Is hem/onc lifestyle comparable to derm?

[TexasMed22]

Obviously one should not pursue either of these fields based on lifestyle, however I often hear about how dermatology has a great lifestyle since it can have a 4 day work week/400k a year/minimal call. However, it seems to me that this setup is also very possible and not uncommon in private practice hem onc. Am I incorrect?

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[whoknows2012]

Obviously one should not pursue either of these fields based on lifestyle, however I often hear about how dermatology has a great lifestyle since it can have a 4 day work week/400k a year/minimal call. However, it seems to me that this setup is also very possible and not uncommon in private practice hem onc. Am I incorrect?

The lifestyle of private hem/onc is not nearly as good from a stress level perspective as Derm. The patients we take care of are much much sicker on average and dealing with complicated issues on a day to day basis is a lot to take on and creeps into your outside of work life quite often. Call is also probably worse and even in a pp there is some call burden though it’s probably not enough to make a major impact. All the above notwithstanding, compensation is pretty awesome in hem/onc at the moment especially for pp. Even in hybrid academic and academic jobs there can be good incentive based bonuses to augment decent base compensation to make total salary >350k (pp seems Like 500k + average a few years in). It’s not an issue of compensation though, as mentioned above

 

[HemeOncHopeful19]

Derm probably has a leg up in that you really don’t need/want to take hospital call at ALL in Derm, but overall I do think they’re probably similar.

Plus I’m sure there’s plenty of “stress” in Derm just different stress. No field has to really grind out patient encounters at lightning speed at the rate Derm does (outside of Radiology which is obviously a way different ballgame).

 

[JoeDilly]

The lifestyle of private hem/onc is not nearly as good from a stress level perspective as Derm.

As a new attending grinding through the predictable first year struggles with workload and stress and poor work/life balance and (already) some burnout, I had a moment with my team just today where I wondered out loud how nice it could be to have a patient start bringing up yet another complex problem and just being able to say something to the effect of, "Oh, I'm sorry, is that located INSIDE of your skin? Best of luck!"

 

[gutonc]

Obviously one should not pursue either of these fields based on lifestyle, however I often hear about how dermatology has a great lifestyle since it can have a 4 day work week/400k a year/minimal call. However, it seems to me that this setup is also very possible and not uncommon in private practice hem onc. Am I incorrect?

A derm working 4d a week for 400K should either be seeing <10 patients a day or should quit. FT derm outside of academics and the VA should net you $750K+ if you're lazy.

Hem/onc is definitely a field where you can be very well compensated for what a lot of people would consider not a lot of work. But it's not derm workload or derm compensation in any way, shape or form.

Hem/onc patients are sicker and more dependent on us than derm patients are. For some people that's a plus, for others a big downside. That said, although we like to pretend "onc emergencies" are a thing, as a colleague said to me today, the only role an oncologist should have in a code situation is to stop it immediately.

Choose based on what you want to do with your life. The delta in comp between derm and hem/onc is not enough to make up for a miserable life if it's not what you want to really do.

 

[Ubba]

Day-to-day Derm is pretty hard to beat in terms of stress, lifestyle, pay-to-work ratio, and demand that is never-ending. Most people who had the scores to apply Derm and went into other fields think wistfully of a hypothetical alternative path chosen in M4. To avoid going overboard on the lionization, though, I like to bear in mind that each and every derm exam carries the responsibility of looking out for malignant lesions. Not easy, especially in patients with darker skin.

 

[randomhemoncpd]

The lifestyle of private hem/onc is not nearly as good from a stress level perspective as Derm. The patients we take care of are much much sicker on average and dealing with complicated issues on a day to day basis is a lot to take on and creeps into your outside of work life quite often. Call is also probably worse and even in a pp there is some call burden though it’s probably not enough to make a major impact. All the above notwithstanding, compensation is pretty awesome in hem/onc at the moment especially for pp. Even in hybrid academic and academic jobs there can be good incentive based bonuses to augment decent base compensation to make total salary >350k (pp seems Like 500k + average a few years in). It’s not an issue of compensation though, as mentioned above

Day-to-day Derm is pretty hard to beat in terms of stress, lifestyle, pay-to-work ratio, and demand that is never-ending. Most people who had the scores to apply Derm and went into other fields think wistfully of a hypothetical alternative path chosen in M4. To avoid going overboard on the lionization, though, I like to bear in mind that each and every derm exam carries the responsibility of looking out for malignant lesions. Not easy, especially in patients with darker skin.

