Gen Peds Job advice

[blue.jay]

My spouse is interviewing for gen peds job in Midwest and West/Mountain state. The job in Midwest pays well but has 1:4 call responsibility with rounding in newborn nursery. The other job is out in urban west has a lower base pay but with 50th percentile productivity she could match Midwest compensation without in-house call. Calls in Midwest are for C-section and high risk delivery with newborn nursery rounding. The Midwest hospital is in a rural location and the deliveries are in a 50 bed hospital.

My question is which one would be a better sustainable job. Would you take a high paying job with call or just do 100% outpatient clinic without newborn calls for a lower pay??


EDIT:
Midwest hospital job description. Compensation ~230k

• Practice in two clinic locations – which are 15 min apart
• Will need to be present for high risk and emergent deliveries (average 1x/month and spread between the team)
• Do not need to be present for all c-sections
• Call is 1:4
• Need to be within 30 minutes of hospital call
• 750 births per year

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[FrkyBgStok]

That is an answer you and your spouse would need to figure out. I would drill a hole in my head if I was doing 100% outpatient clinic, but I hate clinic with a passion. I would gladly take the call as well as the extra money if it meant even a little less clinic time. And I enjoyed newborn.

But do you know what the call actually looks like? 1:4 call where you are at the hospital every time you are on call is much different than 1:4 with going in once per month. The first scenario is probably not sustainable for long at all where the second is fine. In addition, is your spouse a productive type of pediatrician? Some people can hammer out 40 total visits a day and some feel that they aren't giving their patients enough time with 20 patients per day. If they want to spend the time for all the anticipatory guidance, a productivity model could be very stressful. And then the cost of living, long term factors (schools and safety if you have/plan to have children, etc.), and the environment. Are they the only pediatrician in the office? Is there a support system?

Ultimately, it is up to you and your spouse.

 

[calvnandhobbs68]

My spouse is interviewing for gen peds job in Midwest and West/Mountain state. The job in Midwest pays well but has 1:4 call responsibility with rounding in newborn nursery. The other job is out in urban west has a lower base pay but with 50th percentile productivity she could match Midwest compensation without in-house call. Calls in Midwest are for C-section and high risk delivery with newborn nursery rounding. The Midwest hospital is in a rural location and the deliveries are in a 50 bed hospital.

My question is which one would be a better sustainable job. Would you take a high paying job with call or just do 100% outpatient clinic without newborn calls for a lower pay??


EDIT:
Midwest hospital job description. Compensation ~230k

• Practice in two clinic locations – which are 15 min apart
• Will need to be present for high risk and emergent deliveries (average 1x/month and spread between the team)
• Do not need to be present for all c-sections
• Call is 1:4
• Need to be within 30 minutes of hospital call
• 750 births per year

I mean 1:4 call with newborn rounding on top of a full clinic time is more of an old school peds schedule. Doable but it's gonna be a lot of early mornings getting up to round before clinic and will have to be answering questions about the newborns during the day at clinic intermittently as well. Also, I'd clarify, when it says "do not need to be present for all c-sections" what does that mean? That's at OB's discretion, pediatrics discretion, what? I'd try to get a good idea of how many times a month on average people are actually having to go in overnight or during the day for deliveries because that could really interrupt your clinic day or screw up your night before a full clinic day the next day for minimal payoff. They're only averaging a couple deliveries a day though if it's 750 births a year total, so may not be that bad. When you're saying "in house call", are they expecting you to actually sleep in the hospital overnight? That's a **** deal that I'd definitely not do for only 230K.

However, if your spouse can hit 230K with 50th percentile productivity at the other job with full time clinic there's not a lot of incentive to take the newborn rounding job. Unless they're terribly unproductive, she/he should be able to be average in regards to RVUs unless there's a new patient base to build up or they're starting you in a brand new clinic or something.

Also payment structure for these two jobs are important. Are you comparing a set salary job with a purely productivity based job? A set salary job with a base pay + productivity job?

Lots of other details though too in order to compare jobs adequately. Vacation time? CME? Any NP supervision? Teaching responsibilities or purely clinical? Expected RVUs/time per visit? Paid on billed or scheduled RVUs (so if high no-show rate for the productivity based clinic, may end up getting screwed)? Any relocation bonus/loan payback for either? What the clinic support structure like for each clinic? Good nurse lines or do you end up answering all the mommy calls?

Short answer is that the newborn rounding job/delivery coverage job is probably less sustainable long term just from the pure scheduling aspect but I'd agree it depends on how much your spouse likes deliveries and rounding or how much he/she wants to stay in practice on deliveries. If your spouse wants deliveries to be a part of his/her practice long term, then probably better to stay in practice with this as those skills/assessment comfort decline if not used over time.

 

[blue.jay]

She has 2 job offers that are very different.

1st one in Arizona (pop 50,000) has a 15k sign on bonus and guaranteed salary of 185k for 2yrs, then production based on top of a base 150k. The median wRVU is 44$ and the expected 50th percentile pay is 232k. We have family in AZ and she likes this job as it's M-F clinic hours and near a good school district suburb. There is no call or newborn nursery. CME 4000$ for 5 days a year. Retirement 4% Match after 1 year. 4 week vacation.

The second offer is in Wisconsin. Their pay is straight up 235k with no mention of RVU or production but she is on 1:4 call with nursery rounding. This is in a rural area (pop 10,000) where we don't see ourself living for more than 3years. She is also not thrilled about being on call every 4th day. Similar benefits and CME. Retiremenr is 3% match. Vacation is 4 weeks.
Income tax in Wisconsin is also higher than Arizona.

The straight salary 235k in Wisconsin seems good but we don't know if that can decrease if she isn't productive and doest have a full patient panel.