Typical salary for this situation?

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littleemma

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Will graduate next summer and started job hunting.

I really appreciate if some one could tell the typical salary for the following situation:
1. location: no west and east coast, no florida, no coast line, no big city and major city
2. location: at small-medium size city or small town, or rural
3. non-academic,
4. hospital employee or private practice
5. hospital pays staff
6. physician salary based on professional fee an suppose gets all the professional fee
7. daily on treat 20 patients
8. technology mixture of 2D, 3D, IMRT, SBRT, HDR, etc
9. after the first two years of transition time.

Thank you very much!

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What's average consults/week and average daily treatments under beam? Will depend on a lot of factors as above but also payor mix, imrt/igrt/srs mix etc.

I'm guessing it's some kind of guarantee for a couple years transitioning to prof fees?
 
What's average consults/week and average daily treatments under beam? Will depend on a lot of factors as above but also payor mix, imrt/igrt/srs mix etc.

I'm guessing it's some kind of guarantee for a couple years transitioning to prof fees?

7. daily on treat 20 patients
8. technology mixture of 2D, 3D, IMRT, SBRT, HDR, etc
9. after the first two years of transition time.

Thank you!
 
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It is hard to answer, transition to where? Straight salaried job like this one, which is solo and presumes independent HDR practice, should start out at 325-375K IMO. If there is a bunch of people cross-covering, lower.
 
It is hard to answer, transition to where? Straight salaried job like this one, which is solo and presumes independent HDR practice, should start out at 325-375K IMO. If there is a bunch of people cross-covering, lower.
I would expect more than that if they are trying to pay you your equivalent in pro fees, although it could be $375k+ generous benefits I guess
 
1. location: no west and east coast, no florida, no coast line, no big city and major city
2. location: at small-medium size city or small town, or rural

If by this you really mean a town (even an isolated small city with a total "metro" population <50,000) or especially the rural Mid-West or the deep South (where you drive 30 minutes to the nearest Walmart where you also do your grocery shopping) then the sky is the limit, especially if you can convince the hospital that you can start a program that is now well within the standard of care but that they may not have (SBRT, SRS, etc).
 
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Sounds like you are looking for a hospital employeed job in the middle of the country in an area with low population density. E.g., Nebraska, but Scottsbluff (pop 15k) instead of Omaha or Lincoln. Not many people want these. They may offer you a lot upfront or give you a low offer that you'll have to negotiate up. You have a lot of bargaining power. I would expect 500-600k base guarantee with an RVU bonus structure that tops out in the $70-80/wRVU range. Typical signing bonuses I have seen are 50k to over 100k. The more rural you go, the higher the numbers will become. I talked to lots of these places and am not making these numbers up.
 
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Sounds like you are looking for a hospital employeed job in the middle of the country in an area with low population density. E.g., Nebraska, but Scottsbluff (pop 15k) instead of Omaha or Lincoln. Not many people want these. They may offer you a lot upfront or give you a low offer that you'll have to negotiate up. You have a lot of bargaining power. I would expect 500-600k base guarantee with an RVU bonus structure that tops out in the $70-80/wRVU range. Typical signing bonuses I have seen are 50k to over 100k. The more rural you go, the higher the numbers will become. I talked to lots of these places and am not making these numbers up.

I second these numbers. Although you don't have to be in very small towns to find them. In the Midwest, you can land in this ballpark even in towns with a few to several hundred thousand people. In such case, one should be able to find somewhere serviceable to buy one's groceries.
 
Thank you very much! These number seems reasonable.

This maybe the worse situation if we can not get the desired job.

Sounds like you are looking for a hospital employeed job in the middle of the country in an area with low population density. E.g., Nebraska, but Scottsbluff (pop 15k) instead of Omaha or Lincoln. Not many people want these. They may offer you a lot upfront or give you a low offer that you'll have to negotiate up. You have a lot of bargaining power. I would expect 500-600k base guarantee with an RVU bonus structure that tops out in the $70-80/wRVU range. Typical signing bonuses I have seen are 50k to over 100k. The more rural you go, the higher the numbers will become. I talked to lots of these places and am not making these numbers up.
 
