Unsolicited Jobs Thread

[medgator]

I'm a medical oncologist and routinely get bombarded with emails from recruiters - don't think I've ever seen 800K starting as an offer. Highest is probably 650. As a PP you can make 800K+ but you will be working your ass off for it, and it will take years to get there. Offers I got out of fellowship in the Northeast were all 300-400K starting (all ~one hour radius to Boston). Higher in midwest and rural. You guys definitely have a skewed idea of what med oncs make.

Now with that being said I agree that we should be making more, given what we bring in to the hospital...

Look into doing locums if that is feasible for your situation. Way more than that

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[sirspamalot]

We need someone in MedOnc right now (as in yesterday) and if you can live 2.5 hrs from a major metro area (~1 hr to major shopping), you'll make a ton of dough live like a king and enjoy your colleagues and staff. I bet you could ask for 750k for a 4 day work week and if you're good (in person and acceptable CV), they won't hesitate. As in, when can you start?

 

[communitydoc13]

We need someone in MedOnc right now (as in yesterday) and if you can live 2.5 hrs from a major metro area, you'll make a ton of dough live like a king and enjoy your colleagues and staff. I bet you could ask for 750k for a 4 day work week and if you're good (in person and acceptable CV), they won't hesitate. As in, when can you start?

Dammit. @sirspamalot stealing my thunder!!!

I've got a coastal but rural gig. Good community hospital. We are in the same boat. I can't promise 750k, but I can promise way more than those Boston area numbers.

Any interested medoncs are welcome to PM me.

 

[metallica81788]

We need someone in MedOnc right now (as in yesterday) and if you can live 2.5 hrs from a major metro area (~1 hr to major shopping), you'll make a ton of dough live like a king and enjoy your colleagues and staff. I bet you could ask for 750k for a 4 day work week and if you're good (in person and acceptable CV), they won't hesitate. As in, when can you start?

My current hospital, not rural in a semi-undesirable (I think it's fine but depends on preference) southern city, has medoncs making 800+
They are incredibly busy and I would say overworked, but they make the money and admin is starting to bend over to help their QOL requests. Four day weeks, locums covering weekend call, etc.
But they've had turnover and I think it scares the medoncs with so many options
The ones that have left had trouble making the same $ elsewhere
So that is my skewed low n experience for medonc compensation

 

[Royster33]

The med oncs I know that do really well (close to 1million plus)....

- work very hard. Though mostly 4 days/week long days. Long call weeks. See a gazillion patients.
- are part of a big group with their own pharmacy. THey own their own real estate/buildings. Maybe even some imaging.
- have TONS of PA's/NP's. Like 3 NP's per every doc. IMO this compromises care but this is becoming a trend in the med onc world. Med onc sees at initial consult and then may not see for a long time as NP's are making decisions/managing chemo issues.

Yep, these are the people who will see the big bucks. As you stated, they work hard for it.

I am happy to make half of what they make, work 4 days a week, see ~15pts per day and be home by 4pm and not worry a single thing about with regards to ownership, business, real estate, etc. To each their own of course.

 

[RadOncDoc21]

The med oncs I know that do really well (close to 1million plus)....

- work very hard. Though mostly 4 days/week long days. Long call weeks. See a gazillion patients.
- are part of a big group with their own pharmacy. THey own their own real estate/buildings. Maybe even some imaging.
- have TONS of PA's/NP's. Like 3 NP's per every doc. IMO this compromises care but this is becoming a trend in the med onc world. Med onc sees at initial consult and then may not see for a long time as NP's are making decisions/managing chemo issues.

I’ve seen this setup, docs were making a mil each.

 

[HemeOncHopeful19]

If you guys will say what regions these jobs are in you might honestly get some interest.

Highest job spiel I ever saw was 700k for somewhere in WV. Maybe I’m not signing up for the right emails.

 

[Royster33]

We need someone in MedOnc right now (as in yesterday) and if you can live 2.5 hrs from a major metro area (~1 hr to major shopping), you'll make a ton of dough live like a king and enjoy your colleagues and staff. I bet you could ask for 750k for a 4 day work week and if you're good (in person and acceptable CV), they won't hesitate. As in, when can you start?

My only regret in life is that I do not live in areas that pay that. I'm tied down to this location but if that ever changes you bet I'll be hitting you up.

 

[deleted1116990]

I'm a medical oncologist and routinely get bombarded with emails from recruiters - don't think I've ever seen 800K starting as an offer. Highest is probably 650. As a PP you can make 800K+ but you will be working your ass off for it, and it will take years to get there. Offers I got out of fellowship in the Northeast were all 300-400K starting (all ~one hour radius to Boston). Higher in midwest and rural. You guys definitely have a skewed idea of what med oncs make.

Now with that being said I agree that we should be making more, given what we bring in to the hospital...

I don't know.

GA Hematology Oncology -60K Sign-on - $700K+ potential - 4 day work week - Georgia job with Jackson Physician Search | 598076

Phoebe Putney Health System is at the center of healthcare for Southwest Georgia and is seeking a Hematologist/Oncologist. Both a leader in advance...

www.nejmcareercenter.org

We don't see ads like this in rad onc. Meanwhile, the lowest seems to be 600, and the ads seem to be in the 600-700 range. It's rare for rad onc to even list base salaries or income potential in ads.

