Thoughts on job offer?

[bigboyonc]

Thoughts on job offer?
Hospital employed
Midwest
J1 visa so waiver needed.
Heme/onc though likely more onc and benign heme
3 year contract.
500k base for 5000 RVU
$98/RVU above 5000
50k sign on
4.5 days/week
~15-17 pts/day
Call 1:5 (clinic in mornings and then hospital in afternoon - with NP there full time M-F. Weekends are solo)
EPIC
30 days vacation, holidays, etc
5 days CME, $5000

Thoughts?

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[CatFactorial]

Sounds like a ton of money for a ton of work

 

[bigboyonc]

Sounds like a ton of money for a ton of work

You think so?

I actually didn’t… it’s 1/2 day more than I’d want but other than that, not terrible compared to other numbers I’ve seen for rural places (and not academic jobs).

 

[HOIV]

Thoughts on job offer?
Hospital employed
Midwest
J1 visa so waiver needed.
Heme/onc though likely more onc and benign heme
3 year contract.
500k base for 5000 RVU
$98/RVU above 5000
50k sign on
4.5 days/week
~15-17 pts/day
Call 1:5 (clinic in mornings and then hospital in afternoon - with NP there full time M-F. Weekends are solo)
EPIC
30 days vacation, holidays, etc
5 days CME, $6000

Thoughts?

Decent.

Honestly 5,000 rvus is easy to hit. Seeing only 15-17 a day isn’t going to net you much of a bonus. The job sounds pretty average. Average money. Average rvu rate. Sign on good. Call average. Hopefully you don’t admit. 30 days is pretty good time off.

For reference we are 115/rvu production but with expenses closer to 100 take home. Need to know what expenses look like for take home pay. Also is incident to supported? Does your group pay the NPs?

 

[bigboyonc]

They do admit AML but ALL/BMT get transferred (and obviously some aggressive lymphoma and inpatient chemo) but mostly consult service. There’s a dedicated NP for inpatient M-F. It’s an employed position so I don’t think any of the overhead would impact me. Please correct me if I’m misunderstanding it. This is all new for me.

The woman did preemptively say if I find these numbers to be low, to let her know a counter and she can take it to her bosses. Just wondering what to push on and how much? I’m thinking I’d rather increase the base a lot more rather than RVU, because you’re right, I won’t get to much >5000 and definitely not anytime soon.

 

[sallyhasanidea]

They do admit AML but ALL/BMT get transferred (and obviously some aggressive lymphoma and inpatient chemo) but mostly consult service. There’s a dedicated NP for inpatient M-F. It’s an employed position so I don’t think any of the overhead would impact me. Please correct me if I’m misunderstanding it. This is all new for me.

The woman did preemptively say if I find these numbers to be low, to let her know a counter and she can take it to her bosses. Just wondering what to push on and how much? I’m thinking I’d rather increase the base a lot more rather than RVU, because you’re right, I won’t get to much >5000 and definitely not anytime soon.

Why do you think you won’t get to 5000?

Assuming avg 2.5 RVUs/visit 99214/5 mostly (correct me if this average RVU wrong) 5000/2.5= 2000 patient encounters / 15 = 133 days... that’s like 4 months only but including weekends ... 133/4.5 = 29 weeks you would have half the year to pump your rvu over 5000?

 

[CatFactorial]

You think so?

I actually didn’t… it’s 1/2 day more than I’d want but other than that, not terrible compared to other numbers I’ve seen for rural places (and not academic jobs).

Actually I have no idea what I am talking about, I am transplant/cell therapy and don’t know standard RVU targets. Would listen to others on this thread, if the location is good May be a good gig

 

[HemeOncHopeful19]

The words “MOSTLY consult service” in combination with “weekends are solo” gives me pause to be honest but I don’t know maybe that is typical.

 

[Mehena]

I am transplant/cell therapy

If a transplanter says it's a ton of work then it's probably a ton

Seriously for the OP, on the surface this sound like a descent offer and you can only decide if this is a perfect match given your circumstances including but not limited to immigration status etc. Clinical practice is a marathon not sprint and think your overall happiness and longevity within the future institution, interactions with future colleagues and inclusivity within the community at large (especillay if you have spouse and kids & of a minority: happy wife, happy life). It seems you already have made up your mind but you can't go too wrong since oncology is a sellers market now.