Domestique: This is true. I had an offer for $550k in a midwest metro area of about 400k people (this was very strong, most were more around 450-500). But I think to get in the 600-700 range for a new grad, you are going to be in a very rural, very far from a metro center/airport situation.
 
If you have a PRO-only arrangement, your volume and payor mix will dictate your pay. At 20 beam patients daily with a splash of HDR, LDR, and SBRT, you may be looking at roughly 500-600k of collections.

Those first two years, I'd aim to get a guarantee on the low end of that with RVU bonus if truly a non-desirable locale.
 
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I had an offer of 650k in a city in the south/midwest cross section with a metropolitan population of 1.5 million people for a non-academic but also not private practice - more like a health network. It was an amazing job. I ended up taking a job for 300k in the southwest in a comparably large city for 4-days per week to be closer to family and to start my own family. It's really surprising what you might find. I think there are definitely general trends, but you never really know until you're in the market yourself.
 
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I would echo would has already been said here a few times... $450-500k should be a minimum for a job like that with 20 or so on treatment. You should make sure that you get either an RVU rate of $60+ or some percentage of collections. You can spin this to the administrators as an incentive to build the practice.
 
I would echo would has already been said here a few times... $450-500k should be a minimum for a job like that with 20 or so on treatment. You should make sure that you get either an RVU rate of $60+ or some percentage of collections. You can spin this to the administrators as an incentive to build the practice.

I'd just like to break in here to point how good this field is in this domain. Private practices of 20 patient on treatment is a very doable practice and many have 1 day off/week from clinic. The pace is reasonable and there's no inpatient service you have to cover on weekends and no holiday work. What medical field offers this pay for this work? My friend is a pediatrician....he works his BUTT off for less than 1/2 that, with inpatient call, weekend clinic, 15 min new consult slots with the kid having autism, parents drinking, never heard of bike helmets....solve that mess in 15 min or you are behind with an admin on you. We chose well....that's my point.
 
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I'd just like to break in here to point how good this field is in this domain. Private practices of 20 patient on treatment is a very doable practice and many have 1 day off/week from clinic. The pace is reasonable and there's no inpatient service you have to cover on weekends and no holiday work. What medical field offers this pay for this work? My friend is a pediatrician....he works his BUTT off for less than 1/2 that, with inpatient call, weekend clinic, 15 min new consult slots with the kid having autism, parents drinking, never heard of bike helmets....solve that mess in 15 min or you are behind with an admin on you. We chose well....that's my point.

It's because they're living in the middle of nowhere that salaries can be inflated that high. Anesthesiologists can make 750k working in rural areas, or they can make 250k working in major metros. In every field, if you go to somewhere rural, you will get paid more as the hospital has to entice people to come work for them. With zero back-up. Nobody to bounce ideas off of.

Continually parroting "don't complain, you have it better than the peds doc (or whatever specialty you want to compare it to next)" isn't valuable IMO. It's also not on-topic to the question at hand.

So that I remain on topic - Good haul if that situation is going for 600k+/year, IMO.
 
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It's because they're living in the middle of nowhere that salaries can be inflated that high.


You can make a lot in many metro areas in rad onc.

when you apply you'll see what's really out there.
 
What's "a lot" ? I was never offered anywhere close to 450k+ in or even close to metro areas.

I get the sense these numbers aren't for grads straight out of training, but rather BC docs after a few years out, unless you're really going to the middle of nowhere. Many of these offers in decent locales wanted experienced BC ROs
 
I get the sense these numbers aren't for grads straight out of training, but rather BC docs after a few years out, unless you're really going to the middle of nowhere. Many of these offers in decent locales wanted experienced BC ROs

I'm a few years out and BC. I'm still not seeing offers like this.
 
By high volume they probably mean 12,000 professonal wRVUs per year to make $450k lol

I hate wRVUs... for some reason no matter how much I do, I always make even. I stopped caring.
 
There's not too many jobs where you start at 450k, even as an experienced physician. The one's "out there" are likely to be actually rural (read: not a half million people). But there are partnership tracks where you'l make more than that after a few years.
 
Didn't know if I should start a new thread or not, but here it goes anyways.

I'm graduating 2019 and have talked with a private practice in a major metropolitan area (>2mil). They're offering $320k starting, which seems in line with Terry Walls survery. However, it's not for a partnership track. They said your pay will go up with experience, then asked what I thought would be reasonable. I had no idea. Anyone know a reasonable amount to expect as far as pay increase for years 2-5 in practice?
 
