Job opportunity

[BloodySurgeon]

W2
$425k
$67/RVU after 6250 wRVU
4 weeks vacation

Procedure must be done in hospital none in office
Slow turnover rate for procedures
Max 20 procedures per day
Max 30 patient office visits

What’s the likelihood of making high RVU as a hospital employee and potential salary

Also how would you rate this job

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[Ferrismonk]

This job is excellent.

 

[buddababa]

W2
$425k
$67/RVU after 6250 wRVU
4 weeks vacation

Procedure must be done in hospital none in office
Slow turnover rate for procedures
Max 20 procedures per day
Max 30 patient office visits

What’s the likelihood of making high RVU as a hospital employee and potential salary

Also how would you rate this job

This job is golden. Sign.

 

[BloodySurgeon]

What do you think the income potential range is. Previous providers wRVU under 6000 and left for private practice

 

[Dr. Ice]

Do you have to work the entire day? Oh right it’s a hospital..

Other than that, sounds pretty good

 

[BloodySurgeon]

Solo practice. 9am-6pm. Minimal inpatient consults. No scribe, PA or NP. Remote location but OR privileges for kyphoplasty and implants.

New staff so some administrative work as well

 

[Ferrismonk]

Only thing I'd hate is the 6PM leave time. There is no reason you can't get out by 4 with that schedule, even in a hospital. You may want to inquire about future hiring of a PA/NP if the referral volume makes sense. Kyphoplasty can be done in the HOPD fyi.

 

[buddababa]

What do you think the income potential range is. Previous providers wRVU under 6000 and left for private practice

You should make average 7500-9000 minimum after a few years of building up your practice

 

[drusso]

W2
$425k
$67/RVU after 6250 wRVU
4 weeks vacation

Procedure must be done in hospital none in office
Slow turnover rate for procedures
Max 20 procedures per day
Max 30 patient office visits

What’s the likelihood of making high RVU as a hospital employee and potential salary

Also how would you rate this job

They are only able to pay that because they're juicing the vig on the SOS and cost-shifting facility fees/revenue to your W2. You're being subsidized/paid off to generate facility fees. Can you wake up every day and be okay with that? If yes, how? How would you explain the situation to others?

 

[DrMDAware]

The max I predict will be 425k.

I ask you - how do you feel about that?

Slow room turnovers = won’t do more than 20 cases a day. So, the ceiling is fixed.

Are you able to start later in the day and leave earlier to make it more cush in line with the pay?

I have a few friends who have taken a similar offer. They have been “bought out” by the hospital system and are ok not not hustling or going for a higher ceiling. They have a bonus structure but realistically can’t get it. It fits in like with their desires for a job.

 

[so55b]

Solo practice. 9am-6pm. Minimal inpatient consults. No scribe, PA or NP. Remote location but OR privileges for kyphoplasty and implants.

New staff so some administrative work as well

9-6 is too long for 6250 unless it is 4 days a week IMO

 

[BloodySurgeon]

Bingo.

They are only able to pay that because they're juicing the vig on the SOS and cost-shifting facility fees/revenue to your W2. You're being subsidized/paid off to generate facility fees. Can you wake up every day and be okay with that? If yes, how? How would you explain the situation to others?

Bingo!

Physician fee $100-200 for 10 minute injection
Facility fee $1000-2000 for 10 minute injection

Conveniently they don’t allow physician assisted sedation (2mg IV Versed) and require all sedation to be anesthesia sedation by hospital employed team ($$$). They agreed to allow oral versed but will have to be prescribed at home and not in hospital so increased liability.

The max I predict will be 425k.

I ask you - how do you feel about that?

Slow room turnovers = won’t do more than 20 cases a day. So, the ceiling is fixed.

Are you able to start later in the day and leave earlier to make it more cush in line with the pay?

I have a few friends who have taken a similar offer. They have been “bought out” by the hospital system and are ok not not hustling or going for a higher ceiling. They have a bonus structure but realistically can’t get it. It fits in like with their desires for a job.

