Salary growth in heme/onc

[Plutarch02]

Hello, I'm a current heme/onc fellow and I'll be interviewing for jobs in a couple of years.

I saw this article on CMS changes to fiscal year 2021 with estimated impacts on specialty salary.

https://www.acponline.org/system/files/documents/advocacy/where_we_stand/assets/acp_summary_of_2021_final_physician_fee_schedule_and_quality_payment_program_dec_2020.pdf

It looks like heme/onc was third highest beneficiary with an estimated salary growth of 14% in 2021. With all the new therapies, (mutation-directed therapies, immunotherapies, CAR-T cell/TCR etc) cancer patients are living longer than ever before and with a higher QOL, allowing to remain in outpatient setting longer. Combined with the fact that the baby boom generation is just now entering the age where cancer risk is highest it appears there's going to be a large population of patients with cancer as a chronic disease.

I suspect these two factors will drastically increase the demand for heme/onc,

How do salary increases happen in the private practice setting? For instance if you are a hospital employed heme/onc can you expect a 10-14% increase in your salary for this year?

Or would it better to try for a partnership track position if you expect reimbursements to increase over the next 5-10 years.

Do you agree with my analysis and think heme/onc will grow substantially?

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[whoknows2012]

Hello, I'm a current heme/onc fellow and I'll be interviewing for jobs in a couple of years.

I saw this article on CMS changes to fiscal year 2021 with estimated impacts on specialty salary.

https://www.acponline.org/system/files/documents/advocacy/where_we_stand/assets/acp_summary_of_2021_final_physician_fee_schedule_and_quality_payment_program_dec_2020.pdf

It looks like heme/onc was third highest beneficiary with an estimated salary growth of 14% in 2021. With all the new therapies, (mutation-directed therapies, immunotherapies, CAR-T cell/TCR etc) cancer patients are living longer than ever before and with a higher QOL, allowing to remain in outpatient setting longer. Combined with the fact that the baby boom generation is just now entering the age where cancer risk is highest it appears there's going to be a large population of patients with cancer as a chronic disease.

I suspect these two factors will drastically increase the demand for heme/onc,

How do salary increases happen in the private practice setting? For instance if you are a hospital employed heme/onc can you expect a 10-14% increase in your salary for this year?

Or would it better to try for a partnership track position if you expect reimbursements to increase over the next 5-10 years.

Do you agree with my analysis and think heme/onc will grow substantially?

Without getting too much into your specific questions, much of the answers you seek lie in areas that are quite unknown. Assuming things remained stable, then I would expect salaries to continue to grow nicely in heme/onc and as you mentioned, unfortunately, there will be no shortage of patients. Longer term this is less clear given greater potential (IMO) for changes to payment models. For now, especially in private practice, jobs are there and compensation is generous. Even in academics I feel things are better today than 5 years ago

 

[gutonc]

Hello, I'm a current heme/onc fellow and I'll be interviewing for jobs in a couple of years.

I saw this article on CMS changes to fiscal year 2021 with estimated impacts on specialty salary.

https://www.acponline.org/system/files/documents/advocacy/where_we_stand/assets/acp_summary_of_2021_final_physician_fee_schedule_and_quality_payment_program_dec_2020.pdf

It looks like heme/onc was third highest beneficiary with an estimated salary growth of 14% in 2021. With all the new therapies, (mutation-directed therapies, immunotherapies, CAR-T cell/TCR etc) cancer patients are living longer than ever before and with a higher QOL, allowing to remain in outpatient setting longer. Combined with the fact that the baby boom generation is just now entering the age where cancer risk is highest it appears there's going to be a large population of patients with cancer as a chronic disease.

I suspect these two factors will drastically increase the demand for heme/onc,

A lot to unpack and discuss here. And as @whoknows2012 pointed out, there are a lot of "unknown unknowns" going forward.

How do salary increases happen in the private practice setting? For instance if you are a hospital employed heme/onc can you expect a 10-14% increase in your salary for this year?

You're cute! If you think hospitals are going to just pass this money on to their salaried physicians, you're sorely mistaken. My take is that there might be less pushback on COL increases this year and next, but I wouldn't expect a wholesale salary bump of 10-20%. What you might see is, for physicians with a productivity component to their compensation, the change in CMS rules and coding will likely lead to increased wRVUs and increased productivity based "bonuses".

Or would it better to try for a partnership track position if you expect reimbursements to increase over the next 5-10 years.

Again, too hard to predict. But the upside potential is almost universally greater in a PP model that owns their own infusion. The bolded can not be emphasized enough. If you look at MGMA data, for Hem/Onc, 20-25% of that number is based on a share of infusion. If 100% of your compensation is based strictly on E/M, you're not getting anywhere near that without moving massive amounts of meat.