Just browsing... Hematology / Oncology jobs | Permanent

 

[HemeOncHopeful19]

I don't know.

GA Hematology Oncology -60K Sign-on - $700K+ potential - 4 day work week - Georgia job with Jackson Physician Search | 598076

Phoebe Putney Health System is at the center of healthcare for Southwest Georgia and is seeking a Hematologist/Oncologist. Both a leader in advance...

www.nejmcareercenter.org

We don't see ads like this in rad onc. Meanwhile, the lowest seems to be 600, and the ads seem to be in the 600-700 range. It's rare for rad onc to even list base salaries or income potential in ads.

Just browsing... Hematology / Oncology jobs | Permanent

Fair enough, although when I read "700k potential" I think "work like you're in PP earning $1 million and we'll pay you 700." I do not see anywhere on that page the 800k+ jobs that were claimed initially.

Last I looked at the MGMA RO still edged out HO at every single percentile. Maybe the data will be dramatically different in a year or two.

 

[sirspamalot]

That "data" lags at least 2 years. Right now, Medonc Locums is paying 500/hr (ie desperation level). Two people in this thread have posted jobs that are in the 7-8 range and for the one I'm mentioning, its a 4 day work week.

 

[Royster33]

If you guys will say what regions these jobs are in you might honestly get some interest.

Highest job spiel I ever saw was 700k for somewhere in WV. Maybe I’m not signing up for the right emails.

Fair enough, although when I read "700k potential" I think "work like you're in PP earning $1 million and we'll pay you 700." I do not see anywhere on that page the 800k+ jobs that were claimed initially.

Last I looked at the MGMA RO still edged out HO at every single percentile. Maybe the data will be dramatically different in a year or two.

A lot of times included in "XXX+potential" is benefits like 401k matching, loan forgiveness, moving stipend, signing bonus, etc.

I don't know.

GA Hematology Oncology -60K Sign-on - $700K+ potential - 4 day work week - Georgia job with Jackson Physician Search | 598076

Phoebe Putney Health System is at the center of healthcare for Southwest Georgia and is seeking a Hematologist/Oncologist. Both a leader in advance...

www.nejmcareercenter.org

We don't see ads like this in rad onc. Meanwhile, the lowest seems to be 600, and the ads seem to be in the 600-700 range. It's rare for rad onc to even list base salaries or income potential in ads.

Just browsing... Hematology / Oncology jobs | Permanent

I hate listings that don't include income...Messed up that thats the norm for you

 

[madchemist89]

We have to go through the whole interview process before even talking about money.

 

[sirspamalot]

We have to go through the whole interview process before even talking about money.

Is this a joke? You gaslighting bro?

 

[deleted1116990]

its a 4 day work week.

This seems pretty standard and expected for med onc these days.
Need to get there for rad onc. I think people are starting to "get it" but will still take some more time until we see this commonly advertised like it is for med onc (and not something you have to try and negotiate for because it's a pain in the a to negotiate for).

 

[deleted1116990]

Is this a joke? You gaslighting bro?

For full-time? Definitely not a joke. If you reply to job ads with, "Hi, I'm really interested in your job. My compensation requirement is $70/wRVU" you won't get a reply and probably blacklisted. I have tried. You have to waste your time (a lot of it) with multiple phone interviews, an on site interview, get an initial offer, then try and negotiate to find out if the job will be acceptable for you.

Locums is different. Of course you start the conversation with your fee when discussing locums jobs. Because locums deals are bid. Should it be like that? No. But it's the way it is. Favorable supply/demand curve changes things. I am sure that med oncs who email West Butthole, NE and say I'm interested in your job, but it would take a $900k guarantee and a 4 day week for me to move, aren't going to get blacklisted. They're going to get a phone call, at least. The same way a rad onc will waste time investigating a job advertising unacceptably low pay in hopes of negotiating it to something they feel is reasonable, just in reverse.

 

[HemeOncHopeful19]

For full-time? Definitely not a joke. If you reply to job ads with, "Hi, I'm really interested in your job. My compensation requirement is $70/wRVU" you won't get a reply and probably blacklisted. I have tried. You have to waste your time (a lot of it) with multiple phone interviews, an on site interview, get an initial offer, then try and negotiate to find out if the job will be acceptable for you.

Locums is different. Of course you start the conversation with your fee when discussing locums jobs. Because locums deals are bid. Should it be like that? No. But it's the way it is. Favorable supply/demand curve changes things. I am sure that med oncs who email West Butthole, NE and say I'm interested in your job, but it would take a $900k guarantee and a 4 day week for me to move, aren't going to get blacklisted. They're going to get a phone call, at least.

Coincidentally I can actually confirm that Butthole, NE will ask you to name your price and if you throw out that number you will absolutely get ghosted.

 

[sirspamalot]

For full-time? Definitely not a joke. If you reply to job ads with, "Hi, I'm really interested in your job. My compensation requirement is $70/wRVU" you won't get a reply and probably blacklisted. I have tried. You have to waste your time (a lot of it) with multiple phone interviews, an on site interview, get an initial offer, then try and negotiate to find out if the job will be acceptable for you.