 

[Mehena]

The words “MOSTLY consult service” in combination with “weekends are solo” gives me pause to be honest but I don’t know maybe that is typical.

OP please do explain. But the way i read it is that there'll be a 'doctor of the day' scenario where each doctor every 5 days goes inpatient in the afternoon to round with NP and cosign the notes.

 

[bigboyonc]

Thank you for the input.
The call is 1 in 5 weeks so you’ll be in clinic in the morning and then round in the hospital in the afternoon. The NP rounds on the patients and does the notes and then you round with the NP (so basically like a fellow). There isn’t a primary onc service but I think if the patient is admitted for like 7+3, RCHOP, etc., then they take primary ownership.

By weekends are solo, I meant the NP isn’t there to round and do notes on the weekend, so you would have to see new consults or follow ups on the weekend independently.

The location is decent. I’m single so have more flexibility. But being a J1 waiver job, it’s pretty good from a location/amenities perspective — from what I’ve seen.

Just wondering what peoples thoughts were on the compensation, RVU, etc. I plan to negotiate for more because I don’t think that’s even at 50%ile for the Midwest, but didn’t know if I should push more for increase base or RVU? Or something else? This is all pretty new.

 

[HOIV]

I do 1000-1200 rvus per month. That’s about 180 patients a week plus consults inpatient.

Depends on the rvu scale for 2020 or 2021. We took a higher rate and kept the 2020 values of:

Follow up
2.11 rvu for level 5
1.5 for level 4
0.96 level 3

3.17 new 5
2.42 new 4

Hospital follow ups are 3.86 IHC3 and 2.6 or so IHC2. Rare that insurances cover the prior consult codes outpatient or inpatient.

Hospital follow ups are 1.39 for level 2 and 2 for level 3.

That will help your math.

If you’re only seeing 15 a day you have to assume most are new up front but you get a lot of heme upfront. You may hit 6,000 but you aren’t going to kill it at 15 a day.

Getting a higher base and building your practice how you want to over time would be my recommendation. Hustling up front is important though to build a reputation so sometimes your guarantee becomes laughable because you get so busy so fast you’re over it.

That has been the case with our last two motivated partners.

Hope this helps.

 

[bigboyonc]

That is helpful, thank you. WOW - that’s a very busy practice.

It sounds like I should ask for an increase in the base by 15% rather than increasing the RVU by 15%?

For a three year contract, has anyone negotiated an increase by x amount in the third year? (Presumably you should be at full census by the third year)

Thanks for any input.

 

[sallyhasanidea]

I do 1000-1200 rvus per month. That’s about 180 patients a week plus consults inpatient.

Depends on the rvu scale for 2020 or 2021. We took a higher rate and kept the 2020 values of:

Follow up
2.11 rvu for level 5
1.5 for level 4
0.96 level 3

3.17 new 5
2.42 new 4

Hospital follow ups are 3.86 IHC3 and 2.6 or so IHC2. Rare that insurances cover the prior consult codes outpatient or inpatient.

Hospital follow ups are 1.39 for level 2 and 2 for level 3.

That will help your math.

If you’re only seeing 15 a day you have to assume most are new up front but you get a lot of heme upfront. You may hit 6,000 but you aren’t going to kill it at 15 a day.

Getting a higher base and building your practice how you want to over time would be my recommendation. Hustling up front is important though to build a reputation so sometimes your guarantee becomes laughable because you get so busy so fast you’re over it.

That has been the case with our last two motivated partners.

Hope this helps.

Wow you’re busy, working 5 days a week that’s 36 patients a day? How? This includes NP supervision?

With 12k+ rvu/year are you netting 1.2M a year? What part of country is this? How can we become this busy?

 

[HOIV]

Wow you’re busy, working 5 days a week that’s 36 patients a day? How? This includes NP supervision?

With 12k+ rvu/year are you netting 1.2M a year? What part of country is this? How can we become this busy?

Some NP supervision.

Paying your NPs is paramount to allowing certain types of billing. I work 4.75 days a week. Fridays til 2.

Netting 1.2…not after Uncle Sam. Grossing that.

Southeast.

