Professional revenue %

[Homeboy123]

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Does anyone have a resource to demonstrate what the average % breakdown is for Pro vs Tech fees across all types of cases/modalities...that is contemporary? Bonus points if it has a regional breakdown as well. I found a post saying 15-30% for Pro (10% bad, 25% really good), but where does this information come from?

 

[Neuronix]

Detailed business discussions are restricted to the business forum.

Please PM me to validate your identity as a rad onc and we can have this discussion there.

 

[BobbyHeenan]

Does anyone have a resource to demonstrate what the average % breakdown is for Pro vs Tech fees across all types of cases/modalities...that is contemporary? Bonus points if it has a regional breakdown as well. I found a post saying 15-30% for Pro (10% bad, 25% really good), but where does this information come from?

You can look up individual codes here and see what the pro fees are versus technical at least for medicare.

License for Use of Current Procedural Terminology, Fourth Edition ("CPT") | CMS

www.cms.gov

 

[deleted1116990]

I have a somewhat related question.

What is the expectation when someone makes a lateral career move into a private practice?

I have about 3 years experience and am BC. I made a lateral move from a hospital with a decent salary fixed around the 75%-tile MGMA to a PP. My income is now around the 20th percentile level. I've talked to a few other rad oncs, and they told me I was stupid for accepting this offer as they basically treated me like a new grad and should I have not accepted a salary cut back to entry level.

My understanding is that PP will offer low salaries in the 300 range or so to new grads for a few years as a "trial period." This makes sense somewhat as new grads aren't very productive at first. But is this the expectation for someone who is experienced and wants to join a private practice as well? Does it matter if it is a professional only practice or a practice that lets you buy-in and split a portion of global revenue? In my situations, it is a busy practice with 30-40 on beam per MD so around 1M in professional collections. There is an opportunity to buy into a small amount of technical, but the buy-in is unreasonably high so that's not going to happen - the pro side would be more than enough to keep me happy. It is frustrating to be doing double the work I used to for half the income. I wonder if I am being gaslit and they know experienced rad oncs want to get paid for their services at a minimum or if this underpaid "trial period" is the expectation even for experienced docs going into a pro-only group.

For instance, if you are experienced/BC making $700k at a hospital right now, and you interview at a pro-only private practice where you can reasonably expect to bring in 1M in collections based on volume, and they offer you a fixed salary of $325k for 3 years with an opportunity to "buy-in" for $100k and collect on the pro-side only, do people actually take this? The offer seems ridiculous on its face to give to someone they know is doing well already and can hit the ground running, but I am just curious.

 

[medgator]

I have a somewhat related question.

What is the expectation when someone makes a lateral career move into a private practice?

I have about 3 years experience and am BC. I made a lateral move from a hospital with a decent salary fixed around the 75%-tile MGMA to a PP. My income is now around the 20th percentile level. I've talked to a few other rad oncs, and they told me I was stupid for accepting this offer as they basically treated me like a new grad and should I have not accepted a salary cut back to entry level.

My understanding is that PP will offer low salaries in the 300 range or so to new grads for a few years as a "trial period." This makes sense somewhat as new grads aren't very productive at first. But is this the expectation for someone who is experienced and wants to join a private practice as well? Does it matter if it is a professional only practice or a practice that lets you buy-in and split a portion of global revenue? In my situations, it is a busy practice with 30-40 on beam per MD so around 1M in professional collections. There is an opportunity to buy into a small amount of technical, but the buy-in is unreasonably high so that's not going to happen - the pro side would be more than enough to keep me happy. It is frustrating to be doing double the work I used to for half the income. I wonder if I am being gaslit and they know experienced rad oncs want to get paid for their services at a minimum or if this underpaid "trial period" is the expectation even for experienced docs going into a pro-only group.

For instance, if you are experienced/BC making $700k at a hospital right now, and you interview at a pro-only private practice where you can reasonably expect to bring in 1M in collections based on volume, and they offer you a fixed salary of $325k for 3 years with an opportunity to "buy-in" for $100k and collect on the pro-side only, do people actually take this? The offer seems ridiculous on its face to give to someone they know is doing well already and can hit the ground running, but I am just curious.

