Thoughts on first contract

[yakattack16]

Have an offer for my first academic hospitalist gig out of residency; in a major metro area in the NE. Curious to hear thoughts about the offer. My hesitancy is salary given VHCOL, however, the gig itself does lend itself to the lower pay given the better lifestyle.

Salary: 230 base w/o incentives/bonus. 1800/shift for days, 2100 for nights with ample moonlighting opportunity.
Benefits: 5% contribution to 403b, 2wks PTO with 1wk CME
7/7 model with a hard rounding cap of 15 with an avg of 1-2 admits. Most leave before 7p. Closed icu, no procedures, no rapids/codes. Mixed work with mid-level and residents when on teaching service.

My gut tells me it's a good tradeoff, but I hesitate with the low salary.

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[CCM-MD]

Have an offer for my first academic hospitalist gig out of residency; in a major metro area in the NE. Curious to hear thoughts about the offer. My hesitancy is salary given VHCOL, however, the gig itself does lend itself to the lower pay given the better lifestyle.

Salary: 230 base w/o incentives/bonus. 1800/shift for days, 2100 for nights with ample moonlighting opportunity.
Benefits: 5% contribution to 403b, 2wks PTO with 1wk CME
7/7 model with a hard rounding cap of 15 with an avg of 1-2 admits. Most leave before 7p. Closed icu, no procedures, no rapids/codes. Mixed work with mid-level and residents when on teaching service.

My gut tells me it's a good tradeoff, but I hesitate with the low salary.

Not bad at all. Especially with the patient cap, no rapid/code, resident/midlevel support, paid time off, and location. Math doesn’t add up though, $1800 per shift should come out to >300k for 7 on/off. Most hospitalist gigs don’t have PTO so you should consider that when comparing with other gigs to ensure an “apples to apples” comparison.

 

[yakattack16]

That was my thinking as well. Given the benefits and lifestyle, it's hard to beat.

I'm not sure what to make of the per diem rate, as it's confirmed with multiple current faculty members, and delineated in my offer contract.

 

[NITRAS]

If you had resiidents the whole time, maybe .. wth are you doing staying till 7pm?

Also clarify about how often you are on teaching service. We have a few teaching teams, (think A-D are teaching a E-U are not) but really only a few people rotate on them, and honestly they are sometimes more work than they are worth. I’d also carify what most people got in Terms of bonus and quality metrics.

The per diem rate should be moonlighting. . . Right? And just clarify how many weeks you work. Is it 26? Or 23? It kinda sounds like 23-24.5. A 1 FTE Hospitalist at my place works 26 weeks year without PTO or CME time but there is some weird nuances to it. There is officially 2 weeks of STD parental leave, but I effectively got one week off.

 

[yakattack16]

To clarify, will either have residents or midlevels the entire time. Teaching service likely average one week/month in the beginning. Most leave around 530 or so.

There is no bonus or quality metrics to boost comp, and yes - it is for 23 weeks

 

[TaroBubbleTea]

Salary seems low for VHCOL area.

 

[yakattack16]

Salary seems low for VHCOL area.

Not really sure if hospitalist salaries run in concordance with COL. My search, albeit short, has yielded opposite results.

 

[gutonc]

Not really sure if hospitalist salaries run in concordance with COL. My search, albeit short, has yielded opposite results.

Your results are generally true. Ridiculous, but true.

Most places with high COL are also desirable (hence the high COL). So the supply generally outweighs the demand.

 

[gutonc]

Not bad at all. Especially with the patient cap, no rapid/code, resident/midlevel support, paid time off, and location. Math doesn’t add up though, $1800 per shift should come out to >300k for 7 on/off. Most hospitalist gigs don’t have PTO so you should consider that when comparing with other gigs to ensure an “apples to apples” comparison.

I understood it as "here's the base for X shifts, if you want to work more, here's the per diem". i agree that it doesn't make a ton of sense though, unless they have a hard time filling extra shifts and need to entice people to pick up extras.

My (non-hospitalist, outpatient subspecialty) practice pays a per diem for extra days that is within $2 of what the base salary pays averaged out over 4d/wk for 48wk/y which is FT in the group.

 

[yakattack16]

I understood it as "here's the base for X shifts, if you want to work more, here's the per diem". i agree that it doesn't make a ton of sense though, unless they have a hard time filling extra shifts and need to entice people to pick up extras.