Hem

The lifestyle of private hem/onc is not nearly as good from a stress level perspective as Derm. The patients we take care of are much much sicker on average and dealing with complicated issues on a day to day basis is a lot to take on and creeps into your outside of work life quite often. Call is also probably worse and even in a pp there is some call burden though it’s probably not enough to make a major impact. All the above notwithstanding, compensation is pretty awesome in hem/onc at the moment especially for pp. Even in hybrid academic and academic jobs there can be good incentive based bonuses to augment decent base compensation to make total salary >350k (pp seems Like 500k + average a few years in). It’s not an issue of compensation though, as mentioned above

Hem/Onc can scale much, much higher than this. This feels like numbers from 5 years ago IMHO

 

[TexasMed22]

Hem/Onc can scale much, much higher than this. This feels like numbers from 5 years ago IMHO

What are more accurate numbers then? Per MGMA 2021, median is 481k with a mean of 535. Has it really changed that much since then?

 

[whoknows2012]

What are more accurate numbers then? Per MGMA 2021, median is 481k with a mean of 535. Has it really changed that much since then?

Academic is 250-350 pp is around 500, i believe my numbers are fairly accurate

 

[randomhemoncpd]

What are more accurate numbers then? Per MGMA 2021, median is 481k with a mean of 535. Has it really changed that much since then?

 

[randomhemoncpd]

1) MGMA is a survey and tends to underreport. It is used to depress physician salaries so places can claim they’re giving you a certain percentile of median when the whole scale is low.
2) It isn’t that hard to hit 8k RVU and at a going rate of about 100/RVU (sometimes higher)…you do the math. Oncology got a big boost when the E&M codes were buffed over the last few years. You can hustle and rake in over 10k RVU a year in oncology.
3) You have to look around for good positions. There will plenty of places that will keep you low and claim that that’s fair market value. But if you keep your eyes peeled there’s plenty of places with earning potential well north of 5-600k.
4) lots of pharma consulting opportunities too. Can add another 6 digits potentially there

 

[whoknows2012]

1) MGMA is a survey and tends to underreport. It is used to depress physician salaries so places can claim they’re giving you a certain percentile of median when the whole scale is low.
2) It isn’t that hard to hit 8k RVU and at a going rate of about 100/RVU (sometimes higher)…you do the math. Oncology got a big boost when the E&M codes were buffed over the last few years. You can hustle and rake in over 10k RVU a year in oncology.
3) You have to look around for good positions. There will plenty of places that will keep you low and claim that that’s fair market value. But if you keep your eyes peeled there’s plenty of places with earning potential well north of 5-600k.
4) lots of pharma consulting opportunities too. Can add another 6 digits potentially there

There’s no question you can make more I just wonder if the median is as high —without a doubt there’s lots of potential to make $$$ in hem/onc today even in academics

 

[randomhemoncpd]

There’s no question you can make more I just wonder if the median is as high —without a doubt there’s lots of potential to make $$$ in hem/onc today even in academics

I can tell you from personal experience that there’s definitely no shortage of academic places that try their hardest to keep those numbers low. My non data driven guess is that this median is significantly less than total compensation.

 

[HemeOncHopeful19]

Academic is 250-350 pp is around 500, i believe my numbers are fairly accurate

True PP should be 700+ but if you're talking about "community employed" then 500 may be accurate

 

[TexasMed22]

Speaking of MGMA, anyone have the most recent data for hem/onc? Most recent I could find was 2021 (notwithstanding the underreporting)

 

[osprey099]

True PP should be 700+ but if you're talking about "community employed" then 500 may be accurate

I think it also depends on pre-partner vs partner in pp. My pre-partner salary is only gonna be 350-400. Partner salary 1m+ though. This is 5 day weeks 20-25 a day.

