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  • Considering changing jobs - please advise

    Hello everyone, despite my username I am a board certified attending, been out for over 2 years. I am considering leaving my first job. I am in a hospital based specialty that generates large technical revenue.

    Current job - Hospital employed W2, 540k base flat no production bonus (hospital doesn't want t incentivize overtreatment). This is is an undesirable location in the midwest, somewhat cold, metro population 700k. 403 and 457 available with small match. There is a state and city tax here.

    Job offer I received - Private practice group with long history . The structure is a corporation and the docs are W2 which I thought was unusual. They offered me 1 year partnership and first year salary of 500k, they said partners make 600-670k. They normally have a 2 year partnership track, but they made it 1 year for me since I am BC with experience. I thought that was very generous of them. There is a 401K with employee+employer match+profit sharing which maxes out at 61k, I could participate in this in year 2. They haven't hired for several years (last hire was 5+ years ago), low turnover group. City is better, in the south, warm, 1.4 mil metro pop. I had a really good interview with them. They said at the corporate level they try to pay everything out to avoid double taxation. Closer city to my parents and where I grew up (1 hour flight). There is only a state tax here without city tax which is nice

    My gripe with my current job is being a hospital employee. The hospital has several sites in their network and I am at the least productive site (we dont rotate around). There are some senior docs at the main site that make 1.25-2x what I make. They also generate more RVUs. I recently tried to re-negotiate my contract with the hospital and they declined saying they would not re-negotiate since I have only been here two years with not huge production (10.6k rvus) and they want physician pay to be fair. Well it's not fair because you have other docs at other sites making way more. I brought up the point that my site has the least referrals and is in the lesser populated area (neither of which are my fault) and they didn't really have a good solution. My site collects 4mil a year prof+tech, prof is usually 17-18% so I am underpaid even at my site. What is even more alarming is that the group has hired a few new grads from a program an hour away and they will be starting soon. They will be having the same terms and compensation as myself who is 2 years in and BC. This really bugs me. In addition in my current group, there is a clear hierarchy among the physicians and myself being at the distant site, I am at the bottom. It almost feels like an academic feel and I hate it. They have started giving out titles to other physicians for quality and leadership and other things, it is really ridiculous. I didn't join medicine to kiss ****************** or climb the corporate ladder.

    I have come to the conclusion that I don't particularly care for hospital employment. I love my site and my staff and my patients. I am also not in love with my current location and I don't see a clear upward trajectory for me here. Please share your thoughts.
    Last edited by finalyearresident; 02-10-2022, 03:04 PM.

  • #2
    Looks like there are a lot of favorable features for you in the new offer.

    I am in a private practice, and over the years, I prefer our headaches to the employed doc headaches.

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    • #3
      Read your post again and pretend that it was written by a friend. The answer is clear unless you are leaving something out. You should take the new job.

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      • #4
        Is there a difference in call, nights/weekends, or hours per week? I would consider lifestyle of the two jobs as well.

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        • #5
          What would be the pros to staying put?

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          • #6
            Originally posted by Shant View Post
            What would be the pros to staying put?
            If the OP likes being underappreciated and undercompensated then staying put sounds like a match made in heaven.

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            • #7
              What's the debate?

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              • #8
                Agree you have either made your decision based off that post or overlooked the negatives to private practice. Clearly Pros seem better. Make a list of objective cons and compare those.

                I would say look at payer mix, average collections, and how hard those partners are working to make 600k+. If thats fits your lifestyle pull the trigger. All us hospital employed docs dream about jumping to private practice at some point.

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                • #9
                  Life is too short to stay in a job that is obviously causing you stress. Go for the new job!

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                  • #10
                    2 options. Enjoy 550k a year on 5k RVUs (if I read that right) which means you’re paid very well per RVU. Since you’re not production driven and at a smaller distant site no one will likely be on you or riding you for more. As you mentioned you’re a warm body and not worth their time or hassle. So enjoy the cake walk and do the least amount of work as possible. That’s the only way imo that a doc wins in such an employed gig

                    if you want to hustle more to with make more money, help more patients or just build more experience than obviously leave and find a job that rewards that.

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                    • #11
                      Some updates: This is a 9-5 gig at both places, minimal call. The private group has 3 sites and is in the process of adding a 4th which is 90 miles away, I would be spending 1-2 days a week at that new site so there will be some driving. Although in my current gig if I wanted to live in the nice part of town I would be 40 miles away from work each way so that would be 400 miles driving per week. My current gig I produce 10.6k RVUs per year so I am getting $50/rvu which is low. The pros to staying put are its an easy job at a remote site, stable system, although the private group has also been around for 20 years so it's not like they are going anywhere.

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                      • #12
                        What brings you happiness and fits your personality.better? This job and location or the new one?

                        500k for a simple easy job being described. Few are going to be lending a sympathetic ear on the troubles.

                        So really come down to which situation is going to make you less grumpy. Despite all the warts of current job, you feel hesitant.....why?

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                        • #13
                          Originally posted by finalyearresident View Post
                          Some updates: This is a 9-5 gig at both places, minimal call. The private group has 3 sites and is in the process of adding a 4th which is 90 miles away, I would be spending 1-2 days a week at that new site so there will be some driving. Although in my current gig if I wanted to live in the nice part of town I would be 40 miles away from work each way so that would be 400 miles driving per week. My current gig I produce 10.6k RVUs per year so I am getting $50/rvu which is low. The pros to staying put are its an easy job at a remote site, stable system, although the private group has also been around for 20 years so it's not like they are going anywhere.
                          Yea that changes things. $50/rvu to be a chump low on ladder with no real prospects to improve or grow.

                          Move on.

                          Good luck.

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                          • #14
                            Compensation, job, location.
                            I can guarantee will have some aspects in the job that you won’t particularly care for either. You may not love you patients and staff or the pressure on volume, No easy answer. I would focus on the job. You seem to have a lot of positives in the daily practice. Wouldn’t underestimate that. Your. choice.

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                            • #15
                              Look at it from the viewpoint of what brings you happiness and what brings you unhappiness and see where you fit in with the top 2 of both for each location. You also have not told us anything about spouse / children, if you have any since they also have the same feelings and might not want to move or want to move at any cost.

                              Both give good income. If I were you, my top 2 for happiness would be a warm climate with some seasonal change and wanting to come to work when I get out of bed. My top unhappiness would be if I felt I was slighted or people were taking advantage of me, even if I were well compensated. Based on these I would move to the new job even if the pay is the same or the work is a bit more. Just make sure that income is divided equally in your new job and that others in the group also travel to the far flung 4th location.

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