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avg collections first year out of fellowship?? pain salaries?
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Bonus is 10% of what?
First year collections will be all over the board. Depends on how busy you are and how quickly you bill, and what percent of bills you actually collect on. Even if you are busy there will be a significant lag the first year.
And if it is a good location with a good payer mix what is the competition like?
How long is the wait time for the current doc?
Wait time at competitors?
How will new consults be distributed?
What is the referral base?
Will you be managing narcotics? Does your partner? Do your competitors?
Are there strong hospital networks in the area? Do hospitals control the PCPs? Spine Surgeons?
First year collections will be all over the board. Depends on how busy you are and how quickly you bill, and what percent of bills you actually collect on. Even if you are busy there will be a significant lag the first year.
And if it is a good location with a good payer mix what is the competition like?
How long is the wait time for the current doc?
Wait time at competitors?
How will new consults be distributed?
What is the referral base?
Will you be managing narcotics? Does your partner? Do your competitors?
Are there strong hospital networks in the area? Do hospitals control the PCPs? Spine Surgeons?
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If the owner is so sure that you'll make a huge bonus, he could raise the base above 200k.
You're taking all the risk. I wouldn't consider a job without at least a 230K salary at a bare minimum.
To be offered less than 200K salary speaks bad things about the practice owner and how much values you.
Both offers are substandard. 250K base and only 10% bonus? That should be at least 25%
You're taking all the risk. I wouldn't consider a job without at least a 230K salary at a bare minimum.
To be offered less than 200K salary speaks bad things about the practice owner and how much values you.
Both offers are substandard. 250K base and only 10% bonus? That should be at least 25%
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Go with the first offer.
But, for year one: Take the LOWEST salary guarantee possible and aim for THE HIGHEST bonus incentive possible **AND** put in the contract a "re-opener" for financials only prior to the start of year two. In short: SHOW UP! Really bang it out for a year and see where the money lands. From there, you can recalibrate your guarantee and bonus in year two and beyond.
This is unconventional advice, but I'll tell you why it's good advice. Your first year in practice is a cluster-f*ck no matter what you do--not just for you but for your employer (getting credentialed, paneled, building your rep, etc). No one collects as much as they think they will and it is generally your worst year (financially) in your career. But, from where you're sitting now, even by taking the LOWEST salary guarantee possible you're still getting a big "raise" compared to your fellowship salary.
By setting up the contract THIS way (low sunk costs on year one and a re-opener on year two for financials only) you are basically practicing negotiations Aikido. At the end of one year, you'll have the upper hand because you'll have an established track records, hard numbers, and the data to support a juicer package. In this scenario, you won't be "applying for a job," they will be wanting to make you "an offer you can't refuse" because they'll know you, know your work habits, and objectively see the fruits of your labor. Then, do it again! Negotiate new one-year financials and a re-opener...
Unless your future employer is a complete d-bag or you're a complete loser it is HIGHLY unlikely that either of you will quit each in the first year. There's just too much going on to make that call.
Give away the razor and make them buy the blades at a premium.
But, for year one: Take the LOWEST salary guarantee possible and aim for THE HIGHEST bonus incentive possible **AND** put in the contract a "re-opener" for financials only prior to the start of year two. In short: SHOW UP! Really bang it out for a year and see where the money lands. From there, you can recalibrate your guarantee and bonus in year two and beyond.
This is unconventional advice, but I'll tell you why it's good advice. Your first year in practice is a cluster-f*ck no matter what you do--not just for you but for your employer (getting credentialed, paneled, building your rep, etc). No one collects as much as they think they will and it is generally your worst year (financially) in your career. But, from where you're sitting now, even by taking the LOWEST salary guarantee possible you're still getting a big "raise" compared to your fellowship salary.
By setting up the contract THIS way (low sunk costs on year one and a re-opener on year two for financials only) you are basically practicing negotiations Aikido. At the end of one year, you'll have the upper hand because you'll have an established track records, hard numbers, and the data to support a juicer package. In this scenario, you won't be "applying for a job," they will be wanting to make you "an offer you can't refuse" because they'll know you, know your work habits, and objectively see the fruits of your labor. Then, do it again! Negotiate new one-year financials and a re-opener...
