Any hospitalists make a percentage of their collections instead of RVUs?

[drumass]

I got offered a hospitalist job with a private practice multispecialty group at a community hospital in major city
The job is 190K base + 55% of your collections.
7on/7off
Very busy hospital, can see upwards to 20-30 pts a day with residents or run the nonteaching team with 2 NPs. Residents/NPs doing all the H&Ps, progress notes, and DC summaries. (I know this is true as I am a resident at this hospital).
No procedures. No nights. Residents run codes.
Cons: patient load. the hospital is part of a major corporation that sounds like ABA and uses meditech

I have never heard of any hospitalist jobs with a payment structure based on collections instead of RVU so I am curious if anyone is familiar with this kind of setup. Are setups like this favorable?

My other offers are a nocturnist job at a level 1 center
310K/year flat no rvu, 7on/off (182 shifts year), 8hr shifts, no codes, no procedures, closed ICU, no cross cover, 9 admits/night
I could also do the same nocturnist job but 0.8 FTE at 12/shifts a month (144 shifts) and Full benefits @ 240K flat.

Other than these 2 jobs the metro area I am in is saturated and groups are full.

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[chessknt]

I got offered a hospitalist job with a private practice multispecialty group at a community hospital in major city
The job is 190K base + 55% of your collections.
7on/7off
Very busy hospital, can see upwards to 20-30 pts a day with residents or run the nonteaching team with 2 NPs. Residents/NPs doing all the H&Ps, progress notes, and DC summaries. (I know this is true as I am a resident at this hospital).
No procedures. No nights. Residents run codes.
Cons: patient load. the hospital is part of a major corporation that sounds like ABA and uses meditech

I have never heard of any hospitalist jobs with a payment structure based on collections instead of RVU so I am curious if anyone is familiar with this kind of setup. Are setups like this favorable?

My other offers are a nocturnist job at a level 1 center
310K/year flat no rvu, 7on/off (182 shifts year), 8hr shifts, no codes, no procedures, closed ICU, no cross cover, 9 admits/night
I could also do the same nocturnist job but 0.8 FTE at 12/shifts a month (144 shifts) and Full benefits @ 240K flat.

Other than these 2 jobs the metro area I am in is saturated and groups are full.

PP hospitalist is rare which is why you haven't heard of it.

Is there a partnership track? How much of the payor mix is uninsured or on government insurance? When is their contract with the hospital up again and how is the relationship with the hospital admin? What is the average collections for a new partner? I could see this being worth 400k+ depending on a lot of factors but they are eating a huge chunk of your collections so would be good to know when that changes.

 

[NotAProgDirector]

Problems with salary based upon collections:

1. Your salary will depend highly upon payor mix. Medicaid pays almost nothing, you'll be seeing those patients basically for free. If there are multiple teams, how are patients divided up? Uninsured will be even worse - expect absolute zero payment from them.
2. Collections are often delayed. Not surprising if bills get paid 2-3 months later. This is a big problem at the beginning, and at the end -- when you leave, you might just lose all the collections at the end (depends on contract and honesty).
3. Not everyone pays their bill, even when insured (although this is usually less of a problem since insurance covers most of it)

 

[NotAProgDirector]

Also, you would need to clarify how supervising NP/PA's will work now. Before Jan 1, you could just review their notes, discuss the case with them, and attest their notes and get the RVU's/payment at the full rate (rather than the 85% they get). With the new billing rules, to do so you must spend more than 50% of the total time of the visit managing the patient to do so. So most patients will now end up getting billed at the lower rate, and that income will be credited to the NP/PA's.

 

[collegestud2013]

I got offered a hospitalist job with a private practice multispecialty group at a community hospital in major city
The job is 190K base + 55% of your collections.
7on/7off
Very busy hospital, can see upwards to 20-30 pts a day with residents or run the nonteaching team with 2 NPs. Residents/NPs doing all the H&Ps, progress notes, and DC summaries. (I know this is true as I am a resident at this hospital).
No procedures. No nights. Residents run codes.
Cons: patient load. the hospital is part of a major corporation that sounds like ABA and uses meditech

I have never heard of any hospitalist jobs with a payment structure based on collections instead of RVU so I am curious if anyone is familiar with this kind of setup. Are setups like this favorable?

