Unsolicited Jobs Thread

[Mandelin Rain]

It seems like an above average employed job. Odd to speculate on contractual details without having interviewed or received a written contract. Even if you’re not a sports fan, Patrick Mahomes will be racking up Super Bowl wins for the next decade, and that’s neat. Personally I would take 2M metro population in the Midwest over a small town 3+ hours from major metro in California or PNW or New England. I’d apply if I was a PGY-5 or making mgma median or less.

Meh. Not many jobs send out unsolicited fliers nationwide. The ones that have in the past, have typically had some.... issues.

Perhaps that's not the case here. I don't know. Review the first few posts in this thread. Similar flier, same agency. Job available 2016, 2020, 2022.

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Members don't see this ad.

 

[MidwestRadOnc]

Meh. Not many jobs send out unsolicited fliers nationwide. The ones that have in the past, have typically had some.... issues.

Perhaps that's not the case here. I don't know. Review the first few posts in this thread. Similar flier, same agency. Job available 2016, 2020, 2022.

This.

I am pretty sure a hospital employed job in a reasonable Midwest metro that is posted for years is not reliably paying anywhere near 800k or 700k for that matter.

I can almost promise you this is a 520k 2 year guarantee with production after that with a gradual reduction in RVU rate as you produce more up to a maximum cap of 850 and change.

Why? Because it’s literally how all of these perma-posted Midwest jobs are. Nobody will take them because the comp is a joke for the location. Trust me I’ve seen many. It’s take it or leave it we’ll use locums of whatever quality for as long as we have to if you don’t want it. (Edit: this only works because locums rates are also an absolute joke for rad onc compared to other specialties and wouldn’t happen if they had to pay 5k/day like they do for med onc or other subspecialists).

 

[NotMattSpraker]

I've thought this too, and not just limited to rad onc. Did the systems already buy out and employ all the specialty groups they thought might be profitable, or to they just go on a random buying spree and then determine that many specialty groups just don't make much sense to employ?

Rad onc is one of the specialties that seemingly makes the least sense for a system to want to employ.

Great question. I dont know a ton but just from watching think demand for a group at least plays some role. I've noticed that groups/specialties with strong "coverage" leverage in town seem to remain private and aligned, even if the field is not traditionally profitable.

Rad Onc seems to make a lot of sense to employ? Low demand and you already own the hardware, potentially many or all staff. I think we will see some wild stuff with staffing too. Cant do that to a surgeon.

 

[drowsy12]

Rad onc is a perfect field in which it makes sense to employ. The economics demand it because of the high technical reimbursements. The same forces drive hospital consolidation of small centers.

 

[MidwestRadOnc]

Rad onc is a perfect field in which it makes sense to employ. The economics demand it because of the high technical reimbursements. The same forces drive hospital consolidation of small centers.

The problem is the hospitals won’t factor in technical into reimbursement because of fair market value nonsense. So if it’s a rural clinic that produces 500 pro and 1500 tech, they should be able to pay you 1M salary and still be in the green but will scream stark law violation. So they staff with locums probably total cost close to 1M anyway but stark doesn’t apply for rando locums of the week. Stupid system.

 

[Mandelin Rain]

Man, I really have to disagree that it makes sense for a hospital to employ a rad onc.

1. End of referral chain. Doesn't drive new patients into the system. Typically doesn't drive further downstream referrals or services/ancillaries.
2. Relatively high salary and benefit requirements.
3. All the money is in the technical, which they already own. It's not like a PSA rad onc is going to refer patients to a different linac.

As a system, your best case scenario is you skim a few grand in pro fees, while taking on the downside risk of a high base salary.

 

[medgator]

Man, I really have to disagree that it makes sense for a hospital to employ a rad onc.

1. End of referral chain. Doesn't drive new patients into the system. Typically doesn't drive further downstream referrals or services/ancillaries.
2. Relatively high salary and benefit requirements.
3. All the money is in the technical, which they already own. It's not like a PSA rad onc is going to refer patients to a different linac.

As a system, your best case scenario is you skim a few grand in pro fees, while taking on the downside risk of a high base salary.

