cover 2-3 hospitals, 10k relocation, no sign on bonus
3) Private Practice in WA, Cover 2 hospitals, 350k, didn't really understand their reimbursement after base salary, combined sign on bonus/education loan repayment of 60k
4) I accepted a hospital employed position, in Pacific Northwest, 570k/yr base salary, RVU based tier system. 20k sign on bonus, 50k loan repayment over 5 yrs, 10k relocation

From my experience, the need for Interventionalist is pretty good, however, expect to do a lot of general cardiology.

That hospital salary is remarkably better than the others. Whats the catch?

 

[pbrocks15]

The real question is: why are the other three so low.

I guess the question would be is around 500k more normal for starting?

 

[nlax30]

Highly variable..... for private practice groups Intervetional or EP I would say starting salaries upper 300’s to mid 400’s. Of course highly variable and there are some outliers where you may could get a starting salary in high 6 figures in a very rural/“undesirable” location.

For typical popular suburban type places I’d put ballpark around 400 for private, likely slightly higher for employed positions and little lower for academic spots.

 

[nlax30]

The real question is: why are the other three so low.

If the other 3 are true private practice positions (not hospital employed) then there may be other aspects of compensation that come into play later..... partnership, profit sharing, etc....

From what I’ve seen in some friends the starting for a true private group was a little lower. Obviously the hope is that eventually they can be a “partner” and/or share in other sources of income that the group has.

For a hospital employed position you may start at a higher base salary and then just be on a production/RVU model or base salary plus RVU bonus model with generally not much growth up unless you take on paying admin/leadership roles.

 

[IMreshopeful]

That hospital salary is remarkably better than the others. Whats the catch?

Prob low salary and working for 2-3 years with a huge jump when making partner - can easily triple salary when that happens

Can’t always go purely by starting salary... have to look at 10 years down the road.

 

[Phospholipid]

From what I’ve seen in some friends the starting for a true private group was a little lower. Obviously the hope is that eventually they can be a “partner” and/or share in other sources of income that the group has.

For a hospital employed position you may start at a higher base salary and then just be on a production/RVU model or base salary plus RVU bonus model with generally not much growth up unless you take on paying admin/leadership roles.

There are lots of private groups out there. As a new grad, you have to be careful what you're joining. Some may say for sure partnership in x amount of time and you'll easily double triple yr salary. Money doesn't grow on trees, and just because you become "partners" does not automatically equal more money. You have to earn it, either increasing your productivity, investing in some portion of the buisness, and reaping the benefits from it as passive income (i.e. invest in a nuclear camera, invest in ECHO's, invest in the business). Essentially it becomes an investment, not very much differ than if I were to invest in stocks per se. So technically, in my opinion, it is not really your salary from work, but more so generating interest from your investments of your work. As with all investments, there are huge ups and downs, and you have to be ready for the downs, when things are not going well, employees quitting, employees complaining, employees stealing, hospital administration moving more towards hospital employed, hospital potentially buying your practice, selling off your practice to somebody else, employees or partners quitting, junior partners quitting..etc... the list goes on. You can lose money as partners as well (just like investments). In addition, you have to take into account that many do not become partners, or the group makes it very hard to become partners (it may not be evident when you interview), and that the senior partners take advantage of new grads so they reap most of the monetary benefits. Also, a lot of people say as a private practice I can do whatever I want, nobody to tell me my schedule. That is not true, you still have to follow the norms, what the hospital wants from you. If a hospital is not happy with your group's performance, they can easily push the group out. Also, many private practice has to round on 2-4 hospital systems. I think this is so inefficient way of patient care. Imagine rounding on 3 patients in one hospital, 2 patients in another, and 1 in another, and while you are at another hospital, a family member wants to talk to you, a nurse wants to talk to you.. etc.. It is a very inefficient way of work. Iam not saying it is all doom, but one has to take into consideration all of this, rather than just say.. o yea I want private practice because I want to make tons of $$$$. I trained in a hospital employed model where one cardiologist rounds on the whole hospital for the weekend (15-30 pts), and it is much much more efficient this way. Remember.. efficiency = $$. Regarding growth of private practice, I believe it is probably actually harder for growth in private practice if you want to be administrator or have influence at a hospital. Yes, you can become a partner, and own the practice, but for you to become a hospital administrator, the hospital has the final say, not your group. If a hospital is more favoring their own hospital employed physicians, they will unlikely select you to be an admin over their own.