My other offers are a nocturnist job at a level 1 center
310K/year flat no rvu, 7on/off (182 shifts year), 8hr shifts, no codes, no procedures, closed ICU, no cross cover, 9 admits/night
I could also do the same nocturnist job but 0.8 FTE at 12/shifts a month (144 shifts) and Full benefits @ 240K flat.

Other than these 2 jobs the metro area I am in is saturated and groups are full.

Pay is very variable here and depends largely on patient volume and insurance payor mix, and much harder to predict than RVU-based pay. General rule is commercial insurance > Medicare >> Medicaid > no insurance (and probably nothing if the patient has no insurance). If the hospital is a more affluent part of town, it may ending being good money, but if it's more of a safety net hospital, you'll end up effectively doing a lot of work for free. Collection-based pay like this is not common model for full-time hospitalist jobs, and I would suspect it is not favorable for hospitalist at most places. This is because at most hospitalist groups don't break even when just accounting for the collections from E&M alone, and generally require some of the costs of running the group to be subsidized by the hospital's pool of money. And, unlike in the outpatient setting where you can exclude patients without insurance or those with low reimbursing insurance, you pretty much have to see everyone in the hospital (or at least pass the patients onto another provider/group in the hospital).

Look up the current Medicare payment conversion factors for each H&P, progress note, d/c summary to get a rough middle of the ground estimate (as commercial insurance will pay more while Medicaid will pay a lot less than these numbers), though still hard to estimate collections even if you knew your patient volume. Best thing to do is ask the younger attendings at this group and see how much they're getting (and since you're already a resident at this hospital it may not be too hard to do this), and see how patients are assigned to make sure there's no way one person is systematically getting more of the uninsured or medicaid patients. The 45% of collections they are taking are presumably to cover your bases salary, NP/PA salaries, and other overhead costs of running the group. Also, 20-30 patients per day is a pretty high volume (even if they were all follow-ups and discharge; if some of those are new admits, that would be an even heaving workload); even with residents and NP/PAs covering you still have to see all the patients and sign off their notes so there may be some burnout. Would make sure your pay ends up being in line with the volume. And with new billing rules, if the NP/PA writes most of the note collections are now at 85% of the physician value unless you attest that you spent more time on the patient.

Would look into additional jobs outside your metro area than these 2 if you want a good offer (usually base + RVU pay is the most straightforward and most predictably compensates you for seeing more patients) and if you're not a big fan of doing nights. If you're geographically restricted, might also want look into other jobs besides hospitalist (like telemedicine, urgent care, PCP).

 

[chessknt]

Pay is very variable here and depends largely on patient volume and insurance payor mix, and much harder to predict than RVU-based pay. General rule is commercial insurance > Medicare >> Medicaid > no insurance (and probably nothing if the patient has no insurance). If the hospital is a more affluent part of town, it may ending being good money, but if it's more of a safety net hospital, you'll end up effectively doing a lot of work for free. Collection-based pay like this is not common model for full-time hospitalist jobs, and I would suspect it is not favorable for hospitalist at most places. This is because at most hospitalist groups don't break even when just accounting for the collections from E&M alone, and generally require some of the costs of running the group to be subsidized by the hospital's pool of money. And, unlike in the outpatient setting where you can exclude patients without insurance or those with low reimbursing insurance, you pretty much have to see everyone in the hospital (or at least pass the patients onto another provider/group in the hospital).

Look up the current Medicare payment conversion factors for each H&P, progress note, d/c summary to get a rough middle of the ground estimate (as commercial insurance will pay more while Medicaid will pay a lot less than these numbers), though still hard to estimate collections even if you knew your patient volume. Best thing to do is ask the younger attendings at this group and see how much they're getting (and since you're already a resident at this hospital it may not be too hard to do this), and see how patients are assigned to make sure there's no way one person is systematically getting more of the uninsured or medicaid patients. The 45% of collections they are taking are presumably to cover your bases salary, NP/PA salaries, and other overhead costs of running the group. Also, 20-30 patients per day is a pretty high volume (even if they were all follow-ups and discharge; if some of those are new admits, that would be an even heaving workload); even with residents and NP/PAs covering you still have to see all the patients and sign off their notes so there may be some burnout. Would make sure your pay ends up being in line with the volume. And with new billing rules, if the NP/PA writes most of the note collections are now at 85% of the physician value unless you attest that you spent more time on the patient.