You work hard. There is a point of diminishing returns. I’m over that but I enjoy what I do. You have to learn how to balance schedules and how to deal with needier patients. I schedule them at times where I can start seeing them a little early or right before lunch or right after lunch so I can start early there. If you get ahead great. If not you can catch up on easier treatment patients…keytruda etc or heme patients.

It takes effort to balance the schedule to allow seeing that many people so it’s work on top of work. Having good NP support is paramount for TLC.

Shooting for a salary threshold is not a recipe for happiness. You have to see patients you enjoy. See things you are good at. Try to have a niche if possible. Map things out for patients honestly and compassionately so they understand upfront. Clear goals of care make treatment more realistic and outcomes less surprising. The sequence of response and progression becomes more linear for patients. I never walk out of a room without asking patients for questions. I run late sometimes. Mostly though I don’t. Divide difficult patients on different days.

Everything about practicing takes work. You need to train your nurses and MAs to know what you need. Make sure your employer or practice has enough help. Paying an extra nurse or Ma to do clerical stuff (NGS, PA’s) etc without their constantly having to ask for help makes life so much better in the lung run.

Don’t expect palliative care to do your difficult discussions but know who needs their extra TLC along the way.

Surround yourself with good partners who will be a good ear.

Realize early that guidelines are guides and that your gut is important but that inexperience shouldn’t lead to fear. Ask your older more experienced partners for advice often. Regimens you perceive as “hard” as a fellow because you haven’t written for much shouldn’t become things you avoid. Become comfortable with all the drugs and preemptively give meds for diarrhea etc and take the time to explain when to use and what to expect. It saves phone calls and admissions later. Have formal NP educations/chemo teachings about when to call and side effects to really expect. All of these things set you up for success to focus on the patient in front of you in the room and not the million other things going on.

See your patients frequently. It avoids smaller problems from becoming larger and they feel cared for. Be aggressive with fluids and day 3 supportive meds for pumps (folfox, folfiri etc).

 

[HOIV]

That is helpful, thank you. WOW - that’s a very busy practice.

It sounds like I should ask for an increase in the base by 15% rather than increasing the RVU by 15%?

For a three year contract, has anyone negotiated an increase by x amount in the third year? (Presumably you should be at full census by the third year)

Thanks for any input.

Up the guarantee ask but make it even over three years. Don’t ask for 25/25/50. Ask for 33/33/33. Explain that you expect to be over guarantee by then so it shouldn’t hurt them if a reasonable ask. the guarantee is more important upfront because once over the guarantee you aren’t actually getting extra guaranteed money, you are earning it.

Make sure your rvu rate is commensurate with others unless they get a higher rate to pay practice overhead. This should be transparent up front.

 

[bigboyonc]

Up the guarantee ask but make it even over three years. Don’t ask for 25/25/50. Ask for 33/33/33. Explain that you expect to be over guarantee by then so it shouldn’t hurt them if a reasonable ask. the guarantee is more important upfront because once over the guarantee you aren’t actually getting extra guaranteed money, you are earning it.

Make sure your rvu rate is commensurate with others unless they get a higher rate to pay practice overhead. This should be transparent up front.

Sorry I don’t follow… what’s 25/25/50 vs 33/33/33? Do you mean increase in base pay K per year?

I was thinking more like asking for 50-75k more per year? I heard somewhere that as a rule, to ask for 10-15% more than what you’re offered.

 

[HOIV]

Sorry I don’t follow… what’s 25/25/50 vs 33/33/33? Do you mean increase in base pay K per year?

I was thinking more like asking for 50-75k more per year? I heard somewhere that as a rule, to ask for 10-15% more than what you’re offered.

I meant if you are asking for an increase have it even over three years as opposed to escalating the last year. I may have misunderstood your prior post. If you were going to ask for 100K extra total, tack 33 to each year as opposed to asking for 25, 25 then 50K.

 

[sallyhasanidea]

Some NP supervision.

Paying your NPs is paramount to allowing certain types of billing. I work 4.75 days a week. Fridays til 2.

Netting 1.2…not after Uncle Sam. Grossing that.

Southeast.

You work hard. There is a point of diminishing returns. I’m over that but I enjoy what I do. You have to learn how to balance schedules and how to deal with needier patients. I schedule them at times where I can start seeing them a little early or right before lunch or right after lunch so I can start early there. If you get ahead great. If not you can catch up on easier treatment patients…keytruda etc or heme patients.