Hospital employed has its issues too, but in my experience is generally more stable. You may not have as much autonomy, and are more dictated by what the hospital wants from you, however, benefits are generally better (disability, 401k matching, insurance, holiday time off). It is true that hopsital employed generally has higher starting salary, and peak generally less than a WELL RUN private practice. Keep in mind the "WELL RUN", as there are many private practice that are not well run. However, as mentioned above, alot of income from private practice is in your investment into yourself, thus technically, if I take my money from my hospital employed job, and invest it in stocks, I may generate the similar monetary values if not more, but without the headaches of running a buisness (i.e. private practice). I personally know hospital employed cardilogist making > 7 figures, a few > 2 million, so the notion that private practice makes more is not always true.

I personally would like to keep my money I generate from work separate from investments, and once I come home from work, I don't want to worry about work, and spend time with my family without worrying about the nuance of running a business, thus I believe for me hospital employed is a better for me.

 

[Instatewaiter]

From my class:
Academic hf in very well known program in midwest-$300k

Academic program in iowa- 250k

Academic program in StL- 180k (I mean really?!)

Academic heart failure in the midatlantic- 250k base with automatic bonus of 120k. Full benefits Inc Relocation

Academic hf in phili-$250k base. Sign-on bonus and relocation

Hospital based, non-academic LVAD program in 1 hour from phili $375k. 25k signon bonus, 10k relocation

Quasiacademic (lvad with residency) in very small City (45 min outside of major US city) on east coast-$440k with 25k sign-on and full/unlimited relocation (sent people out to pack, move and unpack)

Offers I know of to people a few years out:
non-academic lvad- 450 to start, 510 next year 650 after 2 years (Inc base and an automatic bonus)

Quasiacademic HF midatlantic- 440 + 60k bonus (attend meetings, have reasonable press-ganey) +40k bonus as director

 

[EPADHA]

From my class:
Academic hf in very well known program in midwest-$300k

Academic program in iowa- 250k

Academic program in StL- 180k (I mean really?!)

Academic heart failure in the midatlantic- 250k base with automatic bonus of 120k. Full benefits Inc Relocation

Academic hf in phili-$250k base. Sign-on bonus and relocation

Hospital based, non-academic LVAD program in 1 hour from phili $375k. 25k signon bonus, 10k relocation

Quasiacademic (lvad with residency) in very small City (45 min outside of major US city) on east coast-$440k with 25k sign-on and full/unlimited relocation (sent people out to pack, move and unpack)

Offers I know of to people a few years out:
non-academic lvad- 450 to start, 510 next year 650 after 2 years (Inc base and an automatic bonus)

Quasiacademic HF midatlantic- 440 + 60k bonus (attend meetings, have reasonable press-ganey) +40k bonus as director

The 180K job must be at Wash U!! The big universities practically get away with exploitation.

 

[docimg]

Heard from seniors - difficult to find interventional cardiology jobs in SoCAL. 2 offers sub 300K for private practice jobs! Unattainable bonus formula.

1 offer of 325k - three hospital coverage. Unclear partnership track, production bonus above collection of 1 million.

He chose to move out of California to Texas where he had some family. About 350 k base with easily attainable bonus of 50k. Plus RVU based production that he thought would atleast be another 50k.

 

[arrhythmia1]

These salaries are unheard of in the UK! Starting salaries are less than $100K and taxed at 45% and pension 12% therefore you end up taking home way less.