Locums is different. Of course you start the conversation with your fee when discussing locums jobs. Because locums deals are bid. Should it be like that? No. But it's the way it is. Favorable supply/demand curve changes things. I am sure that med oncs who email West Butthole, NE and say I'm interested in your job, but it would take a $900k guarantee and a 4 day week for me to move, aren't going to get blacklisted. They're going to get a phone call, at least. The same way a rad onc will waste time investigating a job advertising unacceptably low pay in hopes of negotiating it to something they feel is reasonable, just in reverse.

I think its reasonable to ask up front, what is the maximum salary you expect to provide for a top notch recruit who is willing to start promptly?

If the answer isn't #, then off we go. It seems most places are doing straight $, rather than wRVU but hey, I would ask similarly for wRVU what they have historically done.

Get blacklisted from the place you're asking? Good riddance. If they can't be honest about compensation (in a tactful way) upfront, what else will they f you on later? I had this conversation with a hospital much closer to home. They were eager to hire. But, it became apparent that there was no way they would meet my requirement. Mutually wished each other well. They prolly will find someone, but I'm not taking a 20% pay cut.. and I'm definitely not willing to give up and be W2 plus a pay cut.

ps. With paid vacation and holidays.. your real wRVU should be closer to 90 if you're not W2...

 

[deleted1116990]

Coincidentally I can actually confirm that Butthole, NE will ask you to name your price and if you throw out that number you will absolutely get ghosted.

I am confident we are talking about the same place. I sincerely hope this place never hires and an independent place opens and runs them out of business. Admin that boneheaded to advertise a job for 5 years in the belief that someone is going to eventually come along and throw out a 400k number deserves to be unemployed. It's like the solid 2 refusing to swipe right on Tinder on anyone other than a 10 in belief that eventually one will see their value. Sorry West Butthole, you're a 2. But I'll give them this -- at least they don't waste your time.

 

[dieABRdie]

I think its reasonable to ask up front, what is the maximum salary you expect to provide for a top notch recruit who is willing to start promptly?

If the answer isn't #, then off we go. It seems most places are doing straight $, rather than wRVU but hey, I would ask similarly for wRVU what they have historically done.

Get blacklisted from the place you're asking? Good riddance. If they can't be honest about compensation (in a tactful way) upfront, what else will they f you on later? I had this conversation with a hospital much closer to home. They were eager to hire. But, it became apparent that there was no way they would meet my requirement. Mutually wished each other well. They prolly will find someone, but I'm not taking a 20% pay cut.. and I'm definitely not willing to give up and be W2 plus a pay cut.

ps. With paid vacation and holidays.. your real wRVU should be closer to 90 if you're not W2...

Man... I love your swag; but circa 2018 was a VERY different experience for me. And I'm an anglo-saxon that hates a metro area and isn't restricted to any region.

I got instantly ghosted at every place I started by asking a number. So I went through the rigmarole, song and dance. Pretended to be genuinely interested. Only to get smacked in the face with a number below median MGMA.... EVERY.... TIME. The biggest town I interviewed in was 80K pop.


I have diamond hands.

So all worked out for me. But man it was nothing like your experience.

 

[sirspamalot]

I hear ya. And diamond hands are what it takes to not get hosed. As you point out, it all worked out.

Me? I did locums after getting hosed out of the only W2 job I have had since graduation 20+ years ago (nothing to do with me personally, it was a victim of COVID closures). 1099 before and after, never again will I be a W2.

That means then that I'm doing locums.. until one converted into a real job with appropriate # and good lifestyle. Miracles happen, but usually only to those that put the work in.

Hard work + luck = success. I tell the kids this whenever the opportunity arises; hope it sinks in.


ps. You doin NBPAS instead of ABR? Given your username.. I had to ask..

 

[deleted1116990]

I have diamond hands. View attachment 363680 So all worked out for me. But man it was nothing like your experience.

At some point it almost becomes enjoyable to laugh at these places when they finally come to you with a "boilerplate" contract with absurd terms.
You basically have to make it a game or else you will go insane.

Use your credit card and rack up points, max out mileage to get the IRS reimbursement rate, max out travel expenses, hotel, airline points, etc. Add on a few days for a long weekend if the site is even a few hours driving from anything interesting and make them pay for it as you "explore the area." It's still not worth it, of course, compared to a day of work, but still. If they are going to waste your time, get as much for your time as you can.

I interviewed in one place that owed me over 2k for interview expenses and kept dodging it every time I brought it up, basically accused me of being petty, etc. I am CONFIDENT some admin was literally trying to get out of paying interview expenses to save a few bucks. When I picked up the rental car, they had put the wrong expiration date for the company card on the reservation, so I had to pay for it myself. Accident? I think not. I eventually got paid but had to jump through a stupid number of hoops. I got an offer, but negotiations eventually broke down and almost became hostile with my concern over being reimbursed for interview expenses brought up as a contributing factor. I can't imagine the nightmare that would have been working for these people.

 

[sirspamalot]

At some point it almost becomes enjoyable to laugh at these places when they finally come to you with a "boilerplate" contract with absurd terms.
You basically have to make it a game or else you will go insane.