It takes effort to balance the schedule to allow seeing that many people so it’s work on top of work. Having good NP support is paramount for TLC.

Shooting for a salary threshold is not a recipe for happiness. You have to see patients you enjoy. See things you are good at. Try to have a niche if possible. Map things out for patients honestly and compassionately so they understand upfront. Clear goals of care make treatment more realistic and outcomes less surprising. The sequence of response and progression becomes more linear for patients. I never walk out of a room without asking patients for questions. I run late sometimes. Mostly though I don’t. Divide difficult patients on different days.

Everything about practicing takes work. You need to train your nurses and MAs to know what you need. Make sure your employer or practice has enough help. Paying an extra nurse or Ma to do clerical stuff (NGS, PA’s) etc without their constantly having to ask for help makes life so much better in the lung run.

Don’t expect palliative care to do your difficult discussions but know who needs their extra TLC along the way.

Surround yourself with good partners who will be a good ear.

Realize early that guidelines are guides and that your gut is important but that inexperience shouldn’t lead to fear. Ask your older more experienced partners for advice often. Regimens you perceive as “hard” as a fellow because you haven’t written for much shouldn’t become things you avoid. Become comfortable with all the drugs and preemptively give meds for diarrhea etc and take the time to explain when to use and what to expect. It saves phone calls and admissions later. Have formal NP educations/chemo teachings about when to call and side effects to really expect. All of these things set you up for success to focus on the patient in front of you in the room and not the million other things going on.

See your patients frequently. It avoids smaller problems from becoming larger and they feel cared for. Be aggressive with fluids and day 3 supportive meds for pumps (folfox, folfiri etc).

Very helpful post!

When you say you gross 1.2M this means before tax your take home is 1.2M?

How common are salaries like this in onc? If we want to work hard are 1M+ salaries like this reasonably attainable?

 

[HOIV]

Very helpful post!

When you say you gross 1.2M this means before tax your take home is 1.2M?

How common are salaries like this in onc? If we want to work hard are 1M+ salaries like this reasonably attainable?

I think the rvu rates most places present the possibility to get to this level of comp. it depends on the need of the community onc wise. If the market is saturdated even at a good rvu rate if you can’t get enough patients you won’t bring that in. Communities with a need will have good rates combined with volume. You probably won’t make this in a huge city like NY or SF.

I think crossing the million dollar mark is a diminishing return. From the effort it takes to get there and the taxes you pay it’s not the best gain.

My partners who make 800K have a great work life balance. They are also further along in their careers so just take referrals from who they want to in one or two disease sites.

When younger turning off referral sources is riskier so you often pay for it by seeing more. Referrals aren’t a kitchen sink where you can get a tiny stream of water; rather, they are a fire hose a lot of times and either on or off.

 

[HemeOncHopeful19]

Very helpful post!

When you say you gross 1.2M this means before tax your take home is 1.2M?

How common are salaries like this in onc? If we want to work hard are 1M+ salaries like this reasonably attainable?

I’ve heard it is available in private practice which is becoming harder and harder to find.

Most employed places will find a way to keep you lower unless you’re in an area that is hard to recruit for like HOIV.

 

[bigboyonc]

Any tips on what would be a reasonable ask in terms of negotiating this contract?

Also, they say patient load is probably closer to 20 per day, but I figured it’d be closer to 15-17 for the first couple of years.

 

[CatFactorial]

I found contract diagnostics helpful in reviewing my offer

They didn’t have much to suggest as far as negotiating a fairly standard offer but it was helpful having all the MGMA data in that I didn’t feel like I was overtly being screwed by signing

 

[bigboyonc]

Thanks @CatFactorial.
Any other advice on how much to negotiate?

 

[gutonc]

Thoughts on job offer?
Hospital employed
Midwest
J1 visa so waiver needed.
Heme/onc though likely more onc and benign heme
3 year contract.
500k base for 5000 RVU
$98/RVU above 5000
50k sign on
4.5 days/week
~15-17 pts/day
Call 1:5 (clinic in mornings and then hospital in afternoon - with NP there full time M-F. Weekends are solo)
EPIC
30 days vacation, holidays, etc
5 days CME, $6000

Thoughts?

Overall I think it looks pretty good. More work (4.5 clinic days, 1:5 call) than I'm interested in, but you do you boo.

