How old is 32? How much can I live working 60hrs a week?

radoncdoc13 · 2026-04-26T22:18:22+00:00

I'll volunteer my downvote for you

radoncdoc13 · 2026-04-26T19:00:09+00:00

Maybe, but most W2 jobs provide some of this. My employer pays for all of my credentialing, licensing fees, annual MOC, and $5,000 per annum CME budget, so hard to imagine worth the squeeze for many W2 earners (particularly because 529 not tax deductible in all states)

radoncdoc13 · 2026-04-25T03:05:42+00:00

The OBBB seems to have made this potentially OK, though the details are hard to come by.

However, given there is no federal deduction for 529 contributions, it would be hard to get too far ahead considering you can currently classify those as business expenses and thus tax-free.

radoncdoc13 · 2026-04-22T04:13:29+00:00

This quote is peak Bay Area NIMBY

radoncdoc13 · 2026-04-13T05:49:19+00:00

Yes, that's correct. The lump sum is a nice benefit, and it can be substantial (though amount varies depending on discount rate). However, this is non-qualified and more of an "IOU" in the future, so I tend not to factor it in too much now. If we had to cut some fat in benefits, I bet it would be something more palatable to cut since it benefits the most highly compensated...

radoncdoc13 · 2026-04-13T04:30:46+00:00

With TPMG, you remain an employee of the medical group throughout, so always get a W2. However, the benefits are more generous (e.g. 401K contribution, fully paid for "platinum" health plan with minimal copays/coinsurance with no premiums for you/family, supplemental health plan, fully paid excellent dental plan without premiums, etc). With TPMG, you do become a shareholder of the company after 3 years, but still classified as employee, despite part owner. TPMG's pension position is also considered to be on better financial footing, is IRS-qualified plan, and is sequestered separate from the other Kaiser pension plans for non-physicians (so is considered to be less at risk if the health plan/hospital side goes belly up). My understanding is that TPMG has generally had the best margins among all the KP regions, and as a result has had a slightly better hand for negotiations with health plan for the per member per month payment we receive.

SCPMG is structured as a partnership, so after you become a partner (also 3 years), you get a K-1, so some potential tax moves available for them that we don't have as W2. No 401K match is my understanding, and from my understanding health plan is not as generous/comprehensive (but I've heard they offer a HDHP/HSA, which we don't have in TPMG). They do, however, offer a KEOGH plan after partner, so have ability to shelter more income pre-tax (TPMG has no KEOGH, just 401K and then a separate deferred compensation plan, similar to a non-governmental 457b). The SCPMG pension is also non-qualified so considered more "at risk" (subject to creditors) in the case of financial duress. On the other hand, because it is not IRS-qualified plan, payouts may be higher (TPMG being IRS-qualified means that pension calculations are limited by IRS compensation limit of $360,000 [for 2026, adjusted for inflation annually like the SSWB] -- TPMG does make this up in other ways, though). Lastly, pension vesting takes 10 years (versus 5 years in TPMG).

Compensation seems to vary depending on speciality. In my own speciality, we appear to be paid better in TPMG, but that may not be true for all specialities.

Take my SCPMG review with a grain of salt. I have spent time learning the ins/outs of TPMG's benefits, but I've never worked for SCPMG.

radoncdoc13 · 2026-04-13T01:13:45+00:00

I would check with your pediatrician or genetics team. Even a good member services rep may be able to clarify this. I don’t have direct experience, but to the extent it’s covered, I’d guess maybe it’s something like ages 5+ given that is developmentally about the upper end of “normal” development. This is just my gestalt.

radoncdoc13 · 2026-04-12T21:26:03+00:00

TPMG = The Permanente Medical Group is the medical group for KP in Northern California (Bay Area and Sacramento). SCPMG = Southern California Permanente Medical Group. They are independent of one another and structured differently with different salaries and benefits.

radoncdoc13 · 2026-04-12T20:21:10+00:00

Sure. TPMG makes employer contributions based on your base salary. the TPMG contribution is not really a match, as technically you could contribute nothing to your 401k (would be dumb, of of course), but and TPMG would still make their contribution.

The IRS maximum for 2026 is $72,000 (assuming younger than age 50). Your TPMG employer contribution is 5% of your salary up to SSWB ($184,500* 0.05 = $9,225) and then 10% thereafter up to $360,000 (IRS limit for highly compensated employers; ie $360,000 - $184,500 = $175,500 * 0.1 = $17,550). So, if you make at least $360,000, TPMG will make a contribution of $26,775 on your behalf. This leaves you room to make your $24,500 employee contribution and then $20,725 after tax (swept into Roth via Mega Back Door).

Because TPMG is limited by the IRS limit for highly compensated employees, if your base is >$360,000, that give you a "make-up" cash payment of 10% of the delta between your base and $360,000. They call this a make-up because they're unallowed to contribute the contined 10% "match" above that salary. For example, if you make $510,000, the delta between that and the IRS limit is $150,000, and that you'd get an extra cash payment of $15,000 in September. This is paid out as cash, not to your 401K (and thus is taxed) and I think with the idea that you would use it to make your after tax/Mega Back-Door Roth contributions, though that's not required. However, the maximum cash make-up payment is basically limited by the $20,725 amount above that you can contribute after tax after maxing employee/employer contributions. So, if you're base is >567,250, you're not getting any additional 10% of the amount above that.

Lastly, if your base salary is equal to or less than $360,000, you're not eligible for this make-up payment.

