salary

[indytravl]

I've tried to do some research on range of salary for a hospice medical director or palliative med consultant but with very limited results. I even spoke with a fellow who refused to disclose numbers & said I would get an idea when I started job interviewing & rec'ing offers . I'm doing a non-primary care specialty residency & would like to practice in a more rural setting. Remuneration is one factor involved in deciding to commit an additional year on the fellowship.
thanks for your help, [email protected]

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[RuralMedicine]

I've tried to do some research on range of salary for a hospice medical director or palliative med consultant but with very limited results. I even spoke with a fellow who refused to disclose numbers & said I would get an idea when I started job interviewing & rec'ing offers . I'm doing a non-primary care specialty residency & would like to practice in a more rural setting. Remuneration is one factor involved in deciding to commit an additional year on the fellowship.
thanks for your help, [email protected]

What is your primary specialty training in?

 

[indytravl]

hello....?

anyone?

no one has any info or can refer a resource?

 

[RuralMedicine]

hello....?

anyone?

no one has any info or can refer a resource?

I'll ask again (since this post is turning into an echo) what is your primary specialty training in?

 

[indytravl]

ruralmedicine, thanks for taking an interest in my query. if you have something productive to contribute, I'd be grateful. please preface why your "asking again" is germaine? only reason mentioned my training is because my time commitment to residency is more than the 3 years of usual IM/FP/Ped residencies & moment has come to balance professional interests with life practicalities. information would help with that.
thanks again

 

[RuralMedicine]

ruralmedicine, thanks for taking an interest in my query. if you have something productive to contribute, I'd be grateful. please preface why your "asking again" is germaine? only reason mentioned my training is because my time commitment to residency is more than the 3 years of usual IM/FP/Ped residencies & moment has come to balance professional interests with life practicalities. information would help with that.
thanks again

From my experience (and from having friends in the field) salary, responsibilities, and job description seem to be based on both the primary specialty training as well as subsequent palliative fellowship, hence my question. I'm sorry if you feel like I was prying needlessly into your life. Best of luck with your career decisions.

 

[indytravl]

thanks for the qualification that reimbursement & responsibilities vary based on primary specialty. that is new; how is it assessed, esp in a more rural region? my specialty will be pmr. can you please share any further info?
thanks

 

[indytravl]

hello...ruralmedicine?

I am sorry if offended by asking about relevance for your repeated questioning. now that realize the context & have answered, would really appreciate your assistance with my question. could you please help me?

thank you

 

[indytravl]

..........

 

[RuralMedicine]

hello...ruralmedicine?

I am sorry if offended by asking about relevance for your repeated questioning. now that realize the context & have answered, would really appreciate your assistance with my question. could you please help me?

thank you

More busy than truly offended....If you're coming from PM&R I'd doubt that on average in a salaried position that having a done a palliative care fellowship will significantly change your earning potential. Obviously this doesn't mean don't pursue palliative and it doesn't mean you may not be able to work out something more lucrative but if you're looking at only financial return on time investment it probably isn't worth it.

 

[HeyDoc]

Jeez can't somebody just give the guy an answer. I honestly have looked into salaries myself and have found no hard numbers so all I can say is the hospice worker in my local area (California) who works for Kaiser makes 200K a year. Now is that the norm, higher end or lower end I have no clue. Good luck in your request and I'm sure somebody will have a good answer for you.

 

[Ice-1]

I'm in internal medicine and possibly interested in the 1 yr fellowship but also would like some salary info. Is there some sort of specialty college for this? That could be a source

 

[dodoc07]

I am an ABHPM-certified physician working in a very small, strictly consultative palliative care practice in a local community hospital on the east coast. The practice is roughly 95% hospital-based (similar to a hospitalist role) with the remainder being a small but rapidly growing outpatient practice. I recently finished IM residency followed by a 1-yr fellowship in palliative medicine.
I can tell you that income is not one of the highlights of a career in hospice and palliative medicine. Many of my colleagues from residency who went directly into private practice or hospitalist medicine (without additional fellowship training) are making 1.5 - 2 times as much as I am. While there may be some adjustments to salary based on experience of the individual physician, generally speaking, this is not a lucrative profession.