Use your credit card and rack up points, max out mileage to get the IRS reimbursement rate, max out travel expenses, hotel, airline points, etc. Add on a few days for a long weekend if the site is even a few hours driving from anything interesting and make them pay for it as you "explore the area." It's still not worth it, of course, compared to a day of work, but still. If they are going to waste your time, get as much for your time as you can.

I interviewed in one place that owed me over 2k for interview expenses and kept dodging it every time I brought it up, basically accused me of being petty, etc. I am CONFIDENT some admin was literally trying to get out of paying interview expenses to save a few bucks. When I picked up the rental car, they had put the wrong expiration date for the company card on the reservation, so I had to pay for it myself. Accident? I think not. I eventually got paid but had to jump through a stupid number of hoops. I got an offer, but negotiations eventually broke down and almost became hostile with my concern over being reimbursed for interview expenses brought up as a contributing factor. I can't imagine the nightmare that would have been working for these people.

Thats exactly what it becomes, a stupid game. Except nobody plays games with their income. The beatings will continue until morale improves, or you reject this way of life (and perhaps have some temporary financial setback).

 

[seper]

At some point it almost becomes enjoyable to laugh at these places when they finally come to you with a "boilerplate" contract with absurd terms.
You basically have to make it a game or else you will go insane.

Use your credit card and rack up points, max out mileage to get the IRS reimbursement rate, max out travel expenses, hotel, airline points, etc. Add on a few days for a long weekend if the site is even a few hours driving from anything interesting and make them pay for it as you "explore the area." It's still not worth it, of course, compared to a day of work, but still. If they are going to waste your time, get as much for your time as you can.

I interviewed in one place that owed me over 2k for interview expenses and kept dodging it every time I brought it up, basically accused me of being petty, etc. I am CONFIDENT some admin was literally trying to get out of paying interview expenses to save a few bucks. When I picked up the rental car, they had put the wrong expiration date for the company card on the reservation, so I had to pay for it myself. Accident? I think not. I eventually got paid but had to jump through a stupid number of hoops. I got an offer, but negotiations eventually broke down and almost became hostile with my concern over being reimbursed for interview expenses brought up as a contributing factor. I can't imagine the nightmare that would have been working for these people.

2K is a lot of money for a smallish RadOnc admin's budget (in their opinion). I've experienced this firsthand. People will jump through through the hoops to deny your request for reimbursing license fees, they will scrutinize your crumpled restaurant receipts, etc

 

[RadRadRad]

2000 dollars is a trivial amount for all radonc departments. And can’t imagine taking a job somewhere if they wouldn’t even reimburse interview expenses

 

[seper]

2000 dollars is a trivial amount for all radonc departments. And can’t imagine taking a job somewhere if they wouldn’t even reimburse interview expenses

Supposed to be trivial. God knows what goes on in these money counting meetings or Teams chats. Yuck

 

[madchemist89]

When I was a resident, the lady who did our reimbursement would scour our receipts from ASTRO. "Was this 1 AM uber ride conference related?" Of course it was, it occurred during the conference.

 

[RadOncDoc21]

When I was a resident, the lady who did our reimbursement would scour our receipts from ASTRO. "Was this 1 AM uber ride conference related?" Of course it was, it occurred during the conference.

We must have trained at the same place! They made it so painful to get reimbursed, literally debating over a lunch that cost me 18 dollars! Looking back, I don’t feel bad for using the chair’s credit card to buy 2 main entrees for myself later on.

 

[yesmaster]

When I was a resident, my wonderful PD flat out refused to reimburse me for a conference's registration or travel fees. Needless to say, that was the only conference I attended during residency outside my home city.

 

[A_DeMichele]

Residents, sure. Our current program did not even have a formal budget for them until last year. But I was surprised to encounter widespread pettiness as a W2 attending.

 

[elementaryschooleconomics]

Ah. Residency reimbursement should have an ACGME case log for the difficulty and subsequent skills you acquire.

My program started to require credit card statements which matched the receipts. They wouldn't accept a statement without the last 4 digits of the card being visible. I became excellent at redacting, you know, all the personal expenses that I didn't care to be open to some rando admin's scrutiny.

Though we could use our GME money for electronics (i.e. laptops) if we didn't do conference travel, we had to go through the university's preferred vendor. I know this is very common for institutions, but it would drive me nuts when I knew I was getting ripped off for a device or whatever I could get for half the price somewhere else.

My personal hack for going to ASTRO was to not purchase anything myself and wait/fight for reimbursement. Instead, I would email our program coordinator for a meeting. I would then sit in her office and have her book tickets etc for me using the department credit card.

Obviously that trick didn't work for meals. But I never ever ever trusted them to not mess with me. Since the "big ticket" items - registration, flight, hotel - ate up the bulk of my stipend anyway, I didn't have to worry about how long (or if) it would take to get reimbursed.

I'm fairly certain she wasn't supposed to do that for me. She was fairly inexperienced at the job, then we started going down the pandemic road and a lot of stuff got lost in the noise, then I graduated and they have never heard from me again.