Would look into additional jobs outside your metro area than these 2 if you want a good offer (usually base + RVU pay is the most straightforward and most predictably compensates you for seeing more patients) and if you're not a big fan of doing nights. If you're geographically restricted, might also want look into other jobs besides hospitalist (like telemedicine, urgent care, PCP).

20 level 2 FU at medicare rates (truly uninsured people are rare because hospitals get them on emergency medicaid that retroactively pays the hospital) is approx $1600; this is assuming they are paying based off total RVU and not just wRVU since the practice is collecting the entire portion. This is a conservative estimate because admits and higher level fu will flex that number up. OP's daily rate is 1065 (assuming 180 shifts/yr) so add another 800 on and you are looking at 335/yr conservatively which seems a little meh for the amount of work with the plus side being you know when you are working hard that you are paying yourself. When OP makes partner that should flex up significantly since a pure inpatient practice should have an overhead of less than 15%.

 

[Splenda88]

I got offered a hospitalist job with a private practice multispecialty group at a community hospital in major city
The job is 190K base + 55% of your collections.
7on/7off
Very busy hospital, can see upwards to 20-30 pts a day with residents or run the nonteaching team with 2 NPs. Residents/NPs doing all the H&Ps, progress notes, and DC summaries. (I know this is true as I am a resident at this hospital).
No procedures. No nights. Residents run codes.
Cons: patient load. the hospital is part of a major corporation that sounds like ABA and uses meditech

I have never heard of any hospitalist jobs with a payment structure based on collections instead of RVU so I am curious if anyone is familiar with this kind of setup. Are setups like this favorable?

My other offers are a nocturnist job at a level 1 center
310K/year flat no rvu, 7on/off (182 shifts year), 8hr shifts, no codes, no procedures, closed ICU, no cross cover, 9 admits/night
I could also do the same nocturnist job but 0.8 FTE at 12/shifts a month (144 shifts) and Full benefits @ 240K flat.

Other than these 2 jobs the metro area I am in is saturated and groups are full.

9 admits/night for 8-hr shift is a lot. 6 is ideal IMO

 

[Nocturnist]

I got offered a hospitalist job with a private practice multispecialty group at a community hospital in major city
The job is 190K base + 55% of your collections.
7on/7off
Very busy hospital, can see upwards to 20-30 pts a day with residents or run the nonteaching team with 2 NPs. Residents/NPs doing all the H&Ps, progress notes, and DC summaries. (I know this is true as I am a resident at this hospital).
No procedures. No nights. Residents run codes.
Cons: patient load. the hospital is part of a major corporation that sounds like ABA and uses meditech

I have never heard of any hospitalist jobs with a payment structure based on collections instead of RVU so I am curious if anyone is familiar with this kind of setup. Are setups like this favorable?

My other offers are a nocturnist job at a level 1 center
310K/year flat no rvu, 7on/off (182 shifts year), 8hr shifts, no codes, no procedures, closed ICU, no cross cover, 9 admits/night
I could also do the same nocturnist job but 0.8 FTE at 12/shifts a month (144 shifts) and Full benefits @ 240K flat.

Other than these 2 jobs the metro area I am in is saturated and groups are full.

I've never heard of a collections based salary structure so I can't speak to it more than to say that I highly doubt the hospital structured it that way because it is more lucrative for the hospitalists than RVU based. It also sounds much less transparent because you can roughly keep track of your billed RVUs but you will never, ever get access to the hospital's collection records nor have any ability to audit them.

With regards to the nocturnist job, 9 admits in 8 hours is a joke. To sit there with a straight face and pretend that an admission every 50 minutes without a break is sustainable or safe is preposterous. Even if that was a 12 hour shift, 9 admits consistently would be back breaking.
$1700 per shift for 9 admits with no productivity is $190 an admission- pretty low. Continue to look elsewhere.

 

[aafisahar]

9 admits in 8 hours is fine until one of them is a train wreck. Otherwise, shouldn't be a big deal after 1-2 years of attending.

 

[Nocturnist]

9 admits in 8 hours is fine until one of them is a train wreck. Otherwise, shouldn't be a big deal after 1-2 years of attending.

