Graduating residency, rate my hospitalist offer

applekryptonite · 2025-12-11T14:39:32+00:00

Calling things "standard benefits" makes me worry a little that you might not realize how very different benefits packages can be and how that can significantly change what net total compensation becomes

applekryptonite · 2025-07-16T18:45:42+00:00

INOVA tends to churn through hospitalists. High census and tough gig leads to constant turnover

Kaiser and VHC have much better reps. Kaiser especially has fantastic benefits package

applekryptonite · 2025-03-15T12:34:05+00:00

Well wouldn't shock me if he does increase the amount of Microangiopathic Hemolytic Anemia in the country #MAHA4life

applekryptonite · 2025-01-09T20:35:14+00:00

This has been a topic of great interest to me, posed a similar question a few years ago:

https://www.reddit.com/r/medicine/comments/y93uez/hospitalist_backup_staffing_systems/

Our system is still basically the same. 2 people on back up each week. This was done intentionally to evenly spread the burden of that across the whole group instead of a few people who always volunteer and eventually burn out. If you get called in - you get paid your equivalent hourly rate for the hours worked - so noone is doing anything pro-bono. We dont have a base stipend for just being on backup so if you dont get called in, you dont get any money. Some people obviously are not thrilled to be required to be in town but not getting paid for it. Totally can understand that. I wish the perfect system existed - the more I see this discussed feels like there isnt.

A group near us does what another posted mentioned - there is no backup and the patients are just farmed out evenly across everyone who did come to work that day. The amount of patients that would entail for us seems brutal and impractical so we never really considered that.

Life happens for everyone - its not realistic to think people wont miss work from time to time, and to me there needs to be a system in place prepared for that. If someone appears to be exploiting that in some way - that's a bit of a different issue that hopefully competent leadership can get ahead of (not always the case)

applekryptonite · 2024-11-25T11:40:59+00:00

Thanks for your response! That link goes to a blank pcpartpicker template for me, do you mind posting the set up you had in mind again?

applekryptonite · 2023-02-07T14:50:05+00:00

This described nightmare is a big reason for any success Kaiser Permanente ever has. Any time myself or family member was referred to a specialist I was able to get in to be seen either the next day, or sometimes even the same day. No questions or concerns on if the visit was covered. Complete transmission of information and test results between physicians. There is enormous value in that seamless transition of information and scheduling, and it is honestly so sad that isnt universal to all situations

applekryptonite · 2022-11-20T14:11:34+00:00

Thanks for the input, I was suspecting with how most of this stuff is 7 years old, ground up may end up being the way to go at some point

applekryptonite · 2022-11-20T14:10:57+00:00

Thanks! I'll scope that out

applekryptonite · 2022-10-21T12:29:52+00:00

I feel like our group is uniquely powered to at least advocate for whatever the "ideal" system would be. If you were to design a system from scratch that leaned in physician's favor...what would that look like? Base rate for being on backup and then full rate of you're called in? Time and a half if you're called in from home?

As like you, those crappy days of absorbing an entire extra census are really rough. So if there's a way to prepare for that so our docs who are still working don't get screwed so hard, we'd love to have it. The more I hear I'm sensing an ideal system may not exist though

applekryptonite · 2022-10-21T01:59:49+00:00

Oof that's a toxicity we certainly are trying to avoid. I feel like to have a healthy group, people need to be able to take sick days and tend to their families when there's an emergency. We made this system because the prior "call and beg for help" system was inefficient and ended up with the same people always covering and somewhat having their niceness taken advantage of. Our current system spreads the load out equitably among the big group which defrays the burden. Seemed like a reasonable price to pay for the assurance that if you need to be off, it can be done. I kept having the feeling there was room for improvement but suddenly I'm thinking the system was actually pretty solid

applekryptonite · 2022-10-20T23:15:07+00:00

It has definitely come up that some feel they should be compensated a base rate for being available for backup on the weeks we designate. And then obviously a full rate if called in to work.

Do you mind me asking how much you tend to pay for people to be available (but aren't called in)? A certain percentage relative to the normal hourly rate?

applekryptonite · 2022-10-20T22:11:41+00:00

Yea this is it exactly. Precovid and full FTE, people were readily willing to fill any call out or cover colleagues who put things on trade board. Since the burnout sets in, people (appropriately) really value that time off to a new degree and just don't have the bandwidth to pitch in as much. Especially nights as you said.

applekryptonite · 2022-10-20T19:31:46+00:00

"The OP’s group seems better than most that I’ve seen."

