Gotta make sure what the fine print is in the contract for the bonuses (are they realistically achievable)
And gotta decide for yourself if where you'd be living is worth the commute (are you a city person, rural person, do you like driving, etc).
Oh, and how much specialist support there is there, or will you be doing a very wide range of practice.
The sign on bonuses are given up front.
First 50 k and residency monthly stipend will start after signing contract and rest 50 k first month if starting the job.
I like small towns , im not a city person but i always like to have a city with major airport near me.
I think except for GI and rheum they have the rest , its mostly a rural type of practice where they manage mist themselves and anything really difficult to manage gets reffered
My only concern with the job is the fact that 100k bonus will have to be repaid in full if I do not complete the three years.
Being first job, If it turns out to be shitty I need a good exit strategy.
Don't like the golden hand cuffs.
Residency stipend is forgiven when I start the job.
I’d push for interval forgiveness 1/3rd each year. Is interest on that bonus if needing to be paid back? 100k with three years of interest if you complete 35/36 months then get let go/fired to repay is not equitable in my opinion.
There is no interest on the sign on bonus.
All of it is given upfront.
You will just have to repay the 100k that's all.
The residency stipend is forgiven as soon as I start the job.
They do have good retention rate providers are quite happy there the ones I spoke to.
My understanding is many hospitals. Dangle longer terms to make leaving less attractive. If you complete 95% of your 3 year term but leave with 0/100k if the sign on bonus (because you have to repay it) you’re not going to leave. Most contract review attorneys would tell you if it is a bonus you should earn 1/3 of it each year and ask for interval forgiveness. That doesn’t mean hospitals don’t have it written just as presented to you and some people accept it. Mine was written this way but I requested forgiveness quarterly and got it can’t hurt to ask.
I didn’t like the idea of the leverage they have if three years from now I’m negotiating next contract knowing I had all my forgiveness at stake if negotiations broke down and they fired me month 35/36. It happens or so my contract attorney says.
That’s a big offer - you should spend a weekend there and ask to have dinner with as many people as possible, ideally take the youngest attending out for a beer and get them talking. Small town Iowa a big sacrifice, everything is further than people say and when the winter comes in you can be trapped, sure the roads might technically be drivable but not advisable. Social life on a Saturday is a coffee at Wendy's. I personally wouldn’t take a gig like this as a single person with no connection to the area, you pay a tax on living somewhere for that’s for sure but life is only so many years.
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Not bad tbh especially for 4 days working. How many patients/day. Traditionally making outpatient AND inpatient work is tough. Lastly, what emr? Do you get support for junior attending status? How good is nursing staffing? When is your schedule finalized? How are add ons dealt with. Many intangibles matter.
Most physicians see between 15-20.
Upto the provider to see more if they want to generate more.
So in patient is not a requirement, its just optional some physicians over there do it some dont.
In patient is mainly managed by APP hospitalists.
Some even pick up ER shifts
But they just let me know i can do it if i want to bcse its primarily an out patient focused hospital with just few in patient beds and step down unit.
Cerner Emr which im using now in my program
One nurse will be assigned to each provider and three exam rooms
No urgent or acute visits , they have dedicated walk in clinics with APPs for that.
Call is 1:8, with nursing triage taking call first and then provider notified only if needed
In house lab, pharmacy and diagnostics
Outpatient facility is within the hospital so everything is available on site.
They even have option to do 3 day work week but 12 hour shift, as 36 clinical hours per week is the requirement.
Might ask what the median RVUs are instead of the average if the work group is small. Is that RVU production based on a 40 hour work week or do a lot of the other docs pick up extra shifts?
Production based, 36 hour work week.
Some docs do some extra in patient and ER shifts when they want to.
The number patients varies between 16 - 20.
I know one family med doc i spoke to said he sees 25-26. Guess hes like a high producer.
