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Bronx,
do you know how by how much the number of fellowship spots has increased over the past ~10 years?
thanx
Cardiology Job market
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Bronx,
do you know how by how much the number of fellowship spots has increased over the past ~10 years?
thanx
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joseph,
what is the estimated # of years to partnership with this job? and what would partner income be?
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On call 2-3 nights per week? For 250k? While hospitalists get 180-200k for 16 shifts a month? Ok, that's it. Not applying cards... pretty sure critical care can pull more than that in a major metro.
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In this day and age, not sure I would bank on making partner. More likely than not, the practice will be sold/bought by large health care systems.
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Yeah, I totally agree. I've heard that's the trend with PC and cards. I've heard of hospitalist jobs paying ~220K + incentives, so I don't see the incentive to apply Cards unless one just really loves the heart. I imagine many of these applicants are FMGs.
Bronx, do you know why the # cards spots has increased so much in recent years?
get a lawyer to review this and aggressively negotiate your compensation. ...a bit low
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I don't think spots have increased THAT much. Back in 2006, I think there were around 650 spots for cardio. It's increased by about 130 since then, which isn't entirely unreasonable. Similar increases have been seen with GI. I think the bigger issue is that people just aren't retiring, which is true for every field. But, for the time being, cardio has become saturated faster than the other ones.
What did you think they got paid in major metro area? That's about what I would expect. Just do yourself a favor and become a hospitalist. You'll be miserable as a cardiologist.
does bronx43 have an axe to grind? jeeez...let it rest dude.
Probably trying to convince people not to apply...lol
In fact, I think 250K in a major metro area is very good. That means you could top off at 400 to 500 far down the path in your career. What's so bad about that?
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More like I'm working my ass off on cards research projects, but looking at a payoff that isn't much better than if I just slacked off and did hospitalist. I love cards, but you gotta question the financial potential when you're doing bench work on your "free time."
And no, I wouldn't come to the cardiology subforum to spout off if I wanted people not to apply, lol.
? ...then why not just "slack off." If the pay off isnt enough for you dont do it. The pay off was/is/and will be good for people for years to come (and not just financially). If it's not for you...it's not for you. Please dont shove it down our throats.
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Just voicing my thoughts in a public forum. If you don't like it, then don't read it.
whatever floats your boat man
I don't think it's that people mind reading your opinion. However, you keep posting how great being a hospitalist is. Then maybe you should do it? I agree with your concerns that the current climate against cardiology is worrisome. However, it's not stopping me from doing it. Do you really think its gonna go from being one of the highest paid specialties to one of the worst? Lets face it the cardiologists back in the day use to get paid alot more than other specialties. Did you think that was going to last forever? And same thing goes for GI. You frequently comment how great GI is getting paid. Trust me, that will not last forever either.
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Major metro area
250K
3 weeks vacation
Call 1:4 weekends, 2-3 nights/wk
Any similar offers
Anyone going to look in rural US to make the big $$$?"
That looks not totally unreasonable, but the salary looks a little lowball, even for general cards. Would expect more like 270, especially for doing that much call. It also depends on what type of call it is. If it's easy call where hospitalists do most of the admits and you just take the occasional phone call and very occasional admission, that's not awful, but 2 weeknights plus 1:4 weekends isn't super great if it's busy call. Especially not with that salary offer.
250K
3 weeks vacation
Call 1:4 weekends, 2-3 nights/wk
Any similar offers
Anyone going to look in rural US to make the big $$$?"
That looks not totally unreasonable, but the salary looks a little lowball, even for general cards. Would expect more like 270, especially for doing that much call. It also depends on what type of call it is. If it's easy call where hospitalists do most of the admits and you just take the occasional phone call and very occasional admission, that's not awful, but 2 weeknights plus 1:4 weekends isn't super great if it's busy call. Especially not with that salary offer.