Turn overs will be longer then the procedure themselves and will have to work with hospital staffing for more available procedure days per month if needed. so that’s why I agree the ceiling is fixed and very little incentive to work hard. PA or NP is possible after hitting a certain RVU but I negotiated to have a scribe instead with a lower RVU threshold due to above issues and concern of bringing more work home which should be factored in

9-6 is too long for 6250 unless it is 4 days a week IMO

they are flexible on moving hours around. If I want 8am-4pm M-Fri or half day Friday but will need to work more hours on another weekday evening to make up for it.

 

[PainApp2021]

Sounds like a higher paid VA position basically. Depending on where you are in your career and what compensation you're happy with it may be a good or bad fit. Do you think you will be frustrated with a rigid administration?

 

[hyperalgesia]

W2
$425k
$67/RVU after 6250 wRVU
4 weeks vacation

Procedure must be done in hospital none in office
Slow turnover rate for procedures
Max 20 procedures per day
Max 30 patient office visits

What’s the likelihood of making high RVU as a hospital employee and potential salary

Also how would you rate this job

To me, the money is fine for the volume/time but other potential headaches set off alarm bells. Like "minimal inpatient..."

 

[DOctorJay]

The max I predict will be 425k.

I ask you - how do you feel about that?

Slow room turnovers = won’t do more than 20 cases a day. So, the ceiling is fixed.

Are you able to start later in the day and leave earlier to make it more cush in line with the pay?

I have a few friends who have taken a similar offer. They have been “bought out” by the hospital system and are ok not not hustling or going for a higher ceiling. They have a bonus structure but realistically can’t get it. It fits in like with their desires for a job.

This exactly

 

[deleted875186]

Excellent. IMO would need to be ok with making just base. In reality if the referral source is good and no show rate not too high, should be able to do 7000-8000 RVU pretty easy even with the turnover times being limited.

I don’t like working till 6PM. Is the last patient scheduled at 545, if so that terrible. If last patient is scheduled at 445 with some admin time at end of the day then fine.

My main question would be what is the patient population, Medicaid rate, what’s the opioid situation like at the clinic, etc.

 

[RoloTomassi]

Also they didn't offer mid-level or scribes but how many, if any, MAs?

 

[BloodySurgeon]

Excellent. IMO would need to be ok with making just base. In reality if the referral source is good and no show rate not too high, should be able to do 7000-8000 RVU pretty easy even with the turnover times being limited.

I don’t like working till 6PM. Is the last patient scheduled at 545, if so that terrible. If last patient is scheduled at 445 with some admin time at end of the day then fine.

My main question would be what is the patient population, Medicaid rate, what’s the opioid situation like at the clinic, etc.

1700: double book new consult
Or
17:30: last new consult
(Usually for patients who need to come after work)

History, physical exam, review imaging with patient, discuss R/B/A procedure or meds, and book procedure with very little time for notes. Hard to finish before 6pm with possible notes at home to finish.

No administrator or surgeon pulling my arm to prescribe narcotics but has a few in the practice that will need refills. Usually cancer patients.

50-60% Medicare/ 25-30% commercial / 10% other (jail/no fault/cash/etc)

Inpatients do not need to be seen right away can be delayed until procedure days in the hospital and usually limited to 1-2x/month. No weekend calls and consults are limited to procedures. They have palliative team for medication management.

 

[BloodySurgeon]

Also they didn't offer mid-level or scribes but how many, if any, MAs?

One MA. Not responsible for notes.

 

[deleted875186]

1700: double book new consult
Or
17:30: last new consult
(Usually for patients who need to come after work)

History, physical exam, review imaging with patient, discuss R/B/A procedure or meds, and book procedure with very little time for notes. Hard to finish before 6pm with possible notes at home to finish.

No administrator or surgeon pulling my arm to prescribe narcotics but has a few in the practice that will need refills. Usually cancer patients.

