What are features of a bad job offer / bad job?

[IRattending2021]

I am from over the radiology side so the features of a bad job could be a bit different, just curious to hear what would make a radonc job “bad”.

I’ll start with an example of what makes a rad job bad. One of my fellow interviewed with this private practice job, which from the get-go was an employee only position. IMO employees in PP are usually treated like second class citizens. More over, when he gets there, he was told that he was to cover IR from 2-9pm everyday for a week (week on week off), but also supposed to cover the ED diagnostic radiology! That’s basically two jobs rolled into one. He was not offered a commensurate compensation for it either so it was a hard pass.

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[Mandelin Rain]

Obviously "bad" is all relative and may be different for each individual.

But usually, it's one of a few things beyond the usual location/money/quality of life stuff.

1. Churn and burn private practice where the partners have no plan to ever make you partner. Just string you along while skimming your collections. Cut you loose for a new grad when you complain. This is what your fellow interviewed for.

2. The academic equivalent. Put you in a satellite with no protected time or support for research. No tenure track or chance for professional/income advancement. Just skim your collections to give to the chair/dean/labs.

3. Hospital employed with initial guarantee that seems great for a year or two that then transfers you to a confusing/capped production based model that drops your income while they shovel bureaucratic nonsense work on your plate. Just skim your collections to fund the ICU/dozens of nurse administrator salaries.

 

[scarbrtj]

Obviously "bad" is all relative and may be different for each individual.

But usually, it's one of a few things beyond the usual location/money/quality of life stuff.

1. Churn and burn private practice where the partners have no plan to ever make you partner. Just string you along while skimming your collections. Cut you loose for a new grad when you complain. This is what your fellow interviewed for.

2. The academic equivalent. Put you in a satellite with no protected time or support for research. No tenure track or chance for professional/income advancement. Just skim your collections to give to the chair/dean/labs.

3. Hospital employed with initial guarantee that seems great for a year or two that then transfers you to a confusing/capped production based model that drops your income while they shovel bureaucratic nonsense work on your plate. Just skim your collections to fund the ICU/dozens of nurse administrator salaries.

Some of medicine now becoming a dystopian fantasy. May the odds be ever in the physicians’ favor. I must joke so’s not to cry. Imagine if physicians reddited (or something like it) against #2 and #3 eg. I think they will one day. “Wait a sec. What the hell did I go through that crazy hard med school and residency for? For this?!”

 

[RADONC4285]

Obviously "bad" is all relative and may be different for each individual.

But usually, it's one of a few things beyond the usual location/money/quality of life stuff.

1. Churn and burn private practice where the partners have no plan to ever make you partner. Just string you along while skimming your collections. Cut you loose for a new grad when you complain. This is what your fellow interviewed for.

2. The academic equivalent. Put you in a satellite with no protected time or support for research. No tenure track or chance for professional/income advancement. Just skim your collections to give to the chair/dean/labs.

3. Hospital employed with initial guarantee that seems great for a year or two that then transfers you to a confusing/capped production based model that drops your income while they shovel bureaucratic nonsense work on your plate. Just skim your collections to fund the ICU/dozens of nurse administrator salaries.

Definitely pay attention the point brought up in 3. Whether it's an employed position in a hospital/PP, or a partner position, you should always have a clear picture of how your income will be structured. If you're okay with an employed position, fine, but know exactly how you'll be paid. Is it RVU based? is there an RVU target? what happens if you don't meet the target? how much do you get paid per RVU?

if it's PP, the best thing is to be partner, but even then, you should know how the partners are paid. is it eat what you kill? does everything go into one pool and gets divided equally?

 

[deleted969641]

Obviously "bad" is all relative and may be different for each individual.

But usually, it's one of a few things beyond the usual location/money/quality of life stuff.

1. Churn and burn private practice where the partners have no plan to ever make you partner. Just string you along while skimming your collections. Cut you loose for a new grad when you complain. This is what your fellow interviewed for.

2. The academic equivalent. Put you in a satellite with no protected time or support for research. No tenure track or chance for professional/income advancement. Just skim your collections to give to the chair/dean/labs.

3. Hospital employed with initial guarantee that seems great for a year or two that then transfers you to a confusing/capped production based model that drops your income while they shovel bureaucratic nonsense work on your plate. Just skim your collections to fund the ICU/dozens of nurse administrator salaries.