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The person who posted that 2/5 week days call sounded awful, I agree that it does...but I often take that much call,
BUT it's mostly 1 or 2 phone calls a night b/c it is ONLY patient phone calls and phone calls from 1 ER that is a pretty small hospital, and has hospitalists 24/7 on call. Patients, when they call our office @night, get an operator who immediately asks them if it's an emergency. If they say no, they are immediately told to call back during regular office hours. The ER also doesn't usually call unless it's a real MI or unstable angina, or very unstable CHF, which doesn't happen incredibly often. Hospitalists occasionally call for consults but most often it's between 7am-6p.m., unless they are really worried about a patient. Some hospitalist are more "independent" than others. Actually, getting reamed occasionally in clinic with multiple ER or consult calls, or calls to read a stat or urgent echo in the middle of a clinic day is actually more of a problem than middle-of-the-night calls. Private practice type setups are usually not like a large academic hospital, where nurses and other docs tend to call the fellow or resident a lot for every little thing - there are still nurses who call you to d/c a defunct order at 12:30 a.m. or to clarify a Tylenol order at 5:45 a.m. but it's more rare.
p.s. I agree the EP job market sucks. I would say the most job postings I have seen recently are for interventionalists (who would presumably do a lot of general cards as well), and followed closely by general and CHF docs. If you are general, it helps to be able to do TEE's and nuclear, but I have seen very few ads looking for people who need to be able to do CT or MRI (especially not MRI). I think being certified in CT could still give you an edge for certain jobs, however. MRI I expect will/would remain more of a research and big academic hospital type of thing - it's just not very cost effective and there aren't that many cardiac disorders that you really "need" an MRI to dx or treat.
I'm not sure about these people expecting to make 500k doing cardiology - if you want to work like a dog and live in Alabama or Oklahoma as an interventionalist, you can probably make that after a while, but you should expect to probably take a LOT of STEMI call. This might work for you if you have a stay-at-home spouse to take care of 99% of stuff at home and you like to work and don't have many hobbies, but I suspect many of use wouldn't want that life.
Also, some people on here seem to be expecting some magical rise in their income a few years after "starting a practice" but I know zero people from my program on the West coast who went and started up a practice, and only 1/4 graduating fellows who joined a private practice at all, and last I heard he was doing call all weekend every other weekend. Most jobs out here are employed by a hospital system , and several older docs either joined a hospital or large employed group, or moved out of state. There are some still-existing private practices but the cost of owning all that equipment such as echocardiogram machines, and employing the medical assistants, etc. to run one's office, is not affordable any more, from what I have been told. And you would probably have trouble getting "partners" to join you any more, given the uncertain future reimbursements in our field.
In an ideal world, I'd like to be in a group with 4-8 other docs and I'd like to dictate/determine my clinic schedule, and have more say in my call schedule, but that doesn't seem feasible any time soon.
I don't think you have to worry about having no job at all s/p cardiology fellowship right now, if you go to a decent program and have some skills, but if you are in a major metro area like Chicago or SF, you may have to move to get a job. I have heard Chicago is particularly bad - it's not just cardio but anesthesia and probably other fields also - perhaps this is due to the multiple number of residency and fellowship spots in the city, plus perhaps other ppl trying to move there from other parts of the Midwest (not sure about the latter).
BUT it's mostly 1 or 2 phone calls a night b/c it is ONLY patient phone calls and phone calls from 1 ER that is a pretty small hospital, and has hospitalists 24/7 on call. Patients, when they call our office @night, get an operator who immediately asks them if it's an emergency. If they say no, they are immediately told to call back during regular office hours. The ER also doesn't usually call unless it's a real MI or unstable angina, or very unstable CHF, which doesn't happen incredibly often. Hospitalists occasionally call for consults but most often it's between 7am-6p.m., unless they are really worried about a patient. Some hospitalist are more "independent" than others. Actually, getting reamed occasionally in clinic with multiple ER or consult calls, or calls to read a stat or urgent echo in the middle of a clinic day is actually more of a problem than middle-of-the-night calls. Private practice type setups are usually not like a large academic hospital, where nurses and other docs tend to call the fellow or resident a lot for every little thing - there are still nurses who call you to d/c a defunct order at 12:30 a.m. or to clarify a Tylenol order at 5:45 a.m. but it's more rare.
