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If you look at the Medscape surveys, Hemonc salary has decreased dramatically since 2011. Cardiology has held steady however, I though the big wigs were going to cut all specialist, what happened.
The switch to employment among oncologists, and the lack of getting a cut of the drug money is probably the biggest change. Base salaries aren't all that different, it's the total compensation that has taken a hit.
1. It's expensive to start up an Oncology practice unless you turf all your chemo to an inpatient infusion unit (my medium sized office has 5 front desk staff, 6-8 RNs depending on the day, 3-4 MAs, a pharmacist and 2 pharm techs, a lab tech and 2 people whose FT job is doing prior auths...and that doesn't count the 4 docs and 1 NP). Or have a turnkey thing with something like US Oncology, in which case, they're going to be making the money off the chemo, not you. Buy and bill is too expensive for many smaller groups, especially with the pricing that academics and non-profits get.So why are they switching to employment? is it impractical for oncologist to go into PP nowadays for some reason??
I can only speak for a few groups where I know people (plus myself), but the answer is generally yes. Although it may not be a strict production based bonus but may have other factors included (QI projects, admin duties, etc). Even Kaiser (a completely closed system) uses this structure for their oncologists.Sorry if this is a dumb question, but I am honestly totally ignorant here: Is compensation for hospital-employed oncologists usually base salary + production like in many PP groups?
Yup. And since it's not just oncologists that are being brought "in-house", the referral issue will only get worse in the future for PP docs. I anticipate that the one remaining, fiercely independent group in my town has about 5 years left before they shrivel up and blow away in the wind. All the hospital systems but one have either brought employed docs in-house or made strategic partnerships/collaborations (like the one I'm in). The one hospital that hasn't done that already kicked that group out anyway.The other reason it is impractical to be in conventional private practice is "the referral issue." Much easier to get referrals if you are in a hospital system with surgeons, etc.
In 2015 the only justification for joining an extant private practice is if a) you have geographic restrictions and b) the hospital-employed group in the region in question is dysfunctional.
1. It's expensive to start up an Oncology practice unless you turf all your chemo to an inpatient infusion unit (my medium sized office has 5 front desk staff, 6-8 RNs depending on the day, 3-4 MAs, a pharmacist and 2 pharm techs, a lab tech and 2 people whose FT job is doing prior auths...and that doesn't count the 4 docs and 1 NP). Or have a turnkey thing with something like US Oncology, in which case, they're going to be making the money off the chemo, not you. Buy and bill is too expensive for many smaller groups, especially with the pricing that academics and non-profits get.
2. Hospitals are buying up PP groups like they're going out of style. For senior partners, this can be a good thing since theyll get a pretty nice payout in lieu of decreased annual compensation. Sucks for the junior folks though.
As a very practical example, in my medium-sized metro area, 10 years ago there were 7 PP groups, the University Hospital and a Kaiser hospital. Today, all but 2 of the PP groups have been bought by various hospitals. One of those 2 remaining PP groups is looking to sell but can't find a buyer, the other is a US Oncology group and is hemorrhaging docs (6 down in the last 3 years, none hired)
Are all these people necessary? Are they being paid a salary based on what the doctors bring in? Healthcare to me seems to be extremely bloated. There are a lot of direct primary care offices that are opening with 1 doctor and a Medical Assistant that is also a phlebotomist, and receptionist.
Thanks gutonc for detailed replies. My hospitalist program now also has a community oncologist as nocturnist..since his solo practice has financial viability issues. It gives a pause to aspiring fellows like me.