For sure. With many of the low volume gigs I've seen in less desirable, less busy areas, no way in hell you're making that base salary with benefits on just pro fees

 

[OTN]

The problem is the hospitals won’t factor in technical into reimbursement because of fair market value nonsense. So if it’s a rural clinic that produces 500 pro and 1500 tech, they should be able to pay you 1M salary and still be in the green but will scream stark law violation. So they staff with locums probably total cost close to 1M anyway but stark doesn’t apply for rando locums of the week. Stupid system.

That's all a lie. They would pay more if they had to.

 

[Mandelin Rain]

For sure. With many of the low volume gigs I've seen in less desirable, less busy areas, no way in hell you're making that base salary with benefits on just pro fees

Yeah. Employment only makes sense when the system needs to heavily subsidize the salary from the technical just to get someone in the door.

I'm talking about the flip side scenario. Like, I can't imagine a hospital admin being really happy with a stable PSA arrangement but thinking, "I should really try to force employment here. It'd make the system A LOT more money." But hospital admins do dumb things all the time.

 

[MidwestRadOnc]

Man, I really have to disagree that it makes sense for a hospital to employ a rad onc.

1. End of referral chain. Doesn't drive new patients into the system. Typically doesn't drive further downstream referrals or services/ancillaries.
2. Relatively high salary and benefit requirements.
3. All the money is in the technical, which they already own. It's not like a PSA rad onc is going to refer patients to a different linac.

As a system, your best case scenario is you skim a few grand in pro fees, while taking on the downside risk of a high base salary.

I agree with you, but from the vantage of the rad onc. I might make a tiny bit more if a billed my own pro fees and have some more tax write offs. Maybe. I suspect I’d collect less than my total comp package including benefits. I think I’d need at least a few hundred k extra for the hassle and risk to be worth it. The hospital SHOULD jump at the opportunity if I offer to go private and bill pro on my own. But most won’t because they prefer to employ docs for other reasons (they want to control more than just collections)

 

[NotMattSpraker]

For sure. With many of the low volume gigs I've seen in less desirable, less busy areas, no way in hell you're making that base salary with benefits on just pro fees

The problem is the hospitals won’t factor in technical into reimbursement because of fair market value nonsense. So if it’s a rural clinic that produces 500 pro and 1500 tech, they should be able to pay you 1M salary and still be in the green but will scream stark law violation. So they staff with locums probably total cost close to 1M anyway but stark doesn’t apply for rando locums of the week. Stupid system.

I disagree with the reasonable views on this board frequently and I bet hospital administrators feel the same. Not everyone is so money oriented, even hospital administrators.

I find a lot of value in having a well paid employed job in a place I really love to live. I would not change jobs for a raise unless it was really big, and if it brought a bunch of new responsibility being "private", not sure Id do it for any money.

Likewise, a lot of hospital networks want a comprehensive cancer program, not all, but some. There is value to having a cohesive team, and in theory you could have 1 rad onc cover multiple hospitals and maybe even all the patients. Accreditations and other activities do require participation of a rad onc and if they are just aligned, its hard to make them do things.

A Linac is very expensive and worthless if you dont staff it with a doc that can use it. Also, Im sure everyone has seen the effect of replacing a locums with a permanent doctor.. volumes always rise, no doubt there is value there.

If a hospital is banking on their rad onc to drive volume for the cancer program, I feel sorry for them!

 

[Mandelin Rain]

I disagree with the reasonable views on this board frequently and I bet hospital administrators feel the same. Not everyone is so money oriented, even hospital administrators.

I find a lot of value in having a well paid employed job in a place I really love to live. I would not change jobs for a raise unless it was really big, and if it brought a bunch of new responsibility being "private", not sure Id do it for any money.

Likewise, a lot of hospital networks want a comprehensive cancer program, not all, but some. There is value to having a cohesive team, and in theory you could have 1 rad onc cover multiple hospitals and maybe even all the patients. Accreditations and other activities do require participation of a rad onc and if they are just aligned, its hard to make them do things.

A Linac is very expensive and worthless if you dont staff it with a doc that can use it. Also, Im sure everyone has seen the effect of replacing a locums with a permanent doctor.. volumes always rise, no doubt there is value there.