Didn't know if I should start a new thread or not, but here it goes anyways.

I'm graduating 2019 and have talked with a private practice in a major metropolitan area (>2mil). They're offering $320k starting, which seems in line with Terry Walls survery. However, it's not for a partnership track. They said your pay will go up with experience, then asked what I thought would be reasonable. I had no idea. Anyone know a reasonable amount to expect as far as pay increase for years 2-5 in practice?
MGMA is your friend. You'll need to seek that information out.

Will depend on which part of the country you are practicing in. Just keep in mind if you aren't partnership track after a few years, it may be easier for them to cut you loose if need be when you get too "expensive" for what they are paying you
 
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Didn't know if I should start a new thread or not, but here it goes anyways.

I'm graduating 2019 and have talked with a private practice in a major metropolitan area (>2mil). They're offering $320k starting, which seems in line with Terry Walls survery. However, it's not for a partnership track. They said your pay will go up with experience, then asked what I thought would be reasonable. I had no idea. Anyone know a reasonable amount to expect as far as pay increase for years 2-5 in practice?

I would ask for a certain percentage of your profees after “x” amount of years. Perhaps 70-80% after 2 years. (This assumes group is paying for billing services, insurance, etc). If you think that you won’t have enough on treat to justify the salary you expect long term, then move on.

My take in general is that your profees are for your work. If you aren’t getting profees - expenses after putting in your time/sweat equity, then the job is no good.
 
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Didn't know if I should start a new thread or not, but here it goes anyways.

I'm graduating 2019 and have talked with a private practice in a major metropolitan area (>2mil). They're offering $320k starting, which seems in line with Terry Walls survery. However, it's not for a partnership track. They said your pay will go up with experience, then asked what I thought would be reasonable. I had no idea. Anyone know a reasonable amount to expect as far as pay increase for years 2-5 in practice?

So they are paying you a sweat-equity salary with no ability to ever earn partner level income? $320k is a fine starting salary assuming you make partner in 2 years, which you should and would at least double that income. Otherwise you should be getting paid the same as if you were a permanent employee at a hospital, i.e., close to MGMA median + RVU productivity bonus. Sounds like they are just exploiting grads trying to live in a desirable location. Huge pass. However, I am sure they will have no difficulty filling this position with a $320k salary, probably 5% annual raises at most, no productivity bonus, no signing bonus, no option for buy-in, and a city-wide non-compete. If you are actually considering this, have your contract reviewed by a professional to make sure the termination clause doesn't leave you screwed when they cut you loose in a few years. However, also a decent chance it is take-it-or-leave-it.

If this is a PSA-only group that doesn't actually own anything, then they are basically stealing your labor. All the negatives of PP with none of the positives. I've seen a few places where this is happening. I'd rather just approach the hospital or urorads center they are contracting with and just offer to be their employee for $400k/year + bonus. I'd rather lose 20% of my prof fees to a hospital with some job security than 50% to an exploitative PP with no job security.

To answer your question directly, I would tell them that I would be expecting to be earning around MGMA median ($550k) by year 3. But I would expect to be laughed out of the room.

Med students take note, this is the future of our field.
 
I haven't seen partnership track positions being offered anywhere near metro areas that would "at least double" $320k/year even at partner level. Maybe that still exists in the upper midwest or rural south.

Med students take note, this is the future of our field.

That future is now. Exactly what you described (~$300k/year start, slow or non-existent raises, large non-competes, etc) seems to be the vast majority of the jobs out there.

I'm very nervous about the future. Mandatory instructor or fellowship positions for a large portion of new grads to even get to 300k? I talked to a few graduating residents recently. Zero interviews--looking at locums vs. fellowship.
 
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So they are paying you a sweat-equity salary with no ability to ever earn partner level income? $320k is a fine starting salary assuming you make partner in 2 years, which you should and would at least double that income. Otherwise you should be getting paid the same as if you were a permanent employee at a hospital, i.e., close to MGMA median + RVU productivity bonus. Sounds like they are just exploiting grads trying to live in a desirable location. Huge pass. However, I am sure they will have no difficulty filling this position with a $320k salary, probably 5% annual raises at most, no productivity bonus, no signing bonus, no option for buy-in, and a city-wide non-compete. If you are actually considering this, have your contract reviewed by a professional to make sure the termination clause doesn't leave you screwed when they cut you loose in a few years. However, also a decent chance it is take-it-or-leave-it.

