This is based off private practice though. He said they profit money from drug margin (revenue from chemo/cost from manufacturer) and the RVU concept does not play a role. He also mentioned they are 5 days clinic seeing 30 ish patients daily. They rub shoulders with local PCPs and EDs to gain market share of referrals and have to be available by personal cell at all times in order to field new consults and referrals.
1. That's a f***ton of work. And being a concierge oncologist sounds like pure hell. I don't doubt that people are willing to do it, but I sure as s**t wouldn't.
Does anyone in your group actually make a million a year, though? I would imagine if a large portion of the docs started working that hard then your hospital would suddenly want to lower the $/RVU numbers.
Nope. They're too lazy. The work is there for them if they want it, but nobody's interested. TBH, neither am I. I am the most productive in my group (by ~40%) and am just about as busy as I'm interested in being.
How did your employers adjust the comp plan to accommodate the new RVU rates? Just curious.
FMV/“Stark concerns” is a made up term used by administration to justify paying you less, whereas in private practice you just make what you collect and don’t deal with that crap.
Bumped up our base expectation by 10% but didn't adjust anything else. Original plan by the university was 30% but the Cancer Center leadership pushed back on that and arrived at 10%. We're coming up on the end of the FY and adjusting the base and targets again. Oddly, MGMA data (which is how we calculate our numbers) showed wRVUs dropping and median comp increasing, so we'll see how things change.
Can you elaborate more on this gray zone instead of being cryptic?
One example I can potentially think of for this "gray zone" is ordering IV iron for IDA. Private practice can negotiate the best drug margin for one of the dozen formulations of IV iron available (essentially have pharm companies compete against one-another), and order this for a lot of IDA patients by documenting they cannot tolerate oral iron due to "constipation" or something like that.
I’m just a fellow but depending on the partnership track that could be a really good deal. I’m assuming you really mean revenue minus expenses and not profit minus expenses.
Thank you for your valued input. Yes I meant revenue minus expenses. The 425k is guaranteed but the bonus will start once I reach 5500 RVU.
Just ask what the median annual gross income is for the pre-partner and partnership docs. If they're not willing to give you that information, that's a red flag. If they are, it should give you all you need to know.
Thank you very much, I sure will.
I’ve never heard of this when I’ve interviewed but I would definitely stay away from any practice with this stuff. I’ve more commonly seen 2 year partnership track equal partnership no buy-in. Aren’t you in the NYC area? Perhaps it is more common there?
Are you in a very saturated market? The bolded raise some concern about supply-demand mismatch. If you're not tied to the region then I suggest perhaps looking further afield.
I am in DC MD VA corridor, at least closer you are to a major city here that is the norm. If you move out 1.5-2hrs out it gets similar to what you suggested.
Thanks for the honest opinion. I really appreciated
That is a good point, currently I am practicing in a very competitive area, to be fair, I think my current salary is good enough giving the large hospital system in a large metropolitan area (+3 million), but again lots of changes happening such as hiring the oncology hospitalist which took a bite out of our RVUs, we do on call 3 weeks a year lol instead of monthly. Also, we are not allowed to cosign the NP notes in the clinic, the NP works as a separate entity and usually see 6-7 patients out of our schedule so that's another loss of RVU, we are left with baseline salary that has not changed in years and the employer does not seem to care because plenty of new fellows would welcome such an opportunity (open door policy, you don't like leave, you are replaceable).
Thank you, it is a great question that I should ask
I am following up on the type of insurance in the city: 35% employer coverage, 24% Medicaid, 13.5% Medicare, 9.5 uninsured, 3% military, rest uninsured or non group?