If a hospital is banking on their rad onc to drive volume for the cancer program, I feel sorry for them!

Definitely a fair take

 

[NotMattSpraker]

I can almost promise you this is a 520k 2 year guarantee with production after that with a gradual reduction in RVU rate as you produce more up to a maximum cap of 850 and change.

I wanted to add, this made me laugh and then get a little sad. I didnt realize the level to which these companies copy each other's contracts until a year or two ago. I do not know about this particular job but Ive seen this contract multiple times before haha. One of the many times Ive wondered "I thought this was supposed to be illegal?"

I do not understand the employed 2 year base + production then conversion to eat what you kill. It makes zero sense to me. If I am employed, Im your employee. Bring me patients, I will treat them. Of course I will do outreach and show my pretty face for you, but thats part of the job. For that job I get a guaranteed base.

If Im going to go for the ceiling, I want full control so I can try to make it. Your employee but my entire salary is dependent on your competence running a cancer program? No thanks.

If I have no control, I want a stable base (Rad Onc stable, I mean).

 

[thecarbonionangle]

employing rad oncs is about control. PSA shields these physicians from some things from the empty suits. they dont like not having to “approve” your time off, etc. It is always about control and them “owning” you

 

[NotMattSpraker]

employing rad oncs is about control. PSA shields these physicians from some things from the empty suits. they dont like not having to “approve” your time off, etc. It is always about control and them “owning” you

PSAs also shield the employer from a lot of state laws a larger hospital system would have to follow, such as providing benefits. In my experience, some RO practice leads are as bad as the bean counters, sometimes even worse.

I have seen as many people treated terribly in PSAs as academics and hospital employed.

 

[thecarbonionangle]

PSAs also shield the employer from a lot of state laws a larger hospital system would have to follow, such as providing benefits. In my experience, some RO practice leads are as bad as the bean counters, sometimes even worse.

I have seen as many people treated terribly in PSAs as academics and hospital employed.

Thats true but my point was mainly towards the people claiming that it makes little sense to try to get rid of PSAs and employ a group. There are plenty of “pros” there for them. I know it triggers some but i think there are reasons for why PP is dying. People know people who have been screwed and the personalities in these PSAs and “senior partners” dynamics are not for everyone. As such, these are the benefits of employment in a reputable place where you actually have HR protections, transparency about how you make money instead of “lead” guy in PSA telling you thats just what it is.

 

[MidwestRadOnc]

I wanted to add, this made me laugh and then get a little sad. I didnt realize the level to which these companies copy each other's contracts until a year or two ago. I do not know about this particular job but Ive seen this contract multiple times before haha. One of the many times Ive wondered "I thought this was supposed to be illegal?"

I do not understand the employed 2 year base + production then conversion to eat what you kill. It makes zero sense to me. If I am employed, Im your employee. Bring me patients, I will treat them. Of course I will do outreach and show my pretty face for you, but thats part of the job. For that job I get a guaranteed base.

If Im going to go for the ceiling, I want full control so I can try to make it. Your employee but my entire salary is dependent on your competence running a cancer program? No thanks.

If I have no control, I want a stable base (Rad Onc stable, I mean).

employing rad oncs is about control. PSA shields these physicians from some things from the empty suits. they dont like not having to “approve” your time off, etc. It is always about control and them “owning” you

The employed arrangements I have had have a base guarantee somewhere around 60-75th percentile mgma. This is your biweekly draw. Then you have a wRVU conversion factor of ideally $70 or higher. The difference between this and a PSA is your salary draw is guaranteeed. You don’t have to pay it back if your wRVU numbers for the month don’t get you to your draw. Anything beyond your draw is then paid out periodically. Vs. a private practice where you have to take a much lower draw salary to ensure you don’t have a deficit. This plus not having to pay your own insurance and more importantly vacation coverage is the value of being employed to the rad onc.

The key to successful employment is not having toxic admin. If admin is toxic you’re probably better off private even if you make less.

There is no way I would ever consider employment with eat what you kill without a guarantee paid by RVU with declining conversion factor and ultimate salary cap. This is a garbage job arrangement that no one should ever agree to yet sadly represents many jobs out there. They can’t fill because this arrangement sucks.