Thoughts on this job offer?

[deleted564496]

Hi all,

Current DR resident (third year). I have received a very enticing job offer - but was wondering if I could et thoughts from somebody who knows more about the current job market than me.

The job would be 7 day, 14 off. 12pm - 10 pm on weekdays, 8a-5p weekends. pay is around 350/hour. Volume is reasonable (or so they say).

The pay per hour seems very reasonable from what I've seen/heard from other jobs in my area, but these are more traditional 8-5 jobs. My main question is if this holds true for evening shifts and weekends. Obviously I'd expect that they'd be worth more, but just not sure how much more they seem to be valued compared to typical 8a to 5p weekday jobs. I'm very intrigued by the 7 on 14 off component, but just want to be sure I'm being fairly compensated for working 17 weekends and evening shifts.

thanks for your time

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[guytakingboards]

Hi all,

Current DR resident (third year). I have received a very enticing job offer - but was wondering if I could et thoughts from somebody who knows more about the current job market than me.

The job would be 7 day, 14 off. 12pm - 10 pm on weekdays, 8a-5p weekends. pay is around 350/hour. Volume is reasonable (or so they say).

The pay per hour seems very reasonable from what I've seen/heard from other jobs in my area, but these are more traditional 8-5 jobs. My main question is if this holds true for evening shifts and weekends. Obviously I'd expect that they'd be worth more, but just not sure how much more they seem to be valued compared to typical 8a to 5p weekday jobs. I'm very intrigued by the 7 on 14 off component, but just want to be sure I'm being fairly compensated for working 17 weekends and evening shifts.

thanks for your time

Seems okay at first glance. The hourly rate is decent but not amazing, but the job is unique for a 7on/14off in that its not pure deep nights or swing shift.

Back of the envelop math is $404k for the job with 34 guaranteed weeks off and only 5x5hr of evening work per cycle. I think that'd be pretty popular, especially if as you say the volume isn't that bad.

Some basic follow-up questions I'd have are:
- Is this a partner or employed position? (I assume employed)
- If employed: is this salaried or 1099? I.e. are benefits included or not... if included what/how good are the benefits?
- If employed, what is the contract term? i.e. how long are you bound to them AND how long are they guaranteeing these contract terms.
- Is this pure remote or is there on-site work/procedures required
- What is the case mix like? You'd be covering as much weekday day work as swing. Will you have to read mammo, nucs, MR or is it mostly ER level cases?

I do think it's an above market/desirable job based on the comp and particular shift. Especially if you get full benefits.

I'd be concerned about the long term stability of the contract terms. E.g if in a year they come back to you and say "hey, you're doing a great job but we want to renew you at $325/hr instead" or in two years they say "you're doing a great job, but we've decided to cut this position and we're giving you the options of going to day-side full time with normal 8wk vacation/year, going to pure deep nights at the same terms, or being let go". This can be said of any employed position but particularly one that has such desirable terms.

 

[clutch21]

Agree with above. Just to add- I’d get a more concrete answer about RVU per hour expectations. Anything over $30 per RVU for tele is pretty fair.

As an aside, I would be hesitant to sign on for a job like this with so much time left in residency. This would especially apply if you’re doing a fellowship. I take it that your probably forgoing fellowship?

The job market is white hot right now and there are several jobs like this. Your outlook on what kind of job you want may change.

 

[GadRads]

Agree with above. Just to add- I’d get a more concrete answer about RVU per hour expectations. Anything over $30 per RVU for tele is pretty fair.

As an aside, I would be hesitant to sign on for a job like this with so much time left in residency. This would especially apply if you’re doing a fellowship. I take it that your probably forgoing fellowship?

The job market is white hot right now and there are several jobs like this. Your outlook on what kind of job you want may change.

Assuming 1 week/2 weeks and let us say one reads 100 wRVU per day (which is A LOT!), at 30$/wRVU, that comes to 357K/year. That’s low.

 

[deleted564496]

Thanks for the response and you bring up some good questions that I should ask about as well. It is a salary position with benefits including malpractice, health insurance, etc. Some retirement match (not amazing, but not bad).