I wouldn't take that, esp if i wasn't a new grad

 

[deleted1116990]

I wouldn't take that, esp if i wasn't a new grad

Your comment is basically the same as what others I have told me. I need to figure out what to do now. I think trying to re-negotiate is off the table. They will just hire a new grad (or two).
If I interview at another PP with similar volume, what is a reasonable expectation in terms of comp? Will you get laughed out of the room if you want to collect your share up front? Assume pro-only or low share of global. I understand taking a very low salary for a few years as sweat equity to be able to share global equally. That's not what we're talking about here.

 

[Mandelin Rain]

I have a somewhat related question.

What is the expectation when someone makes a lateral career move into a private practice?

I have about 3 years experience and am BC. I made a lateral move from a hospital with a decent salary fixed around the 75%-tile MGMA to a PP. My income is now around the 20th percentile level. I've talked to a few other rad oncs, and they told me I was stupid for accepting this offer as they basically treated me like a new grad and should I have not accepted a salary cut back to entry level.

My understanding is that PP will offer low salaries in the 300 range or so to new grads for a few years as a "trial period." This makes sense somewhat as new grads aren't very productive at first. But is this the expectation for someone who is experienced and wants to join a private practice as well? Does it matter if it is a professional only practice or a practice that lets you buy-in and split a portion of global revenue? In my situations, it is a busy practice with 30-40 on beam per MD so around 1M in professional collections. There is an opportunity to buy into a small amount of technical, but the buy-in is unreasonably high so that's not going to happen - the pro side would be more than enough to keep me happy. It is frustrating to be doing double the work I used to for half the income. I wonder if I am being gaslit and they know experienced rad oncs want to get paid for their services at a minimum or if this underpaid "trial period" is the expectation even for experienced docs going into a pro-only group.

For instance, if you are experienced/BC making $700k at a hospital right now, and you interview at a pro-only private practice where you can reasonably expect to bring in 1M in collections based on volume, and they offer you a fixed salary of $325k for 3 years with an opportunity to "buy-in" for $100k and collect on the pro-side only, do people actually take this? The offer seems ridiculous on its face to give to someone they know is doing well already and can hit the ground running, but I am just curious.

That seems unreasonable.

What is the 100k buy-in for? To be able to collect the full pro-charges? That's crazy after a 3 year-track at 300k.

I'd just see if I could get my job back at the hospital.

Unless the hospital was making you completely miserable (which it may have been), I would not leave a 700k hospital employed job for a 325k employed job in a PP practice x 3 years with the upside being 1 million dollars as a partner. You'd have to work at least 7 years at the practice just to break even (more if you consider the time value of money).

 

[deleted1111261]

That seems unreasonable.

What is the 100k buy-in for? To be able to collect the full pro-charges? That's crazy after a 3 year-track at 300k.

I'd just see if I could get my job back at the hospital.

Unless the hospital was making you completely miserable (which it may have been), I would not leave a 700k hospital employed job for a 325k employed job in a PP practice x 3 years with the upside being 1 million dollars as a partner. You'd have to work at least 7 years at the practice just to break even (more if you consider the time value of money).

Never pay for professional- only for physical revenue generating assets

 

[medgator]

Your comment is basically the same as what others I have told me. I need to figure out what to do now. I think trying to re-negotiate is off the table. They will just hire a new grad (or two).
If I interview at another PP with similar volume, what is a reasonable expectation in terms of comp? Will you get laughed out of the room if you want to collect your share up front? Assume pro-only or low share of global. I understand taking a very low salary for a few years as sweat equity to be able to share global equally. That's not what we're talking about here.

Maybe do a 3 year track with a graduated increase in salary based on productivity, no buy in if pro only. There should never be a buy in for pro only practices. Your buy in is your time during the partnership track period and your "sweat equity" helping to build the practice

 

[Mandelin Rain]

Maybe do a 3 year track with a graduated increase in salary based on productivity, no buy in if pro only. There should never be a buy in for pro only practices. Your buy in is your time during the partnership track period and your "sweat equity" helping to build the practice

Bingo.

The graduated "sweat equity" track with no buy-in is pretty common in the pro-only groups.

Usually board certified, experienced docs get more money during the "sweat equity" period and potentially a faster track to partnership.