I have found that many physicians in this field fall into several broad categories that make up for the lack of substantial compensation:
1) Academics - these tend to be the researchers/pioneers/leaders of this very nascent field that have genuine altruistic motives for pursuing this career. They tend to be based at the major teaching/academic centers in this country and have been able to find allies in higher administration which have provided and secured financial support. They have published extensively; you can find their names on the editorial boards of the major journals http://www.liebertonline.com/jpm
2) Second career - these are physicians who may have tired of their initial specialty or the drawbacks of private practice and have found that they can establish and make a name for themselves in a relatively young field. They may have a keen interest in palliative medicine based on their prior career - oncology, neurology, anesthesiology; or prior experience - personal loss of loved one, introduction to hospice, etc.
3) "Jack of all trades" this group consists of energetic individuals who have been able to wear multiple hats in medicine, and may have continued their traditional medical career, with a side hand in hospice or palliative medicine consultation. An example is the practicing internist who may also act as a hospice medical director to supplement income, or the psychiatrist who is frequently called to help for terminal patients with agitated behavior, or the neurologist who is "known" to determine brain death for a patient on a vent. Some physicians have found other creative ways to generate income in their spare time, i.e., medical writing, lecturing, providing testimony, etc.
4) "Lifestyle aficianados" - this is probably the smallest yet most rapidly growing group. These tend to be the younger folks ("Gen X") who place their personal and family life above work, and who value free time at home more than what they bring home in terms of salary. Because palliative medicine can be both less time intensive and less stressful than other specialties, many people willingly choose to enter this field knowing that their bank account will take a hit. Not surprisingly, job satisfaction is a higher priority for this group, as many folks feel disenchanted with traditional medicine, for example seeing too many patients unnecessarily in pain, or kept alive artifically on machines, and find it rewarding to have the rare opportunity in medicine to truly relieve patients' suffering and allow for a peaceful and dignified death.

Most active palliative care services will market themselves as cost-saving rather than as income-producing for hospitals or medical centers (decreasing length of stay, fewer ICU days, avoiding expensive procedures / tests). For this reason, more productivity (more savings) does not necessarily translate into bigger salaries for the individual physicians. So while it is expected that there will be growth in the field, with more and more palliative care programs popping up in hospitals and communities across the country, and more opportunities for physicians to enter, it is unlikely that palliative medicine will ever reach the heights of other subspecialties such as cardio or GI in terms of income.

Hope this helped.

 

[dodoc07]

I

 

[jroosthmd]

Eloquently put. I am an Internist who back in 1999 was asked to be a team physician for a large hospice in the Houston area. That work allowed me to become board certified. I am now working as a Medical Director for another large hospice in the same region. But to the point of the original poster, while they pay me a nice figure for my work for them, it certainly is not a 'living wage'. In addition, when you consider that 4 out of 5 nights I get several calls all night long to pronounce or give advice to the nurses, well the amount I am paid is probably a good deal for the hospice more so than for me. But I enjoy doing it and that to took me 14 years to understand. It is a nice supplement to my private practice. I've yet got to the point where I want to give up my IM practice. Matter of fact it took me 14 years to realize how much I truly enjoyed being an Internist. If I wanted to spend all day making home visits I imagine I could with my wife as my secretary, work from home, get rid of the office and all that overhead and do just hospice. And I might just do that someday. I imagine most of us are hesitant to say what we actually get paid by particular hospice compaines mainly due to the fact that we all have contracts and the contracts are not public documents, It might even be a violation of my contract to post what they pay me.

Personally I'm a little amazed at your comments. That was a really well thought of post and I think you hit the different types of docs doing hospice right on the head of the nail so to speak.

