Rheumatology job contract

[Zika]

Not rheum but:
#1-Be very wary, they are going to be making money hand over first from ancillary charges you will be generating for them, do you ever get to see any of that action? How long? Is there contract language for this? Are they open about how much they make? Asking these questions might raise important red flags.

#2-For the ultrasound if they won't buy one you can get a butterfly IQ for 3k so this really shouldnt be a deciding factor.

I am questioning them a lot and they have been open about what they make to some extent. For example how much they make after how many years and with how much effort.
There's ancillary too and they get a share of its profits proportional to what they contributed to it.

I know I can buy my own ultrasound but not sure if that would billable then. Especially that it would be in a large medical group that everything needs to be coded and lots of paperwork.

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[Entadus]

20 patients for rheumatology PP is normal. Unless you work in a real academic setting and in that case you see 10-12.
I don't think there's any rheumatologist who sees 6-8 patients a day.
Salaries are location dependent too, you may go work in middle of no where and earn 300-400k after a few years.

What is making the decision hard for me is the potential in the PP. I have to work harder however I may be able to make 400k+ in 5 years if I learn how to do the business, yet in the second option I get a fixed salary with some production on top and end up somewhere around 300k forever.

I know it's apples to oranges. I'm not suggesting you find a job seeing 6-8 pts. My point is that you should know your worth! As a palliative doc I don't generate much revenue for my employer. (Palliative consults do save a ton of money, so there is some value added there, but I digress)

The point is that seeing 20-25 pts a day you will be generating some serious income. If they are only willing to pay $225 base and make you hustle to get the RVU bonus, someone is going to be profiting off you. Big time.

 

[chessknt]

I am questioning them a lot and they have been open about what they make to some extent. For example how much they make after how many years and with how much effort.
There's ancillary too and they get a share of its profits proportional to what they contributed to it.

I know I can buy my own ultrasound but not sure if that would billable then. Especially that it would be in a large medical group that everything needs to be coded and lots of paperwork.

If it is a hospital-based clinic there will be some medical tech clearance for a device otherwise there is no issue with use or payment regardless or what device you are using.

The issue with the PP is will they sell (or are they already in the process of selling) before you get cut in on the ancillary income--ask that question and see how direct of a response you get. I would ask about buy in too--you are already guying to be buying in from salary which is under your production if they want even more money I would want to see more pay as an employee. Are there layers of partnership or are you an equal partner after X years with equal voting rights? If not that is a huge red flag too. I would also ask to see contract language regarding partnership--if there is none or it is some sort of verbal or handshake agreement you should assume you will never partner and evaluate the job with that in mind.

 

[Zika]

If it is a hospital-based clinic there will be some medical tech clearance for a device otherwise there is no issue with use or payment regardless or what device you are using.

The issue with the PP is will they sell (or are they already in the process of selling) before you get cut in on the ancillary income--ask that question and see how direct of a response you get. I would ask about buy in too--you are already guying to be buying in from salary which is under your production if they want even more money I would want to see more pay as an employee. Are there layers of partnership or are you an equal partner after X years with equal voting rights? If not that is a huge red flag too. I would also ask to see contract language regarding partnership--if there is none or it is some sort of verbal or handshake agreement you should assume you will never partner and evaluate the job with that in mind.

They don't offer traditional partnership, but they say if you are interested in staying after a few years you can partner in opening a new location where there is potential and partner 50/50. So in that case you will be a partner in that location with equal voting rights, but you will not be a partner just after 2-3 years in the whole practice.

 

[chessknt]

They don't offer traditional partnership, but they say if you are interested in staying after a few years you can partner in opening a new location where there is potential and partner 50/50. So in that case you will be a partner in that location with equal voting rights, but you will not be a partner just after 2-3 years in the whole practice.

Yep turn that one down is my recommendation--they got all the ncillary income off you in all the other locations in perpetuity sounds like a great deal for them especially while only having to pay you a near academic salary while you work like a dog.

 

[Renal_Prometheus]

They don't offer traditional partnership, but they say if you are interested in staying after a few years you can partner in opening a new location where there is potential and partner 50/50. So in that case you will be a partner in that location with equal voting rights, but you will not be a partner just after 2-3 years in the whole practice.

Sounds fishy. I don’t think you should take this private practice job. If you are going to work hard, at least do it for a group who will treat you fairly.

 

[RheumDoc112]

Zika, 20-25 patients a day is very very tiring. It's doable but not pleasant. No idea when you would find time to see consults with that kind of volume.
Like others said before, it likely will not be difficult to get the hospital to purchase an US for you. I was able to get one last year and to be honest use it maybe a few times a month at most because it tends to slow the pace down.
Either way good luck!

 

[bronx43]

Hey guys,

I'm wondering if anyone can help me here.

I have 2 job offers in my desired location.

First is PP, very well established , 5 rheumatologists, 5 locations, infusion, pt, x-ray, us, lab, dexa.
220k first year + 10k sign on, 240 second year with option to go 50/50 (negotiable).
Also option to open a new location and become partner for that location again 50/50.
I don't like the numbers at all but I am being promised that there's a huge potential and if I work right , see 20-25 patients daily, use ultrasound and etc I can easily make 300k+ and can get a PA, and. Potentially add 100k+.
Pros: location and accessibility , potential high income
Cons: low starting salary, have to cover consults (different EMRs)


Second is a hospital employed. Large community hospital system with strong referral base.
Fixed salary 265k, sign on bonus 70k! productivity bonus starting 2nd year, wrvu goal 5800, $55 per wrvu in excess, and great benefits. Average 15 patients a day. One half day for admin stuff.
Pros: can cover consults over phone?! And see patients in clinic. Epic emr which I'm using now.
only one location. Great benefits.
cons: don't have a working US machine and nobody uses it! Time consuming? Which I don't like because I'm getting certified and want to incorporate it in my practice. Location a bit off from main city and not great accessibility.