100% remote. No mammo or procedures obviously. I would have a focus on body and there would be PET/CT. There is a mix of coverage including a low income hospital (not tertiary care), an outpatient center, and a cancer center that's going to be coming up. It sounds that there would be a lot of cancer staging (no big emphasis on rectal cancer or a lot of the more difficult MR cancer workups). I feel that I will be well trained for htis. The 5-10 pm would be finishing up cases from the day and mostly urgent care/ER at a level II trauma center.

I don't want to put out all the information on the job, but the volume sounded very low to me, though I don't understand the difference between weighted RVU's and RVU's. I read way more on call than what the owner thought I would typically read during the weekday shift.

 

[deleted564496]

Assuming 1 week/2 weeks and let us say one reads 100 wRVU per day (which is A LOT!), at 30$/wRVU, that comes to 357K/year. That’s low.

What is the difference between wRVU and a RVU?

 

[deleted564496]

Agree with above. Just to add- I’d get a more concrete answer about RVU per hour expectations. Anything over $30 per RVU for tele is pretty fair.

As an aside, I would be hesitant to sign on for a job like this with so much time left in residency. This would especially apply if you’re doing a fellowship. I take it that your probably forgoing fellowship?

The job market is white hot right now and there are several jobs like this. Your outlook on what kind of job you want may change.

I would prefer to not do fellowship as after interviewing/applying I realized that it just seems like a big scam too me. The number of weekends and call necessary is clearly just a way to get cheap, easy labor. I feel I can make the most out of my 4th year to learn what my job requires of me, but my plan would be to live like a resident during the first year post-residency with the plan to go back and do a fellowship if I feel I'm not performing adequately.

I hear ya about how my outlook could change, but honestly I don't think so. I don't want to work my tail off to make a million dollars a year, I am fairly frugal and enjoy time off. I completed a different residency before radiology so the grind is really starting to get to me. The 7 on 14 off has always been really appealing to me, especially remote as I love to travel. I plan on doing some moonlighting during the 14 off occasionally, but really making 350-400k is plenty for me to be happy off of - just want to make sure I'm being appropriately compensated. Are there other reasons you think I should be hesitant about signing a contract this early?

 

[GadRads]

I would prefer to not do fellowship as after interviewing/applying I realized that it just seems like a big scam too me. The number of weekends and call necessary is clearly just a way to get cheap, easy labor. I feel I can make the most out of my 4th year to learn what my job requires of me, but my plan would be to live like a resident during the first year post-residency with the plan to go back and do a fellowship if I feel I'm not performing adequately.

I hear ya about how my outlook could change, but honestly I don't think so. I don't want to work my tail off to make a million dollars a year, I am fairly frugal and enjoy time off. I completed a different residency before radiology so the grind is really starting to get to me. The 7 on 14 off has always been really appealing to me, especially remote as I love to travel. I plan on doing some moonlighting during the 14 off occasionally, but really making 350-400k is plenty for me to be happy off of - just want to make sure I'm being appropriately compensated. Are there other reasons you think I should be hesitant about signing a contract this early?

Do you have a wife and kids? Perspectives change when these come into the picture.

Also, if you prefer not to do a fellowship, then work your tail off R4 year to maximize your mini-fellowship(s). One of my colleagues did not do a fellowship and is doing great 5 years out.

 

[deleted564496]

Do you have a wife and kids? Perspectives change when these come into the picture.

Also, if you prefer not to do a fellowship, then work your tail off R4 year to maximize your mini-fellowship(s). One of my colleagues did not do a fellowship and is doing great 5 years out.

No, in fact newly single after long relationship which I agree is probably not best for making life decisions, but still not sure it would change what I want to do. I would love that schedule even with children, but I realize I am naive - do you think having children/spouse makes that kind of schedule not as ideal and if so why? Financially or time?

Definitely would work very hard next year. My thoughts were to come in early every day and read old MR from staff who I think do the best job and try to free dictate copying their style. It would honestly probably help me study for boards as well knowing I have a job lined up without fellowship.

 

[Cognovi]

What is the difference between wRVU and a RVU?

wRVU is a physician work RVU - this is one component of the RVU, minus the technical component, the malpractice adjustment, the practice expense, and the geographical modifier.

When radiologists talk about wRVU as a measure of physician productivity, they are typically talking about wRVU.