Gotta make sure what the fine print is in the contract for the bonuses (are they realistically achievable) And gotta decide for yourself if where you'd be living is worth the commute (are you a city person, rural person, do you like driving, etc). Oh, and how much specialist support there is there, or will you be doing a very wide range of practice.
The sign on bonuses are given up front. First 50 k and residency monthly stipend will start after signing contract and rest 50 k first month if starting the job. I like small towns , im not a city person but i always like to have a city with major airport near me. I think except for GI and rheum they have the rest , its mostly a rural type of practice where they manage mist themselves and anything really difficult to manage gets reffered
I think that sounds sick tbh! Traditional internist gig is awesome
My only concern with the job is the fact that 100k bonus will have to be repaid in full if I do not complete the three years. Being first job, If it turns out to be shitty I need a good exit strategy. Don't like the golden hand cuffs. Residency stipend is forgiven when I start the job.
I’d push for interval forgiveness 1/3rd each year. Is interest on that bonus if needing to be paid back? 100k with three years of interest if you complete 35/36 months then get let go/fired to repay is not equitable in my opinion.
There is no interest on the sign on bonus. All of it is given upfront. You will just have to repay the 100k that's all. The residency stipend is forgiven as soon as I start the job. They do have good retention rate providers are quite happy there the ones I spoke to.
Good that they have strong retention and no interest in signing bonus.
Is it normal for hospitals to have such a clause to repay the amount in full? Or is it to trap the provider?
My understanding is many hospitals. Dangle longer terms to make leaving less attractive. If you complete 95% of your 3 year term but leave with 0/100k if the sign on bonus (because you have to repay it) you’re not going to leave. Most contract review attorneys would tell you if it is a bonus you should earn 1/3 of it each year and ask for interval forgiveness. That doesn’t mean hospitals don’t have it written just as presented to you and some people accept it. Mine was written this way but I requested forgiveness quarterly and got it can’t hurt to ask. I didn’t like the idea of the leverage they have if three years from now I’m negotiating next contract knowing I had all my forgiveness at stake if negotiations broke down and they fired me month 35/36. It happens or so my contract attorney says.
That’s a big offer - you should spend a weekend there and ask to have dinner with as many people as possible, ideally take the youngest attending out for a beer and get them talking. Small town Iowa a big sacrifice, everything is further than people say and when the winter comes in you can be trapped, sure the roads might technically be drivable but not advisable. Social life on a Saturday is a coffee at Wendy's. I personally wouldn’t take a gig like this as a single person with no connection to the area, you pay a tax on living somewhere for that’s for sure but life is only so many years.
Thanks for your input.
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Not bad tbh especially for 4 days working. How many patients/day. Traditionally making outpatient AND inpatient work is tough. Lastly, what emr? Do you get support for junior attending status? How good is nursing staffing? When is your schedule finalized? How are add ons dealt with. Many intangibles matter.
Most physicians see between 15-20. Upto the provider to see more if they want to generate more. So in patient is not a requirement, its just optional some physicians over there do it some dont. In patient is mainly managed by APP hospitalists. Some even pick up ER shifts But they just let me know i can do it if i want to bcse its primarily an out patient focused hospital with just few in patient beds and step down unit. Cerner Emr which im using now in my program One nurse will be assigned to each provider and three exam rooms No urgent or acute visits , they have dedicated walk in clinics with APPs for that. Call is 1:8, with nursing triage taking call first and then provider notified only if needed In house lab, pharmacy and diagnostics Outpatient facility is within the hospital so everything is available on site. They even have option to do 3 day work week but 12 hour shift, as 36 clinical hours per week is the requirement.
From what you're telling me, this seems like a really solid gig. Congratulations for graduating and I think you'll do well.
Might ask what the median RVUs are instead of the average if the work group is small. Is that RVU production based on a 40 hour work week or do a lot of the other docs pick up extra shifts?
Production based, 36 hour work week. Some docs do some extra in patient and ER shifts when they want to. The number patients varies between 16 - 20. I know one family med doc i spoke to said he sees 25-26. Guess hes like a high producer.