 

[HolySmokes]

For full-time? Definitely not a joke. If you reply to job ads with, "Hi, I'm really interested in your job. My compensation requirement is $70/wRVU" you won't get a reply and probably blacklisted. I have tried. You have to waste your time (a lot of it) with multiple phone interviews, an on site interview, get an initial offer, then try and negotiate to find out if the job will be acceptable for you.

I definitely agree with this. I interviewed for a hospital employed job where I knew all the employed rad oncs were making 1-1.3M and one of my first questions in the interview was just "how are you going to ensure that RVUs/consults are distributed evenly with a new provider coming in" and stressed my concern about being hospital employed as a new doc with a group that have all been there for 5+ years. I didn't even ask about $/RVU or my own total salary. Never got a call back despite living in that city and having almost immediate availability.

 

[Neuronix]

I'm a doc with some admin responsibility. I remain full time clinically, however. Only recently have I been privy to what it's like to have docs ask for more and more.

I'm quite privy to what it's like to have admin ask for more and more.

I do agree that most non-physician admin don't quite get the docs position. The pay disparity is hard to get around emotionally. If you are making 250k as an admin and a doc is bitching about making 600 or 700k, this is not going to resonate at all, it just wont. Most admin are like most people in general, they want to know that they are getting more for paying more, or at least that they are rewarding excellence.

The admins are support staff. Nobody is walking in that door or paying money to see the admins. If an admin is making 250k/year they are making more than several specialties of MDs here, and should be thanking their lucky stars they are allowed make that much money to be in such a supportive, non-productive role.

A market shortage of physician labor invites self serving behavior and a lack of accountability. I wish this wasn't the case, but it is.

Self serving behavior like reasonable hours and sufficient clinic support? The horror.

You know what it is.

Endless metrics that are impossible to meet with your bonus in the balance, staff are equal to the MD in all disputes and asking them to do anything results in one of these "staff complaints", and anything on your record that isn't a perfect score gets held against you forever? Yes, I know what that "commitment to quality" is. Feels great to be in the patient room asking patients to make sure they give me a perfect score on that survey they're going to get just like the guy who sold me my Kia.

What we have now is a failed market in medical oncology. I am not talking about any radoncs that I have dealt with. I am talking about some of the medoncs I have dealt with and the reality of the present medonc locums market. If you think this market is a healthy thing and something we should be cheering or aspiring to, I think you are mistaken. It is just going to lead to closures and further consolidation of care.

Strongly disagree. It's simple supply and demand. I have seen it first hand. The only way to get salaries raised or working conditions improved is to not be redundant or immediately replaceable. Otherwise, there is no limit to the amount of skim off your collections that health systems will take or abuse you will get.

 

[sirspamalot]

Neuronix bringing down the HAMMER. Please continue..

 

[deleted1116990]

Strongly disagree. It's simple supply and demand. I have seen it first hand. The only way to get salaries raised or working conditions improved is to not be redundant or immediately replaceable. Otherwise, there is no limit to the amount of skim off your collections that health systems will take or abuse you will get.

The sad reality for us is that we have a bloated locums pool, so even if you are in rural North Dakota, you are immediately replaceable at or possibly below your cost to the hospital as a W2 employee. Will your replacement provide good care and treat with modern plans? Who knows? Who cares? Admin doesn't. They have a pulse, a license, are eager to please, do what they are told, and can click a few buttons. The exception may be academics, where you can't be immediately replaced with minimally competent locums, but for community hospital employed rad oncs, this is the situation.

This is not the case for med onc where locums cost 5k+ / day if they can even get them. The locums market tells the story. I watched the med oncs get away with so much including grossly unprofessional behavior on top of constant complaining and fighting with admin. Med onc would threaten to quit, and actually submit their resignation multiple times, admin would come begging and throw some more $$$, PTO, or clinic resources at them. When rad onc raised far less aggressive objections with admin they became a "problem hire" and were made gone. Oh you're unhappy? There's the door. Bye. No really, leave. Don't worry about staffing, we got that covered in 2 seconds.

 

[sirspamalot]

The sad reality for us is that we have a bloated locums pool, so even if you are in rural North Dakota, you are immediately replaceable at or possibly below your cost to the hospital as a W2 employee. Will your replacement provide good care and treat with modern plans? Who knows? Who cares? Admin doesn't. They have a pulse, a license, are eager to please, do what they are told, and can click a few buttons. The exception may be academics, where you can't be immediately replaced with minimally competent locums, but for community hospital employed rad oncs, this is the situation.

This is not the case for med onc where locums cost 5k+ / day if they can even get them. The locums market tells the story. I watched the med oncs get away with so much including grossly unprofessional behavior on top of constant complaining and fighting with admin. Med onc would threaten to quit, and actually submit their resignation multiple times, admin would come begging and throw some more $$$, PTO, or clinic resources at them. When rad onc raised far less aggressive objections with admin they became a "problem hire" and were made gone. Oh you're unhappy? There's the door. Bye. No really, leave. Don't worry about staffing, we got that covered in 2 seconds.

I'm not so sure its bloated in locums at this point. I get very aggressive emails/calls when something opens up. Thankfully, I'm unavailable to go to Bunghole, OH or Cluckstick, Kentucky or god forbid Shytkicker, Montana or Festering Pool, ND.