If you're collecting ~1million/year (as your post stated) and being paid 325k per year for 3 years, you're getting boned. Even if you were a new grad.

 

[deleted1111261]

Bingo.

The graduated "sweat equity" track with no buy-in is pretty common in the pro-only groups.

Usually board certified, experienced docs get more money during the "sweat equity" period and potentially a faster track to partnership.

If you're collecting ~1million/year (as your post stated) and being paid 325k per year for 3 years, you're getting boned. Even if you were a new grad.

If you’re a new grad, that’s life.

If nor, certain groups make adjustments, certain don’t. There is a reason most good independent private groups hire fresh grads only. It’s a pain to try to explain to someone 5 years out wht the salary is low and non negotiable. That’s why SERO/etc just hire new grads.

 

[deleted1116990]

Maybe do a 3 year track with a graduated increase in salary based on productivity, no buy in if pro only. There should never be a buy in for pro only practices. Your buy in is your time during the partnership track period and your "sweat equity" helping to build the practice

Sorry, I think I've muddled two separate examples together. I have seen a pro-only practice offering a buy in like that to new grads, but that's not my current situation. That was a hypothetical. I'm glad we can all agree that is a bad deal, even for new grads.

My question is whether an experienced rad onc should expect to walk into a pro-only practice at start collecting 100% of what he brings in on day 1, or if making less for a short period is typical in this market and what that percentage should be for a new grad vs. experienced grad. In my case, I'm making about 30-40% of what I bring in for the first 2 years (new grads would make only about 5% less here than what I was offered as experienced), then I get to split the pro pot equally without a buy-in or else I can choose to buy in well into the 7-figures to get a dividend that bumps my income 5-10% beyond pro, maybe.
Bail on this?

 

[deleted1116990]

If you’re a new grad, that’s life.

If nor, certain groups make adjustments, certain don’t. There is a reason most good independent private groups hire fresh grads only. It’s a pain to try to explain to someone 5 years out wht the salary is low and non negotiable. That’s why SERO/etc just hire new grads.

This makes no sense to me about our field. So you graduate residency and take a job at a PP somewhere far from home because it's all you can get. You eventually buy-in and are doing very well. But you want to move back closer to family and eventually a PP back home needs someone. They expect you to go back to new grad level for another 3 years? So the reality is once you are in a PP out of residency, you are married to it or else your only other option is hospital employed? Talk about golden handcuffs...

 

[medgator]

Sorry, I think I've muddled two separate examples together. I have seen a pro-only practice offering a buy in like that to new grads, but that's not my current situation. That was a hypothetical. I'm glad we can all agree that is a bad deal, even for new grads.

My question is whether an experienced rad onc should expect to walk into a pro-only practice at start collecting 100% of what he brings in on day 1, or if making less for a short period is typical in this market and what that percentage should be for a new grad vs. experienced grad. In my case, I'm making about 30-40% of what I bring in for the first 2 years (new grads would make only about 5% less here than what I was offered as experienced), then I get to split the pro pot equally without a buy-in or else I can choose to buy in well into the 7-figures to get a dividend that bumps my income 5-10% beyond pro, maybe.
Bail on this?

No. Shouldn't expect all pro fees from day one. Probably a quicker track and better salary than a new grad though, maybe one or both depending on the market

 

[deleted1116990]

No. Shouldn't expect all pro fees from day one. Probably a quicker track and better salary than a new grad though, maybe one or both depending on the market

Thanks, this is what I was looking for -- What would you be happy with if you made a lateral move like that? Walk into a busy practice and take home 75% of what you bring in for the first year then 100% thereafter? Is that fair? Wondering what kind of numbers would be typical to leave on the table to get the job. Sounds like leaving 70% on the table for 2 years is not a fair deal, but I kinda already figured that one out on my own, sadly.

 

[TheWallnerus]

Thanks, this is what I was looking for -- What would you be happy with if you made a lateral move like that? Walk into a busy practice and take home 75% of what you bring in for the first year then 100% thereafter? Is that fair? Wondering what kind of numbers would be typical to leave on the table to get the job. Sounds like leaving 70% on the table for 2 years is not a fair deal, but I kinda already figured that one out on my own, sadly.