p.s. I agree the EP job market sucks. I would say the most job postings I have seen recently are for interventionalists (who would presumably do a lot of general cards as well), and followed closely by general and CHF docs. If you are general, it helps to be able to do TEE's and nuclear, but I have seen very few ads looking for people who need to be able to do CT or MRI (especially not MRI). I think being certified in CT could still give you an edge for certain jobs, however. MRI I expect will/would remain more of a research and big academic hospital type of thing - it's just not very cost effective and there aren't that many cardiac disorders that you really "need" an MRI to dx or treat.
I'm not sure about these people expecting to make 500k doing cardiology - if you want to work like a dog and live in Alabama or Oklahoma as an interventionalist, you can probably make that after a while, but you should expect to probably take a LOT of STEMI call. This might work for you if you have a stay-at-home spouse to take care of 99% of stuff at home and you like to work and don't have many hobbies, but I suspect many of use wouldn't want that life.
Also, some people on here seem to be expecting some magical rise in their income a few years after "starting a practice" but I know zero people from my program on the West coast who went and started up a practice, and only 1/4 graduating fellows who joined a private practice at all, and last I heard he was doing call all weekend every other weekend. Most jobs out here are employed by a hospital system , and several older docs either joined a hospital or large employed group, or moved out of state. There are some still-existing private practices but the cost of owning all that equipment such as echocardiogram machines, and employing the medical assistants, etc. to run one's office, is not affordable any more, from what I have been told. And you would probably have trouble getting "partners" to join you any more, given the uncertain future reimbursements in our field.
In an ideal world, I'd like to be in a group with 4-8 other docs and I'd like to dictate/determine my clinic schedule, and have more say in my call schedule, but that doesn't seem feasible any time soon.
I don't think you have to worry about having no job at all s/p cardiology fellowship right now, if you go to a decent program and have some skills, but if you are in a major metro area like Chicago or SF, you may have to move to get a job. I have heard Chicago is particularly bad - it's not just cardio but anesthesia and probably other fields also - perhaps this is due to the multiple number of residency and fellowship spots in the city, plus perhaps other ppl trying to move there from other parts of the Midwest (not sure about the latter).
Ill calrify more about the offer I got
Cover 4 small hospitals in am, clinic in PM 30 patients, nuchs, echos
250K - bonus of 10% on all collections over 500K
3 weeks vacation
Call 1:4 weekends, 2-3 nights/wk, the call does have some hospitalist support but you never know what you can raelly manage over the phone or not
partnership buy in after 3 years - not sure it will be a big salary jump or what the real $$$ potential is, lots of guys get told after their 3 year incubaton period 'you arent a good fit for the culture' and get tossed out straight away.
Located in big city in SE US, all other jobs here going for 250
tremendous amount of competiion from small groups and solo guys, no real hospital integration has taken off here yet
the cost of living here is also high
Interventional paying maybe 20-30 K higher maybe
EP (When there is an opening) probably 350.
Hospitalist jobs in this area for 7 on 7 off with RVU bonus can hit 240 for probably half the work and no call. I think VA cardiology around here also 225ish with rediculously easy schedule, awesome benefits.
contrast this with offers in TN, AL, AK, KY, GA that can start 350K, partnership 'potential' (whatever that means) touted at 500-700K after 2 years
some other rare start at 500K jobs in real rural areas I have ssen as well
Per diem hospitalist paying 100/hr, critical care 120/hr, cardiology 100-150/hr but primarily for CATH.
overall I have to wsay I think sitting in fellowship these last 3 years was a waste of time unless I decide to head out to the boonies for 2-5 years and bag a million cash and then decide to live wherever I want and make 250K/yr.