 

[guytakingboards]

I would prefer to not do fellowship as after interviewing/applying I realized that it just seems like a big scam too me. The number of weekends and call necessary is clearly just a way to get cheap, easy labor. I feel I can make the most out of my 4th year to learn what my job requires of me, but my plan would be to live like a resident during the first year post-residency with the plan to go back and do a fellowship if I feel I'm not performing adequately.

I hear ya about how my outlook could change, but honestly I don't think so. I don't want to work my tail off to make a million dollars a year, I am fairly frugal and enjoy time off. I completed a different residency before radiology so the grind is really starting to get to me. The 7 on 14 off has always been really appealing to me, especially remote as I love to travel. I plan on doing some moonlighting during the 14 off occasionally, but really making 350-400k is plenty for me to be happy off of - just want to make sure I'm being appropriately compensated. Are there other reasons you think I should be hesitant about signing a contract this early?

The cost/benefits of doing fellowship have been discussed several times on this subforum but I think the cautionary advise bears repeating.

Jumping into a remote gig out of training sans fellowship is a not small task in terms of acclimation and skill development.

I get the 'never ending grind' argument for wanting to skip fellowship, but TBH fellowship is way easier than the first few years of attending-hood. It was perhaps the least stressful year I've had in my entire medical career dating back to MS1. Just throwing it out there.

 

[clutch21]

Assuming 1 week/2 weeks and let us say one reads 100 wRVU per day (which is A LOT!), at 30$/wRVU, that comes to 357K/year. That’s low.

Yeah, my response was more for a regular day tele gig. There’s certainly a higher premium on the swing shifts and 7 on type jobs. It’s quite nuanced though and depends on several variables so hard to give a general answer.

 

[guytakingboards]

Agree, at baseline he needs to get a sense of what the wRVU/shift expectation is. Then he can calculate the $/wRVU rate,

 

[deleted564496]

Agree, at baseline he needs to get a sense of what the wRVU/shift expectation is. Then he can calculate the $/wRVU rate,

From what I've heard, this should be around $55-65 per wRVU

 

[guytakingboards]

From what I've heard, this should be around $55-65 per wRVU

That would be unheard for the type of job you're talking about.

$55-65/wRVU is what partners in independent PP with good contracts in a big city make. Mid 40's $/wRVU would still be a solid number for many practices.

$30-35/wRVU is the high end of what tele-gig's usually offer.

If you made $404k per year at $55 wRVU, that'd 7,345 wRVUs per year. The national average is close to 11k wRVU/year.

I.e. what you've described is full partner parity compensation for an employed, tele, 1on/2off, mostly day shift job. If everything you've said is true, that would be the single most desirable job offer I've ever heard of.

I'm skeptical of this job needing to recruit an R3 sans fellowship, but maybe you just lucked into a total hidden gem.

 

[PhysMatMan]

It sounds like a private equity job. They've been offering daytime employed pure tele to keep the lights on as they've been losing radiologists. Guess why?

 

[guytakingboards]

It sounds like a private equity job. They've been offering daytime employed pure tele to keep the lights on as they've been losing radiologists. Guess why?

i don't know of any PE employed tele gig offering $55-65/wRVU

 

[vm26]

Agree with above. Just to add- I’d get a more concrete answer about RVU per hour expectations. Anything over $30 per RVU for tele is pretty fair.

As an aside, I would be hesitant to sign on for a job like this with so much time left in residency. This would especially apply if you’re doing a fellowship. I take it that your probably forgoing fellowship?

The job market is white hot right now and there are several jobs like this. Your outlook on what kind of job you want may change.

Agree with above particularly about pay per wRVU (eg. are you making $1/latte or 50 cents/latte and are you expected to make 15 latte/hour or 25/hour?)...One needs to see numbers as being "busy" or "relatively busy" are subjective-particularly when coming from potential future employer.

Would also highly recommend doing a fellowship and keeping your options open

 

[deleted564496]

Well I thought that the typical "busy day RVU #" was low so I'll try to confirm this... perhaps I misheard him.