I like hospice for a lot of reasons;
1. After working in nursing homes for a long time I realize how aweful it is for people to be kept alive just for the sake of being kept alive and both the patients and their families have been asking for an alternative for most of the modern era.
2. You know we do very few tests or diagnostics, yet the shear amount of pathology I get to be involved with helps keep me sharp as an Internist. There is not greater teacher than seeing a disease up close and personal weather you are treating it with palliation or to save.
3. I like the team interaction and find it so much more fulfilling that just 'stick out you tongue and say ah, or now this is going to be my finger with some gooy stuff on it." ....and it surely is not going to hurt hehehehe
4. Maybe pride is getting in the way, but it is nice to be part of a young and developing area of medicine.
5. A lot of loks out there are doing it poorly. I like the idea of being one of the ones trying to change that.
6. I like teaching people and my role as medical director has me teaching daily. I would not have minded being in academic medicine, but I prefer direct patient care and hospice is all about direct patient care.
7. The hours are flexible and yet also inflexible....I'm always on duty
8. Very low malpractice risk
9. I get to travel a bit
10. I don't get to use explosives.....damn

 

[Ice-1]

OK, since some of the above posters won't give their actual salaries how about a range. It's great to know all the reasons why you enjoy the specialty but if you can't pay back all those student loans as well as live any kind of decent life then the enjoyment is going to disappear. let's see some stats please

 

[joejabjab]

jroosthmd,

How is it that you get to travel a lot? By travel, do you mean vacation? Or do you mean business?

Thanks!

 

[George85]

Very informative and useful thread with some excellent posts. It makes me realize what an asset and positive resource these forums could be - if only the moderators would stamp out the childishness that permiates throughout.

INDYTRVL - try reading between the lines.

 

[jroosthmd]

How is it that you get to travel a lot? By travel, do you mean vacation? Or do you mean business?

Actually I was trying to make a joke. In the movie Armageddon, the character Rock Hound makes what for me was a memorable comment about "the pay is good, I get to travel and use explosives." In effect there is not "travel" per se beyond that I get to go ALL OVER a HUGE area to see patients in their homes which is both a blessing and a curse. Blessing in that I can listen to audiobooks, CME etc, or just crank up the amp and JAM. Curse in that I might not get but 2 patients seen in an afternoon due to having to go a long distance.

I have found a much greater interest in attending conferences, something I have always found boring as heck for Internal Medicine meetings.

 

[Aloha Kid]

jroothsmd,

Just wondering how your typical day goes. Many of us are interested in palliative care, but are not quite sure what the responsibilities entail. If I understand it right, it would seem hospice obligations are never extremely urgent, can almost always be manged by phone, requires hands on the patient with initial eval, and maybe to proclaim death, and lots of verbal communicating w/ family and nursing. I could be totally of wrong.

Could you give us a better idea of what you do?

How do you mange a hospice and run your own practice effectively?

 

[jroosthmd]

I would be inappropriate if I said I was managing a hospice. I am Medical Director for a division of a large hospice that has offices in my area. As of last week we had about 130 patients spread out accross two teams. I am medical director for both. That makes me the medical voice for the teams. I am called on to answer questions such as just a minute ago when a crisis care nurse called to ask what to do about a terminal cancer patient's increased shortness of breath.

For each team I do a weekly team meeting. At the meeting we discuss the new patients in detail, go over the deaths that have occurred and discuss each of the patients on our team; usually A to L one week and M to Z the next. I practice signing my name on numerous death certificates, triplicate prescriptions and Medicare acceptance forms. Some the state of Tx says you can stamp and some you just have to sign...I actually just sign...stamps always squeek too much. Fortunately my name is not "Brudeskineofsenstky" or some such monster so it's easy. I guess if my name was like that I'd just practice a really unique "mark." Usually at least 4 days of the month I will go and see patients for the teams in the afternoon. I don't think my contract specifies a set number of visits each month, but I try and do about 20 a month.

I'm generally always on call. That's the bummer part of the deal. On the other hand, you are right in one regard; you don't have to get up in the middle of the night and go to the ICU, but you still have to wake up and answer what at times can be lengthy discussions of what needs to be done. I have to be patient, kind and pleasant no matter the situation that the calls present themselves to...use your imagination...

I also run a full time medical practice...well not exactly full time anymore since I am doing my two team meetings each week. I am often called during the day with questions about new patients, new problems etc. Sometimes this can get kind of frustrating when I am in the middle of a rectal exam or just busy with lots of patients in the office. "rectal" don't always involve a finger and a glove.