Cover 4 small hospitals in am, clinic in PM 30 patients, nuchs, echos
250K - bonus of 10% on all collections over 500K
3 weeks vacation
Call 1:4 weekends, 2-3 nights/wk, the call does have some hospitalist support but you never know what you can raelly manage over the phone or not
partnership buy in after 3 years - not sure it will be a big salary jump or what the real $$$ potential is, lots of guys get told after their 3 year incubaton period 'you arent a good fit for the culture' and get tossed out straight away.
Located in big city in SE US, all other jobs here going for 250
tremendous amount of competiion from small groups and solo guys, no real hospital integration has taken off here yet
the cost of living here is also high
Interventional paying maybe 20-30 K higher maybe
EP (When there is an opening) probably 350.
Hospitalist jobs in this area for 7 on 7 off with RVU bonus can hit 240 for probably half the work and no call. I think VA cardiology around here also 225ish with rediculously easy schedule, awesome benefits.
contrast this with offers in TN, AL, AK, KY, GA that can start 350K, partnership 'potential' (whatever that means) touted at 500-700K after 2 years
some other rare start at 500K jobs in real rural areas I have ssen as well
Per diem hospitalist paying 100/hr, critical care 120/hr, cardiology 100-150/hr but primarily for CATH.
overall I have to wsay I think sitting in fellowship these last 3 years was a waste of time unless I decide to head out to the boonies for 2-5 years and bag a million cash and then decide to live wherever I want and make 250K/yr.
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need to look for a different hospital. 30 patients/day in clinic 4.5 or 5 days a week? And rounding at 4 different hospitals...sounds not good.
Try a different city or state, if you are able. Or just go with VA or something.
Try a different city or state, if you are able. Or just go with VA or something.
Actually this is bad schedule. Salary should commensurate with level of work. I would either negotiate the amount of work or the money or both. With the level of work involved, shoot for $300,000. Remember the first offer is always a low ball. There is always an expectation that you will ask for 10-15% and if you are good may be 20%.
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Two job offers:
1. Semi-rural college town:
Non-invasive
300K guaranteed first year then you eat what you kill for 4 years before being able to leave.
Call is 1:4
No mention of partnership
2. 40 minutes from major US city (subarb of the city):
Non-invasive
350K starting with bonus, partnership in 2 years
Call is 1:6
Yeah I signed up with number 2
1. Semi-rural college town:
Non-invasive
300K guaranteed first year then you eat what you kill for 4 years before being able to leave.
Call is 1:4
No mention of partnership
2. 40 minutes from major US city (subarb of the city):
Non-invasive
350K starting with bonus, partnership in 2 years
Call is 1:6
Yeah I signed up with number 2
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I am glad that people are discussing their job offers. Data on starting salary is hard to come by. I am not sure what you people are using for reference but I am certainly receiving less than MGMA salaries. However, my remuneration seems to be in line with what has been posted so far:
I had two offers:
$280,000, Major city in North East.
Noninvasive with advanced imaging.
8 weeks inpatient with 1:6 weekends or so.
Fellow support.
$210,000
Academic center in small college town.
Not much call, no CCU, mostly clinic based.
?Fellow support.
Took first choice.
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Punk,
Thanks for posting. Is there any possibility of partnership with either of these? Do you have a sense of what the upward potential is?
thanx
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I do not understand these posts. Why are starting salaries so low? Is this for real?
Medscape, Beckers Hospital Review, other physician salary surveys always quote 300-low 400s. Would those with experience please also start posting. This is alarming to hear for those residents going into cardiology... Thank you in advance for those who reply!
Medscape, Beckers Hospital Review, other physician salary surveys always quote 300-low 400s. Would those with experience please also start posting. This is alarming to hear for those residents going into cardiology... Thank you in advance for those who reply!
It all depends on how desperately you need a certain job and other options available. Here is what I have heard from my friends:
1. $250,000 Heart failure in South major city (hospital employed).
