Rural ENT

Started by kilroth
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kilroth

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Hey everyone,
I'm an Otolaryngology resident beginning the job search and have received an interesting offer from my home town. I don't know all of the details yet because this just happened and I don't have a contract in hand.

I'm from a small rural town in the midwest, population ~5k. I finished med school with ~215k in debt and have no idea how high it is now. The hospital back home has one general surgeon and a part-time ENT that comes in once a week or so from a larger town. He's close to retirement.

The offer I got was full repayment of school loans, $1500 a month stipend while in residency, my own suite in an $8 million dollar clinic they are building, and a salary starting around the 75% percentile for ENTs in the area. They didn't have a figure for me yet but will give me a quote once I signal I'm interested. I was told every doctor at the hospital is greater than the 75% percentile (this was all from the CEO by the way). After two years, I would then start getting quarterly bonuses based on RVUs. She said some of the docs who are hard workers make an extra 30K. Briefly, she said there would be full benefits (no deductibles on health insurance, 6 wks vacation plus time for CME activities, etc).

I would be the only ENT at the hospital so I have to clarify some more information on call, etc. I like the idea of doing my own thing with little competition, but never really considered such a rural job. I'm from the rural area but my wife is from the city, so any advice you could offer would be great.

Have you heard of many other offers like this? I've only heard of loan repayments for primary care up until now.
 
kilroth said:
Hey everyone,
I'm an Otolaryngology resident beginning the job search and have received an interesting offer from my home town. I don't know all of the details yet because this just happened and I don't have a contract in hand.

I'm from a small rural town in the midwest, population ~5k. I finished med school with ~215k in debt and have no idea how high it is now. The hospital back home has one general surgeon and a part-time ENT that comes in once a week or so from a larger town. He's close to retirement.

The offer I got was full repayment of school loans, $1500 a month stipend while in residency, my own suite in an $8 million dollar clinic they are building, and a salary starting around the 75% percentile for ENTs in the area. They didn't have a figure for me yet but will give me a quote once I signal I'm interested. I was told every doctor at the hospital is greater than the 75% percentile (this was all from the CEO by the way). After two years, I would then start getting quarterly bonuses based on RVUs. She said some of the docs who are hard workers make an extra 30K. Briefly, she said there would be full benefits (no deductibles on health insurance, 6 wks vacation plus time for CME activities, etc).

I would be the only ENT at the hospital so I have to clarify some more information on call, etc. I like the idea of doing my own thing with little competition, but never really considered such a rural job. I'm from the rural area but my wife is from the city, so any advice you could offer would be great.

Have you heard of many other offers like this? I've only heard of loan repayments for primary care up until now.
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First, a CEO is a recruiter before anything else--as far as you are concerned at this point. She will say what she needs to entice you in.

Second, this sounds like a salaried position. That has it advantages and disadvantages. If you are very hard working and just bill like crazy, you will be losing money to the hospital. If you get a production bonus, you can be sure the hospital is taking the majority of it. Most production bonuses are less than 50% of the revenue. If you work adequately, you will probably be in good shape. If you're lazy, this will be wonderful for you.

Third, as a rural ENT you need to have some kind of backup. What do you do with the total laryngectomy patient. You can probably handle it yourself, at least from the ENT POV. But is that best for the pt. Can they get adequate chemorads? Will you be able to have a tumor board to help you out? Same for trauma, airways, etc. Do you have the use of an ICU?

Fourth, an ENT needs a draw of about 35K to stay busy. You're in a town of 5k. Is the referring region able to provide the additional 25-30k? If not, you'll be pretty slow.

Fifth, if you're employed, definitely consider your non-compete clause, severance packages in case the hospital thinks you're not working out, insurance (not just malpractice)? Do you choose who/when/why to hire and fire for your staff? What if you want out after a year because it just sucks? Do you have to pay off what they gave? How long do you have to stay for there not to be a pay off to walk away and go somewhere else?

Lots of questions you need to learn before you can decide if this is right for you.
 
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