Academics: Bad job = non-tenure track. (instructor positions, satellite 'academic' positions, etc.)
Non-academics: Bad job = no path for ownership or at least an ability to bill and collect independently (basically all hospital employed jobs).

This should be rad onc 101 taught on day 1 and a core part of any program that is supposed to prepare doctors for real-world practice. Sadly 4 years of rad onc residency usually isn't enough time to squeeze in this 10 minute lecture, so it is usually skipped entirely and supplanted with immensely more valuable hundreds of hours of pimping retrospective trial data. But lucky for us, there is plenty of on-the-job-training in places like Victoria, TX and Stanford University to fill in this knowledge gap for those who didn't learn this during residency. But unlike residency, you have to pay tuition for this lesson, and it is STEEP.

 

[Chartreuse Wombat]

Cribbing from Tolstoy-
All happy families good jobs are alike; each unhappy family bad job is unhappy bad in its own way.

Good jobs align with the workers' interests, expectations and geographic preferences.
Bad jobs come in many forms as outlined above.

The other complicating factor is that there is enormous consolidation is occurring across the board in health care.

10 Major Healthcare Merger & Acquisition Deals Announced in 2020

As 2020 nears to a close, here are ten of the most transformational healthcare merger and acquisition deals announced so far.

revcycleintelligence.com

The result is that individual physicians are less in control of their own destiny (especially in RadOnc which is tied to a linear accelerator in most instances).

A good job can transform into a bad job overnight.

 

[ramsesthenice]

I know a lot of people who are very happy at academic satellite positions. There are plenty of malignant and abusive academic satellite centers but there really are some that are pretty relaxed with good autonomy and relative security that comes from being part of a major operation. Some people are happy to be employed with a modest salary and 9-5(ish) job as long as they are otherwise treated well. The problem is that you have limited protection from change. Chair A may more or less leave you alone and be happy you are generating revenue. But Chair A won't be there forever and if you have a non-tenure track position (which basically all of these are) you won't have a lot of power or control over your situation when they leave. Of course, in reality, that isn't all that different from my tenured position. A new chair can't fire me but they can decide I am overpaid and reduce my salary or make me so unhappy I decide to leave. Tenure isn't really all it is cracked up to be either.

 

[RickyScott]

In my experience the worst type of employment is like the one in Irvine, where doc is paying you out of his own bank account. Can lead to an ugly dynamic with the wrong person .Hospitals may try to screw you, but at the end of the day,it is not the administrators personal money.

 

[Neuronix]

Anonymous post sent to me by PM:

Make sure when you interview for non-partnership positions that you ask what the work responsibilities are. If a senior partner tries to see the majority of consults, will he follow through with all the downstream work for his patients, or will he assign the work to MDs who he/she deems are not as busy?

 

[FrostyHammer]

Anonymous post sent to me by PM:

This. Finding out about how much seniority/rank is pulled is so key. Rank/seniority are boomer-terms for "I've already made my millions, but I just want to do as little work to collect as fat a salary possible, so I'll use this as an excuse to do just that"

 

[Burt Radnolds]

Good job - effect of healthy supply demands dynamics promoting appropriate physician autonomy and negotiating power

Bad job - effect of wanton residency overexpansion and decreased utilization leading to "hunger games" level desperation in the job market

Academics: Bad job = non-tenure track. (instructor positions, satellite 'academic' positions, etc.)
Non-academics: Bad job = no path for ownership or at least an ability to bill and collect independently (basically all hospital employed jobs).

What percentage of jobs now fall into these definitions? 60%?

There is nothing inherently special about being a radiation oncologist. The free market will pay what it pays and you will be treated as poorly as the hospital administration or chair can get away with. What are you supposed to do if you can't get one of these increasingly rare "good" gigs? Hold the line 💎💎👐👐? Or take an abusive position and let Turaco come kick you in the nuts/ovaries?

 

[RickyScott]

Good job - effect of healthy supply demands dynamics promoting appropriate physician autonomy and negotiating power

Bad job - effect of wanton residency overexpansion and decreased utilization leading to "hunger games" level desperation in the job market




What percentage of jobs now fall into these definitions? 60%?