But if I was, I'd certainly tell them 2800/d without hesitation plus every last expense.

The hospitals hiring locums will have a tough decision: go cheap with either green radoncs (ok if you need a warm body) or old/difficult/"bad paper" folks who will take any $ (maybe for a couple weeks?) or.. pay appropriately for someone who will actually commit to coming for 3 months or more and do the job right but refuses to work for peanuts (hello 2800).

My favorite part is when they first turn you down.. and then come begging at the last minute. One time..many years ago.. (opens the great golden book of locums stories).. I was in Godforsaken, Midwest (on my own contract, not locums agency) and they had hired me to come for I forgot how many months. Full rate. Near the end.. Played games asking for a discount since they ended my stay early (they had hired someone to come). I happily provided with a big smile a glorious 5% discount given to the jr admin who wouldn't accomodate any of my requests previously. Yup.. thats right.. got a month of 'paid vacation.' As I was departing, I asked for them to cover 50$ to get my rental cleaned because it was filthy from the environment. Sr Admin was, lets just say, unkind about it. I indicated in no uncertain terms I wouldn't be back (learned he got fired later on).

Not one month later they call in desperation asking for emergency coverage. Hello my friends! "That'll be my entire weekly rate (13k) for 3 days plus all expenses including my fuel of course." Little did they know, I was already headed that way to go for my lake vacation. I sat there for a couple days, did absolutely next to nothing, and enjoyed my holiday weekend including my fuel covered. Karma is beautiful like that..

 

[medgator]

The sad reality for us is that we have a bloated locums pool, so even if you are in rural North Dakota, you are immediately replaceable at or possibly below your cost to the hospital as a W2 employee. Will your replacement provide good care and treat with modern plans? Who knows? Who cares? Admin doesn't. They have a pulse, a license, are eager to please, do what they are told, and can click a few buttons. The exception may be academics, where you can't be immediately replaced with minimally competent locums, but for community hospital employed rad oncs, this is the situation.

This is not the case for med onc where locums cost 5k+ / day if they can even get them. The locums market tells the story. I watched the med oncs get away with so much including grossly unprofessional behavior on top of constant complaining and fighting with admin. Med onc would threaten to quit, and actually submit their resignation multiple times, admin would come begging and throw some more $$$, PTO, or clinic resources at them. When rad onc raised far less aggressive objections with admin they became a "problem hire" and were made gone. Oh you're unhappy? There's the door. Bye. No really, leave. Don't worry about staffing, we got that covered in 2 seconds.

Butthole, SD locums rates have increased significantly post pandemic, following what is happening in most places from what I've seen

 

[communitydoc13]

Strongly disagree. It's simple supply and demand.

Where do you work?

If it's a PPS exempt or similar academic center in a high cost of living and generally considered favorable location (a city like NY, PH, Boston, DC, Miami, LA, Seattle. SF, Chicago), you have no idea what the market is like where I am.

There is so much cultural capital in a large, urban, academic place, that you will always be able to staff it. You will always have less leverage for negotiating salary and almost uniformly will be paid less than where I am. You will also be more susceptible to administrative overreach.

I doubt that staffing medical oncology is difficult where you are, and between hematology and oncology there may be 50 to over a hundred docs. This is not a place with 4-6 generalists.

This is where I am. A 200 bed hospital system with a massively growing and aging demographic more than 2 hours away from a major metro.

There are whole regions of rural America with massive net negative oncology staffing at the physician level. (As in roughly 400k people and a net -10 in terms of oncologists available). I am speaking for medonc only, as I've said before, we can more than make do with who is out there in terms of radiation oncology.

Call it healthy if you want. Your so called healthy market will result in further consolidation and asking the population to travel 90 min to 2 hours for cancer care will just harm the radonc market even more. I would be treated far worse (if I could even land a job) at a large regional center that had taken over care in my area than I am by the local hospital.

It's a failed market. There is a gross physician shortage of some types of docs (not radonc) in this country. When hospitals and practices loose any ability to provide care or select hires, it is not good.

Endless metrics that are impossible to meet with your bonus in the balance, staff are equal to the MD in all disputes and asking them to do anything results in one of these "staff complaints", and anything on your record that isn't a perfect score gets held against you forever? Yes, I know what that "commitment to quality" is. Feels great to be in the patient room asking patients to make sure they give me a perfect score on that survey they're going to get just like the guy who sold me my Kia.

I'm sorry that this is your experience, and I have witnessed lesser versions of this behavior by admin myself. This is not the culture where I am at present. Admin that behave this way have lost sight of who does the work. However, you may not be privy to the behavior of low quality docs at your place (everybody who is at a center like yours has some degree of buy in). I'm talking about docs who lose 20% of their new patient referrals after their first patient encounter because they suck and then say, "what are you going to do about it, fire me?" This behavior exists. If there is no possibility of replacing the doc, it engenders bad care.