If this is a PSA-only group that doesn't actually own anything, then they are basically stealing your labor. All the negatives of PP with none of the positives. I've seen a few places where this is happening. I'd rather just approach the hospital or urorads center they are contracting with and just offer to be their employee for $400k/year + bonus. I'd rather lose 20% of my prof fees to a hospital with some job security than 50% to an exploitative PP with no job security.

To answer your question directly, I would tell them that I would be expecting to be earning around MGMA median ($550k) by year 3. But I would expect to be laughed out of the room.

Med students take note, this is the future of our field.

Yea, the grass does seem greener outside of this metro area.
Where can I get a hold of MGMA data? I stumbled upon a spreadsheet from 2015, but it did not have data from years 1-2 or 3-7 in practice. Years 8-12 was $508k and did not separate by region, academics vs private.
 
Yea, the grass does seem greener outside of this metro area.
Where can I get a hold of MGMA data? I stumbled upon a spreadsheet from 2015, but it did not have data from years 1-2 or 3-7 in practice. Years 8-12 was $508k and did not separate by region, academics vs private.
Doximity may have some data... Overall national average for 2018 across specialties: Doximity 2018 Physician Compensation Report
 
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I was been in exact same situation about 5 years ago. Employed salaries (assuming you're competent) are dictated by local market, not MGMA. You may have to switch jobs to get any pay raise, unfortunately.

Didn't know if I should start a new thread or not, but here it goes anyways.

I'm graduating 2019 and have talked with a private practice in a major metropolitan area (>2mil). They're offering $320k starting, which seems in line with Terry Walls survery. However, it's not for a partnership track. They said your pay will go up with experience, then asked what I thought would be reasonable. I had no idea. Anyone know a reasonable amount to expect as far as pay increase for years 2-5 in practice?
 
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approximate total comp numbers:

10%tile: 305k (4700 wRVUs)
25th:450k
Median:525k (8200 wRVUs)
75th:620k
90th:760k (13400 wRVUs)

So keep in mind if you are getting paid 300k, you are getting paid for around 4500 wRVUs. That's like, what 8-10 patients on treatment at most? If you're treating 25 patients, getting paid that much, and not having an opportunity to buy in at all in the future, someone is making a HUGE profit off of your labor.

Would be interesting if they broke the data up by metro area and not just geographic region.
Again, very clear if you want to get a salary that is going to approach anywhere near your actual collections, you need to get out of the big cities.
Sad.
 
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I was been in exact same situation about 5 years ago. Employed salaries (assuming you're competent) are dictated by local market, not MGMA. You may have to switch jobs to get any pay raise, unfortunately.

This is what it feels like - dictated by local market. There's a big difference between the MGMA and Doximity data. Mid-career rad oncs in my metro area are getting something in the middle. One that strikes me as odd about the Doximity data is the tight range across geographic regions. It looks like $420-450k no matter where you go...

approximate total comp numbers:

10%tile: 305k (4700 wRVUs)
25th:450k
Median:525k (8200 wRVUs)
75th:620k
90th:760k (13400 wRVUs)

So keep in mind if you are getting paid 300k, you are getting paid for around 4500 wRVUs. That's like, what 8-10 patients on treatment at most? If you're treating 25 patients, getting paid that much, and not having an opportunity to buy in at all in the future, someone is making a HUGE profit off of your labor.

Would be interesting if they broke the data up by metro area and not just geographic region.
Again, very clear if you want to get a salary that is going to approach anywhere near your actual collections, you need to get out of the big cities.
Sad.

Thanks for the info. Is this based off 2017 data?
 
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Keep in mind that MGMA is the total comp - pension contributions, etc. For the real world RadOnc base salary numbers in large metros, look at AAMC salary survey.

This is what it feels like - dictated by local market. There's a big difference between the MGMA and Doximity data. Mid-career rad oncs in my metro area are getting something in the middle. One that strikes me as odd about the Doximity data is the tight range across geographic regions. It looks like $420-450k no matter where you go...