There is nothing inherently special about being a radiation oncologist. The free market will pay what it pays and you will be treated as poorly as the hospital administration or chair can get away with. What are you supposed to do if you can't get one of these increasingly rare "good" gigs? Hold the line 💎💎👐👐? Or take an abusive position and let Turaco come kick you in the nuts/ovaries?

Absolutely.

 

[ramsesthenice]

There is nothing inherently special about being a radiation oncologist. The free market will pay what it pays and you will be treated as poorly as the hospital administration or chair can get away with. What are you supposed to do if you can't get one of these increasingly rare "good" gigs? Hold the line 💎💎👐👐? Or take an abusive position and let Turaco come kick you in the nuts/ovaries?

This x 10. Its one thing for those of us with good paying jobs and (hopefully) sizable savings to say I would never take a job in Victoria TX for $450,000. Its entirely another for a new grad whose only other option is to work at their departments satellite on the clinical track for $250,000 and no chance of promotion.

Turaco is going to come kick me in the nuts, probably repeatedly, for what I am about to say but lets face it, most of us on here are early to mid career. Of course we think senior partners/employers should give us our full cut (or at least close to it) of what we bring in. But we do practice in a free market. If the actual going rate for new grads is $400K (hypothetical here) how many of us can honestly say we would pay them $700K because its what they should be worth and its the "right" thing to do. I really like to think that I would but when it was time to sign the checks would I really do it? This is the eternal struggle with free market enterprise. The line between being greedy and following market trends is always blurry. To me, the single best metric of a potential employers character is how they treat people and absolutely nothing speaks to that like long term survival. In PP that means people actually make partner and stick around for the long haul. In academics, it means people actually get promoted and stay long term. No one will straight up screw you out of fair pay but otherwise be a decent employer. If someone is capable of truly screwing you out of compensation (beyond what is reasonable within market forces) they are not going to stop with money. They will also keep the cushiest, most interesting, best parts of the job for themselves and doll out the worst for everyone else. High turnover = bad job. Period. You are not more special than the people that came before you.

 

[deleted969641]

What percentage of jobs now fall into these definitions? 60%?

There is nothing inherently special about being a radiation oncologist. The free market will pay what it pays and you will be treated as poorly as the hospital administration or chair can get away with. What are you supposed to do if you can't get one of these increasingly rare "good" gigs? Hold the line 💎💎👐👐? Or take an abusive position and let Turaco come kick you in the nuts/ovaries?

This x 10. Its one thing for those of us with good paying jobs and (hopefully) sizable savings to say I would never take a job in Victoria TX for $450,000. Its entirely another for a new grad whose only other option is to work at their departments satellite on the clinical track for $250,000 and no chance of promotion.

Turaco is going to come kick me in the nuts, probably repeatedly, for what I am about to say but lets face it, most of us on here are early to mid career. Of course we think senior partners/employers should give us our full cut (or at least close to it) of what we bring in. But we do practice in a free market. If the actual going rate for new grads is $400K (hypothetical here) how many of us can honestly say we would pay them $700K because its what they should be worth and its the "right" thing to do.

I don't think it's as high as 60%. Maybe 25-30%? There are only a few jobs posted online at any given time, and many of these are repeat posting (another indicator of a bad job -- in this market a job should only need to be advertised once). With nearly 200 grads per year in addition to experienced rad oncs in the job market, this obviously means most people are getting jobs through other means than applying to want ads.

As an employer in PP, you should give your new hire 1-2 years to prove themselves as somebody that you want to work with and let them either keep all of their collections after that or split group collections evenly depending on your philosophy of sharing income and time off vs. eat what you kill. If you have ownership, they should have the option of buying in at this time. Yes, there are some rad oncs that will realize they can churn new hires every two years and keep their collections. I'd say that's a bad job. A really bad job.

I understand the reality of having to put food on the table and make loan payments for new grads. I get that there's some amount of luck in finding a place off the bat that will pay you near what you are bringing in and treat you well. However, my point has been that if you can't find one of these places and have to settle for a bottom quartile salary in a position with no opportunity for advancement, then for the love of God do not do it in Victoria, TX. The state of our field is not that bad (yet).

 

[Mandelin Rain]

To me, the single best metric of a potential employers character is how they treat people and absolutely nothing speaks to that like long term survival.

Yup.

If a practice has been stable for decades and people stay until retirement, it likely means they're doing something right. They are probably treating well. Patients, referring docs, hospital systems, and each other.

