Rheumatology job offer

[TaroBubbleTea]

Hey all, currently in my last year of Rheum fellowship and got a job offer and wanted to see what people thought. It's a hospital employed position for a large health system. Current group has 4 rheumatologists, with 1 retiring. 1:1 MA support with 2 nurses doing triaging inbox messages.

Location: HCOL, similar in price to LA
Base: guaranteed base 275k for 2 years, can do straight production earlier than 2 years if you exceed your base, ~$55/RVU
Sign on bonus 20k (10k day 1, 10k year 3)
4k CME funds, 5 days of CME
10k relocation
5% employer contribution to 401k
20 days PTO + holidays
Average patient load once ramped up seems to be 16-20 per day,

Things I like:
4.5 days/week with flexibility for a 4 day work week, 35 patient contact hours per week
Location is great
group seems to get along, not much turn over
light inpatient call 1 week per month
Epic EMR

Was wondering what you guys thought about the $/RVU and if you think I can feasibly negotiate up the signing bonus

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[Renal_Prometheus]

I’m a little worried about the HCOL, and your ability to buy a house and raise a family. Property prices in Cali is insane. Unless your spouse is also a physician and have dual incomes. I’m not a rheum specialist, but I would think you should aim for an higher salary to compensate for cost of living adjustments.

 

[dozitgetchahi]

Hey all, currently in my last year of Rheum fellowship and got a job offer and wanted to see what people thought. It's a hospital employed position for a large health system. Current group has 4 rheumatologists, with 1 retiring. 1:1 MA support with 2 nurses doing triaging inbox messages.

Location: HCOL, similar in price to LA
Base: guaranteed base 275k for 2 years, can do straight production earlier than 2 years if you exceed your base, ~$55/RVU
Sign on bonus 20k (10k day 1, 10k year 3)
4k CME funds, 5 days of CME
10k relocation
5% employer contribution to 401k
20 days PTO + holidays
Average patient load once ramped up seems to be 16-20 per day,

Things I like:
4.5 days/week with flexibility for a 4 day work week, 35 patient contact hours per week
Location is great
group seems to get along, not much turn over
light inpatient call 1 week per month
Epic EMR

Was wondering what you guys thought about the $/RVU and if you think I can feasibly negotiate up the signing bonus

Pretty average rheumatology deal. The sign on is a bit low, and they should be giving you all of it day 1 (a $10k bonus year 3 isn’t a sign on bonus anymore, that would be more correctly termed a retention bonus).

That said, if the COL is similar to LA and you’re a one income family, you are going to struggle. If you can’t negotiate the income up (good luck), I think you need to be looking elsewhere. $275k at LA level COL is about enough to live in a van down by the river (and I am only half joking).

 

[sloh]

Pretty average rheumatology deal. The sign on is a bit low, and they should be giving you all of it day 1 (a $10k bonus year 3 isn’t a sign on bonus anymore, that would be more correctly termed a retention bonus).

That said, if the COL is similar to LA and you’re a one income family, you are going to struggle. If you can’t negotiate the income up (good luck), I think you need to be looking elsewhere. $275k at LA level COL is about enough to live in a van down by the river (and I am only half joking).

Yup I live in SoCal and would say minimum HHI to enjoy living here and raise a family is 1 M.

 

[bronx43]

Yup I live in SoCal and would say minimum HHI to enjoy living here and raise a family is 1 M.

I got a buddy in NorCal with HHI of 600-700k and he only recently was able to buy a house 2 hours outside of SF.

 

[Residentdoc86]

Yikes.
If location isn't an issue, definitely look elsewhere. Most employer don't care about cost of living adjustments.
10 K at year 3 is a joke. Should be at least 25K.
Student Loan repayment?
Licensing, board exam stipend?
Could negotiate CME money.
If 1 MD is retiring, you will likely be seeing 16-20 patients within 3 months if not earlier. So if you do the rVU calculations seeing average 16 patients a day (14 level 4 follow up and 2 new level 4 or 5) for 4.5 days, your base is likely to be higher than what they are offering you. Not sure what your rVU target is. 5000 rVR at $55 is 275k base.

I negotiated a similar offer to yours in the east coast.

One fellow from my program went to the CA area for 325K but private practice, 4.5 days a week.

Rheum is in demand so try to find other offered if you are set on staying in the area.

 

[TaroBubbleTea]

Hey all, just an update. I was able to negotiate the bonus to 20k year 1, 20k retention bonus year 3, as well as a fellowship stipend. I tried to get them to offer student loan forgiveness but no dice. The base unfortunately is comparable to other offers I have received in the area as well as speaking to another rheumatologist in the area who was 1 year ahead of me in fellowship. I am currently single and no plans for kids in the future, so and I’m fairly certain I can make the income work and save for a down payment on a house in the near future.

I just received another offer in my current city, which I would categorize as a MCOL city. This gig is PP so definitely higher income potential in the future. However, location wise, I think I would be much happier leaving my current city.