 

[gutonc]

I think it also depends on pre-partner vs partner in pp. My pre-partner salary is only gonna be 350-400. Partner salary 1m+ though. This is 5 day weeks 20-25 a day.

That…sounds…terrible.

I could make that kind of money at my employed job doing the same amount of work. But I’d never want to work that hard. That volume is soul crushing.

 

[MD46]

That…sounds…terrible.

I could make that kind of money at my employed job doing the same amount of work. But I’d never want to work that hard. That volume is soul crushing.

Is it? Our admin thinks 20-25 patients 4.5-5 days. Week is the norm???

 

[osprey099]

That…sounds…terrible.

I could make that kind of money at my employed job doing the same amount of work. But I’d never want to work that hard. That volume is soul crushing.

I wish hospital employed positions in my area pays like yours. The highest I've heard is around 700k (after several years exp) for the same workload as above. I'd rather 1099 with a pp making >1m with business tax deductions than w2 with a hospital for 700k

 

[gutonc]

Is it? Our admin thinks 20-25 patients 4.5-5 days. Week is the norm???

If you're going to pay partners ~$1M then yes, you're going to have to move a ton of meat to do it. Obviously admin thinks that way.

As I said, my hospital employed gig would pay me that much if I chose to work that much. But I don't. I can clear $600K doing 16-18 patients 3.5 days a week which is just fine with me.

 

[Ubba]

If you're going to pay partners ~$1M then yes, you're going to have to move a ton of meat to do it. Obviously admin thinks that way.

As I said, my hospital employed gig would pay me that much if I chose to work that much. But I don't. I can clear $600K doing 16-18 patients 3.5 days a week which is just fine with me.

Does this mean you see 16-18 pts on your half-day too, or more like 8-9 (i.e., at a rate of 16-18/full day)?

 

[MD46]

In my current practice if i avg 16-18 a day for 4.5 days a week ill be in 475-525k range

 

[Mehena]

I am a new attending physician. Based on my initial observations, it seems that I could potentially earn a million dollars by working 5 days a week and reducing the allocated PTO. However, I personally believe that this approach might not be sustainable, particularly in oncology. Additionally, the financial benefit might not be as substantial as it appears, considering the tax obligations to Uncle Sam.

While the administration might express reservations and reference FMV, I suspect they might secretly appreciate it due to the increased revenue generated from my high patient volume. I've noticed that PCP and other IM subspecialists often operate on a 4d work week. IMHO, a 4.5-day work week could easily blur into a 4.75-day or even a 4.90-day work week once you're deeply entrenched in the clinic routine.

 

[whoknows2012]

I am a new attending physician. Based on my initial observations, it seems that I could potentially earn a million dollars by working 5 days a week and reducing the allocated PTO. However, I personally believe that this approach might not be sustainable, particularly in oncology. Additionally, the financial benefit might not be as substantial as it appears, considering the tax obligations to Uncle Sam.

While the administration might express reservations and reference FMV, I suspect they might secretly appreciate it due to the increased revenue generated from my high patient volume. I've noticed that PCP and other IM subspecialists often operate on a 4d work week. IMHO, a 4.5-day work week could easily blur into a 4.75-day or even a 4.90-day work week once you're deeply entrenched in the clinic routine.

Don’t fall in the trap-bust your butt sure, but thinking in terms of time off = money lost will drive you crazy. When I started making more ( under half of those estimates above) I started thinking to myself hmm 7 days off = $1500-2k/day=$10k+ lost. 1 day here and 1 day there, should I take an extra wknd to make $6000??

It started to get in the way of how I considered a personal day for an event for on of my kids and that’s when I had to shun that way of thinking bc if it continued I would’ve been driven crazy. In addition if you start working parts of your PTO it’s an easy way to burn out.