Average oncology patient is 2.4 wRVU. Figure you can ramp up to 18 pts/d in a year, for a 4.5d work week, you're looking at 190-195 wRVU/wk. At 45 weeks of work a year, that's >8500 wRVU/y. So you're looking at a productivity bonus in the $350K/y range. You should be able to make your base with 10-ish patients/d.

If you're going to ask for something, I'd honestly ask for more $/wRVU in the productivity bonus side.

 

[HOIV]

Overall I think it looks pretty good. More work (4.5 clinic days, 1:5 call) than I'm interested in, but you do you boo.

Average oncology patient is 2.4 wRVU. Figure you can ramp up to 18 pts/d in a year, for a 4.5d work week, you're looking at 190-195 wRVU/wk. At 45 weeks of work a year, that's >8500 wRVU/y. So you're looking at a productivity bonus in the $350K/y range. You should be able to make your base with 10-ish patients/d.

If you're going to ask for something, I'd honestly ask for more $/wRVU in the productivity bonus side.

How are you figuring the average onc patient is 2.4. Are you including chemo administration in rvus. 2021 scale? Level 5 fu as of 2020 2.11 rvus.

Just curious how you’re getting that figure. Is that including new patients?

 

[gutonc]

How are you figuring the average onc patient is 2.4. Are you including chemo administration in rvus. 2021 scale? Level 5 fu as of 2020 2.11 rvus.

Just curious how you’re getting that figure. Is that including new patients?

That's just E&M coding, not chemo admin or other stuff. Based on 2021 codes, the most recent MGMA data (or it might have been AGMA) had 2.4 as the median for oncology. It obviously depends on your mix of patients, problems and how well you code.

Even assuming 2.0 avg wRVU it's still ~$725K total a year.

It honestly doesn't really matter what number you pick when you're comparing jobs, as long as you use the same number to compare.

A similar job (assume same patient numbers) with a lower base (let's say $450K) but a higher wRVU over target (let's say $110) maps out more or less the same with each assumption. Just pick a number to use as a comparator.

And to the OP, my advice doesn't change about this job. Can we quibble about numbers? Sure. Will you make a metric f***ton of money at this job if you even kind of hustle? Absolutely.

 

[HOIV]

That's just E&M coding, not chemo admin or other stuff. Based on 2021 codes, the most recent MGMA data (or it might have been AGMA) had 2.4 as the median for oncology. It obviously depends on your mix of patients, problems and how well you code.

Even assuming 2.0 avg wRVU it's still ~$725K total a year.

It honestly doesn't really matter what number you pick when you're comparing jobs, as long as you use the same number to compare.

A similar job (assume same patient numbers) with a lower base (let's say $450K) but a higher wRVU over target (let's say $110) maps out more or less the same with each assumption. Just pick a number to use as a comparator.

And to the OP, my advice doesn't change about this job. Can we quibble about numbers? Sure. Will you make a metric f***ton of money at this job if you even kind of hustle? Absolutely.

Totally agree. Was not arguing was just curious. We kept 2020 numbers for “FMV” sake at a higher wRVU rate.

 

[gutonc]

Totally agree. Was not arguing was just curious. We kept 2020 numbers for “FMV” sake at a higher wRVU rate.

How long are you all going to keep that?

 

[HOIV]

How long are you all going to keep that?

We have a market readjustment FMV check clause every 2 years. My experience has been they simply give you a % raise. We had just gone through all of that and for ease signed our initial psa without reinventing the wheel with the standard re-look clause.

Our contract is nice in that our wRVU payment is our floor. We have an ability to share in upside of the machine’s success by guaranteeing we get a percentage of EBPC. We get the higher of the two.

 

[HemeOncHopeful19]

We have a market readjustment FMV check clause every 2 years. My experience has been they simply give you a % raise. We had just gone through all of that and for ease signed our initial psa without reinventing the wheel with the standard re-look clause.

Our contract is nice in that our wRVU payment is our floor. We have an ability to share in upside of the machine’s success by guaranteeing we get a percentage of EBPC. We get the higher of the two.

 

[sallyhasanidea]

Decent.

Honestly 5,000 rvus is easy to hit. Seeing only 15-17 a day isn’t going to net you much of a bonus. The job sounds pretty average. Average money. Average rvu rate. Sign on good. Call average. Hopefully you don’t admit. 30 days is pretty good time off.