Thanks for the info. Is this based off 2017 data?
 
approximate total comp numbers:

10%tile: 305k (4700 wRVUs)
25th:450k
Median:525k (8200 wRVUs)
75th:620k
90th:760k (13400 wRVUs)

So keep in mind if you are getting paid 300k, you are getting paid for around 4500 wRVUs. That's like, what 8-10 patients on treatment at most? If you're treating 25 patients, getting paid that much, and not having an opportunity to buy in at all in the future, someone is making a HUGE profit off of your labor.

Would be interesting if they broke the data up by metro area and not just geographic region.
Again, very clear if you want to get a salary that is going to approach anywhere near your actual collections, you need to get out of the big cities.
Sad.

Excellent (and really smart) way to think about it. I can’t remember the last time I heard of a colleague (in Rad onc or otherwise) upon making partner cutting a check for the “buy in” ... rather the “excess” from the first 2 years is used as “sweat equity.” If you’re treating 25 patients and being paid for 8-10 (sounds about right for 4500 RVU) and they are just pocketing the difference vs considering it the “buy in” then they are making a killing (like literally multiple hundreds of thousands of dollars/yr) off of you!

It’s almost impossible to “fire” a partner but it’s relatively easy to let an employee go - just say patient volume, compensation, etc has decreased so we are not renewing your service agreement, sorry! In this market I would definitely take a job that offered partnership (and hope they don’t screw me over)vs one that didn’t but paid a little more.

If they have endless supplies of graduating residents what’s to stop them from just letting everybody go after they get what sounds like small annual pay increases when they can just replace with newer doctors who cost them less?
 
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[QUOTE=" I talked to a few graduating residents recently. Zero interviews--looking at locums vs. fellowship.

This is me. If anybody has leads to jobs in a city >1 million on the coast, please PM me.[/QUOTE]

Just curious when you guys say “the coasts” do you mean literally coastal cities like Boston, NYC etc or just “not middle of country”

And one million in city itself or metro?

It looks like Buffalo, NY is hiring or will be soon (see other thread ... it looks like that was a huge practice so I assume University of Buffalo and/local practices will absorb those patients and hire more MD’s). I just looked it up and was surprised to learn that the metro at least is over a million (but also that despite being in a costal state it’s as far from NYC as possible).
 
Just curious when you guys say “the coasts” do you mean literally coastal cities like Boston, NYC etc or just “not middle of country”?

And one million in city itself or metro?

It looks like Buffalo, NY is hiring or will be soon (see other thread). I just looked it up and was surprised to learn that the metro at least is over a million (but also that despite being in a costal state it’s as far from NYC as possible).
In the last few years, I've seen jobs posted, many with partnership track, in cities like Daytona Beach FL, NC outer Banks, Savannah GA, Jacksonville FL, Virginia Beach etc. Sure they aren't Boston or NYC, but they aren't Rhinelander wi or salina ks either.

Restrictions in geography when looking for a job have always been the case in rad onc, even when times were better and we were only graduating a hundred a year
 
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Excellent (and really smart) way to think about it. I can’t remember the last time I heard of a colleague (in Rad onc or otherwise) upon making partner cutting a check for the “buy in” ... rather the “excess” from the first 2 years is used as “sweat equity.” If you’re treating 25 patients and being paid for 8-10 (sounds about right for 4500 RVU) and they are just pocketing the difference vs considering it the “buy in” then they are making a killing (like literally multiple hundreds of thousands of dollars/yr) off of you!

It’s almost impossible to “fire” a partner but it’s relatively easy to let an employee go - just say patient volume, compensation, etc has decreased so we are not renewing your service agreement, sorry! In this market I would definitely take a job that offered partnership (and hope they don’t screw me over)vs one that didn’t but paid a little more.

If they have endless supplies of graduating residents what’s to stop them from just letting everybody go after they get what sounds like small annual pay increases when they can just replace with newer doctors who cost them less?


It's important for new grads to understand that not all practices that require a buy-in are exploitative and a bad deal.