My (non-hospitalist, outpatient subspecialty) practice pays a per diem for extra days that is within $2 of what the base salary pays averaged out over 4d/wk for 48wk/y which is FT in the group.

This is the case. Salary is flat and per diem rate is largely out of proportion to the base rate.

 

[CCM-MD]

$230k for 23 weeks. Add $1800 per shift for 3 weeks = $37k. So this gig is essentially $267k for 26 weeks (what most consider 1.0 FTE for hospitalists).

It’s not bad considering everything else you are getting and the location.

 

[TaroBubbleTea]

Not really sure if hospitalist salaries run in concordance with COL. My search, albeit short, has yielded opposite results.

I’m just curious, would a non academic job in the same area pay a similar salary or more?

 

[NITRAS]

I’m just curious, would a non academic job in the same area pay a similar salary or more?

Non-academic Hospitalist see more patients and make more money.

 

[sss2g2]

Guessing your taxes in this HCOL city either NYC or Boston? is off the charts. If you're single you are going to get wrecked. Knock out 40% of that 230 if you are single and your take home is 140 or 11k per month. Loans and rent? Hard pass for me unless you have a spouse doing well.

 

[collegestud2013]

Have an offer for my first academic hospitalist gig out of residency; in a major metro area in the NE. Curious to hear thoughts about the offer. My hesitancy is salary given VHCOL, however, the gig itself does lend itself to the lower pay given the better lifestyle.

Salary: 230 base w/o incentives/bonus. 1800/shift for days, 2100 for nights with ample moonlighting opportunity.
Benefits: 5% contribution to 403b, 2wks PTO with 1wk CME
7/7 model with a hard rounding cap of 15 with an avg of 1-2 admits. Most leave before 7p. Closed icu, no procedures, no rapids/codes. Mixed work with mid-level and residents when on teaching service.

My gut tells me it's a good tradeoff, but I hesitate with the low salary.

They're still paying you a bit less than what you're likely brining in RVU wise if those patient volumes they're telling you are accurate. If you assume an average of 1.8 wRVUs per rounding patient (a mix of Level 2 and Level 3 progress notes and discharge summaries) and 3.86 wRVUs per admission (99223, or a Level 3 H&P), and assume 15 rounding patients and 1.5 admissions per shift, that.s (1.8 x 15) + (3.86 x 1.5) = 32.79 wRVUs per shift. If you work 7 shifts per week for 23 weeks then the total is 32.79 x 7 x 23 = 5279 wRUVs. The current CMS reimbursement for codes used by hospitalists averages to around $52 per wRVU. So that's 5279 x $52 = $274,508. Then again, if you also have midlevel support it could be argued that some of your productivity would be going to pay for them.

Also be very wary about "hard" patient caps as an attending and not having a production/RVU bonus. Unless it's written that way in your contract, the patient census and policies can change all the time. And it's uncommon for employers to want to place a hard cap on an attending since this could lead to staffing issues and less flexibility for them depending on patient census. For example, if there's another COVID surge and the census blows up and they can't find extra attendings to cover on certain days, who will see those extra patients? For this reason I usually don't recommend taking any attending job that doesn't have RVU bonus (as you have the incentive to see the least amount of patients as possible, while your employer has the incentive to dump more patients on you).

But overall I would go with this job only if the benefits of living in this VHCOL area are worth it to you and outweigh the financial downsides of the job. Volumes are on the lower side if what they're saying is true and you have sometimes have help from residents or midlevels (but not always from the sounds of it) but pay is very low for what you're bringing in and considering local cost of living. And if the cap is not a true hard cap, you could get stuck seeing larger volumes at busier times without any additional compensation.

 

[bobow98]

Used to moonlight at a shop similar to what you describe. Life is definitely pretty good when you have a midlevel or resident rounding on every patient you see daily and don't have rapids/codes/ICU.

This seems to be a fair offer if it's in a desirable city with nearby airport.
Most of the full time people did about 3 or 4 extra shifts a month and this raised them to 300-315k a year by the end.

 

[yakattack16]

Guessing your taxes in this HCOL city either NYC or Boston? is off the charts. If you're single you are going to get wrecked. Knock out 40% of that 230 if you are single and your take home is 140 or 11k per month. Loans and rent? Hard pass for me unless you have a spouse doing well.

Correct with location, and SO earns similarly to myself, and this would drop drastically if we moved elsewhere. This is also our home city and where all family is based.