Unless your future employer is a complete d-bag or you're a complete loser it is HIGHLY unlikely that either of you will quit each in the first year. There's just too much going on to make that call.
Give away the razor and make them buy the blades at a premium.
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OK, so I actually have the opposite advice (ask for the highest starting salary and lowest in the "incentive" bonus).
Here is why:
1) You don't know how aggressive the business will be about going after collections i.e. after denials. The other issue with collections, is that unless you are physically seeing the checks, you don't know if collections reported to you by your employer is truthful or if there is a percentage being non-reported.
2) You don't know how much they will charge you overhead... are you being charged a ton to rent a fluoroscopy unit that is very old but has already been paid off? How much of the employee compensation is going to be charged to you... afterall it's "more work" to support someone starting off (I can give more examples of being screwed by overhead but I'll stop for now)
3) You don't know if you'll love being there in the first place... coworkers, environment, etc, so if you want to leave, at least you've maximized your income from the start.
4) You should be busting your butt no matter where you go or what you do and trying to make yourself invaluable so I don't see how that is a factor in receiving a lower starting salary.
Here is why:
1) You don't know how aggressive the business will be about going after collections i.e. after denials. The other issue with collections, is that unless you are physically seeing the checks, you don't know if collections reported to you by your employer is truthful or if there is a percentage being non-reported.
2) You don't know how much they will charge you overhead... are you being charged a ton to rent a fluoroscopy unit that is very old but has already been paid off? How much of the employee compensation is going to be charged to you... afterall it's "more work" to support someone starting off (I can give more examples of being screwed by overhead but I'll stop for now)
3) You don't know if you'll love being there in the first place... coworkers, environment, etc, so if you want to leave, at least you've maximized your income from the start.
4) You should be busting your butt no matter where you go or what you do and trying to make yourself invaluable so I don't see how that is a factor in receiving a lower starting salary.
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Yikes!! Those are low numbers, unless those jobs are in California (or in a major metropolitan area located in the Northeast), you may want to keep searching. Starting pay in the Midwest and South is substantially higher. But, if you absolutely have to stay in California or the supersaturated Northeast due to family, your hands are tied and you have to take what you can get.
First year collections are highly variable, depending on payor mix, proportion of in network vs out of network, site of service for procedures (office based vs ASC vs hopd), volume of procedures, types of procedures performed, presence of ancillary revenue streams such as urine drug testing, denial rates, delays in credentialing, etc. First year collections are highly unpredictable.
$500,000 is a reasonable ballpark figure, but I can tell you from personal experience that first year professional fee collections in the neighborhood of $2 million are possible in the appropriate setting (and I'm not talking about a block shop or a pill mill, but rather a hospital based practice).
Choose wisely!
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Agree with maximizing your base salary. These sound like northeast numbers to me. I feel your pain. Most people don't stay at their first job. The problem with medicine is that there are no lateral moves as there is in law. When you leave and go somewhere else you start at the bottom. Since you have no idea what this situation is gonna be like you can't bank on anything especially if they are trying to make a new office work. It's new you will be new..that's a losing proposition for the first few years unless you have an extraordinary marketing team as it is quite difficult to change referral patterns from pcps initially.
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My collections weren't anything near $2 million my first year of practice...and that was over 10 years ago when office-based SCS, kypho, etc were better reimbursed. Things will be harder now...unless you're getting a cut of the HOPD payment which I don't think is legal...
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I was shocked, too, when I saw the number, but I didn't make this up: $1,800,000 in professional fee collections the first year. I just got the annual report.
Of course, I only got a small fraction of that in compensation, since I'm a hospital employee...where the remainder went, God only knows. Probably funding some executive's salary or helping pay for a new building somewhere. The crazy thing is that I have no idea what the revenue from facility fees was. Probably 3 times that number...
It's safe to say that practicing medicine in the South and Midwest is a VERY different ballgame compared to the northeast and California. I'll never understand why physicians practice in either region unless they absolutely have to do so because of family obligations. The pay differential is enormous.