2. $300,000 Heart failure in a major city in South (hospital employee)
3. $250,000 Interventional major city in major city 2 years ago (group practice, not sure about partnership)
Here is what I have learnt through the process. There will always be people who have similar qualifications to you but are earning more in the same area. Either I can look at those and moan or I can be satisfied with what I have knowing fully well that my lifestyle will probably be the same even if I was earning $40K more. After taxation and all, you probably will get only $20K extra in hand.
1. $250,000 Heart failure in South major city (hospital employed).
2. $300,000 Heart failure in a major city in South (hospital employee)
3. $250,000 Interventional major city in major city 2 years ago (group practice, not sure about partnership)
Here is what I have learnt through the process. There will always be people who have similar qualifications to you but are earning more in the same area. Either I can look at those and moan or I can be satisfied with what I have knowing fully well that my lifestyle will probably be the same even if I was earning $40K more. After taxation and all, you probably will get only $20K extra in hand.
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So If I finish med school with 400K in loans and then spend another 6 years in training, I would owe ~612K @ the current avg. 7.35% interest. Hrm. K.
Hospitalist sounds....better all the time?
How can you say high 2 And low 300s is is too low. How much you expect a cardiologist to make? If I start out at 300 I'll be thrilled.
What do you think is a fair starting salary?
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Are those starting (as in, fresh out of training) salaries? Or are they salaries offered to new hires, which includes more experienced physicians.
My guess is across-the-board lower starting salaries for all sub-specialties, especially for hospital-based employment. People always quote "average physician" salaries, but it's the older docs who own their practices/keep their profit who are making a ton. They'll sell their practice before they retire for millions and deny us a chance to earn the same in the long run.
I tend to think older docs in private practice selling their practices for millions as they retire to hospitals leaves fresh grads with less chances of owning, less higher income potential/profits over the next several decades, and no ownership to sell to the next generation of doctors to follow us. Lose, lose, lose on all accounts when it comes to the income.
Am I off on my thinking?
My guess is across-the-board lower starting salaries for all sub-specialties, especially for hospital-based employment. People always quote "average physician" salaries, but it's the older docs who own their practices/keep their profit who are making a ton. They'll sell their practice before they retire for millions and deny us a chance to earn the same in the long run.
I tend to think older docs in private practice selling their practices for millions as they retire to hospitals leaves fresh grads with less chances of owning, less higher income potential/profits over the next several decades, and no ownership to sell to the next generation of doctors to follow us. Lose, lose, lose on all accounts when it comes to the income.
Am I off on my thinking?
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FWIW, I don't know a fellow in the last 3 years from my program in the West that started for less than 350k. Not SF/LA area but otherwise big western cities. Most General have been 350-450k (higher end was more rural). Interventional/EP 400-500k (one rural for 600+). Personally I couldn't even fathom taking a non-academic gig for <300k and I sure wouldn't be all that fired up for a 300k/year spot.
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What are the fellows getting THIS year? The lower salaries seem like a new development. With 800 fellows coming out yearly, I fear that the field's hit a tipping point.
Shocker....more doom and gloom from Bronx. I spoke to a recruiter today. He said when I finish interventional to ask for a 400 to 500K starting if I'm not in a bg city. Ill take 300 and be thrilled.
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Now having taken a job, and now in month 3 post fellowship...I will add this:
The vast majority of jobs have become employment based with a hospital or a hospital group where after your guarantee is done(2-3 yrs) you will be primarily compensated based on your work RVUs.
When you go out and look for a job, it is critical that along with a up front guarantee there be some explanation of where these work RVUs will come from after your guarantee is over. I interviewed at a place that was offering me $400K for non invasive but did not have the echo or nuclear volume to support such a salary. I'd have to see 30-40 patients a day in order to produce the wRVUs equal to my guarantee salary.
Whats the point of earning $400K for 2-3 years only to either have to leave because the compensation drops after the initial period or having to deal with a unsustainable work schedule to meet that guarantee?