In reality of course “keeping 100%” will never be feasible with billing and coding expense, fees, license, etc. Keeping 90% or a little more is the best anybody does. Coming in at 75% would be very fair… even if you were god’s gift to rad onc.

 

[medgator]

In reality of course “keeping 100%” will never be feasible with billing and coding expense, fees, license, etc. Keeping 90% or a little more is the best anybody does. Coming in at 75% would be very fair… even if you were god’s gift to rad onc.

Id say even less at least for a year, you're an unknown quantity to the practice and referrings

 

[Mandelin Rain]

Yeah, like maybe 66% year one, then 75% year two or something like that.

Obviously a far cry from 30%.

 

[deleted1116990]

In reality of course “keeping 100%” will never be feasible with billing and coding expense, fees, license, etc. Keeping 90% or a little more is the best anybody does. Coming in at 75% would be very fair… even if you were god’s gift to rad onc.

Sorry, should have clarified. Yes, I meant 100% after deducting my share of overhead. Although I did know a rad onc who was offered > 100% collections at a hospital. It was something like 115% in a rural area. I told him to take it. Obviously not possible in a private group with pro collections as the only source of revenue.

Thanks for all the feedback on this one.

 

[deleted1111261]

Sorry, I think I've muddled two separate examples together. I have seen a pro-only practice offering a buy in like that to new grads, but that's not my current situation. That was a hypothetical. I'm glad we can all agree that is a bad deal, even for new grads.

My question is whether an experienced rad onc should expect to walk into a pro-only practice at start collecting 100% of what he brings in on day 1, or if making less for a short period is typical in this market and what that percentage should be for a new grad vs. experienced grad. In my case, I'm making about 30-40% of what I bring in for the first 2 years (new grads would make only about 5% less here than what I was offered as experienced), then I get to split the pro pot equally without a buy-in or else I can choose to buy in well into the 7-figures to get a dividend that bumps my income 5-10% beyond pro, maybe.
Bail on this?

If you’re happy with the job and location, and the money makes you happy (as an absolute, not in comparison to others), then stay. If you feel you deserve more and are not being treated fairly, leave. Fairness is the one thing physicians cannot compromise in. Internally, if you feel you are being treated unfairly, you’ll never feel comfortable.

 

[dieABRdie]

I'll give my take after interviewing at many different practice types and working hospital for some time before settling on private practice.

Most important question I would ask is are you being offered the same thing the other partners are? If the other partners had 3 years at crap salary and a 100K buy in then I don't see why it isn't fair. The argument would be that you are BC and have 3 years experience, so you should get paid more, because you are going to be more efficient and effective in practice. But to them there is no guarantee of that... so maybe you can suggest some mechanism for a productivity bonus? If I was a partner who spent 3 years at 325K flat and did not complain... I think I'd be irritated if someone expected to be paid just because they aren't fresh from residency. You are still fresh to the practice.

As for the 100K buy in I would agree its weird for a pro fee group. Some groups do have that though. I think its stupid... but if everyone else did it, then I don't think new partners should expect to be excluded. I'm assuming you get it back when you exit the partnership... or is that a loss? Where the hell does it go?

My view on jobs have changed drastically over the last 3 years. I used to think that 700K job at the hospital with a moderate number of patients on beam was the best all around, assuming you could deal with the location. I mean, all that cash with no risk of ownership and not having to deal with any billing? The perfect job right? Until the hospital administration realizes they are paying way over what they need to fill that slot and slash your salary. Or maybe they realize they only need someone for two days and switch you to part time. Every year you have to argue to someone with an MBA who has never touched a patient why you are worth 700K. Eventually, that will come to an end... and I can tell you right now those jobs are not being offered any more.

Or you can get paid like **** for 3 years... the make around 1M as a partner for the rest of your career without ever having to pray some dip**** in a business suit will see your value and renew your contract. As long as you are happy with everything else and can see yourself there long term, the PP job is far more secure.

 

[deleted1116990]

My view on jobs have changed drastically over the last 3 years. I used to think that 700K job at the hospital with a moderate number of patients on beam was the best all around, assuming you could deal with the location. I mean, all that cash with no risk of ownership and not having to deal with any billing? The perfect job right?

