Question for those going in to outpatient IM straight out of residency

[yellowdonkey]

Hi all,

There's plenty of info online about hospitalist pay and hours but having a harder time finding info about outpt IM

1) What are some offers (please include general area if possible) that you've received?
2) What have been your average hours for a normal day?
3) Were you able to negotiate your contract at all? If so, what sort of things were you able to successfully negotiate for?
4) What are your thoughts on DPC?

Thanks!

YellowDonkey

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[tylerb1800]

I am in a small southeastern US city. I am currently practicing more traditional IM. I round on my patients in the hospital prior to clinic. I have only been out practicing for ~9 months, so I usually have 0 to 4 patients in the hospital at a time. The offers that I received ranged from $210k to $240k guaranteed for 2 years then changes to production. Most groups are wRVU based and some are collections based. Your initial salary will be lower than a hospitalist. Once on production and depending on how you work, you can surpass the hospitalist salary based on your billing, value-based compensation, and if you round on your own patients. Always negotiate your contract. I asked for more sign-on bonus as well as more toward loan repayment.

I am currently working 4.5 days per week. I have control over my schedule. I choose when I start and how many patient slots that I want per day. I choose how long the appointment slots are as well. I usually get to the hospital around 7:30AM. My first patient appointment I set at 8:15 with my last being between 3:30 and 4pm. I usually head home between 4 and 4:30pm depending on the day. My group is rather large. I am weekday night call once a week with a weekend call once every 7 to 8 weeks.

DPC would be nice. I did not see it as a feasible option coming right out of residency.

 

[jdh71]

Hey @VA Hopeful Dr @Blue Dog @Bacchus @smq123 any thoughts?

 

[jdh71]

I've asked some folks who post here regularly and do outpatient medicine to weigh in. Most (all?) of them have an FP background but that shouldn't matter too much for the conversation.

 

[VA Hopeful Dr]

Hi all,

There's plenty of info online about hospitalist pay and hours but having a harder time finding info about outpt IM

1) What are some offers (please include general area if possible) that you've received?
2) What have been your average hours for a normal day?
3) Were you able to negotiate your contract at all? If so, what sort of things were you able to successfully negotiate for?
4) What are your thoughts on DPC?

Thanks!

YellowDonkey

1. 200k starting is more or less the standard these days.
2. 8-5, hour for lunch 4 days a week, 8-12 the 5th day. My contract requires 36 hours of patient care/week.
3. Somewhat, mainly for things in the first year. After that, stuff like CME, income, and days off are standard across the group.
4. Its a nice idea, has some downsides but it can definitely work. I did it for 2 years.

 

[smq123]

Hi all,

There's plenty of info online about hospitalist pay and hours but having a harder time finding info about outpt IM

1) What are some offers (please include general area if possible) that you've received?
2) What have been your average hours for a normal day?
3) Were you able to negotiate your contract at all? If so, what sort of things were you able to successfully negotiate for?
4) What are your thoughts on DPC?

Thanks!

YellowDonkey

I live in South Florida (not really by choice, but here we are.)

Around here, they are offering 225K+, with the caveat that they are looking for someone "who is ready to work" - i.e. churn through at least 25 patients a day. Most are requiring 8-5, 5 days a week, with q4 telephone call. Some also offer nursing home rounds, but not many. I don't know if that's because it's not available or most people just don't want to round in a nursing home.

The rest of Florida has better offers, from what I have been told by friends. There are also a lot of practices focusing on Medicare, which has its own set of rules and regulations.

I think that DPC is a good idea and patients are probably ready for it. I probably wouldn't do it straight out of residency, though.

EDIT: I should probably clarify that any geographic restrictions is due to my spouse's job, not mine. Outpatient primary care, as always, has a tremendous amount of geographic flexibility.

 

[yellowdonkey]

I've asked some folks who post here regularly and do outpatient medicine to weigh in. Most (all?) of them have an FP background but that shouldn't matter too much for the conversation.

Thank you jdh71, im a lurker but i just wanna say i always appreciate your posts and enjoy reading your replies

 

[yellowdonkey]

1. 200k starting is more or less the standard these days.
2. 8-5, hour for lunch 4 days a week, 8-12 the 5th day. My contract requires 36 hours of patient care/week.
3. Somewhat, mainly for things in the first year. After that, stuff like CME, income, and days off are standard across the group.
4. Its a nice idea, has some downsides but it can definitely work. I did it for 2 years.