Do you agree with my analysis and think heme/onc will grow substantially?

As long as cards keeps the 2 pack a day smokers from dying of MIs in their 50s and Hepatology keeps the alcoholics with HepC from dying of ESLD, our numbers are only going to increase.

 

[aafisahar]

As long as cards keeps the 2 pack a day smokers from dying of MIs in their 50s

Fat people not wearing their CPAP are going to put my kids through college.

 

[Mehena]

Again, too hard to predict. But the upside potential is almost universally greater in a PP model that owns their own infusion. The bolded can not be emphasized enough. If you look at MGMA data, for Hem/Onc, 20-25% of that number is based on a share of infusion. If 100% of your compensation is based strictly on E/M, you're not getting anywhere near that without moving massive amounts of meat.

In that case there may be upside to pausing earlier job searches until we know the real impact in PP compensation.

 

[osprey099]

Along a slightly similar line, what time do fellows typically begin the job search and when should you have a job secured by (assuming you want to work right after fellowship ends)?

 

[whoknows2012]

Along a slightly similar line, what time do fellows typically begin the job search and when should you have a job secured by (assuming you want to work right after fellowship ends)?

Depends-for sure start preparing late 2nd year and plan to interview oct-feb 3rd year (though I’ve known fellows to get jobs as early as late 2nd yr and as late as may 3rd year. It does depend a bit on academics vs pp but most jobs are secured by the spring if not late winter

Prepare to do a lot of cold calling/emailing calling on your mentors to help reach out on your behalf in certain circumstances. It was far from an enjoyable process for me

 

[gutonc]

In that case there may be upside to pausing earlier job searches until we know the real impact in PP compensation.

Why? It's probably going to be a couple of years before everything shakes out. And it's not like a job that was offering $425k to start last year is suddenly going to bump it to $500, or drop it to $350. And every other gig out there is going to make some kind of change in the future.

My group has been planning a comp plan adjustment for almost a year and it's about to go into effect. For about half of the docs, projections showed it was going to be roughly neutral and the other half evenly split between a 15-20% pay cut (the very low performers) and a 20-40% increase (solid performers). I did a little back of the envelope math on 2 of our docs based on the new coding rules, one at each end of the spectrum, and those changes are now looking like 10-15% loss and 30-50% increase.

 

[osprey099]

Depends-for sure start preparing late 2nd year and plan to interview oct-feb 3rd year (though I’ve known fellows to get jobs as early as late 2nd yr and as late as may 3rd year. It does depend a bit on academics vs pp but most jobs are secured by the spring if not late winter

Prepare to do a lot of cold calling/emailing calling on your mentors to help reach out on your behalf in certain circumstances. It was far from an enjoyable process for me

I’m looking at private practice jobs. Wow, it sounds like pp h/o jobs are a lot about connections and networking. That’s pretty different from getting Hospitalist jobs where you can just show up anywhere and start working.

 

[whoknows2012]

I’m looking at private practice jobs. Wow, it sounds like pp h/o jobs are a lot about connections and networking. That’s pretty different from getting Hospitalist jobs where you can just show up anywhere and start working.

I actually meant (and sorry if this was confusing) that academic jobs were more about networking. PP is all about need. There was no shortage of pp jobs in NYC metro area (including city itself) when I was looking this year and from my understanding the job market is quite strong for pp h/o at the moment

 

[gritsngravy]

Depends-for sure start preparing late 2nd year and plan to interview oct-feb 3rd year (though I’ve known fellows to get jobs as early as late 2nd yr and as late as may 3rd year. It does depend a bit on academics vs pp but most jobs are secured by the spring if not late winter

Prepare to do a lot of cold calling/emailing calling on your mentors to help reach out on your behalf in certain circumstances. It was far from an enjoyable process for me

Would end of first year/early second year be ridiculously too early? Feel silly even typing that, I know, but we are really looking at one area and one area only given family situation. I did not match at our #1 which would have put us there, so the goal from day 1 is to head back. Absolutely not looking at academics, more hybrid or PP.

 

[gutonc]

Would end of first year/early second year be ridiculously too early? Feel silly even typing that, I know, but we are really looking at one area and one area only given family situation. I did not match at our #1 which would have put us there, so the goal from day 1 is to head back. Absolutely not looking at academics, more hybrid or PP.

It's definitely early, but I usually get 1-2 CVs a year from 2nd year fellows so not completely outside the normal range. I would say it's not a bad time to be making contacts and just letting people know you're interested. They're probably not going to know what their needs are in 2 years, but if I have a couple of CVs to pull from and can avoid spending the time and money to advertise, that's a bonus for me as the person doing the recruiting.