Noticing a lot of people are recommending fellowship - I will read some other threads, but I honestly don't get it. We spend so long in training. I read a ton of studies. I study. I can handle overnight call reading over 80 cross sectionals per night. My last time on night call I think I had one major miss (because I trusted a staff who had a recent read and also missed it). I've watched two classes of seniors completely waste their fourth year taking cupcake "electives" and online courses. I'm sure this is universal - people think "I'm going to do fellowship, I'm just going to slack now that I passed boards". I can guarantee I'm not going to be doing Stoller course or online OB if I have a job in a year lined up. I'm going to come in early, read extra MR, and read as many damn cases as I can every day. You can't tell me you don't have a good baseline knowledge of radiology by the time you start 4th year can you? I just feel people completely waste their fourth year.

If I'm going to be a general radiologist how does doing a neuro fellowship make me better at my generalist job - if anything I think I'll be worse. I'll have just spent 12 months doing strictly neuro. I'd also be curious to hear whether people who are fellowship trained felt like they learned more in their first year as an attending or during their fellowship year. I'd venture to guess they'd all say their first year of being an attending. I'd also bet they found this year really difficult despite doing fellowship. I understand it limits my options. I understand I likely won't every be accepted at an academic institution or a large PP group.

Also is the biggest concern of having to go back to fellowship later on from a financial purpose? This is irrelevant to me, I am planning to save money and retire early. If I have to go back and do a fellowship so be it. Like I said I'm not trying to make as much money as possible. Lifestyle and work-life balance is more important to me.

I am applying for fellowship still and have done multiple interviews - however, I applied really late because initially I was going to just stay at my current institution. What is interesting is that tons of big name programs have TONS of openings. They are honestly borderline desperate to recruit fellows. Perhaps the dynamic is starting to shift and you'll see less people doing them. When essentially the minimum # of weekends and overread call is 10 weekends, 10 weeks.

I haven't decided 100%, but I have a really hard time justifying doing a fellowship at this point. It seems like a big scam that we created to create cheap labor for academic programs. I realize I'm naive and not in the work force. I realize that there are radiologists reading very complex studies that would require a fellowship to feel competent with, but this doesn't seem true of most practices I've talked with. They need me to read routine brain MRI, stroke, workup HCC/pancreatic cancer, lots of cancer staging that's not rectal or pelvic, bread&butter degn spine & big joint msk mri. Those more complex cancers are often referred to bigger, academic centers.

I'm probably naive and just don't understand, but I really don't. Just feels like something we allowed academic radiology to become a norm so that they can get more cheap labor. With that being said I do realize that there are benefits and that you would obviously get better at your specialty, just would also claim that with some effort you could make your 4th year work to learn what your job wants you to do.

 

[guytakingboards]

At the risk of being overly condescending, your post has Dunning Kruger written all over it. That classic post-R2 call year supreme confidence in being able to read anything and handle anything.

From my POV, i think you are needlessly giving yourself a lot of hurdles to overcome. Choosing to work 17 weeks a year... sounds great but that's going to be extremely challenging to just maintain skills much less grow like normal early career rads. You're also working remote, where you likely won't have the same opportunities for feedback and consultation with your colleagues and clinicians like most jobs. Then you also won't have the fellowship, which should be your rock skill wise. You paint a picture of a possibly very rocky transition to practice and early career arc.

That all being said, you are correct in that it's not impossible. I just think it's gonna be a lot harder and have more unintended consequences than you're expecting. You do sound like the person with the kind of mindset who could pull it off though.

 

[letmebe]

@Kapooya you can read 80 cross-sectionals per night on consecutive nights with just one miss as a resident. How did you get to that point.. Impressive..

 

[deleted564496]

At the risk of being overly condescending, your post has Dunning Kruger written all over it. That classic post-R2 call year supreme confidence in being able to read anything and handle anything.

From my POV, i think you are needlessly giving yourself a lot of hurdles to overcome. Choosing to work 17 weeks a year... sounds great but that's going to be extremely challenging to just maintain skills much less grow like normal early career rads. You're also working remote, where you likely won't have the same opportunities for feedback and consultation with your colleagues and clinicians like most jobs. Then you also won't have the fellowship, which should be your rock of stability skill wise. You paint a picture of a possibly very rocky transition to practice and early career arc.

That all being said, you are correct in that it's not impossible. I just think it's gonna be a lot harder and have more unintended consequences than you're expecting. You do sound like the person with the kind of mindset who could pull it off though.