Thank you for your opinion. I have had similar thoughts, and it's part of why I accepted a paycut like that. I didn't trust the hospital not to fire me when a cheaper alternative came along.

Could somebody explain the nuance of why hospital CEOs are so obsessed with making all of their doctors employees?
For rad onc, I understand it in a competitive market. A pro-only group that does their own billing will be cut out, and an employee brought in at 450k or something. If it's a busy practice, then that allows the hospital to eat into a very fat chunk of pro collections. So I get that.

But for a rural lower volume practice, I don't understand the logic of converting the independent rad onc bringing in 650k a year to an employee making 650k/year. Or a very low volume practice without SBRT and 5-10 on beam in an undesirable area -- they are going to have to pay the employee above actual collections to staff it, and I've seen this. What else is in it for the hospital besides trying to get a share of the pro? And this isn't just limited to rad onc, they will convert the other traditionally independent docs - surgery groups, anesthesia groups, radiologist groups, etc. I swear they have secret meetings about it. Guys, we have the anesthesia group as our only holdout, how do we get rid of this contract and employee them? They will deny this to your face. But I have seen them brag to other administrators about converting docs to employees.

What's on the syllabus of employing doctors 101 in hospital CEO school?

 

[TheWallnerus]

Could somebody explain the nuance of why hospital CEOs are so obsessed with making all of their doctors employees?

Why Health Systems Employ Doctors: Money and Control – The Health Care Blog

 

[deleted1116990]

Why Health Systems Employ Doctors: Money and Control – The Health Care Blog

"Hospitals lose about $50,000–$100,000 per doctor per year on their employed practices, according to La Penna. MGMA, which represents independent groups, has estimated that hospitals and health systems lose nearly $196,000 per doctor annually. Both estimates refer to losses on practice operations alone."

Nearly every CEO you talk to will be able to quote you exactly how much money they "lose" on physician salary expense a month. They bring it up all the time, especially during salary negotiations.
For rad onc, I don't understand that. If a private rad onc is billing 650k/year, and the hospital is able to employ him, pay him what he was bringing in before, but bill a multiple higher of this, how are they losing money on him compared to the previous situation where they only collected the facility fee? Are they just lying? Is that it?

 

[Ray D. Ayshun]

"Hospitals lose about $50,000–$100,000 per doctor per year on their employed practices, according to La Penna. MGMA, which represents independent groups, has estimated that hospitals and health systems lose nearly $196,000 per doctor annually. Both estimates refer to losses on practice operations alone."

Nearly every CEO you talk to will be able to quote you exactly how much money they "lose" on physician salary expense a month. They bring it up all the time, especially during salary negotiations.
For rad onc, I don't understand that. If a private rad onc is billing 650k/year, and the hospital is able to employ him, pay him what he was bringing in before, but bill a multiple higher of this, how are they losing money on him compared to the previous situation where they only collected the facility fee? Are they just lying? Is that it?

My place probably "lost" between 100-200K on physician salary this year They're cool with that as a whole as the cancer center made somewhere around 2000K profit.

 

[Irradi8or]

My place probably "lost" between 100-200K on physician salary this year They're cool with that as a whole as the cancer center made somewhere around 2000K profit.

Right - those calculations of losses per physician capita are based on some pretty narrow analyses - doesn’t include downstream ancillaries that tend to be high margin for hospitals, technical revenue gains including operating room, and overall reductions in leakage. Example is a breast surgeon - most hospitals lose money on breast surgery and they really don’t get much more than 6-7k wRVUs. However hospitals and private groups can compete for hiring those same breast surgeons given the capturing of markets and down streams. This recently happened w my group - hospital was glad to let the surgeon go to join my group, as long as that surgeon would still operate at that hospital

 

[deleted1116990]

Why Health Systems Employ Doctors: Money and Control – The Health Care Blog

I was browsing the stock market threads on the anesthesiology forum and came across this gem. It's perhaps the greatest thing I've ever read, even if it is satire (I'm not sure). Just perfect. The comments are worth reading too. Some hospital admin found it and got very butthurt.

How To Discourage a Doctor – The Health Care Blog

 

[Radonc90]

Disclaimer: all figures mentioned below are approximate and used only to illustrate my points.