I Would appreciate any input to help me make my decision.

thanks.

I would take the hospital job, unless you get bad vibes from the admin.
20-25 pts a day should be WAY more than 300k. If you do the math, the hospital job would be 100-200k more than that depending on the percent of news that you see.
You can talk the admin into getting you a US if you need. If you tell them the numbers, they will likely oblige. With that said, the word on the street is that they are cutting MSK US reimbursement... again. So, it may honestly be a net negative sooner rather than later. No point in wasting 10 minutes on a scan when you can just as easily see a return pt for 1.92 wRVU.

 

[dozitgetchahi]

I'm not a rheumatologist... but if all the offers look like that then I am very glad
I like my job (1st year palliative attending). 280k, with yearly COLA raises, clear path to $300k in a few years
M-F no weekends, no night coverage, no call. 6-8 patients per day, no dependence on productivity.
Fellowship was only 1 year!
49 paid days off per year (plus 5 days CME)


LOL @consults at multiple locations, multiple EMR's, 20-25 pts per day??

I would take Option 2 and push hard for a new ultrasound machine. Not that hard.

Even my first crappy rheumatology job was exactly as you described, except seeing 15-20 pts/day or so. Every job I’ve had is no call, no weekends, no hospital rounding, one clinic location.

I don’t know that much about palliative care, but the handful of people I know who went into it didn’t get nearly as sweet a deal as you did (salary much lower, like $100k lower). The palliative docs I know also take a ****load of call, and have to deal with counseling dying patients all the time - which is the real reason for seeing only 6-8 pts/day. One of the things I like about rheumatology is that our treatments largely actually work at this point, and most of our patients are relatively healthy and don’t die. I wouldn’t enjoy a specialty where all my patients are actively dying.

 

[dozitgetchahi]

Hey guys,

I'm wondering if anyone can help me here.

I have 2 job offers in my desired location.

First is PP, very well established , 5 rheumatologists, 5 locations, infusion, pt, x-ray, us, lab, dexa.
220k first year + 10k sign on, 240 second year with option to go 50/50 (negotiable).
Also option to open a new location and become partner for that location again 50/50.
I don't like the numbers at all but I am being promised that there's a huge potential and if I work right , see 20-25 patients daily, use ultrasound and etc I can easily make 300k+ and can get a PA, and. Potentially add 100k+.
Pros: location and accessibility , potential high income
Cons: low starting salary, have to cover consults (different EMRs)


Second is a hospital employed. Large community hospital system with strong referral base.
Fixed salary 265k, sign on bonus 70k! productivity bonus starting 2nd year, wrvu goal 5800, $55 per wrvu in excess, and great benefits. Average 15 patients a day. One half day for admin stuff.
Pros: can cover consults over phone?! And see patients in clinic. Epic emr which I'm using now.
only one location. Great benefits.
cons: don't have a working US machine and nobody uses it! Time consuming? Which I don't like because I'm getting certified and want to incorporate it in my practice. Location a bit off from main city and not great accessibility.

I Would appreciate any input to help me make my decision.

thanks.

PP job is a ripoff, and unfortunately is reminiscent of many bad PP deals which I encountered while interviewing. There are definitely great PP jobs out there, but there are also a lot of these really bad ones with low starting pay, high volumes, and a strangely low “upper limit” on the salary (agree that 20-25 patients a day should yield a lot more than just “maybe $300k”). I take it they haven’t even talked about a buy-in or anything yet - and my bet is that the buy-in would be curiously huge (like $150k+), and divorced from all reality of the “value” you’re buying into. Also, 20-25 patients/day is exhausting and and trying to do consults on top of that…even more so. I think you said you were searching on the east coast, and this is the classic format for a lousy east coast PP job in my experience. (Plus, I take a dim view of anyone who sees midlevels as “ancillary income”, and unfortunately you will find a lot of PP partners who think this way.) Other folks have hit on most of the other big points I would have made wrt evaluating a partnership contract.

Hospital job is much better all around. I wouldn’t be too concerned about US. Once you get moving with typical patient volumes every day, it takes more time than you’d think and doesn’t reimburse well. It’s slightly helpful here and there, but overall the usefulness of it is not that great.

 

[Zika]

Thanks for all you guys advice!

I ended up turning down that private practice job! and honestly I am so happy that I did that, since I was just convincing myself that I could do it and it would return my sacrifices sometime in future.
And I actually ended up accepting another offer which is a large medical group with similar format to that hospital job but better location for my family. They have a good US machine too which will satisfy me for now even if I end up not doing ultrasound much in the future.
I feel like a big load off of me now, this job hunt is so daunting. Although right now the rheumatology job market is wide open and literally everyone wants you, it's not easy to find the right fit and there's a lot of junk out there that you don't wanna be a part of.

Good luck to everyone out there on their job pursuit!