They're still paying you a bit less than what you're likely brining in RVU wise if those patient volumes they're telling you are accurate. If you assume an average of 1.8 wRVUs per rounding patient (a mix of Level 2 and Level 3 progress notes and discharge summaries) and 3.86 wRVUs per admission (99223, or a Level 3 H&P), and assume 15 rounding patients and 1.5 admissions per shift, that.s (1.8 x 15) + (3.86 x 1.5) = 32.79 wRVUs per shift. If you work 7 shifts per week for 23 weeks then the total is 32.79 x 7 x 23 = 5279 wRUVs. The current CMS reimbursement for codes used by hospitalists averages to around $52 per wRVU. So that's 5279 x $52 = $274,508. Then again, if you also have midlevel support it could be argued that some of your productivity would be going to pay for them.

Also be very wary about "hard" patient caps as an attending and not having a production/RVU bonus. Unless it's written that way in your contract, the patient census and policies can change all the time. And it's uncommon for employers to want to place a hard cap on an attending since this could lead to staffing issues and less flexibility for them depending on patient census. For example, if there's another COVID surge and the census blows up and they can't find extra attendings to cover on certain days, who will see those extra patients? For this reason I usually don't recommend taking any attending job that doesn't have RVU bonus (as you have the incentive to see the least amount of patients as possible, while your employer has the incentive to dump more patients on you).

But overall I would go with this job only if the benefits of living in this VHCOL area are worth it to you and outweigh the financial downsides of the job. Volumes are on the lower side if what they're saying is true and you have sometimes have help from residents or midlevels (but not always from the sounds of it) but pay is very low for what you're bringing in and considering local cost of living. And if the cap is not a true hard cap, you could get stuck seeing larger volumes at busier times without any additional compensation.

Will have either resident or midlevel support 100% of the time. And cap is hard, and I am very familiar with the place, as it's where I did residency. All of the above has been confirmed with current faculty. My tendency is to let this job play out, allow spouse to boost career in the city, and then head for the $$.

 

[CCM-MD]

They're still paying you a bit less than what you're likely brining in RVU wise if those patient volumes they're telling you are accurate. If you assume an average of 1.8 wRVUs per rounding patient (a mix of Level 2 and Level 3 progress notes and discharge summaries) and 3.86 wRVUs per admission (99223, or a Level 3 H&P), and assume 15 rounding patients and 1.5 admissions per shift, that.s (1.8 x 15) + (3.86 x 1.5) = 32.79 wRVUs per shift. If you work 7 shifts per week for 23 weeks then the total is 32.79 x 7 x 23 = 5279 wRUVs. The current CMS reimbursement for codes used by hospitalists averages to around $52 per wRVU. So that's 5279 x $52 = $274,508. Then again, if you also have midlevel support it could be argued that some of your productivity would be going to pay for them.

Also be very wary about "hard" patient caps as an attending and not having a production/RVU bonus. Unless it's written that way in your contract, the patient census and policies can change all the time. And it's uncommon for employers to want to place a hard cap on an attending since this could lead to staffing issues and less flexibility for them depending on patient census. For example, if there's another COVID surge and the census blows up and they can't find extra attendings to cover on certain days, who will see those extra patients? For this reason I usually don't recommend taking any attending job that doesn't have RVU bonus (as you have the incentive to see the least amount of patients as possible, while your employer has the incentive to dump more patients on you).

But overall I would go with this job only if the benefits of living in this VHCOL area are worth it to you and outweigh the financial downsides of the job. Volumes are on the lower side if what they're saying is true and you have sometimes have help from residents or midlevels (but not always from the sounds of it) but pay is very low for what you're bringing in and considering local cost of living. And if the cap is not a true hard cap, you could get stuck seeing larger volumes at busier times without any additional compensation.

You’re assuming everyone is insured and that the hospital is collecting 100% of what they are billing. Those are big assumptions and not how things work in our dysfunctional system.

Hospitalists are in general subsidized (the hospital is paying more out of their pockets to have them there than they are collecting). MGMA data is more relevant in determining whether one is being adequately compensated in an employed setting.

 

[end stage fibro]

You’re assuming everyone is insured and that the hospital is collecting 100% of what they are billing. Those are big assumptions and not how things work in our dysfunctional system.

Hospitalists are in general subsidized (the hospital is paying more out of their pockets to have them there than they are collecting). MGMA data is more relevant in determining whether one is being adequately compensated in an employed setting.

Truth.

I would say it's safer to assume 1.8ish rvu for all comers and make your calculations from there.