Rereading my post I realize it comes across as egotistical and ignorant. I can assure you I am not of supreme confidence where I feel I am this amazing radiologist incapable of missing anything and knowing it all. That isn’t how I feel at all. I do think I’ve gotten pretty decent at general radiology and know where to look when I come across something I don’t recognize or don’t know what to say about. I’m proud of the work I’ve put in to my training to this point.

I just feel like there’s this culture of not being an adequate radiologist after 4 years of training. I’m not sure why that is. We train and work hard for a long time to get to that point.

If I do fellowship, it would be Neuro. I feel fellowship will mostly make me better at reading very complex MRI, something I very likely won’t be doing.

 

[deleted564496]

@Kapooya you can read 80 cross-sectionals per night on consecutive nights with just one miss as a resident. How did you get to that point.. Impressive..

I can appreciate the sarcasm. But if you truly want an answer - they are just preliminary reports, consistent search patterns, and lots of caffeine.

Also not reading 80 cross sectional each and every night, but have had nights that busy and was able to keep up.

 

[vm26]

At the risk of being overly condescending, your post has Dunning Kruger written all over it. That classic post-R2 call year supreme confidence in being able to read anything and handle anything.

From my POV, i think you are needlessly giving yourself a lot of hurdles to overcome. Choosing to work 17 weeks a year... sounds great but that's going to be extremely challenging to just maintain skills much less grow like normal early career rads. You're also working remote, where you likely won't have the same opportunities for feedback and consultation with your colleagues and clinicians like most jobs. Then you also won't have the fellowship, which should be your rock of stability skill wise. You paint a picture of a possibly very rocky transition to practice and early career arc.

That all being said, you are correct in that it's not impossible. I just think it's gonna be a lot harder and have more unintended consequences than you're expecting. You do sound like the person with the kind of mindset who could pull it off though.

I'm 10 years out, currently a partner in a mid/higher volume PP (stroke/trauma 1 center) with 2 hybrid fellowships under my belt and I consistently get stumped with cases and ask for consults from my colleagues.

Working tele-rads/ER in the current market may not require a fellowship but when I came out and the market was ****, only neuro-CAQ rads were qualified for this type of work.

 

[letmebe]

@Kapooya I’m genuinely impressed and not being sarcastic. If you’re reading 80 cross-secrionals, where CT abd pelv is counted as one study when it’s ordered as such, in addition to plain films and US, then you as an R3 stand at the top 30% among my attendings in speed. And they are no joke some of the top trained. So kudos to you.

 

[Cognovi]

Whenever I do a second read on a patient transferred from elsewhere for something neuro-related, and my interpretation differs, I look up whether that first radiologist did neuroradiology fellowship. Invariably the big mistakes are from non-neuro trained rads. eg, missed MCA M1 occlusion on CTA, missed optic chiasm glioma on MRI, misinterpreted venous reflux of contrast as vertebral artery transection on CTA, misinterpreted sphenoid wing meningioma as MCA bifurcation aneurysm on CTA, etc.

That's not to say all non-neurorad-trained rads can't read neuro, but there's a reason many emergency radiology jobs these days are advertising specifically for neuro fellowship trained candidates.

 

[guytakingboards]

Rereading my post I realize it comes across as egotistical and ignorant. I can assure you I am not of supreme confidence where I feel I am this amazing radiologist incapable of missing anything and knowing it all. That isn’t how I feel at all. I do think I’ve gotten pretty decent at general radiology and know where to look when I come across something I don’t recognize or don’t know what to say about. I’m proud of the work I’ve put in to my training to this point.

I just feel like there’s this culture of not being an adequate radiologist after 4 years of training. I’m not sure why that is. We train and work hard for a long time to get to that point.

If I do fellowship, it would be Neuro. I feel fellowship will mostly make me better at reading very complex MRI, something I very likely won’t be doing.

Sounds like you have a supreme faith in the quality of your training and your personal residency experience. That's certainly a good starting point.

If we're talking what else best sets you up for success in the future, most everything else you've mentioned potentially runs counter to that.