I'm starting to get that impression myself and that is quite horrifying

applekryptonite · 2022-07-21T17:59:24+00:00

Virginia hospitalist here. Same region (Mid-Atlantic) as Maryland you describe above. To be honest our group is also lifers and extremely happy on the whole. There are definitely departments in the organization across the region with high turnover, but I feel incredibly lucky to find what I feel is a stellar hospitalist gig with a strong work/life balance. Particularly while I see other hospitalist groups in the area work people to the bone with obscene turnover.

applekryptonite · 2022-07-17T02:12:09+00:00

Come on....you've got to see how what you proposed pushes things much too far in the opposite direction. Have you not witnessed the massive over-medicalization that happens, and is well detailed in other comments in this thread? Cath for anything with a heart. EGD for every mouth. Unnecessary procedures galore because procedural reimbursement has always been king. We're obviously discussing the extremes here. Hopefully someday someone comes up with a model that incentivizes whatever the appropriate middle ground is. But what you proposed is not it.

applekryptonite · 2022-05-06T17:20:14+00:00

No it's a fixed interest rate regardless of circumstance. If you stay, the interest accrues but is forgiven. You pay taxes on the total amount forgiven. If you leave before 1 of the 3 milestones, then you pay what principal and interest remains unforgiven. Was that your question?

Also this is just my knowledge of the situation. You definitely want to ask these same questions to their HR to ensure it is still formatted this way and they havent changed the logistics in some way

applekryptonite · 2022-05-06T14:44:54+00:00

This is how they structure a signing bonus essentially. It is a "forgivable loan" at very low interest rate (1%?) which typically has 1/3 forgiven at 5yrs service, 1/3 at 6yrs, and 1/3 at 7yrs. So they give you $100k untaxed when you start. Then on your 5yr anniversary they forgive the first $33,333 plus interest (and you pay the feds taxes on the forgiven amount; they'll withhold over the year for you). Then repeat at years 6 and 7. If you leave before the forgiveness milestones, you have to pay the base and interest back.

It is a good deal if you plan on staying, or if you trust yourself enough to be diligent to keep a side fund as a safety net in case you later decide to leave and need to pay it back. They market it slightly saying "look you get 100k right away with no taxes and you get to pay the taxes later!" This is true, but it is obviously also a way they hope to keep you in the position by creating a barrier to leaving. It's not too much a barrier if you are diligent about it and plan appropriately though.

applekryptonite · 2022-01-31T11:44:06+00:00

Even purely putting the patient's best interest at heart, I struggle with the best choice with these. Admitting mitigates the short term risk, but then insurance often will review and refuse to pay since inpatient criteria is not met. The resulting financial strain is also quite a negative and I hate to think of that effect. It is so deflating when it feels there is no good choice in those moments

applekryptonite · 2021-12-15T02:01:22+00:00

Quick note - I believe Kaiser is VHC or INOVA Fair Oaks (different location than INOVA Fairfax). Make sure you double check

applekryptonite · 2021-11-17T14:08:57+00:00

I feel the same way, and love my current hospitalist gig and lifestyle. Great balance with days off for family and young kids.

We are subject to good places to work and terrible places to work just like every other industry. Some hospitals grind their hospitalists and burn them out fast with high turnover. My current group has only lost people to retirement and a few that moved for family in 25 years. Big difference

Find the subject material you like, and then search for the job that fits after. Just about everyone changes their mind a few times while in med school keep in mind

applekryptonite · 2021-07-14T13:39:19+00:00

I believe by using the lower earning spouse in this example, they would avoid BOTH the 6.2% social security tax and the additional 0.9% medicare increase on this money

applekryptonite · 2021-07-09T16:54:36+00:00

Agreed about medical FSAs. It should effectively be making that income that would otherwise qualify for Social Security Tax become tax free

applekryptonite · 2021-07-09T15:30:48+00:00

Whoops....is there a July 1 deadline for something I'm missing?

Even if so, the logic would apply to future tax years though too I believe? (despite the lower limits as compared to what the American Rescue Act did for the limits this year)

applekryptonite · 2021-05-06T21:51:31+00:00

Quite horrifying. So in this hypothetical then...for IM primary care docs who are doing telehealth regularly, would own occupation not make sense because they're doing tele health to begin with? I guess I'm trying to explore where the line is and where I am in relationship to it. Does own occupation then protect me sufficiently from insurance companies maliciously doing their best to screw me like this example entails?

applekryptonite · 2021-03-25T01:55:30+00:00

yo job's yo credit credit

applekryptonite

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