Now I believe that it is large institutions like yours that are largely to blame. (Not you personally at all). They often expand into the region and their size and market dominance further erodes physician leverage (it's not just supply and demand that dictate physician leverage, but diversity of opportunity). They often sell a message that working in the community is less and do not in general have a mission "to train community doctors", although this is where the need is greatest. Any medical oncologist from your institution or similar would be welcomed with open arms in a community like mine, would be paid more, would be understood to be a valuable asset and the key stakeholder in the practice and would constantly have their opinion solicited regarding improving care. However, they never come this way, or if they do, they want an admin job or a very defined part time job before retirement.

 

[sirspamalot]

Where do you work?

If it's a PPS exempt or similar academic center in a high cost of living and generally considered favorable location (a city like NY, PH, Boston, DC, Miami, LA, Seattle. SF, Chicago), you have no idea what the market is like where I am.

There is so much cultural capital in a large, urban, academic place, that you will always be able to staff it. You will always have less leverage for negotiating salary and almost uniformly will be paid less than where I am. You will also be more susceptible to administrative overreach.

I doubt that staffing medical oncology is difficult where you are, and between hematology and oncology there may be 50 to over a hundred docs. This is not a place with 4-6 generalists.

This is where I am. A 200 bed hospital system with a massively growing and aging demographic more than 2 hours away from a major metro.

There are whole regions of rural America with massive net negative oncology staffing at the physician level. (As in roughly 400k people and a net -10 in terms of oncologists available). I am speaking for medonc only, as I've said before, we can more than make do with who is out there in terms of radiation oncology.

Call it healthy if you want. Your so called healthy market will result in further consolidation and asking the population to travel 90 min to 2 hours for cancer care will just harm the radonc market even more. I would be treated far worse (if I could even land a job) at a large regional center that had taken over care in my area than I am by the local hospital.

It's a failed market. There is a gross physician shortage of some types of docs (not radonc) in this country. When hospitals and practices loose any ability to provide care or select hires, it is not good.



I'm sorry that this is your experience, and I have witnessed lesser versions of this behavior by admin myself. This is not the culture where I am at present. Admin that behave this way have lost sight of who does the work. However, you may not be privy to the behavior of low quality docs at your place (everybody who is at a center like yours has some degree of buy in). I'm talking about docs who lose 20% of their new patient referrals after their first patient encounter because they suck and then say, "what are you going to do about it, fire me?" This behavior exists. If there is no possibility of replacing the doc, it engenders bad care.

Now I believe that it is large institutions like yours that are largely to blame. (Not you personally at all). They often expand into the region and their size and market dominance further erodes physician leverage (it's not just supply and demand that dictate physician leverage, but diversity of opportunity). They often sell a message that working in the community is less and do not in general have a mission "to train community doctors", although this is where the need is greatest. Any medical oncologist from your institution or similar would be welcomed with open arms in a community like mine, would be paid more, would be understood to be a valuable asset and the key stakeholder in the practice and would constantly have their opinion solicited regarding improving care. However, they never come this way, or if they do, they want an admin job or a very defined part time job before retirement.

 

[deleted1116990]

Butthole, SD locums rates have increased significantly post pandemic, following what is happening in most places from what I've seen

The modest increase in rad onc locums rates (from $1600/day --> $2000/day) corresponds with the modest increase in available jobs.
Compared to the extreme increase in med onc locums rates (from $2500/day to $5000/day) and their extreme increase in advertised jobs.

The locums market tells the real story. Kind of the same way the bond market (not the stock market) tells the story of the economy.

 

[medgator]

The modest increase in rad onc locums rates (from $1600/day --> $2000/day) corresponds with the modest increase in available jobs.
Compared to the extreme increase in med onc locums rates (from $2500/day to $5000/day) and their extreme increase in advertised jobs.

The locums market tells the real story. Kind of the same way the bond market (not the stock market) tells the story of the economy.

$2500 seems to be the going rate lately for multiple hospital gigs I've come across

 

[deleted1116990]

$2500 seems to be the going rate lately for multiple hospital gigs I've come across

West Butthole, NE still offering $1800 (LOL)

What I am typically seeing is it quoted on a per week basis now ($10k). Clever trick. Rad oncs only know how to divide by 1.8, not 5 so 10k sounds like a lot I guess.

Meanwhile, peruse the anesthesia forum and you will see people talking about 10k for a 24 hour shift. Insane.

 

[sirspamalot]

Well it used to be #2600orGTFO .. but you know inflation and all that.

#2800orGTFO is my new rate. If I was available. Which I'm not. But if I was.. I'd only go down if it was very close to home and a very cushy gig.

Oh, did you say there were 30 on treatment consistently? Hmm.. #3200orGTFO.

Forty on treatment? #4000orGTFO. I remember many years ago, at an annual meeting, one of my knowitall peers who knew of my locums prowess approached me. "I'm working at solo at XXX and they have like 40-45 on treatment. They were only paying me 1700 a day so I negotiated and got them up to 1800. What do you think I should get? Because I'm working really hard.. and they do lots of procedures too.. "

"You don't want to know."

"Yes I do, tell me."

"You really don't want to know."

"Yes I do now come on really."

"Are you sure? You won't like my answer..."

"Yes dammit tell me what is it what should it be?"

(long pause, looking into his eager scrunched face knowing what is about to happen)

"Its 4200 a day plus expenses and not a penny less. You're doing 2.5 FTE level work. I'd probably ask for 4500. Oh, and I've worked there as an independent doing the billing.. and made 1.8M a year so I know -exactly- what it should be."