When admin says "…hospitals lose about $50,000–$100,000 per doctor per year on their employed practices, according to La Penna…”, it is all BS.

Let’s say you bring in professional $400K a year and your salary is $300K, hospital breaks even bc it costs ~ $100K for benefits (dental, health care premium, 401(k), 403(b), 457(b) and all that jazz). Same thing if you run a private practice and bring in gross $400K, you still have to pay all these benefits yourself.

Now, let’s say you bring in professional $400K a year and due to market demand, your salary is $400K, then the hospital will say it costs them $100K to employ you. What the hosp won’t tell you is that for a place with average 15-20 pts/daily, you bring in $20M of tech charges (collection is about 30% of so, which is plenty to pay techs, physicists, dosimetrists and you etc.).

In rural Kansas, Iowa, I have seen salary offer twice that much to attract radoncs to towns of 20K-30K population. Even if the rural hosp pays a radonc $700K-$800K in a dept with average of 15-20 pts/daily, the hosp still make a lot money. And it is fair for these MDs who live in small towns like this with few restaurants, entertainment etc.

After years dealing with hosp CEO, Deans, and private (some small chains and some big chains), I can tell you that...

- If you ask me how much a breast surgeon is worth, I'd say $1M.

- If you ask me how much a thoracic surgeon is worth, I'd say $1M.

- If you ask me how much a radonc is worth, I'd say $1M.

The reasons specialists are paid at 30% to 40% of what they are worth is bc Medicare splitting pro vs tech fees and pro fees are priced low compared to tech fees.

Understandably so, bc in surg or radonc there are a lot of costs in tech parts (OR tech, or radon staff tech/physicists/linac machine etc.).

So the surgeon's pro fees and the radonc's pro fees are not much in the big scheme of things.

This is why surgeons who own free-standing centers and radoncs who own free-standing centers make more bc they run on bare-bone staff to maximize profits. If you make $1 as hosp employee collecting only pro fees, then you make $3 if you own your free-standing center, everything else being equal (patients volume etc.).

- The above article by KEN TERRY is excellent. The best sentence is “When health systems employ physicians, they can use their market power to negotiate higher commercial payment rates for those doctors.”

I know this for fact bc BIG chains like to employ docs so they can go to insurance company and negotiate a better rate for themselves. It is all about the mighty dollars.

- In an academic setting, if an admin says "...we lose about $50,000–$100,000 per doctor per year....", usually I tell the Dean and Hosp CEO to fire that person. In an academic setting, it is a big no-no to say that to a teaching MD: it is insulting and stupid. In private practice, it is a different deal.

- Now the question of small chains vs big chains:
---> BIG private chains (I am not talking about BIG academic chains for now):
* Ascension
* HCA
* SSM
* Trinity
* Catholic Health Initiatives (CHI) got married with Dignity Health in 2019 = CommonSpirit is the new entity, the LARGEST chain in the country.

- In the private setting, the best is usually a SMALL chain running 3 to 5 hospitals in one state. They don't want to be bought by the big chains. They are usually customer-service oriented and treat MDs better.

- The BIG chains don't give a damn, all they care is the balance sheets, they treat doctors and pts poorly, the biggest offenders are HCA and CHI. Trinity's only academic place is Loyola in Chicago. Trinity is a bit better and not as bad as CHI. My many friends who work for CHI tell me CHI is a sick entity. Some of us (whether thoracic surgeon, gensurg, surgonc or radonc etc.) don’t have a choice and have to work for one of these monster chains, God Bless these docs.

- So the next time an admin tells you “…we lose about > $100,000 per doctor per year…”, you can tell that admin he/she is full of manure. All they want to do is to instill fear in you and make you feel like you owe the hospital chain something…It is just disgusting that they said that. You are worth $1M…

 

[deleted1116990]

In rural Kansas, Iowa, I have seen salary offer twice that much to attract radoncs to towns of 20K-30K population. Even if the rural hosp pays a radonc $700K-$800K in a dept with average of 15-20 pts/daily, the hosp still make a lot money. And it is fair for these MDs who live in small towns like this with few restaurants, entertainment etc.