 

[RickyScott]

Yup.

If a practice has been stable for decades and people stay until retirement, it likely means they're doing something right. They are probably treating well. Patients, referring docs, hospital systems, and each other.

Eventually, in this market, people will stay because they have nowhere else to go.

 

[CaesarRO]

Definitely pay attention the point brought up in 3. Whether it's an employed position in a hospital/PP, or a partner position, you should always have a clear picture of how your income will be structured. If you're okay with an employed position, fine, but know exactly how you'll be paid. Is it RVU based? is there an RVU target? what happens if you don't meet the target? how much do you get paid per RVU?

if it's PP, the best thing is to be partner, but even then, you should know how the partners are paid. is it eat what you kill? does everything go into one pool and gets divided equally?

With respect to RVU based positions, I know there is talk of $/RVU in the private forum, but as a graduating resident it's really hard to have a proper sense of 'how much work' is equivalent to a given RVU goal.

In a hospital employed set up, I feel like RVUs abstract away a lot and make it hard to have a sense for what the nominal compensation actually means. I feel like equating RVUs to number on treat is also a moving target with apm and hypofrac.

If you guys/gals have any rules of thumb on that front, it would be helpful to us young and naive folks

 

[deleted969641]

With respect to RVU based positions, I know there is talk of $/RVU in the private forum, but as a graduating resident it's really hard to have a proper sense of 'how much work' is equivalent to a given RVU goal.

In a hospital employed set up, I feel like RVUs abstract away a lot and make it hard to have a sense for what the nominal compensation actually means. I feel like equating RVUs to number on treat is also a moving target with apm and hypofrac.

If you guys/gals have any rules of thumb on that front, it would be helpful to us young and naive folks

My advice is to do everything you can to avoid a contract that compensates you based on wRVUs.

The most common compensation model hospitals use is a salary guarantee with an RVU "bonus"
The reason that this is the most common compensation model is because it greatly benefits the hospital and screws the physician. All of the non-physician MBAs that run hospitals all went to the same schools and operate from the same playbook. All of the power is in their hands. They control the billing, they control the RVU reporting, they control how RVUs get assigned when you are on vacation.

Suppose you are going away for a week. You consult, sim, and plan a head and neck patient. However, your dosimetrist isn't done by 5 PM on Friday. Your covering doctor approves the plan on Monday. Who do you think gets the RVU credit for the planning? You, who spent 2 hours contouring and coming up with the plan, or the covering doc who spent 3 minutes checking dose distribution and the OAR checklist and signed it? If the covering doc is a locums, even better. Those RVUs just evaporate and the hospital pockets it. The hospital will delay reporting RVU numbers if it looks like you are going to "bonus." The RVU conversion factor is often set at the MGMA median or lower. If you've got a salary at the MGMA median, but a conversion factor at the MGMA 25% mark, that means you are basically working at a 25%-tile income to earn anything beyond your salary. And they call that an incentive?! Basically, it's all a scam to hold back as much of your collections as possible, and the RVU system gives them a big toolbox to use to do this. The RVU system just does not work well for radiation oncology where services occur over weeks to months. The physician gets screwed.

Better alternatives (in decreasing order):
1. Negotiate to bill and collect professional on your own.
2. Negotiate a percentage of collections (90%) if the hospital wants to employ you and bill for you (a pure production compensation system that avoids RVUs).
3. Negotiate as high of a flat salary as possible without RVU production bonus
4. Negotiate a system where your wRVU conversion factor goes up as the number of wRVUs goes up.

Followed by a very distant number 5 of agreeing to their salary guarantee with their RVU bonus conversion factor. Just know that if you sign that you will never, ever see that bonus. Except for maybe that one time you were treating 40 patients, there on weekends, etc. and the hospital acted like they were doing you a favor when they gave you a $5000 check at the end of the quarter.

 

[DoctwoB]

I disagree that RVU based compensation is a bad thing, it all comes down to the conversion factor. Ideally you want either a flat conversion factor at or above MGMA median, or a structure with a rising RVU conversion factor with resaonable tresholds (e.g. if you do median RVUs you should get median conversion factor, and that continues to rise as RVUs rise)

My (non radonc) job is 100% wRVU based for a large multispecialty group, meaning I lose the ability to collect any of the ancillaries/technical fees that I could get in private practice. The trade off is that I could never in a million years negotiate the $/RVU as a smaller practice that this large multispecialty group can. The extra $/RVU from their insurance contracts more then offsets any revenue I lose. When you talk about billing and collecting professional on your own, I would also worry that as a solo or small group radonc, private insurers will bend you over and offer 80% of medicare or something similar.