 

[gritsngravy]

It's definitely early, but I usually get 1-2 CVs a year from 2nd year fellows so not completely outside the normal range. I would say it's not a bad time to be making contacts and just letting people know you're interested. They're probably not going to know what their needs are in 2 years, but if I have a couple of CVs to pull from and can avoid spending the time and money to advertise, that's a bonus for me as the person doing the recruiting.

Very helpful, thank you!

 

[IMres85]

Would end of first year/early second year be ridiculously too early? Feel silly even typing that, I know, but we are really looking at one area and one area only given family situation. I did not match at our #1 which would have put us there, so the goal from day 1 is to head back. Absolutely not looking at academics, more hybrid or PP.

senior fellow here. I’m a typical “pro-crastinator” - started interviewing early in second year and signed my contract midway through second year (southeast) for a private practice group. Personally I think mid second year was the perfect time to look. (Granted I got extremely lucky as my very last interview came one week before Covid spread like wildfire halting many interviews)

 

[littlecow]

How far below MGMA medians are academic H/O salaries gonna be?

I was seeing numbers like 170-220k in coastal cities which is less than some nurses make...

 

[gutonc]

How far below MGMA medians are academic H/O salaries gonna be?

I was seeing numbers like 170-220k in coastal cities which is less than some nurses make...

Way below. Academics use the AAMC scale, not MGMA.

Also, ROFL at the "less than some nurses make" comment. Are there people in administrative positions with RN degrees (and probably MBAs and PhDs) making $200K? yes. Are floor RNs, even the ones chasing that sweet COVID cash, making $200K? No.

 

[whoknows2012]

How far below MGMA medians are academic H/O salaries gonna be?

I was seeing numbers like 170-220k in coastal cities which is less than some nurses make...

Nyc centric 220-250. Hopkins and farber are worse

 

[gutonc]

Nyc centric 220-250. Hopkins and farber are worse

Farber is a joke. F*** those guys.

 

[littlecow]

Nyc centric 220-250. Hopkins and farber are worse

California academic centers are worse then?

 

[whoknows2012]

California academic centers are worse then?

Idk you tell me? I can only speak about east coast

 

[gritsngravy]

senior fellow here. I’m a typical “pro-crastinator” - started interviewing early in second year and signed my contract midway through second year (southeast) for a private practice group. Personally I think mid second year was the perfect time to look. (Granted I got extremely lucky as my very last interview came one week before Covid spread like wildfire halting many interviews)

This is good to know, thank you. I was going to DM you, but figured I would just ask for others to see if they have similar questions later.

How did you go about finding these places to interview. Seems outrageous to ask how to find a job, but I guess the Match "spoils" us in that way and I have no idea. Cold calls/emails? Recruiter? Friend of a friend? Like I mentioned above, I definitely know the region so that part is done, but no clue where to start after that step!

 

[gutonc]

This is good to know, thank you. I was going to DM you, but figured I would just ask for others to see if they have similar questions later.

How did you go about finding these places to interview. Seems outrageous to ask how to find a job, but I guess the Match "spoils" us in that way and I have no idea. Cold calls/emails? Recruiter? Friend of a friend? Like I mentioned above, I definitely know the region so that part is done, but no clue where to start after that step!

All of the above. Except maybe stay away from 3rd party recruiters if you can. But that’s not a universal truth either.

As someone who hires oncologists, I have hired people who came to me through every one of those avenues.

 

[IMres85]

This is good to know, thank you. I was going to DM you, but figured I would just ask for others to see if they have similar questions later.

How did you go about finding these places to interview. Seems outrageous to ask how to find a job, but I guess the Match "spoils" us in that way and I have no idea. Cold calls/emails? Recruiter? Friend of a friend? Like I mentioned above, I definitely know the region so that part is done, but no clue where to start after that step!

For me, it was networking - I didn't like dealing with recruiters particularly as I feel like they have their own interests in mind (may prefer one practice over another that may not be best for you - this was from direct first hand experience that actually happened). I am fortunate that in my state there are only two hem/onc programs and everybody knows everybody essentially so my attending were able to help me out greatly in setting up interviews in area of interest. Though I also didn't look outside of my state.

Echo what gutonc said, exhausting resources is never wrong in my opinion.

 

[Splenda88]

Way below. Academics use the AAMC scale, not MGMA.

Also, ROFL at the "less than some nurses make" comment. Are there people in administrative positions with RN degrees (and probably MBAs and PhDs) making $200K? yes. Are floor RNs, even the ones chasing that sweet COVID cash, making $200K? No.

One of my RN friends is making 10k/week in TX, but she is working 6 12 hrs/wk...

 

[gutonc]

One of my RN friends is making 10k/week in TX, but she is working 6 12 hrs/wk...

Well sure, if you work 2 jobs you can make that kind of money. But if you had 2 FT hospitalist jobs you'd make $500K too. That sounds like a horrifying way to make that kind of money though.