For reference we are 115/rvu production but with expenses closer to 100 take home. Need to know what expenses look like for take home pay. Also is incident to supported? Does your group pay the NPs?

What state do you live in? Metro area? Rural? Are jobs like yours readily available? Do you think that will be the case in 3 years as well?

 

[HemeOncHopeful19]

What state do you live in? Metro area? Rural? Are jobs like yours readily available? Do you think that will be the case in 3 years as well?

That kind of money is available in metro areas IF you can get into a private practice. For hospital employed you will need to find a place that is hard to recruit for.

Remember just because the hospital suit is paying you less it doesn’t save the patients a dime of their money. Even the “average” Oncologist is generating enough revenue to earn 600-800k+ but the suits don’t want you to understand that.

 

[HOIV]

What state do you live in? Metro area? Rural? Are jobs like yours readily available? Do you think that will be the case in 3 years as well?

Southeast moderately large city. Private practice psa without chemo revenue. Yes this will be available for the foreseeable future.

 

[bigboyonc]

Southeast moderately large city. Private practice psa without chemo revenue. Yes this will be available for the foreseeable future.

What do you mean by chemo revenue?

 

[gutonc]

What do you mean by chemo revenue?

Some PP jobs also split profit from buy and bill chemo with partners. Others just roll it in to the base or production pay.

 

[HOIV]

What do you mean by chemo revenue?

We don’t buy and bill drug. There’s revenue in that but also risk. We negotiated a production rate and stay out of buying and billing. If the buyer doesn’t get paid it doesn’t affect us. We work to make sure we have all auths etc and really work hand in hand. We probably give up some upside for a safety net which at the level of income achievable in my opinion is well worth it.

 

[bigboyonc]

Has anyone negotiated an increased stipend if call frequency increases?
The contract currently states that call will be divided evenly between all physicians. (It would be 1 in 6 currently)

I want it to say:

It will be divided evenly between all physicians, with no more frequent than one week every 5 weeks. Each additional call week that is more frequent than 1 in every 5 weeks would be $7000 for the week.



Additionally, has anyone negotiated pay for supervising midlevels? My contract states my productivity bonus is "for work personally performed by Physician" but I will eventually have a NP that works with me, that I would have to supervise. Shouldn't a portion of my productivity bonus be adjusted for their wRVU? If so you have this, what verbiage would you use?

Thanks

 

[bigboyonc]

Any thoughts?

Has anyone negotiated an increased stipend if call frequency increases?
The contract currently states that call will be divided evenly between all physicians. (It would be 1 in 6 currently)

I want it to say:

It will be divided evenly between all physicians, with no more frequent than one week every 5 weeks. Each additional call week that is more frequent than 1 in every 5 weeks would be $7000 for the week.



Additionally, has anyone negotiated pay for supervising midlevels? My contract states my productivity bonus is "for work personally performed by Physician" but I will eventually have a NP that works with me, that I would have to supervise. Shouldn't a portion of my productivity bonus be adjusted for their wRVU? If so you have this, what verbiage would you use?

Thanks

 

[HOIV]

Has anyone negotiated an increased stipend if call frequency increases?
The contract currently states that call will be divided evenly between all physicians. (It would be 1 in 6 currently)

I want it to say:

It will be divided evenly between all physicians, with no more frequent than one week every 5 weeks. Each additional call week that is more frequent than 1 in every 5 weeks would be $7000 for the week.



Additionally, has anyone negotiated pay for supervising midlevels? My contract states my productivity bonus is "for work personally performed by Physician" but I will eventually have a NP that works with me, that I would have to supervise. Shouldn't a portion of my productivity bonus be adjusted for their wRVU? If so you have this, what verbiage would you use?

Thanks

Private practice or hospital based.

If PP no way the call gets worked out. Would never fly in my group. We take even call. If three people quit or retire you split it until you get other people. If hospital based I could see negotiating something.

For the second piece if PP you should get some credit. Your statement personally performed makes me confident this is a hospital system. Their clause negatively impacts productivity because what incentive do you have to keep accumulating patients you are responsible for without revenue for directing their care. This is the hospital way. We negotiated rvu reimbursement with our psa to increase physician wrvu if they weren’t going to give us credit for the NP visits.