While it is possible that these undesirable places will give you a 750-850k offer after interviewing and negotiating, in my experience if you try to tease out whether they will be willing to compensate fairly upfront, you will not be invited on site and they will no longer answer your calls and emails. It is extremely frustrating to put for the effort to go and interview somewhere after numerous phone calls only to be presented with a 350k salary offer at a location that should be paying over double that. There is a rural practice in Kentucky that has been advertising for a long time that does this according to someone I know who interviewed there. It happened to me too. I interviewed at one of the above mentioned hospitals and was told I would have volume of over 14,000 wRVU (easy 1M in professional collections) and then was presented with a firm salary offer of 400k.

 

[fiji128]

I received a recruiter email recently saying hospital employed in upper rural Midwest with salary and benefits at $850K with $200K sign on bonus. This is the highest I have seen in maybe the past five years. No idea how "true" these numbers are. I'm currently at about 13,000 wRVU but only getting paid at 50% of my professional collections. Dare to dream.

 

[deleted1111261]

I received a recruiter email recently saying hospital employed in upper rural Midwest with salary and benefits at $850K with $200K sign on bonus. This is the highest I have seen in maybe the past five years. No idea how "true" these numbers are. I'm currently at about 13,000 wRVU but only getting paid at 50% of my professional collections. Dare to dream.

yeah, got that email, too. curious about what town it is in.

 

[fiji128]

yeah, got that email, too. curious about what town it is in.

Sioux City, IA?

 

[CaesarRO]

With all the stories of huge discrepancies between collections and salaries, at what point does it make sense to build your own center and get technical too? Maybe more of a private forum question.

 

[Mandelin Rain]

I received a recruiter email recently saying hospital employed in upper rural Midwest with salary and benefits at $850K with $200K sign on bonus. This is the highest I have seen in maybe the past five years. No idea how "true" these numbers are. I'm currently at about 13,000 wRVU but only getting paid at 50% of my professional collections. Dare to dream.

 

[medgator]

With all the stories of huge discrepancies between collections and salaries, at what point does it make sense to build your own center and get technical too? Maybe more of a private forum question.

Have you seen the trajectory of freestanding/Medicare PFS rates the last several years? Not a good place to be. There was also talk of backing out the cost of the vault a few years ago when they tried to figure out costs to Medicare.

You basically would have to be in an unsaturated area with plenty of referrings to get you at 20+ under beam fairly quickly.

 

[Mandelin Rain]

Yup. You'd probably want to partner with some independent docs (breast surgeons, urologists, Neurosurgeons, etc...) to ensure built in referral base.

Unfortunately, the hospitals buy up all the docs these days.

 

[fiji128]

Yup. You'd probably want to partner with some independent docs (breast surgeons, urologists, Neurosurgeons, etc...) to ensure built in referral base.

Unfortunately, the hospitals buy up all the docs these days.

If this was a viable business model for indepent physicians

Easy, not many great alternatives out there. We are still a greatly oversupplied field. If positions were harder to fill, salaries would go up (or the percentage of professional revenue you get to keep).

 

[communitydoc13]

We are still a greatly oversupplied field.

It's all there is to it. As someone involved in recruiting for the hospital system I am contracted to, I can tell you locum rates for medoncs may be 4X what they are for radoncs. This in turn impacts the demands admin can make on medoncs, the terms of compensation and contracts, and even the ability to judiciously discipline medical oncologists.

 

[Mandelin Rain]

If this was a viable business model for indepent physicians

It is. Multispecialty cancer clinics are probably a better bet than a single specialty shop. At least until the hospital buys all the PCP groups.

 

[deleted1116990]

With all the stories of huge discrepancies between collections and salaries, at what point does it make sense to build your own center and get technical too? Maybe more of a private forum question.

I had the same question. The answer seems to be that the risk is substantial. If you are in a CON state, it is a lengthy process and you will probably be challenged in court by existing health systems in the area. If a non CON state you take the risk of default on your loan if you can't get enough patients in quickly. Building costs have ballooned recently, and while good used LINACs are relatively cheap, the initially outlay was around 3M to build an office and a vault and start treating when I looked into it. I suppose you can always do it in Florida and put all of your money in your primary residence as they can't take that in bankruptcy court.

You basically would have to be in an unsaturated area with plenty of referrings to get you at 20+ under beam fairly quickly.