 

[bronx43]

These salaries are unheard of in the UK! Starting salaries are less than $100K and taxed at 45% and pension 12% therefore you end up taking home way less.

It may soon end up this way in the US as well.

 

[Epicurusall]

These salaries are unheard of in the UK! Starting salaries are less than $100K and taxed at 45% and pension 12% therefore you end up taking home way less.

Have to keep in mind that there is a significant loan burden placed on American graduates.

If I were going to med school for free or even for 10-20k/yr instead of 70k/yr at essentially 12% interest per year while in school at 7% thereafter, I wouldn’t be as concerned with future salary

 

[bronx43]

Have to keep in mind that there is a significant loan burden placed on American graduates.

If I were going to med school for free or even for 10-20k/yr instead of 70k/yr at essentially 12% interest per year while in school at 7% thereafter, I wouldn’t be as concerned with future salary

Lol no matter what the tuition is for med school, I would be hard pressed to practice medicine for under $100k a year. Too many hours. Too much risk and liability. Too much time training.

 

[GastriqueGraffin]

These salaries are unheard of in the UK! Starting salaries are less than $100K and taxed at 45% and pension 12% therefore you end up taking home way less.

My dentist makes more than double that.

 

[DocTAWood]

If you can get your hand on compensation surveys they provide benchmarks for this. Includes by practice type and years out


We are seeking gen card, advanced imaging, advanced HF candidates now.

Starting point dependent on how far out from training. Hospital employed practice. South central PA (1h15min philly, 1.5 Baltimore, 2h DC). 10k relocation 25K sign on bonus, Yr 1 300K, yr 2 350k + bonus up to 15K, yr 3 425k + bonus up to 37.5k, yr 4 on 550k + bonus up to 75K. Salary for EP and IC is 600K at yr 4. IC also gets 35K for call. Bonus tends to get hit at the 95-100% level and is quality metric driven. 13.5K in 403b match. 10 wks vacation. 1 wk CME with 3k allowance. Call is 1:18 for gen,ep. 1:5 for IC. Contract values likely to rise with next contract negotiation in 2 yrs. roughly tied to 75th percentile by a blend of survey data

 

[nlax30]

If you can get your hand on compensation surveys they provide benchmarks for this. Includes by practice type and years out


We are seeking gen card, advanced imaging, advanced HF candidates now.

Starting point dependent on how far out from training. Hospital employed practice. South central PA (1h15min philly, 1.5 Baltimore, 2h DC). 10k relocation 25K sign on bonus, Yr 1 300K, yr 2 350k + bonus up to 15K, yr 3 425k + bonus up to 37.5k, yr 4 on 550k + bonus up to 75K. Salary for EP and IC is 600K at yr 4. IC also gets 35K for call. Bonus tends to get hit at the 95-100% level and is quality metric driven. 13.5K in 403b match. 10 wks vacation. 1 wk CME with 3k allowance. Call is 1:18 for gen,ep. 1:5 for IC. Contract values likely to rise with next contract negotiation in 2 yrs. roughly tied to 75th percentile by a blend of survey data

Question regarding compensation at your hospital employed group. What changes from year to year that impacts the compensation that much? $ per RVU or are y’all salary and the contracted salary just increases as time goes on?

 

[DocTAWood]

Question regarding compensation at your hospital employed group. What chances from year to year that impacts the compensation that much? $ per RVU or are y’all salary and the contracted salary just increases as time goes on?

Contracted salary.

It’s the private corollary to them bank rolling you until you start generating your own income. I anticipate our ramp increasing in values with the next contract negotiation cycle as cardiology physician demand increases.

 

[nlax30]

Thanks. I was geographically limited in my search but hadn't come across a hospital employed position with that set up. Just about all the ones I've seen were usually a couple years salary guarantee followed by production based (RVU). I had assumed from then that the only why your compensation would significantly changed would then be to get a higher $ per RVU reimbursement as well as just becoming more efficient with more experience and hence generate more RVUs.