50-60% Medicare/ 25-30% commercial / 10% other (jail/no fault/cash/etc)

Inpatients do not need to be seen right away can be delayed until procedure days in the hospital and usually limited to 1-2x/month. No weekend calls and consults are limited to procedures. They have palliative team for medication management.

Schedule stinks then. I’d rather take a general anesthesia job and do some calls and weekends, at least you would be out earlier and more consistently.

 

[BloodySurgeon]

Schedule stinks then. I’d rather take a general anesthesia job and do some calls and weekends, at least you would be out earlier and more consistently.

That’s what I was planning to do but feel very conflicted with this decision.

 

[Ronin1]

Those late patients/hours would be a nonstarter for me. My last patient scheduled @330. I do start around 730 though

 

[deleted875186]

That’s what I was planning to do but feel very conflicted with this decision.

Why conflicted. Anesthesia market is good. Postcall days can be good. You’ll get better pay and more vacation.

Those clinic hours stink.

 

[RoloTomassi]

One MA. Not responsible for notes.

You doing 100% of the note sucks. Documentation is my least favorite part of the job.

 

[Ducttape]

why do you have to work until 6?

why not start at 8 instead of 9, and end at 5?

i have a similar job, but 40% Medicaid. they have a 20% no show rate.

even with all that, i still average just under 8000 wRVUs.

you can do >6250 wRVUs on just office visits easily, even with a high no show rate.

 

[Centurion38]

I'd be wary of any job that is dictating the precise office hours you must work. You should have flexibility to tailor your schedule as you see fit, even as a new hire

 

[lobelsteve]

M-T In at 630, 1st patient at 730, last patient at 320. OTD at 330 most days.
Friday same in AM, OR from 12-5 depending on 1,2,3 cases.

 

[oneforfighting]

M-T In at 630, 1st patient at 730, last patient at 320. OTD at 330 most days.
Friday same in AM, OR from 12-5 depending on 1,2,3 cases.

Why do you get in so early before patients arrive?

 

[Agast]

I’m surprised the hours end at 6 pm. Not because it’s hard on the doctor, but because they’d have to hire support staff whose hours also end after 6 pm…unless they plan on you discharging the patient and swiping their credit card on the way out. Most hourly wage employees would not be cool with that.

 

[lobelsteve]

Why do you get in so early before patients arrive?

Review charts, imaging, PDMP for the day.
45 min prep lets me stay on time all day long.

 

[oneforfighting]

"Review charts, imaging, PDMP for the day.
45 min prep lets me stay on time all day long."

I do that the night before

 

[jwalker12]

"Review charts, imaging, PDMP for the day.
45 min prep lets me stay on time all day long."

I do that the night before

same, night before quick cheat sheet for next day makes things smooth

 

[SSdoc33]

night before?

SMH

no way

the whole point is to leave the office at the office. no email, no calls, and definitely no chart review

 

[oneforfighting]

To each their own. No problems with taking 15 mins to chart review night before. Sleep better that way.
Charting is a different matter. I finish my notes before leaving the office. Never want to take that home with me.

 

[PainDoc2025]

Where is location for this job?

 

[MitchLevi]

"Review charts, imaging, PDMP for the day.
45 min prep lets me stay on time all day long."

I do that the night before

STOP DOING THAT

 

[deleted875186]

Review charts, imaging, PDMP for the day.
45 min prep lets me stay on time all day long.

I used to do this, but no show rate is too high, and they’ll add patients in my schedule the day of, I ended up just wasting a bunch of time reviewing charts the morning of.

 

[callmeanesthesia]

I used to do this, but no show rate is too high, and they’ll add patients in my schedule the day of, I ended up just wasting a bunch of time reviewing charts the morning of.

I tried it for a while and it made me faster in clinic but I didn’t feel like that justified the extra time at home it cost me. Besides, I use that time to review referrals, PA notes, insurance denials, etc.
I don’t get why people are saying Lobel shouldn’t do it that way though. To each their own; it works well for him.