It seems like the juicy market gaps were filled 20 years ago. The option is to build in a rural area with no competition, where you run the risk of going under because not enough of the population needs cancer treatment, or in a high-density area, where you run the risk of going under because you fail at squeezing in between the competition. If anybody knows of a place with a large population driving >1 hr for treatment, I'm all ears.

It's all there is to it. As someone involved in recruiting for the hospital system I am contracted to, I can tell you locum rates for medoncs may be 4X what they are for radoncs. This in turn impacts the demands admin can make on medoncs, the terms of compensation and contracts, and even the ability to judiciously discipline medical oncologists.

I'm not sure that early career rad oncs understand just how enormous the locums pool of retired rad oncs is including people in their 80s who can barely use email. I guess their 8 figure portfolio isn't enough and they still need to pull in 50k/year with random locums gigs. These people are screwing us all over both by driving locums rates down and by giving employers an easy out if a rad onc is being difficult. I watched a hospital show an unhappy rad onc the door and hire locums while they tolerated grossly unprofessional behavior from med oncs and begged them to stay throwing more money at them when they threaten to quit.

 

[deleted941485]

I had the same question. The answer seems to be that the risk is substantial. If you are in a CON state, it is a lengthy process and you will probably be challenged in court by existing health systems in the area. If a non CON state you take the risk of default on your loan if you can't get enough patients in quickly. Building costs have ballooned recently, and while good used LINACs are relatively cheap, the initially outlay was around 3M to build an office and a vault and start treating when I looked into it. I suppose you can always do it in Florida and put all of your money in your primary residence as they can't take that in bankruptcy court.




It seems like the juicy market gaps were filled 20 years ago. The option is to build in a rural area with no competition, where you run the risk of going under because not enough of the population needs cancer treatment, or in a high-density area, where you run the risk of going under because you fail at squeezing in between the competition. If anybody knows of a place with a large population driving >1 hr for treatment, I'm all ears.


I'm not sure that early career rad oncs understand just how enormous the locums pool of retired rad oncs is including people in their 80s who can barely use email. I guess their 8 figure portfolio isn't enough and they still need to pull in 50k/year with random locums gigs. These people are screwing us all over both by driving locums rates down and by giving employers an easy out if a rad onc is being difficult. I watched a hospital show an unhappy rad onc the door and hire locums while they tolerated grossly unprofessional behavior from med oncs and begged them to stay throwing more money at them when they threaten to quit.

It all comes down to demand.

And yes octolocums are the worst.

 

[madchemist89]

I heard of a locums guy who was incontinent and kept urinating everywhere he sat.

 

[fiji128]

The 75 year old plus locums is so rad onc. You literally have people practicing until they can no longer drive to work or die. Just don’t get it.

 

[TheWallnerus]

I heard of a locums guy who was incontinent and kept urinating everywhere he sat.

I will say this for him. Wherever he works he really leaves his mark.

 

[seper]

that's ageism in its worst

 

[deleted1111261]

that's ageism in its worst

Do you think it’s based in fact?

 

[thecarbonionangle]

I heard of a locums guy who was incontinent and kept urinating everywhere he sat.

These guys are pissing on all of us. Greedy boomers are da worst. Their piss is not rain as there is no way these guys have a great stream, more like a sprinkle, like when a bird poops on your head.

 

[elementaryschooleconomics]

This is why I ask all prospective locum docs what their IPSS score is.

I'm also working on a proprietary blend of Crystal Lite and Flomax. Patent pending!

 

[deleted941485]

This is why I ask all prospective locum docs what their IPSS score is.

I'm also working on a proprietary blend of Crystal Lite and Flomax. Patent pending!

I use an MMSE. Some don’t even know where they are a lot of the time.

May wanna incorporate memantine into that patent

 

[deleted1116990]

I heard of a locums guy who was incontinent and kept urinating everywhere he sat.

The one I was thinking of had a legitimate shuffling gait.

Not that I am making fun of people for becoming old and feeble. It will happen to all of us. The octolocums reaped 7 figure incomes for decades, and if they can't afford to retire, who can? With those days gone, maybe we will really have to plan on working until we stroke out checking a cone beam or our great grandkids take away our driver's licenses.