I've been a nocturnist for 7 years.
I'm the top 2 or 3 most efficient admitters in my group, and because I work close to 2 FTEs I bill more RVUs than any hospitalist in our very large group. Very respectfully- an admit in less than an hour is not "fine". Maybe if every single one is a chest pain rule out or kidney stone on 2 medications but otherwise, it's plain dangerous.
Can I do it for a couple weeks? Sure. Can I do it for a year? Make it a career? Absolutely Absolutely not, and I'm probably going to be sued pretty soon for the stuff I miss.

These jobs are getting more and more ridiculous. Last week someone posted about a 9 hour 9 admit night job, now it's 9 in 8 hours, what next- 10 admits in 2 hours? These gigs are just packing a 12 hour night into less and less hours with no hope of you actually getting out on time to make them look more appealing.

 

[NITRAS]

I've been a nocturnist for 7 years.
I'm the top 2 or 3 most efficient admitters in my group, and because I work close to 2 FTEs I bill more RVUs than any hospitalist in our very large group. Very respectfully- an admit in less than an hour is not "fine". Maybe if every single one is a chest pain rule out or kidney stone on 2 medications but otherwise, it's plain dangerous.
Can I do it for a couple weeks? Sure. Can I do it for a year? Make it a career? Absolutely Absolutely not, and I'm probably going to be sued pretty soon for the stuff I miss.

These jobs are getting more and more ridiculous. Last week someone posted about a 9 hour 9 admit night job, now it's 9 in 8 hours, what next- 10 admits in 2 hours? These gigs are just packing a 12 hour night into less and less hours with no hope of you actually getting out on time to make them look more appealing.

One of my senior residents said his record was 27 in a 24 hour period. . . . . .No thank you.

 

[Splenda88]

I've been a nocturnist for 7 years.
I'm the top 2 or 3 most efficient admitters in my group, and because I work close to 2 FTEs I bill more RVUs than any hospitalist in our very large group. Very respectfully- an admit in less than an hour is not "fine". Maybe if every single one is a chest pain rule out or kidney stone on 2 medications but otherwise, it's plain dangerous.
Can I do it for a couple weeks? Sure. Can I do it for a year? Make it a career? Absolutely Absolutely not, and I'm probably going to be sued pretty soon for the stuff I miss.

These jobs are getting more and more ridiculous. Last week someone posted about a 9 hour 9 admit night job, now it's 9 in 8 hours, what next- 10 admits in 2 hours? These gigs are just packing a 12 hour night into less and less hours with no hope of you actually getting out on time to make them look more appealing.

I agree with you. 6 admits in 8 hrs and 9 in 12 hrs should be the norm.

We should not let administrators exploit our good will. For reason I don get, physicians seem to be ok to let others take advantage of them..

 

[Nocturnist]

One of my senior residents said his record was 27 in a 24 hour period. . . . . .No thank you.

Mine is 18 in 14 hours. It's a sign of a dysfunctional system, not something to be proud of. I'll admit the med recs were booty juice, the plans were bare bones, barely addressed their chronic issues. There was some definite cherry picking involved. I can do that a couple times a month if I know there's a several K pot of gold waiting at the end of the quarter but thats it.

 

[chessknt]

To students or residents reading this thread--5-6 admits per shift will bill about 1/3 of the salary numbers being posted here (21 wRVU at CMS rates is approx $700/shift). On an RVU basis it would make you the least productive physician in the entire health system by far. For reference an outpt level 4 visit (25 minutes by time) bills about half a high level admit; an outpt physician seeing only 10-12 follow up patients a day and saying the hospital should be greatful would be a *****.

The oblivious here will pretend that a subsidy of over 60% of their demanded salary is reasonable but we all know it absolutely is not, especially when no other physician in the hospital comes close to that level of need. That behavior drives midlevel recruitment and supervision models to edge out expensive underproducing physicians and until medicine ceases to be a business that is the reality you need to pay attention to. Being productive should be incentivized, pretending like you need to take 85 minutes to admit every single patient as a hospitalist is ridiculous. Even CCM billing incremented (or used to anyways) at 75 minutes because that encompassed the vast majority of time spent on the sickest people in the hospital. I dont know any of my hospitalist coworkers who takes longer than 40 minutes to admit someone unless there is some really complicated issue requiring in person discussions with specialists or talking to multiple family members.