(Cue the face color going from pink to red to pure unbridled hatred)

Guy storms off.. never spoke to me again.

Moral of the story: What you don't know can really hurt you. You will never be offered the right amount up front. Double it and take 20% off, start your negotiation from there.. lol.

Ya'll know Rule #1. Here's Rule #2: FYPM.

 

[Mandelin Rain]

Where do you work?

If it's a PPS exempt or similar academic center in a high cost of living and generally considered favorable location (a city like NY, PH, Boston, DC, Miami, LA, Seattle. SF, Chicago), you have no idea what the market is like where I am.

There is so much cultural capital in a large, urban, academic place, that you will always be able to staff it. You will always have less leverage for negotiating salary and almost uniformly will be paid less than where I am. You will also be more susceptible to administrative overreach.

I doubt that staffing medical oncology is difficult where you are, and between hematology and oncology there may be 50 to over a hundred docs. This is not a place with 4-6 generalists.

This is where I am. A 200 bed hospital system with a massively growing and aging demographic more than 2 hours away from a major metro.

There are whole regions of rural America with massive net negative oncology staffing at the physician level. (As in roughly 400k people and a net -10 in terms of oncologists available). I am speaking for medonc only, as I've said before, we can more than make do with who is out there in terms of radiation oncology.

Call it healthy if you want. Your so called healthy market will result in further consolidation and asking the population to travel 90 min to 2 hours for cancer care will just harm the radonc market even more. I would be treated far worse (if I could even land a job) at a large regional center that had taken over care in my area than I am by the local hospital.

It's a failed market. There is a gross physician shortage of some types of docs (not radonc) in this country. When hospitals and practices loose any ability to provide care or select hires, it is not good.



I'm sorry that this is your experience, and I have witnessed lesser versions of this behavior by admin myself. This is not the culture where I am at present. Admin that behave this way have lost sight of who does the work. However, you may not be privy to the behavior of low quality docs at your place (everybody who is at a center like yours has some degree of buy in). I'm talking about docs who lose 20% of their new patient referrals after their first patient encounter because they suck and then say, "what are you going to do about it, fire me?" This behavior exists. If there is no possibility of replacing the doc, it engenders bad care.

Now I believe that it is large institutions like yours that are largely to blame. (Not you personally at all). They often expand into the region and their size and market dominance further erodes physician leverage (it's not just supply and demand that dictate physician leverage, but diversity of opportunity). They often sell a message that working in the community is less and do not in general have a mission "to train community doctors", although this is where the need is greatest. Any medical oncologist from your institution or similar would be welcomed with open arms in a community like mine, would be paid more, would be understood to be a valuable asset and the key stakeholder in the practice and would constantly have their opinion solicited regarding improving care. However, they never come this way, or if they do, they want an admin job or a very defined part time job before retirement.

This all makes sense.

But... you also disclosed that you're in an undesirable, rural location looking for a hard to find doc in an in-demand field, but can't offer 750K.

Solution is simple. Pay more. Offer a million.

They will come.

Hospital president gets a smaller bonus. Patients get care. Trade off is worth it.

 

[sirspamalot]

This simple response fails to grasp that those who have the money want you to get less of it. Because the genuinely don't even give 1. Good luck. Counterpoint: What good is making +10 or +20% more when you live in a place where there is nothing to spend it on?

 

[sirspamalot]

This all makes sense.

But... you also disclosed that you're in an undesirable, rural location looking for a hard to find doc in an in-demand field, but can't offer 750K.

Solution is simple. Pay more. Offer a million.

They will come.

Hospital president gets a smaller bonus. Patients get care. Trade off is worth it.

Happy Holidays to all...

 

[communitydoc13]

an undesirable, rural location

Not undesirable (lots of urbanites here on the weekend) but yes, rural by definition.

I don't make the salary decisions, but I do put pressure on to increase pay.

It may come to this.

Kids, go into medonc.

 

[Reaganite]

The med oncs I know that do really well (close to 1million plus)....

- work very hard. Though mostly 4 days/week long days. Long call weeks. See a gazillion patients.
- are part of a big group with their own pharmacy. THey own their own real estate/buildings. Maybe even some imaging.
- have TONS of PA's/NP's. Like 3 NP's per every doc. IMO this compromises care but this is becoming a trend in the med onc world. Med onc sees at initial consult and then may not see for a long time as NP's are making decisions/managing chemo issues.

Late to game, but have to agree with everything you wrote--these med oncs work insanely hard. The rates are good because they are getting murdered in clinic. My med onc buddies see 60+ patients in clinic every day, and they still have to rely heavily on NPs to make things work. Patients are constantly complaining, and appointments are backlogged for months. I don't know a happy med onc personally.

 

[medgator]

.

Kids, go into medonc.

Or medical physics

 

[communitydoc13]

Or medical physics

Another failed market!!!

Call me out @Neuronix

Not enough of them and big radonc gobbling em up for a low efficiency, low added efficacy and ultra high physics utilization intervention known as protons!

My med onc buddies see 60+ patients in clinic every day

Woof!! We don't do that to our medoncs.