Suffice it to say, adding a significant palliative reponsibility to a medical practice can be time consuming and is certainly something you have to be willing to accept some sacrifice for. I've pissed off a few people...I got an email from a person today who is upset because they have been trying to get a new appointment and I've just put a lid on new patients since I started doing the two teams a week. Of course, there are what, 20 IM's, and FP's within 10 miles of my office, not to mention the World Renown Texas Medical Center of Houston. Then again, if they are that pissed in an introductory email, I'm not sure I want to reply at all

I try and do some sort of inservice for the nursing staff of the teams at least 3 out of 4 team meetings. Usually only one/4 takes more than 10 minutes. Usually I'll just pull a couple of pages from a review from the Journal of Palliative Medicine and write up a little outline and present that information. I am often asked to make more detailed presentations elsewhere so those are also useful to present to the team.

Our meetings usually last from 2.5 to 3 hours. usually 2.5 or less sometimes.

Hospice staff people have the most amazing bladder capacities. I have to take a break usually part way through and if nothing else stretch my legs.....

Hospice is a different sort of business. Dealing with the anger, hatred, denial and fear in family members is taxing, but for some very weird reason seems less burdensome to me than the same kinds of things I deal with from my Internal Medicine patients.

It helps tremendously to be board certified. It helps tremendously to go to conferences. The AAHPM's annual Medical Director's Review course is very good. See if your state has an organization that you can get actively involved with. I got involved with a small group called the Texas Academy of Palliative Medicine and less than 1 year later I was asked to make a presentation at the annual educational meeting. Talk to the Cheif of Staff at your hospital and get invited to participate in your hospital's Bioethic's Committee.

 

[Aloha Kid]

I would be inappropriate if I said I was managing a hospice. I am Medical Director for a division of a large hospice that has offices in my area. As of last week we had about 130 patients spread out accross two teams. I am medical director for both. That makes me the medical voice for the teams. I am called on to answer questions such as just a minute ago when a crisis care nurse called to ask what to do about a terminal cancer patient's increased shortness of breath.

For each team I do a weekly team meeting. At the meeting we discuss the new patients in detail, go over the deaths that have occurred and discuss each of the patients on our team; usually A to L one week and M to Z the next. I practice signing my name on numerous death certificates, triplicate prescriptions and Medicare acceptance forms. Some the state of Tx says you can stamp and some you just have to sign...I actually just sign...stamps always squeek too much. Fortunately my name is not "Brudeskineofsenstky" or some such monster so it's easy. I guess if my name was like that I'd just practice a really unique "mark." Usually at least 4 days of the month I will go and see patients for the teams in the afternoon. I don't think my contract specifies a set number of visits each month, but I try and do about 20 a month.

I'm generally always on call. That's the bummer part of the deal. On the other hand, you are right in one regard; you don't have to get up in the middle of the night and go to the ICU, but you still have to wake up and answer what at times can be lengthy discussions of what needs to be done. I have to be patient, kind and pleasant no matter the situation that the calls present themselves to...use your imagination...

I also run a full time medical practice...well not exactly full time anymore since I am doing my two team meetings each week. I am often called during the day with questions about new patients, new problems etc. Sometimes this can get kind of frustrating when I am in the middle of a rectal exam or just busy with lots of patients in the office. "rectal" don't always involve a finger and a glove.

Suffice it to say, adding a significant palliative reponsibility to a medical practice can be time consuming and is certainly something you have to be willing to accept some sacrifice for. I've pissed off a few people...I got an email from a person today who is upset because they have been trying to get a new appointment and I've just put a lid on new patients since I started doing the two teams a week. Of course, there are what, 20 IM's, and FP's within 10 miles of my office, not to mention the World Renown Texas Medical Center of Houston. Then again, if they are that pissed in an introductory email, I'm not sure I want to reply at all

I try and do some sort of inservice for the nursing staff of the teams at least 3 out of 4 team meetings. Usually only one/4 takes more than 10 minutes. Usually I'll just pull a couple of pages from a review from the Journal of Palliative Medicine and write up a little outline and present that information. I am often asked to make more detailed presentations elsewhere so those are also useful to present to the team.