 

[Splenda88]

To students or residents reading this thread--5-6 admits per shift will bill about 1/3 of the salary numbers being posted here (21 wRVU at CMS rates is approx $700/shift). On an RVU basis it would make you the least productive physician in the entire health system by far. For reference an outpt level 4 visit (25 minutes by time) bills about half a high level admit; an outpt physician seeing only 10-12 follow up patients a day and saying the hospital should be greatful would be a *****.

The oblivious here will pretend that a subsidy of over 60% of their demanded salary is reasonable but we all know it absolutely is not, especially when no other physician in the hospital comes close to that level of need. That behavior drives midlevel recruitment and supervision models to edge out expensive underproducing physicians and until medicine ceases to be a business that is the reality you need to pay attention to. Being productive should be incentivized, pretending like you need to take 85 minutes to admit every single patient as a hospitalist is ridiculous. Even CCM billing incremented (or used to anyways) at 75 minutes because that encompassed the vast majority of time spent on the sickest people in the hospital. I dont know any of my hospitalist coworkers who takes longer than 40 minutes to admit someone unless there is some really complicated issue requiring in person discussions with specialists or talking to multiple family members.

You are telling us hospitals do not collect for tests ordered.

They are paying an NP 142k at my place to do 2 admissions/night and cross cover on about 100 non-ICU and stepdown patients. Where that money come from? Does she even generate even 10% of that?

 

[chessknt]

You are telling us hospitals do not collect for tests ordered.

The stark law made that illegal so of course not, the only field that gets legal kickbacks is oncology.

Also admits are capitated by DRGs so ordering a bunch of iron deficiency labs is not making the hospital money, actually doing the opposite.

 

[gutonc]

I agree with you. 6 admits in 8 hrs and 9 in 12 hrs should be the norm.

We should not let administrators exploit our good will. For reason I don get, physicians seem to be ok to let others take advantage of them..

Back in the day when I moonlighted as a nocturnist, I did 10 admits in a 12h shift including 2 ICU patients with "CCM backup by phone" who were fortunately tubed, lined and pressored before leaving the ED so just needed babysitting until the intensivist arrived in the morning.

I called the hospitalist administrator before I left the hospital the following morning, canceled all my remaining scheduled shifts and have never worked a full day (or night) of inpatient medicine since. F*** that noise.

 

[chessknt]

You are telling us hospitals do not collect for tests ordered.

They are paying an NP 142k at my place to do 2 admissions/night and cross cover on about 100 non-ICU and stepdown patients. Where that money come from? Does she even generate even 10% of that?

Nocturnal cross-cover is always going to be charity care since it wont capture anything. Getting that many patients covered by a midlevel and getting them to do some admits (if it is a busy enough place to have someone else on at night) is actually a great deal for them. A better model is using a tele-hospitalist that covers hundreds of patients across multiple sites owned by the same health system. This is going to become the norm-- the hospitals are bleeding money but unlike the tech companies they aren't cutting off their useless employees (because they are all administrators), instead they are just going to make the producers work more for the same or less.

 

[Splenda88]

Nocturnal cross-cover is always going to be charity care since it wont capture anything. Getting that many patients covered by a midlevel and getting them to do some admits (if it is a busy enough place to have someone else on at night) is actually a great deal for them. A better model is using a tele-hospitalist that covers hundreds of patients across multiple sites owned by the same health system. This is going to become the norm-- the hospitals are bleeding money but unlike the tech companies they aren't cutting off their useless employees (because they are all administrators), instead they are just going to make the producers work more for the same or less.

Well, it should also be charity work for the admitting nocturnist who is not sleeping in his/her bed at night...

I am ruthless since the market is good for hospitalist right now. 5 months ago I had a recruiter that contacted me for some locum.... Told her $240/hr; hospital was willing to give $210/hr. Probably would have taken the $210 if I did not get extra shifts at my main gig @ ~190/hr.

 

[Splenda88]

Back in the day when I moonlighted as a nocturnist, I did 10 admits in a 12h shift including 2 ICU patients with "CCM backup by phone" who were fortunately tubed, lined and pressored before leaving the ED so just needed babysitting until the intensivist arrived in the morning.

I called the hospitalist administrator before I left the hospital the following morning, canceled all my remaining scheduled shifts and have never worked a full day (or night) of inpatient medicine since. F*** that noise.

2 train-wrecks in one night can basically f... your night. I maintain my stand 6 admits for 8 hrs and 9 admits for 12 hrs.