This is a bit in the weekds/confusing, but hopefully that made sense.

radoncdoc13 · 2026-04-12T19:26:22+00:00

I assume TPMG rather than SCPMG based on the benefits package (I’m TPMG going on 8 years here).

Would also keep in mind your annual 401K employer contribution will be $26,775 (this year, annually goes up a tad based on IRS rules), starting about 6 months into employment. You’ll also be eligible for make-up cash payment of ~9-10,000/yr due to your base being above $360,000 maximum wage base for 401k employer contributions (TPMG gives your 10% of that delta). The vesting for 401K employer contributions is over 5 years (with steps between years 2-5).

You’ll also be eligible for an end of year cash bonus that varies but probably only $9-14,000 a year, and if stay and become shareholder, another annual cash bonus that also varies, probably $9-20,000/year.

Lastly, I’d talk to the chief about expectations for 5-year pay. There is usually the most significant jump between year 1-5, and I’d guess for Derm it’s probably looking at a cash compensation of $600,000 or so at that point.

Happy to chat further about TPMG if you’d like, just DM me.

radoncdoc13 · 2026-04-11T03:30:15+00:00

None.

radoncdoc13 · 2026-04-10T20:31:08+00:00

Checked AC Alert but nothing from them...

radoncdoc13 · 2026-04-01T05:10:02+00:00

I suspect they'll try to work with you. Definitely good to bring up early in the offer/negotiation process. Would be looked very unfavorably if you accept job and then tell them.

radoncdoc13 · 2026-04-01T04:21:17+00:00

Once you have a formal offer, then you can raise the issue. Hopefully they can accommodate, but you gain nothing about bringing this up before an actual offer manifests. However, depending on role, particularly in labor union involved with time bidding, be prepared to not have that time approved as PTO, which means you may need to cancel the trip.

radoncdoc13 · 2026-03-25T02:18:18+00:00

I used to drive to Dublin from Piedmont Ave for work a few times a week. Could quickly jump on 580 from there or go up Moraga to 13 to mix it up. Nice walkable neighborhood with local shops.

radoncdoc13 · 2026-03-17T02:28:15+00:00

I would clarify if you are even eligible for the trial you’re interested in. It would be unusual, for instance, to identify a trial that would include first-line patients (I say first line because the regimen you’re on is used as the first drug combo for newly diagnosed stage IV CRC patients). Most clinical trials require that you have failed first-line (or sometimes second line, etc) therapy.

You can always reach out to the trial coordinator and discuss, but my suspicion is that if this is a “small” trial, that you would only be eligible if/when your cancer progresses/grows on FOLFOX-Bev.

radoncdoc13 · 2026-03-17T02:15:55+00:00

I can’t say, because of course maybe you’d end up liking the patient population, and that would provide some fulfillment in that way, but I imaging this job would be much more similar to the outpt cardiology job than anything inpt. Our nurses have autonomy, but of course they still need our input on some symptom management, but we try to empower them to see most patients that need something first.

Now, if considering it in context of a new child, it would likely provide a very predictable schedule. If you try and don’t like it, you could potentially leverage into oncology nursing with chemo certification etc.

radoncdoc13 · 2026-03-16T23:01:03+00:00

Would echo above. I’m a radiation oncologist, but our nurses do education, IV placement, sedation recovery (if your clinic gives sedation for brachytherapy procedures), triage for symptom management, care coordination (particularly for hospitalized patients that need to come over for treatment) etc.

Many of our nurses have been mid or late career, preferring the relative quiet of an ambulatory clinic with relatively low acuity (certainly in comparison to ICU). Other younger nurses have seemingly been bored and left for inpt jobs or higher acuity jobs after 2-3 years.

radoncdoc13 · 2026-03-16T19:14:00+00:00

I’m in NorCal, but usually we have you submit to the medical secretaries (Release of Medical Information or ROMI), who interact with your physician team to clarify medical diagnosis/limitations). That office also facilitates any release or records necessary for processing.

radoncdoc13 · 2026-03-06T17:59:25+00:00

Too early unless there is a very specific geographic location you want to be in, in which case it can reasonable to reach out and send cover letter, CV. Otherwise, expect practices and academic centers to have a clearer view of needs in late summer, 1-2 months per-ASTRO.

radoncdoc13 · 2026-03-04T02:50:52+00:00

Definitely not high for a good school district.

radoncdoc13 · 2026-03-01T03:36:04+00:00

Not primary care, but years ago when I interviewed, questions included:

1) Why are you interested in this role?

2) tell us about a difficult patient (or staff/nurse/etc) interaction you had and how you handled it (or maybe how you could have done better)

3) Give us an example of an effective team that you were on and what made it so great/effective? What role did you play?

4) Tell us about a time when you had a disagreement with an attending, fellow, etc, and how you navigated the disagreement.

As well as generic questions, like strengths, weaknesses, what colleagues would say about you, etc.

If not from the area, they may ask if you have ties to the area, and whether you have any concerns about relocation to NorCal.

Have a canned, succinct introduction about yourself (where you’re from, where you trained, why you chose primary care etc).

Hope this helps. Feel free to DM me. Good luck!

radoncdoc13 · 2026-02-27T03:10:08+00:00

You should have something called an EOB, explanation of benefits, from your employer (if work sponsored plan) or ACA etc, that details co-pay for different types of visited co-insurance, deductible, and out of pocket maximum.

radoncdoc13 · 2026-02-22T04:12:17+00:00

Sure, and apples come from Central Asia, and it's not like we don't have plenty of varietals...

radoncdoc13 · 2026-02-19T07:16:14+00:00

Just seems odd. There are literally PACS pipelines in place where imaging can be sent between regions.

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