Our meetings usually last from 2.5 to 3 hours. usually 2.5 or less sometimes.

Hospice staff people have the most amazing bladder capacities. I have to take a break usually part way through and if nothing else stretch my legs.....

Hospice is a different sort of business. Dealing with the anger, hatred, denial and fear in family members is taxing, but for some very weird reason seems less burdensome to me than the same kinds of things I deal with from my Internal Medicine patients.

It helps tremendously to be board certified. It helps tremendously to go to conferences. The AAHPM's annual Medical Director's Review course is very good. See if your state has an organization that you can get actively involved with. I got involved with a small group called the Texas Academy of Palliative Medicine and less than 1 year later I was asked to make a presentation at the annual educational meeting. Talk to the Cheif of Staff at your hospital and get invited to participate in your hospital's Bioethic's Committee.

Great advice! Thank you.

 

[dodoc07]

It helps tremendously to be board certified. It helps tremendously to go to conferences. The AAHPM's annual Medical Director's Review course is very good. See if your state has an organization that you can get actively involved with. I got involved with a small group called the Texas Academy of Palliative Medicine and less than 1 year later I was asked to make a presentation at the annual educational meeting. Talk to the Cheif of Staff at your hospital and get invited to participate in your hospital's Bioethic's Committee.

As someone who just recently received board certification in Hospice and Palliative Medicine, I have to say that the ABHPM's current transition plan for board certification seems a bit unfair. Namely, the fact that the current grandfathering period extends only to 2012 penalizes recent diplomates. That means that someone who sat for the exam in 2006 would have to take the exam again only 6 years later, and would presumably have to incur the expense of hefty exam fees over again. There is something wrong with this picture.

 

[HospiceMD]

Most hospice and palliative care docs make around 150-220K. What is so hard about posting this? I do both home hospice and hospital palliative care full time and make roughly at the higher end of what is stated.

 

[michaelrack]

As someone who just recently received board certification in Hospice and Palliative Medicine, I have to say that the ABHPM's current transition plan for board certification seems a bit unfair. Namely, the fact that the current grandfathering period extends only to 2012 penalizes recent diplomates. That means that someone who sat for the exam in 2006 would have to take the exam again only 6 years later, and would presumably have to incur the expense of hefty exam fees over again. There is something wrong with this picture.

That happens every time a rogue board is replaced by an ABMS-recognized board. The same thing happened with sleep medicine. I agree that it's unfair.

 

[Strength&Speed]

I am an ABHPM-certified physician working in a very small, strictly consultative palliative care practice in a local community hospital on the east coast. The practice is roughly 95% hospital-based (similar to a hospitalist role) with the remainder being a small but rapidly growing outpatient practice. I recently finished IM residency followed by a 1-yr fellowship in palliative medicine.
I can tell you that income is not one of the highlights of a career in hospice and palliative medicine. Many of my colleagues from residency who went directly into private practice or hospitalist medicine (without additional fellowship training) are making 1.5 - 2 times as much as I am. While there may be some adjustments to salary based on experience of the individual physician, generally speaking, this is not a lucrative profession.

I have found that many physicians in this field fall into several broad categories that make up for the lack of substantial compensation:
1) Academics - these tend to be the researchers/pioneers/leaders of this very nascent field that have genuine altruistic motives for pursuing this career. They tend to be based at the major teaching/academic centers in this country and have been able to find allies in higher administration which have provided and secured financial support. They have published extensively; you can find their names on the editorial boards of the major journals http://www.liebertonline.com/jpm
2) Second career - these are physicians who may have tired of their initial specialty or the drawbacks of private practice and have found that they can establish and make a name for themselves in a relatively young field. They may have a keen interest in palliative medicine based on their prior career - oncology, neurology, anesthesiology; or prior experience - personal loss of loved one, introduction to hospice, etc.
3) "Jack of all trades" this group consists of energetic individuals who have been able to wear multiple hats in medicine, and may have continued their traditional medical career, with a side hand in hospice or palliative medicine consultation. An example is the practicing internist who may also act as a hospice medical director to supplement income, or the psychiatrist who is frequently called to help for terminal patients with agitated behavior, or the neurologist who is "known" to determine brain death for a patient on a vent. Some physicians have found other creative ways to generate income in their spare time, i.e., medical writing, lecturing, providing testimony, etc.
4) "Lifestyle aficianados" - this is probably the smallest yet most rapidly growing group. These tend to be the younger folks ("Gen X") who place their personal and family life above work, and who value free time at home more than what they bring home in terms of salary. Because palliative medicine can be both less time intensive and less stressful than other specialties, many people willingly choose to enter this field knowing that their bank account will take a hit. Not surprisingly, job satisfaction is a higher priority for this group, as many folks feel disenchanted with traditional medicine, for example seeing too many patients unnecessarily in pain, or kept alive artifically on machines, and find it rewarding to have the rare opportunity in medicine to truly relieve patients' suffering and allow for a peaceful and dignified death.