Re: fellowship. I think most people would agree all 12 mo of DR fellowships are not high yield. There's the initial phase of building modality comfort and search pattern speed. Then the pure "getting the reps in" phase that's a bit lower yield but still important for solidifying concepts and knowledge. Then the end period where you're checked out and not getting much out of it. In the "getting the reps in" phase, I think it's as important to see a lot of common things presenting uncommonly and vice versa. That's probably way more important than seeing the zebras. You can probably minimize this as a problem if you set up 4th year mini-fellowships right.

Re: the job itself. There are good arguments to be made that the job in question isn't the best option for a new rad graduate. From a life-style perspective, it's amazing. However, it's essentially a part time job. Even at 70 wRVU/day that'd be less than half the wRVU's I read my first year. It generally takes a few years to get comfortable as an attending; who knows how working 1 on/2 off will affect that but its certainly not going to be a positive.

 

[guytakingboards]

Take this next part with a grain of salt, cuz it's pure speculation but: I think your plan may set you up for unfair expectations and/or increased scrutiny by your group.

In my group, we have a general understanding of early career milestones for the full-time associates. First 3 months we give em a total pass on volume and defer starting call. By 6 mo's, they've started call and should have made some pretty decent headway in day- and call- speed. By 1 year, they should be pretty well formed. Probably not at final speed but they should be in working range of the rest of the group.

For you, 6 months in you'll have worked 2 total months worth. By 1 year, 4 mo's total. Imagine being compared to a full-time associate in my group who's worked 44 weeks in 1 year vs your 17wk. Don't expect your group to cut you a break on job performance at evaluation time because you chose to skip fellowship and took a 1-on/2-off job.
_____

Don't take my posts as evidence of me wanting you to fail or being jealous of the job offer (though it does sound great). I'm honestly not trying to fearmonger. You've just chosen a particularly less traveled path and I'm trying to raise the drawbacks that you might not be considering.

 

[deleted564496]

.

 

[guytakingboards]

Good luck is what I'll leave you with. Think I've expressed my concerns and devils advocate arguments as best i can.

 

[GadRads]

If your training is really strong, you are a very good self-learner and you are very motivated, a fellowship is not necessary. One of my colleagues did a 12 month mini-fellowship in my subspecialty and is very good. The value of fellowship is making you an expert in a subspecialty, but the learning never ends. I am still learning my subspecialty and looking up old material/minutiae. If you design your R4 curriculum appropriately, it may not be needed.

I also got a bit worse in general radiology after spending a whole year working in my subspecialty, but it didn't take me more than 1 month to regain old knowledge. The main value I provide in my practice by doing a fellowship is being one of the go-to persons in my subspecialty.

 

[MadRadLad]

Fellowship is not necessary in this market to get a job, probably even good general jobs. However, certain jobs will be completely off the table without a fellowship which does somewhat thin the selection. I had a colleague go back to do fellowship because all the major practices in the area his wife's family was in wanted fellowship trained grads for all their better reading assignments- the generalists were stuck with a lot of the crap nobody else wanted.

If you want to do general forever, especially in a less competitive area, you're probably fine. If the market dips again though, you may have trouble moving around compared to fellowship trained grads who are willing to read a litlte outside their specialty. A compromise for some is to do a non-ACGME fellowship that's on the lighter side and allows for external moonlighting.

 

[vm26]

Fellowship is not necessary in this market to get a job, probably even good general jobs. However, certain jobs will be completely off the table without a fellowship which does somewhat thin the selection. I had a colleague go back to do fellowship because all the major practices in the area his wife's family was in wanted fellowship trained grads for all their better reading assignments- the generalists were stuck with a lot of the crap nobody else wanted.

If you want to do general forever, especially in a less competitive area, you're probably fine. If the market dips again though, you may have trouble moving around compared to fellowship trained grads who are willing to read a litlte outside their specialty. A compromise for some is to do a non-ACGME fellowship that's on the lighter side and allows for external moonlighting.

Unless one is located literally in the middle of nowhere without tele-rad capability, clinicians are expecting fellowship-trained level reports and consultations (eg. if you read MSK MR, gotta be able to speak orthopod lingo). Just don't see this happening based on radiology residency training (even with mini-fellowship)...If you do general in a traditional PP, you'll be expected to be competent in everything from bread/butter MR of all sorts, breast imaging, light IR, nucs (+/- PET/Cardiac), and barium. I suppose it's possible but extremely difficult.