Im now very interested in your 2 year transition in and out of DPC haha, what happened if you dont mind me asking? If 200k starting, in most common situations how much more per year does one usually make once they've got the ball rolling and in a rhythm? Also for your 5th dayfrom 8-12, was that something you decided that you wanted/requested or is that all across the board for your colleagues as well?

 

[yellowdonkey]

I am in a small southeastern US city. I am currently practicing more traditional IM. I round on my patients in the hospital prior to clinic. I have only been out practicing for ~9 months, so I usually have 0 to 4 patients in the hospital at a time. The offers that I received ranged from $210k to $240k guaranteed for 2 years then changes to production. Most groups are wRVU based and some are collections based. Your initial salary will be lower than a hospitalist. Once on production and depending on how you work, you can surpass the hospitalist salary based on your billing, value-based compensation, and if you round on your own patients. Always negotiate your contract. I asked for more sign-on bonus as well as more toward loan repayment.

I am currently working 4.5 days per week. I have control over my schedule. I choose when I start and how many patient slots that I want per day. I choose how long the appointment slots are as well. I usually get to the hospital around 7:30AM. My first patient appointment I set at 8:15 with my last being between 3:30 and 4pm. I usually head home between 4 and 4:30pm depending on the day. My group is rather large. I am weekday night call once a week with a weekend call once every 7 to 8 weeks.

DPC would be nice. I did not see it as a feasible option coming right out of residency.

This sounds like an awesome job, congrats on finishing residency and the new gig! Really dig that you see both inpt and outpt and determine how long the appt slots are. how is that possible?? doesnt your group want you to see as many as possible in a day?

 

[VA Hopeful Dr]

Im now very interested in your 2 year transition in and out of DPC haha, what happened if you dont mind me asking? If 200k starting, in most common situations how much more per year does one usually make once they've got the ball rolling and in a rhythm? Also for your 5th dayfrom 8-12, was that something you decided that you wanted/requested or is that all across the board for your colleagues as well?

An opportunity came to move back to my home town. The practice was going pretty well, but in truth I was starting to get a little burned out being on call 24/7. The volume wasn't bad, it was just knowing I was always at risk of a call/text started to wear on me.

Looking at group wide RVU numbers, most full time doctors who have been here at least 2 years and are under age 60 (when people start to slow down) including bonuses we're averaging around 275k best I can tell. We have a fair number who are in the 300s and 4 who break 400k but they are the ones seeing 30 patients per day 5 days/week with at most 2-3 weeks off per year. My goal is around 25-27/day 4.5 days/week with 4-6 weeks of vacation/year. If I do that and hit the average number of quality measures in the group I'll be sitting on around 350k.

As long as we work the required 36 hours, we can structure it however we want. I have one partner who takes every other Friday/Monday off (meaning every other weekend is a 4 day weekend). Another works 7:30-3 every day so she has the afternoons when her kids get off from school. We have plenty who work 8-5 every day (since that does mean more money). I'm pondering doing that in August when one of my partners retires and I inherit all of his patients.

 

[tylerb1800]

This sounds like an awesome job, congrats on finishing residency and the new gig! Really dig that you see both inpt and outpt and determine how long the appt slots are. how is that possible?? doesnt your group want you to see as many as possible in a day?

Going into residency, I did not realize that traditional IM even still existed. There are 3 groups in town who still practice traditional. Admin is relatively hands off with the doctors schedules. Once your on productivity, you have a base number of RVUs that you have to hit. If you do not hit that number, you owe the practice the difference. I bet there is an absolute minimum that you must work to make it worthwhile for the practice to keep you due to overhead but I am not sure what that number is. Even with me being on guarantee the first two years, I still can hit productivity bonus after a certain number of RVUs (granted will not hit this 1st year due to COVID). Everyone in my group wants to work and earn but everyone has different goals. There a few in the group who routinely see 30 to 35 per day but they do not round in the hospital. Typically the ones who round will see anywhere from 20 to 25 4 days a week with either a half day or full day off of clinic. Ultimately, my goal once getting a full panel is to work 3 full days with two half days. I want to see 22ish on full days and 12ish on half days. I have been told that rounding in the hospital can make a difference in salary from $100k to $150k due to hospital RVUs being higher.

Your career is a marathon. Figure out how much/hard you want to work and what you want to earn. You can find a job that fits. It may not be your first job out of residency.