 

[Grubbe-a-dub-dub]

Well written post. It's also important to understand how RVUs are distributed in a multi-physician practice. Some places pool, others granted to individuals. Both with pluses and minuses.

Hospital systems can even put on the brakes at will if you are surpassing your partners (to keep things "fair").

All nonsense.

Just cash in as much as you can and buy bitcoin. 🚀

 

[Mandelin Rain]

I've never worked on an RVU/wRVU basis. It seems like a system meant to be gamed. Not to your benefit, mind you.

 

[Grubbe-a-dub-dub]

I've never worked on an RVU/wRVU basis. It seems like a system meant to be gamed. Not to your benefit, mind you.

100% agree.

I've seen docs become masterminds of the RVU. Like the Jedi.

But then you get a letter saying you're being paid less per RVU due to COVID... womp

It's a horrible game that you will not win.

 

[DireMoose]

As an employer in PP, you should give your new hire 1-2 years to prove themselves as somebody that you want to work with and let them either keep all of their collections after that or split group collections evenly

I considered asking this in the private forum but seems like a good opportunity: Are things like time to partner negotiable? I've seen wide variation, but most commonly (and in the Terry Wall slides) 1-4 years. If they offer 4 years, is it laughable to ask for 2?

Also, for those who have gotten offers at practices who say "we're just giving you the standard starting contract, same deal as the last __ docs we signed". Is it fair to say, "Oh, so the same as the guy who signed in 2007? Then I'll just take the inflation-adjusted version of that contract, thanks!"

I'm mainly asking about PP, and of course the standard response may be: you're crazy to negotiate anything in this market. But, wanted to see what recent experiences have been.

 

[deleted969641]

I disagree that RVU based compensation is a bad thing, it all comes down to the conversion factor. Ideally you want either a flat conversion factor at or above MGMA median, or a structure with a rising RVU conversion factor with resaonable tresholds (e.g. if you do median RVUs you should get median conversion factor, and that continues to rise as RVUs rise)

My (non radonc) job is 100% wRVU based for a large multispecialty group, meaning I lose the ability to collect any of the ancillaries/technical fees that I could get in private practice. The trade off is that I could never in a million years negotiate the $/RVU as a smaller practice that this large multispecialty group can. The extra $/RVU from their insurance contracts more then offsets any revenue I lose. When you talk about billing and collecting professional on your own, I would also worry that as a solo or small group radonc, private insurers will bend you over and offer 80% of medicare or something similar.

You're a surgeon, right? Most employed surgeons I know are relatively content with the RVU "bonus" system. (I use quotes because I hate the word bonus. It's not a bonus inasmuch that a bonus is extra beyond what you earned. In this case, they are paying you for the extra collections you brought it beyond your salary, but still withholding some of that. I wouldn't really call that a bonus rather than "you've done well, so we'll steal less from you.")

It's different for rad oncs for the reasons I've described. Much easier for the hospital to game it. As a surgeon, you see a patient, perform a procedure, generate RVU, done. As long as your RVU conversion factor results in something near what the collected pro fees are, then yes, theoretically this can be fair. But as you point out, your ability to negotiate a fair RVU number is limited when you are on your own employed directly by the hospital. The way rad oncs generate RVUs is much more complicated and don't all occur on the same day the patient is seen or touched.

You are also correct that as an independent rad onc you can't negotiate as well as larger hospital systems can with private insurers, but you will still do far better than letting the hospital bill and skim. And obviously depends on your payor mix as well.

Hospitals will do anything they possibly can to avoid paying you beyond your salary guarantee. As far as they are concerned, your salary guarantee IS your annual income they will pay you. Another option I failed to mention is going 100% production and having some agreement for reviewing billings and RVU numbers to keep them honest and equitability handling RVUs for your patients when you are out of the office. Mixing a salary guarantee with an RVU production bonus is a set-up for getting hosed. Which is why this is usually what hospitals start with in negotiations.