Also these "guarantees" are not really guaranteed. The "standard" contracts I was sent often had language in them saying that they could scale back the promised dollar amounts if your production was way lower than they anticipated.
A 250K job that will definitively grow and has the potential for large amounts wRVU production may be superior to the 350K job that comes with a pipe dream of potential production.
The vast majority of jobs have become employment based with a hospital or a hospital group where after your guarantee is done(2-3 yrs) you will be primarily compensated based on your work RVUs.
When you go out and look for a job, it is critical that along with a up front guarantee there be some explanation of where these work RVUs will come from after your guarantee is over. I interviewed at a place that was offering me $400K for non invasive but did not have the echo or nuclear volume to support such a salary. I'd have to see 30-40 patients a day in order to produce the wRVUs equal to my guarantee salary.
Whats the point of earning $400K for 2-3 years only to either have to leave because the compensation drops after the initial period or having to deal with a unsustainable work schedule to meet that guarantee?
Also these "guarantees" are not really guaranteed. The "standard" contracts I was sent often had language in them saying that they could scale back the promised dollar amounts if your production was way lower than they anticipated.
A 250K job that will definitively grow and has the potential for large amounts wRVU production may be superior to the 350K job that comes with a pipe dream of potential production.
this past season, 1 fellow got a noninvasive gig in suburban Pennsylvania for ~300,000 annually. One got a gig in SE way outside of any major metro for non-invasive 410,000 with 60 grand to sign on.
I would also say that salary is only one of things to look at. I also wanted quality of life and plenty of options to take out my kids on a weekend. Most places have 3 weeks vacation, I get 4 weeks. Wife seems to have better job options in the area too.
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This is vital for people to understand. These offers you're seeing for 400K+ are almost always some flavor of the above--i.e. you will get that for a couple of years, and then subsequently you will be absolutely breaking your back trying to maintain it. There are certainly still places in the U.S. where you can generate 500-600K a year in RVUs, but by-and-large those days are over for cardiology (and pretty much everybody else).
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Also, I am always dumbfounded by these people saying, "For salaries like that, I might as well be a hospitalist!" Have you ever worked as a hospitalist? I have. I'd probably take a pay cut to be a cardiologist instead of a hospitalist.
Do you think it depends on the job type within being a hospitalist?
I never understood exactly why people hate it so much or say it is so much work. It just seems like an extension of residency with a huge pay bump.
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how often do they make an offer just after the first interview? Seems like a very long process to get the phone interview, in person interview, 2nd interview/visit, contract offer for multiple jobs.
I did not get any offer just after a first visit. If I was interested, I went back for a second look often within 2 weeks and got an offer in another 2 weeks after that. I practically exhausted all my vacation days on interview.
So it seems like average salary for cardiologists in major metro areas is somewhere in the 200s. If you think about this from a purely financial perspective hospitalists make low 200s too but they work half the time and theres no call. Sounds like its not so clear cut that the cardiologists do better if you think about it just from a $$$ perspective.
Agree with the previous post it is spot on. I finished interventional fellowship this year and can tell you the specialty is in horrendous shape.Simple supply and demand. There is minimal difference between hospitalist pay and cardiology pay especially if you consider how much extra work/responsibility there is in cards. I don't think the cards market is going to open up anytime soon. For those that are saying they would be happy making 250-300 when your done with fellowship just wait to you go out in the real world and those around you work half as much making the same if not more. I'm not going to go into all the details about why situation is the way it is...but in my opinion this will not be improving anytime soon.
Had chat with another colleague of mine. Basically, MGMA salaries are overinflated. These salaries are not verified and are by self report only. Physicians obviously have an axe to grind here because if the salaries are high in the survey, they can negotiate a higher number.
redlined, what is the scoop? I will be interested in hearing why do you think the situation is the way it is.
I am also interested in hearing about if people are able to negotiate future salary increases. Future increase is not mentioned in my contract at least.