Most active palliative care services will market themselves as cost-saving rather than as income-producing for hospitals or medical centers (decreasing length of stay, fewer ICU days, avoiding expensive procedures / tests). For this reason, more productivity (more savings) does not necessarily translate into bigger salaries for the individual physicians. So while it is expected that there will be growth in the field, with more and more palliative care programs popping up in hospitals and communities across the country, and more opportunities for physicians to enter, it is unlikely that palliative medicine will ever reach the heights of other subspecialties such as cardio or GI in terms of income.

Hope this helped.

Hot damn that's a good post. even though you didnt give a figure. count me in as #4.

 

[Iquitos]

Hot damn that's a good post. even though you didnt give a figure. count me in as #4.

Definitely a good post. I'd like to thank everyone for all their insight and advice. I like the civil atmosphere in this forum. Could this happen to be a reflection of the actual field???? I hope so. You can count me in as a #4 as well.

 

[hospicedoc]

Hi, I'm new at this so bear with me.
Kudos to docdoc07 and jroosthmd - good info. I am also a hospice physician. I am medical director for a small semi-rural hospice - census usually about 30-40. I was a FP and ER doc for 10 years when I started part time as both a SNF and hospice medical director. I subsequently closed my family practice a year later to do hospice full time. I make from the hospice about half what I did as a full time FP, but with my SNF medical director salary (and fee for service billing of SNF visits) plus a couple ER shifts per month, I end up back at about 140-150K yearly, BUT!!!! My days are so much nicer - 6-8 hours max, schedule flexibility (I drop off and pick up my kids from school), lower malpractice rates, very sane call requirements, rarely woken up at night, rarely called on weekends, etc, etc.
It is truly an excellent specialty from a lifestyle perspective, but it is also emotionally rewarding and satisfying. In my experience, it generally draws a more experienced, dedicated group of nurses, CNA's etc (particularly compared to the SNF's). The team working environment appeals to me. The staff loves having their own "in house" doc. Obviously, the work atmosphere depends a lot on the philosophy of the organization - one of the competing hospices in my area has a reputation as a very mercenary hospice - they agressively recruit patients, and pressure the Nurses and Aides to see a lot of patiets and avoid spending any money on the patients. They don't keep nurses or other staff for long as staff know they are viewed as expendable. Morale is poor. They also have gone through numerous medical directors. They tend to hire inexperienced PCP's. The community is coming to realize that all hospice programs are NOT created equally. Ethical behavior is absolutely necessary in our profession, but particularly in hospice, where we are in peoples homes and dealing with them at their most vulnerable.
Anyway, that is my first rant, only wandered off topic for about half of it.

 

[signomi]

I'll throw in my own 2 cents: I had some job offers ranging from $120,000 to $180,000. I know a hospice doc here who is paid $200,000.

That said, I said no thanks and am doing another fellowship.

 

[argentina09]

Hi Signomi:
I have already interviews at Cleveland Clinic, Indiana,Michigan and MD Anderson... I am pursuing later on Oncology..any inputs about these places? I imagine yo interviewed with them...I don't have many people to ask, hopefully you can help me !
Where did u do palliative Care?
Thanks!

I'll throw in my own 2 cents: I had some job offers ranging from $120,000 to $180,000. I know a hospice doc here who is paid $200,000.

That said, I said no thanks and am doing another fellowship.