 

[RADONC4285]

I considered asking this in the private forum but seems like a good opportunity: Are things like time to partner negotiable? I've seen wide variation, but most commonly (and in the Terry Wall slides) 1-4 years. If they offer 4 years, is it laughable to ask for 2?

Also, for those who have gotten offers at practices who say "we're just giving you the standard starting contract, same deal as the last __ docs we signed". Is it fair to say, "Oh, so the same as the guy who signed in 2007? Then I'll just take the inflation-adjusted version of that contract, thanks!"

I'm mainly asking about PP, and of course the standard response may be: you're crazy to negotiate anything in this market. But, wanted to see what recent experiences have been.

EVERYTHING is negotiable if you do it politely and tactfully. Worst that can happen is they say no and you decide to move on or accept whatever they're offering. IMHO, 4 year partnership tracks are far too long and I wouldn't take it. Ideally it should be 1-2 years, 3 is okay, but I start to question things if they want 4 years. Having said that, I know some practices where the partners make close to 7 figure salaries. In such a situation, if they offer a 4 year track and you're still getting paid very well during those four years, then sure

 

[RADONC4285]

My advice is to do everything you can to avoid a contract that compensates you based on wRVUs.

The most common compensation model hospitals use is a salary guarantee with an RVU "bonus"
The reason that this is the most common compensation model is because it greatly benefits the hospital and screws the physician. All of the non-physician MBAs that run hospitals all went to the same schools and operate from the same playbook. All of the power is in their hands. They control the billing, they control the RVU reporting, they control how RVUs get assigned when you are on vacation.

Suppose you are going away for a week. You consult, sim, and plan a head and neck patient. However, your dosimetrist isn't done by 5 PM on Friday. Your covering doctor approves the plan on Monday. Who do you think gets the RVU credit for the planning? You, who spent 2 hours contouring and coming up with the plan, or the covering doc who spent 3 minutes checking dose distribution and the OAR checklist and signed it? If the covering doc is a locums, even better. Those RVUs just evaporate and the hospital pockets it. The hospital will change RVU accounting periods as they see fit if it looks like you are going to "bonus." (ohh, yeah those charges didn't get submitted yet this quarter, you'll see those RVU numbers on your next production report, etc...). The RVU conversion factor is often set at the MGMA median, but you only trigger it if you work >80th percentile production. Basically, it's all a scam to hold back as much of your collections as possible, and the RVU system gives them a big toolbox to use to do this. The RVU system just does not work well for radiation oncology where services occur over weeks to months. The physician gets screwed.

Better alternatives (in decreasing order):
1. Negotiate to bill and collect professional on your own.
2. Negotiate a percentage of collections (90%) if the hospital wants to employ you and bill for you.
3. Negotiate as high of a flat salary as possible without RVU production bonus
4. Negotiate a tiered wRVU bonus structure such that if you are producing 90th percentile wRVU numbers, your conversion factor in that tier is commensurate (example $90/wRVU for all wRVUs above 11,000 or something).

Followed a very distant number 5 of agreeing to their salary guarantee with their RVU bonus conversion factor. Just know that if you sign that you will never, ever see that bonus. Except for maybe that one time you were treating 40 patients, there on weekends, etc. and the hospital acted like they were doing you a favor when they gave you a $5000 check at the end of the quarter.

Agree 100% with the above. However, the reality is that most of us won't have the luxury of choosing 1 or 2. In most instances you're lucky to start at 3. Do your best to negotiate a flat salary that you're happy with. if you're having to do something structured around RVUs, go in with as much information as possible. My advice to all new grads who are still negotiating is pay the ~ $30 to get the detailed MGMA compensation report. Know median RVU production in your region, median conversion factor, ask how many RVUs the avg doc at that hospital makes, how many patients they have on treatment.... . That way you'll have a good idea of how much you'll be making and how hard you'll have to work. Again, agree it's best to avoid RVUs, but very difficult to do that as a hospital employee in most circumstances

 

[deleted969641]

EVERYTHING is negotiable if you do it politely and tactfully. Worst that can happen is they say no and you decide to move on or accept whatever they're offering. IMHO, 4 year partnership tracks are far too long and I wouldn't take it. Ideally it should be 1-2 years, 3 is okay, but I start to question things if they want 4 years. Having said that, I know some practices where the partners make close to 7 figure salaries. In such a situation, if they offer a 4 year track and you're still getting paid very well during those four years, then sure

Agree. I was offered a PP job once with a 3 year track. I offered 2 and they said sure. Pushed for 1 and they got a little annoyed and said no but definitely didn't pull the offer. I've also seen jobs with longer partnership tracks that ramp up your income gradually to near partner level by year 5 or something like that. If you're talking to a place that wants you to take 325k for all 4 years and hope you make partner, I'd keep looking. If we're talking 325k year then ramping up to 650k by year 4, that's a different story. Time value of money is a thing. Especially in this environment.