Lastly as I am now in my 4th year of practice with income steadily increasing each year, the phenomenon of lifestyle creep is very much at play. In my high COL nyc suburb functionally there will not be a huge difference if I make 500 600 or 700k. Yea I would probably feel a bit more comfortable at 700k and we’d have more in savings and retirement but unless you’re super frugal or live in a low COL area the difference in working more and cutting into your PTO is not going to be worth it in the long run. There’s a Goldilocks zone where you’re humming along in terms of efficiency happiness home life and compensation and it doesn’t usually happen when only your personal life or only your work are prioritized. It’s all about balance, as cliche as that sounds

 

[Mehena]

Indeed, I concur wholeheartedly. As a parent of multiple elementary-age children, I firmly believe that a healthy home life or marriage stands as the sine qua non for achieving financial independence and discovering happiness and effectiveness in both life and work. While marriage and family life might not be suitable for everyone

 

[gutonc]

Does this mean you see 16-18 pts on your half-day too, or more like 8-9 (i.e., at a rate of 16-18/full day)?

That’s per full day.

In my prior job I was seeing 20-25 a day 3 days per week. My current job is 15-ish 3 days a week and a half day of virtual clinic. But I’ve only been here for 5 weeks so I’m still getting up to speed. I anticipate 18-20 a day by the beginning of the year

 

[gutonc]

Lastly as I am now in my 4th year of practice with income steadily increasing each year, the phenomenon of lifestyle creep is very much at play. In my high COL nyc suburb functionally there will not be a huge difference if I make 500 600 or 700k. Yea I would probably feel a bit more comfortable at 700k and we’d have more in savings and retirement but unless you’re super frugal or live in a low COL area the difference in working more and cutting into your PTO is not going to be worth it in the long run. There’s a Goldilocks zone where you’re humming along in terms of efficiency happiness home life and compensation and it doesn’t usually happen when only your personal life or only your work are prioritized. It’s all about balance, as cliche as that sounds

This is what a lot of new physicians (myself included back in the day) don't really realize. The marginal gains from a gross income of $700K compared to $500K is not all that huge, but the amount of work required to get from 500 --> 700 is often quite huge.

 

[whoknows2012]

This is what a lot of new physicians (myself included back in the day) don't really realize. The marginal gains from a gross income of $700K compared to $500K is not all that huge, but the amount of work required to get from 500 --> 700 is often quite huge.

took me 2+ years as an attending to figure this one out…

 

[gutonc]

took me 2+ years as an attending to figure this one out…

Almost 10 here....

But who's counting?

 

[Splenda88]

This is what a lot of new physicians (myself included back in the day) don't really realize. The marginal gains from a gross income of $700K compared to $500K is not all that huge, but the amount of work required to get from 500 --> 700 is often quite huge.

I feel like I need to make 600k/yr (200k above what I made last year) to feel financially comfortable. 4-star hotel does not cut it anymore. Look at me that was very happy to stay at La Quinta 2+ yrs ago when I was a resident, but now I am suspect if hotel is < $400/night. Lifestyle creep is real.

 

[The kitchen sink]

I wish hospital employed positions in my area pays like yours. The highest I've heard is around 700k (after several years exp) for the same workload as above. I'd rather 1099 with a pp making >1m with business tax deductions than w2 with a hospital for 700k

Is 1m net collections in private prac 1099 income better than 700k w2 ?

yes it will get taxed differently. But when you account for overhead and tax on the 1099 1m, then who is coming out ahead?

 

[osprey099]

Is 1m net collections in private prac 1099 income better than 700k w2 ?

yes it will get taxed differently. But when you account for overhead and tax on the 1099 1m, then who is coming out ahead?

The key to pp tax breaks is claiming schedule K1 losses from the business against your personal income. Once/if I become a partner, I'll have a better understanding of this and can update.

 

[The kitchen sink]

The key to pp tax breaks is claiming schedule K1 losses from the business against your personal income. Once/if I become a partner, I'll have a better understanding of this and can update.

Not to mention covering your own benefits, insurance, malpractice, outsourcing of billing (some of which is part of overhead)

Would love an update!