 

[dozitgetchahi]

Hey all, just an update. I was able to negotiate the bonus to 20k year 1, 20k retention bonus year 3, as well as a fellowship stipend. I tried to get them to offer student loan forgiveness but no dice. The base unfortunately is comparable to other offers I have received in the area as well as speaking to another rheumatologist in the area who was 1 year ahead of me in fellowship. I am currently single and no plans for kids in the future, so and I’m fairly certain I can make the income work and save for a down payment on a house in the near future.

I just received another offer in my current city, which I would categorize as a MCOL city. This gig is PP so definitely higher income potential in the future. However, location wise, I think I would be much happier leaving my current city.

This is still not going to be nearly enough money to live decently in a VHCOL area. And yes, lots of doctors in these kinds of places will claim they’re “making it work” with relatively low incomes while struggling mightily to keep their heads above water (go read the anesthesiology forums to find some guy making a combined $740k family income in the Bay Area, who still can’t afford a house).

Rheumatology is hot and in demand. Lotsa jobs out there in lotsa places. If you don’t like your current city, keep looking. You don’t need to live in this specific place. This offer ain’t it.

 

[tacowithgreensauce]

sounds like a hospital employed model

cali and texas recently changed rules so even if the medical group is “for profit” if u affiliated with the non-profit hospital it probably qualifies for pslf

 

[dfib slim]

Currently in a VHCOL in California and started in a large multispecialty private practice group. Guaranteed 230K for the first two years, then 100% production. 4 days a week, 7 hour days, works out to 0.8FTE. Seeing like 12-14 patients a day. Just the wife and I so no large family. She had some scratch to secure us a down payment on a 1.2 mil home with mortage payment 5k a month. Haven't hit production yet but expecting 330-350K seeing 16-20 patients a day, 32 hours a week. Hoping for that PSLF.

 

[Legend of Link]

Currently in a VHCOL in California and started in a large multispecialty private practice group. Guaranteed 230K for the first two years, then 100% production. 4 days a week, 7 hour days, works out to 0.8FTE. Seeing like 12-14 patients a day. Just the wife and I so no large family. She had some scratch to secure us a down payment on a 1.2 mil home with mortage payment 5k a month. Haven't hit production yet but expecting 330-350K seeing 16-20 patients a day, 32 hours a week. Hoping for that PSLF.

Is that a typical offer for pp in Cali? How's the job market in west coast currently? Did they offer partnership track? Any infusion on site/ do they share infusion/ ancillary profit in your production? Do you see yourself being able seeing more patients in the future for more income? How's the referral base? Does the practice screen out fibromyalgia/ chronic pain / low Ana titer patients?

 

[dfib slim]

Is that a typical offer for pp in Cali? How's the job market in west coast currently? Did they offer partnership track? Any infusion on site/ do they share infusion/ ancillary profit in your production? Do you see yourself being able seeing more patients in the future for more income? How's the referral base? Does the practice screen out fibromyalgia/ chronic pain / low Ana titer patients?

From other places I looked at the offer is similar to better. Not sure if the job market now but Practice Link might give you an idea. Yes, I become a partner after 2 years. Off site infusions and do not take call from them so no rvu generation. I can see more or less patients if I want but I like the amount of time I put in now. We take internal and external referrals. A lot of osteoporosis. No screening out fibromyalgia but I only usually see them once and refer back to PCP if no underlying inflammatory condition.

 

[sloh]

From other places I looked at the offer is similar to better. Not sure if the job market now but Practice Link might give you an idea. Yes, I become a partner after 2 years. Off site infusions and do not take call from them so no rvu generation. I can see more or less patients if I want but I like the amount of time I put in now. We take internal and external referrals. A lot of osteoporosis. No screening out fibromyalgia but I only usually see them once and refer back to PCP if no underlying inflammatory condition.

You should check out Kaiser. I think their gig is better based off the offer you described above, especially when you include benefits.

 

[dfib slim]

You should check out Kaiser. I think their gig is better based off the offer you described above, especially when you include benefits.

I've spoken with someone at Kaiser and was offered 270 for 5 days a week. We've also hired 2 rheumatologists over from Kaiser last year.

 

[sloh]

I've spoken with someone at Kaiser and was offered 270 for 5 days a week. We've also hired 2 rheumatologists over from Kaiser last year.

Even after partnership?

 

[dozitgetchahi]

I've spoken with someone at Kaiser and was offered 270 for 5 days a week. We've also hired 2 rheumatologists over from Kaiser last year.

$270k for a full 5 days a week is 🗑️.

That’s what I was making at my first hospital job, where I was treated like garbage and vastly underpaid. I was seeing like 20-22 a day 5 days a week at the end. They were eating a ****load of productivity off me for the last year or so that I was there.

Straight RVU (even at a crap $44/RVU) that should yield something like $400k.

 

[sloh]

Just looked up a Rheumatology job offer from Kaiser in Downey, CA.

Rheumatologist - Downey​

Location: Downey, CA — Orchard MOB #C - 9449 Imperial Hwy #C​

Schedule: Full-Time​

Job number: 62940​

Maximum Salary: $359,559.00​

Minimum Salary: $312,583.00​