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i do find that hard to believe. 1.8 million in professional HOPD fees would be, um, 8 TF per hour, 8 hours a day, 261 days per year, at Medicare rates of $116/TF.
obviously do-able, but unless one is stepping into a pre-existing practice that is fully staffed, it seems kind of high.
i read somewhere to expect it to take 2 years to get up to full bore, and $500K total for the first year, then increasing thereafter, seemed more typical.
obviously do-able, but unless one is stepping into a pre-existing practice that is fully staffed, it seems kind of high.
i read somewhere to expect it to take 2 years to get up to full bore, and $500K total for the first year, then increasing thereafter, seemed more typical.
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Evidently it's feasible with built in referral base, low Medicare population, almost no Medicaid, significant proportion of out of network consults/procedures, and relatively high volume of big ticket item procedures (multilevel kypho, SCS, etc). The truly crazy thing is that I'm not even at 100% capacity. I guess it's a reflection of the out of network fees maybe? Who knows...but the hospital definitely collected $1.8 million in pro fees from my clinical productivity last fiscal year. I can't imagine they would lie about that, right?
Our healthcare system is such a massive clusterf^*k. Huge discrepancies in how individuals, groups, and institutions are reimbursed with no logical reason for the variability.
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how busy are you? are you doing 5 TF/hour, 5 99214 or 3 99204/hour, 2 RFAs/hour, working 8 hours a day, assuming your local carriers are billing 2x Medicare rates? if so, then you are definitely collecting 1.8 million on professional fees.
Double the work if you have large percentage pure medicare reimbursement. (subtract 20%+ if you have a high medicaid population).
if not, those out of network fees may be contributing....
Double the work if you have large percentage pure medicare reimbursement. (subtract 20%+ if you have a high medicaid population).
if not, those out of network fees may be contributing....
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Honestly it's academic at this point. Its not like I benefit directly from the crazy high billing at my job. I'm employed. If they collect $1.8 mil in pro fees I get my salary. If they collect $500k, I get my salary. I get bored easily so I definitely prefer to work hard, but going the extra mile doesn't translate into a substantially larger paycheck for me.
I just brought up the collections to illustrate the tremendous variability in collections, since the OP was asking specifically about this. No other reason.
that 1.8m number is both the facility fees and the professional fees. im guessing that they dont "open the books" and let you look at what you are collecting in facility fees. they roll these 2 numbers together, but im not sure exactly why. i think that a lot of times, docs give too much credit to the administrators doling out the salaries. i really dont think hey know where are themoney is going, and dont pay as much attention to them as we might think.
if you are actually collecting 1.8m in professional fees, you should be making 1 mil. AT LEAST.
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Should be about $1000 net/procedure for hospital.
there is no way you are collecting 1.8 million in professional fees. and you don't even have a full schedule. that is BS. it is impossible. you are being told wrong info
how can that be when a HOPD gets about 600 for an ESI?
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They are more likely confused than lying. Ask them to provide both the pro fees and the facility fees and they will say, Huh?
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1000/net is an average of all: ESI, RFA, Vertebroplasty, SCS trials, etc.
For example RFA of paravertebral nerve is ~$1500 for a SINGLE level (https://www.asipp.org/documents/2016ProposedHOPD.pdf)
Cheers
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This is medicare rate also, so commercial should be significantly higher for HOPD
I think 1.8 million is probably combined fees as well,
but who knows maybe the negotiated rates are excellent
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I specifically asked about the facility fees vs pro fees, because I had figured it was a combination of the two. However, I was told that the number consisted of pro fees only. Crazy, right?
I WISH were making a million. Nowhere near that number.
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So just think how much the Hospital is making off you
i suppose it is possible if you live in a very rural area, and your hospital is the only game in town. just seems very, VERY unlikely.
overhead should be about 50%. so, if you collect 1.8, you should be making 900k. if your professional fees are 1.8, your combined pro and facility fees may be close to 3 or 4 million. doesnt that seem a bit off? say you are taking home 400k. that means that the hospital is making 1.5 mil after overhead? i want to be your boss....