Our practice has a buy-in. We're 18 months to partner, the buy-in is the same for every MD, it's not too large, and that process hasn't changed in 20+ years. I considered it very fair then, and I still do now. It gives you one share of voting stock, so you then become an equal partner along with everyone else. We do not want to be a "hire and fire" practice, as we want to bring in good MDs who are interested in helping us continue to build over the next several decades. We're looking for true partners, and very few of our docs ever leave the practice except to retire.
 
It's important for new grads to understand that not all practices that require a buy-in are exploitative and a bad deal.

Our practice has a buy-in. We're 18 months to partner, the buy-in is the same for every MD, it's not too large, and that process hasn't changed in 20+ years. I considered it very fair then, and I still do now. It gives you one share of voting stock, so you then become an equal partner along with everyone else. We do not want to be a "hire and fire" practice, as we want to bring in good MDs who are interested in helping us continue to build over the next several decades. We're looking for true partners, and very few of our docs ever leave the practice except to retire.

Do you guys own any revenue stream in the linacs or associated imaging? Otherwise the typical pro partnership is your sweat equity = buy in
 
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Do you guys own any revenue stream in the linacs or associated imaging? Otherwise the typical pro partnership is your sweet equity = buy in
Yes, we bill globally, so we own all the linear accelerators, CTs, PET/CTs, labs, etc. Probably should have mentioned that, good point.
 
In the last few years, I've seen jobs posted, many with partnership track, in cities like Daytona Beach FL, NC outer Banks, Savannah GA, Jacksonville FL, Virginia Beach etc. Sure they aren't Boston or NYC, but they aren't Rhinelander wi or salina ks either.

What you're not seeing is that these jobs receive 100-200 applications each. I wonder how many applications @Gfunk6 will get for his new job posting?
 
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Yes, we bill globally, so we own all the linear accelerators, CTs, PET/CTs, labs, etc. Probably should have mentioned that, good point.

Dang seems like this practice is the “real deal” but I really doubt the majority are like this (or will be in 6-8 years when current 3rd year med students are looking for jobs). I agree that some type of “buy in” is very reasonable if when you become partner you are essentially buying some of the equipment.

If you pay to become partner in a group that doesn’t own anything what are you “buying.” I guess job security...

It used to be that you had to weed out the “hire and fire” practices but more and more these days are just straight up saying “no partnership!” no matter how awesome you are, how much you grow the practice, etc. It’s one thing if they are paying you much more but this job is the worst of all (low salary/more work AND no partnership?!?)
 
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What you're not seeing is that these jobs receive 100-200 applications each. I wonder how many applications @Gfunk6 will get for his new job posting?

A lot. Am trying to squeeze in phone interviews during every "free" moment between now and eternity :(
 
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What you're not seeing is that these jobs receive 100-200 applications each. I wonder how many applications @Gfunk6 will get for his new job posting?

I'm guessing gfunk will get plenty being that it's a big stable PP in the highly sought after bay area of California.

I know for a fact the Jacksonville and Daytona jobs were/are likely still open and probably didn't get that number of apps.

I'll be the first one to preach that our field and associated job market are under assault by our inept and self-serving academic leadership but I also know there are still jobs out there in smaller metros in desirable states if one looks hard enough
 
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A lot. Am trying to squeeze in phone interviews during every "free" moment between now and eternity :(

How do you guys handle hundreds of applications for a single spot? Is there a “scoring system” or something to evaluate stacks of CV’s?

We can argue if 500,000 is a city or town, or how tolerable living in North Dakota May be, but man I can’t even imagine how many people would kill to join a well established practice in the Bay Area!
 
How do you guys handle hundreds of applications for a single spot? Is there a “scoring system” or something to evaluate stacks of CV’s?

We can argue if 500,000 is a city or town, or how tolerable living in North Dakota May be, but man I can’t even imagine how many people would kill to join a well established practice in the Bay Area!

It's tough. But really it boils down to how badly people want to be here versus "oh gee whiz, let me apply and see what happens." Surrogates like growing up here, having connections here or otherwise having a compelling reason to be here are all critical in the screening process. We really want a partner, not a physician employee so we are looking for longevity.
 
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A lot. Am trying to squeeze in phone interviews during every "free" moment between now and eternity :(

Before you interview me, I just have two requests... 3 days off per week and a starting salary of 500k. I look forward to working with you soon!
 
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