 

[ramsesthenice]

Hospitals will do anything they possibly can to avoid paying you beyond your salary guarantee.

I was specifically interested in having as high of a base with minimal bonusing for this exact reason. Years like this year when there were no RVU bonuses I was very happy with it. Many other departments were not. Of course, now the hospital system is trying to pressure our chair into changing our arrangement. Fortunately, they are having none of it so far.

 

[Mandelin Rain]

If the group truly has all signed the same contract, they won't be changing it for you. Nor should they. Don't take it personally. Assess if it's still what you want.

 

[OTN]

If the group truly has all signed the same contract, they won't be changing it for you. Nor should they. Don't take it personally. Assess if it's still what you want.

This is true, and what our group does. Not signing a contract with our group (assuming you liked the practice) because you wanted to change something relatively small would be a terrible financial decision.

 

[GI_RadOnc]

Tenure isn't really all it is cracked up to be either.

For those in an academic position; I used to think this as well. Tenure, what an 80K guarantee for life? How's that relevant?
On the other hand, tenure makes it cumbersome/expensive for a new regime or university politics to move you out. And whether it's hospital, private practice, or university/academic; there's always politics!

 

[ramsesthenice]

For those in an academic position; I used to think this as well. Tenure, what an 80K guarantee for life? How's that relevant?
On the other hand, tenure makes it cumbersome/expensive for a new regime or university politics to move you out. And whether it's hospital, private practice, or university/academic; there's always politics!

Depends on a lot of things. Its pretty cumbersome for them to straight up cut my salary unless they can prove some kind of deficiency. But I am a physician scientist which opens me up to a lot of BS that could easily make me want to leave if they wanted to clear out space. Routine satellite coverage. Decreased protected time. Increased RVU targets. None of those have to be justified and these are all liabilities that pure PhDs are simply not vulnerable to. Most regime changes are not hostile so for most people its not going to be an issue (as long as you keep getting funding and being productive). But getting tenure is probably on the order of 5:1 personal accomplishment vs job security.

 

[kimplera]

Depends on a lot of things. Its pretty cumbersome for them to straight up cut my salary unless they can prove some kind of deficiency. But I am a physician scientist which opens me up to a lot of BS that could easily make me want to leave if they wanted to clear out space. Routine satellite coverage. Decreased protected time. Increased RVU targets. None of those have to be justified and these are all liabilities that pure PhDs are simply not vulnerable to. Most regime changes are not hostile so for most people its not going to be an issue (as long as you keep getting funding and being productive). But getting tenure is probably on the order of 5:1 personal accomplishment vs job security.

and also realize that at some institutions (e.g. mine) tenure-track only applies to individuals who expect to be grant funded for the majority of their "effort". the clinical faculty would never be able to be promoted through the tenure committee but this can vary by university.

 

[ramsesthenice]

and also realize that at some institutions (e.g. mine) tenure-track only applies to individuals who expect to be grant funded for the majority of their "effort". the clinical faculty would never be able to be promoted through the tenure committee but this can vary by university.

Mine too. We have the same get up.

 

[RickyScott]

and also realize that at some institutions (e.g. mine) tenure-track only applies to individuals who expect to be grant funded for the majority of their "effort". the clinical faculty would never be able to be promoted through the tenure committee but this can vary by university.

This is the case at most large research institutions. For clinical, translational researchers, tenure may also only apply to a nominal “academic” component of the salary. I have seen tenured docs pushed out by cutting the clinical component (majority) of their salary.

 

[GI_RadOnc]

I agree that tenure doesn't prevent someone from being pushed out. But tenure makes it expensive to do so; not prohibitive to these types of institutions in any way; but much more expensive than just not renewing a clinical contract. I also agree that tenure track positions are not available to most clinicians; but if it's an option/achievable; it is not a bad thing.