 

[deleted131481]

I used to do this, but no show rate is too high, and they’ll add patients in my schedule the day of, I ended up just wasting a bunch of time reviewing charts the morning of.

Same I stopped reviewing anyone who is not actually checked in. But I also have a slower schedule than most here.

 

[drusso]

night before?

SMH

no way

the whole point is to leave the office at the office. no email, no calls, and definitely no chart review

I review both the night before and the morning of. I find problems every time and head them off. I also schedule scans of the whole clinic and look for potential procedure patients, bottlenecks, etc. I text my RN around 6 AM and give her a run-down: "Make sure Ms. T roomed on time at 8 AM;" "tell the MAs to knock on the door of Sally's 10 AM if running late; she talks too much" "I don't see coags on the kypho, call lab" etc. I call it "reviewing the playbook" Then, at 7:45 AM, we have our pre-game huddle for the last-minute check-in. It makes you more efficient. We spend a lot of time emphasizing the need for "situational awareness," and "structured communication" between the control tower and the pilots.

Besides, charge a no-show fee if the patient cancels. It justifies your pre-work. Failing to prepare is preparing to fail.

 

[SSdoc33]

I review both the night before and the morning of. I find problems every time and head them off. I also schedule scans of the whole clinic and look for potential procedure patients, bottlenecks, etc. I text my RN around 6 AM and give her a run-down: "Make sure Ms. T roomed on time at 8 AM;" "tell the MAs to knock on the door of Sally's 10 AM if running late; she talks too much" "I don't see coags on the kypho, call lab" etc. I call it "reviewing the playbook" Then, at 7:45 AM, we have our pre-game huddle for the last-minute check-in. It makes you more efficient. We spend a lot of time emphasizing the need for "situational awareness," and "structured communication" between the control tower and the pilots.

Besides, charge a no-show fee if the patient cancels. It justifies your pre-work. Failing to prepare is preparing to fail.

running a PP is a 5 am - 9 pm job that always loves you back

 

[drusso]

running a PP is a 5 am - 9 pm job that always loves you back

If you can think of a short-cut, let me know.

 

[SSdoc33]

If you can think of a short-cut, let me know.

Sally gets a bonus if she takes less than 5 minutes

as was previously stated, to each his own. i find that you dont really know what the problems are until they present themselves when the patient shows up. i prefer to handle them on the fly.

things like labs, insurance auths, imaging, etc should all be taken care of without a text, then a huddle, then a pep talk re: situational awareness.

 

[Ferrismonk]

I work in a group with built in inefficiencies I'm powerless to change and am faster than most at procedures so I have plenty of time available during working hours.

My first patient is at 8, so they're usually ready by 8:15. I show up at 8 and review the first 3-5 patients for the day. I'll finish reviewing the rest of my morning in between visits/procedures. Usually finish patients by 11:30, then meet with case managers, phone RN, etc until 12. Lunch from 12-1 where I'll finish any notes leftover from the morning and review my afternoon. I finish my afternoon patients by 3:30 then will spend until about 4 finishing up any notes/etc until wrap up. Will take 30s to eyeball the next day and see if I need to brush up on anything weird. Home by 5.

 

[lobelsteve]

If you can think of a short-cut, let me know.

Too soon to let you know about my raise for 2023-24?

 

[drusso]

Too soon to let you know about my raise for 2023-24?

The physician fee schedule is getting cut.

 

[lobelsteve]

The physician fee schedule is getting cut.

Not the concern of the captive employed physician.

 

[drusso]

Not the concern of the captive employed physician.

 

[DOctorJay]

Not the concern of the captive employed physician.

Unless you haven’t gotten a raise in years

 

[lobelsteve]

Unless you haven’t gotten a raise in years

Sounds awful. Some hassles we put up with. But baby needs a new pair of Nike Air Mag low Adapt BB.