 

[bigboyonc]

Private practice or hospital based.

If PP no way the call gets worked out. Would never fly in my group. We take even call. If three people quit or retire you split it until you get other people. If hospital based I could see negotiating something.

For the second piece if PP you should get some credit. Your statement personally performed makes me confident this is a hospital system. Their clause negatively impacts productivity because what incentive do you have to keep accumulating patients you are responsible for without revenue for directing their care. This is the hospital way. We negotiated rvu reimbursement with our psa to increase physician wrvu if they weren’t going to give us credit for the NP visits.

Thanks for the response. It’s hospital-employed.

So if the call frequency does increase, is it reasonable to request additional compensation for being on call?

I have no idea what is “reasonable” so I was thinking $7000/week, but I just made that number up?

RE: mid levels - that’s what I was thinking. It takes up your time, your liability…. that’s why I feel it would reasonable to have some compensation for shared appts.

 

[HemeOncHopeful19]

Thanks for the response. It’s hospital-employed.

So if the call frequency does increase, is it reasonable to request additional compensation for being on call?

I have no idea what is “reasonable” so I was thinking $7000/week, but I just made that number up?

RE: mid levels - that’s what I was thinking. It takes up your time, your liability…. that’s why I feel it would reasonable to have some compensation for shared appts.

I doubt (but could be wrong) that an employer is going to give you an extra call stipend in case someone leaves. It just seems too unpredictable from their perspective that if 2 docs leave they will be scrambling to hire new people and paying you extra on top of it.

You might have a better case on the midlevel supervision but at the same time if you can send all your 99213s to the NP and keep your clinic heavier in 99214/5s then you could technically be making more that way.

 

[HOIV]

I doubt (but could be wrong) that an employer is going to give you an extra call stipend in case someone leaves. It just seems too unpredictable from their perspective that if 2 docs leave they will be scrambling to hire new people and paying you extra on top of it.

You might have a better case on the midlevel supervision but at the same time if you can send all your 99213s to the NP and keep your clinic heavier in 99214/5s then you could technically be making more that way.

The hospital I was formally working at with a psa is now paying their employer docs $1500/night to take call. That was to keep them from leaving to come work in our group. When you are productive you wouldn’t dream of taking call for that amount. Less call is better.

The idea that NPs and extenders are able to do this on their own is wild and thus the idea that there is no money for the physician supervising is egregious. Stick to your guns on that. I wouldn’t work somewhere that I had the liability of the NPs without benefit.

It would be more productive to use them as an expensive scribe at that point.

 

[Ubba]

The hospital I was formally working at with a psa is now paying their employer docs $1500/night to take call. That was to keep them from leaving to come work in our group. When you are productive you wouldn’t dream of taking call for that amount. Less call is better.

The idea that NPs and extenders are able to do this on their own is wild and thus the idea that there is no money for the physician supervising is egregious. Stick to your guns on that. I wouldn’t work somewhere that I had the liability of the NPs without benefit.

It would be more productive to use them as an expensive scribe at that point.

What do you think might be a reasonable ballpark for an overnight H/O call? Obviously depends on the size of the system, but curious as to a generally reasonable #.

 

[HOIV]

What do you think might be a reasonable ballpark for an overnight H/O call? Obviously depends on the size of the system, but curious as to a generally reasonable #.

Well the other group is doing it for $1500. If it’s an easy night that’s easy money. If I have to go in to do a TTP I’m not interested…and it’s not for not knowing how to deal with ttp. Those patients on call then require following for their whole hospitalization. Time is valuable. The hospital is time consuming.

Starting out when you don’t have a big patient load $1500 is reasonable. I would never do a weekend for less than $5000. When you’re busy in clinic you need a weekend to recharge.

Also once you’re earning $400K plus you’re paying almost 50% in taxes on extra money. That’s important because though you always make more and paying high taxes is a good problem in that it means you have a good income it’s also important to remember the law of diminishing returns. Is a weekend worth $2500 after taxes plus half of whatever RVUs you do? Depends on your life stage but I’m 4 years out of training doing a huge amount of rvus so free time is more valuable to me at night and on weekends. Once you agree to call for money you’ll somehow get locked in so make sure it feels good at the time and more because it’ll feel like less down the road.