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Etherbunny, it has to be combined facility and professional fees. If it truly is only professional fees then I would do some serious renegotiating. I would negotiate for 50% of your professional fees or walk. From my understanding most hospitals let docs keep a large % (much greater than 50%) of their professional fees and then also take all of the facility fees. Based on your information I would negotiate 900k or tell them to screw someone else. You should at least be in the 7-800k range take home. Good luck
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the other possibility is that your HOPD may be billing under Global fees as an office based clinic, instead of HOPD. Highly unlikely, but it can happen, and could explain the $1.8 million.
SSDoc makes a good point. most commonly, facility fees are 4 times the professional fees for HOPD. so your $150 epidural garners $450 for hospital, and total $600 to insurance...
SSDoc makes a good point. most commonly, facility fees are 4 times the professional fees for HOPD. so your $150 epidural garners $450 for hospital, and total $600 to insurance...
at which point we are supposed to collect? I heard different version such as once you collect your base + overhead, then start collect; double your base, then start collect; or triple your base, then start collect 40%.....
Do not consider a job that offers you productivity over 3x your base. Although I'm sure at least one of the moderators on here would disagree because they are in that setup. It's pure theft. The practice that offers you that will argue that it's because of them that your belly is full which is only true for the first year maybe two but then it no longer becomes as true. They also factor in their overhead into that scenario. This model most likely mainly applies to large surgical corporate entities with lots of ancillaries and massive overheads to pay for. Most beginning pp non Rvu based employment productivity is 40% or so over twice your base. There are other factors at play including geographic locale and more importantly site of service for procedures.
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Meh. Wonder who you're talking about
. I'm around 2.5x base, then a fairly generous and easily obtainable bonus structure. Year 2 and I'll be around 4.5x base in collections. No chronic narcs, one night of phone call/month, never ending supply of normal working patients who get better w appropriate treatment, as much or little academics as desired with strong support..... sounds horrible right?Sent from my iPhone using SDN mobile app
No sounds like roses except for the idea of walking into work knowing that the surgeons and all support staff have branded you as subhuman or "just a pain management doctor." Even though the non surgeons are the foundation of your practice. Everyone has a title there to narcissize themselves and people with no advanced degree tell you what to do constantly. The finances are only achieved there because of the good contracts you have, created by size, and they let you know it by building the bonus structure that way. In fact the stench of "you are replaceable" and "you should be greatful to work here" pervades. The practice is set up for successs in certain geographic locales and failure in others. Academics is essentially forced on you if you ever want a chance at becoming a "shareholder" whatever that means there. To each his/her own I suppose...
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Is this a hospital-employed gig?
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Lol different strokes I guess..... I've been been very happy over my 2 years though no job is perfect in every way of course. Will just have to agree to disagree on much of what you said as I'm not going to go further into specifics on here. .
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I suspect that some of those with the biggest complaints about how horrible life is as a hospital/system employed physician are those who are just envious...
Haha..umm no
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Or, could have seen how some physicians have been summarily dispositioned out of their jobs by crooked administrators, kangaroo hearings, and plain old dirty politics.
Glad it's working out for you. Give it a couple more years though..the realization that they reward docs with a weaker skill set by allowing them an all office set up while you do your rfa stim cervical procedures in a facility and not give you the chance to buy in may weigh on you. Or it may not..good luck
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You do sound rather bitter, I was a pain Doctor in an Orthopaedic Group in the past and my experience was very positive. I was made a partner in 18 months ( ASC/practice buy in) and I was treated with respect by my partners. If not for wife not wanting to live in the Midwest winter I would have probably stayed. As an adult physician it is your choice if you allow yourself to be treated as a less than equal.
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AXM works in a large Ortho group, and I think her practice is going great.
Maybe..but maybe if you went through what I did you would feel similar..or maybe not I don't know. The compensation model is not the only issue I had but that is beyond what was intended here. I wasn't making a comment on ALL ortho practices. The original commentary was in response to the question regarding a bonus structure that is 3x base which I would think a lot of us would agree is not fair. Unless of course you are all office based and permitted to perform all your procedures in the office which I was not allowed to do. Different strokes for different folks is all.
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To the poster who suggested $1.8M was pro fees, I suggest you take another look. I feel virtually certain those are CHARGES
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