 

[chessknt]

Well, it should also be charity work for the admitting nocturnist who is not sleeping in his/her bed at night...

I am ruthless since the market is good for hospitalist right now. 5 months ago I had a recruiter that contacted me for some locum.... Told her $240/hr; hospital was willing to give $210/hr. Probably would have taken the $210 if I did not get extra shifts at my main gig @ ~190/hr.

I don't blame you at all, absolutely get it while you can. But the reality will come crashing down eventually and being of the mindset that 6 admits is a full time job is absurd. The bumper covid money is gone and the costs of all hospital labor have gone through the rough while reimbursements are heading down. This is going to whip back on subsidized specialties before it hits anyone else and being willing to work of earn whatbyou think you're worth is going to protect you, that is all I am saying.

 

[Splenda88]

I don't blame you at all, absolutely get it while you can. But the reality will come crashing down eventually and being of the mindset that 6 admits is a full time job is absurd. The bumper covid money is gone and the costs of all hospital labor have gone through the rough while reimbursements are heading down. This is going to whip back on subsidized specialties before it hits anyone else and being willing to work of earn whatbyou think you're worth is going to protect you, that is all I am saying.

They will find a way to subsidize hospitalist salary if they are having tough time finding them.

I know a program that is giving a 50k (yes 50k) raise to all hospitalists because they are having a hard time recruiting. They only have 6 FT hospitalists for a hospital of 200 beds, the rest are locum who for the most part do not care.

6 admits in 8 hrs is NOT absurd. How many it should be?

 

[collegestud2013]

You are telling us hospitals do not collect for tests ordered.

They are paying an NP 142k at my place to do 2 admissions/night and cross cover on about 100 non-ICU and stepdown patients. Where that money come from? Does she even generate even 10% of that?

Most hospitalist groups don't break even if you only count the collections based on their E&M alone, and require subsidization from the hospital's pool of money to pay for all compensation and overhead costs. This is especially true for night shifts, which are generally paid at a higher rate but tend to have lower RVUs than their daytime colleagues since most cross coverage work at night is not billable (some of it is, such as billing critical care time on sick patients, or procedures done at night), and so RVUs come mostly from new admissions and consults. The difference will be even more noticeable with this year's CMS changes to RVU weights, which has essentially lowered the wRVUs of H&Ps while increasing the RVUs of follow-ups and discharges.

However, night shifts are still a necessary business expense to keep a hospital running; hence, the higher payment from higher RVUs collected by the day shifts partially subsidize the higher pay of night shifts.


Since most hospitalist groups require subsidization, they are often seen as a necessary business expense as far as accounting goes (ie hiring more hospitalists leads to greater losses). And thus pay will largely fluctuate with supply and demand. But hospitals won't want to go back to the model from the 1980s (ie when there were no dedicated hospitalists and each of the individual non-hospital employed services had to admit their own patients), so dedicated hospitalists are still in demand.

 

[collegestud2013]

They will find a way to subsidize hospitalist salary if they are having tough time finding them.

I know a program that is giving a 50k (yes 50k) raise to all hospitalists because they are having a hard time recruiting. They only have 6 FT hospitalists for a hospital of 200 beds, the rest are locum who for the most part do not care.

6 admits in 8 hrs is NOT absurd. How many it should be?

An AVERAGE of 6 admits in an 8 hr night shift will keep you busy, as you also have cross-coverage responsibilities on top of admitting all by yourself. 6 admits in a daytime admitting shift is reasonable. And keep in mind that if it's just an average, on a busier night you could have 8-10 in 8 hrs.

Pay for physicians, like hospitalists, is largely location dependent. I suspect the program giving a $50k raise may have a hard time recruiting due to being in an undesirable location. Most programs in big cities or desirable coastal areas can probably recruit without being nearly as generous.

 

[Splenda88]

An AVERAGE of 6 admits in an 8 hr night shift will keep you busy, as you also have cross-coverage responsibilities on top of admitting all by yourself. 6 admits in a daytime admitting shift is reasonable. And keep in mind that if it's just an average, on a busier night you could have 8-10 in 8 hrs.

Pay for physicians, like hospitalists, is largely location dependent. I suspect the program giving a $50k raise may have a hard time recruiting due to being in an undesirable location. Most programs in big cities or desirable coastal areas can probably recruit without being nearly as generous.

Correct...