Family Med - salaries, sign-ons, loan payoffs, bonuses, etc

[Silent Cool]

@cabinbuilder ,

When you say vacation ownership, are you talking about something like Marriott or another hotel chain/company that gives you large discounts around the world in return for the miles you have accrued?

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[cabinbuilder]

@cabinbuilder ,

When you say vacation ownership, are you talking about something like Marriott or another hotel chain/company that gives you large discounts around the world in return for the miles you have accrued?

NO, diamondresorts.com it works like property and I can will it to my kids when I'm gone. It's not a hotel chain. I have all of the hotel point cards too that accrue when I'm on a locum job. I also pay all my bills on my alaska airlines visa card so get miles with them and make sure I am flown on that airline or one of their partners for my jobs. I don't generally have to pay to fly anymore or stay anywhere. I have approx 5 months time with my vacation ownership.

 

[altap]

I know someone who is making less than 400k, sign on bonus of less than 200k and loan repayment of 200k. Hospital employed

 

[Dharma]

I know someone who is making less than 400k, sign on bonus of less than 200k and loan repayment of 200k. Hospital employed

Do explain more. I'm assuming they make less than 400k and signed on for less than 200k. How much less? Numbers approaching 400k are extremely rare in FM. Sign on bonuses pushing a median yearly earnings also rare. Being a hospital system's biatch... Not so rare these days though.

 

[altap]

Midwest, hospital employed
This physician loves to work

 

[shivasHeroLike]

i'm a new resident grad in a north east area.. in a very expensive county.
typical offers have been 180-190k with 10-15k sign-on for the first 2 yrs then switch to RVU model.
theres bonuses along the way for meeting metric/meaningful use requirements.
this is for typical outpatient family medicine; no inpatient; no urgent care; 8-5pm and no weekends.

i considered urgent care opportunities at one time bc their compensations were higher at 200-210. but you work more hours (10+) and are required to do atleast one or two saturdays a month. working that many hrs and not having free weekends felt like residency to me so i shy'd away from it.

 

[Dharma]

i'm a new resident grad in a north east area.. in a very expensive county.
typical offers have been 180-190k with 10-15k sign-on for the first 2 yrs then switch to RVU model.
theres bonuses along the way for meeting metric/meaningful use requirements.
this is for typical outpatient family medicine; no inpatient; no urgent care; 8-5pm and no weekends.

i considered urgent care opportunities at one time bc their compensations were higher at 200-210. but you work more hours (10+) and are required to do atleast one or two saturdays a month. working that many hrs and not having free weekends felt like residency to me so i shy'd away from it.

How difficult is it to hit 200k on RVU following those first few years?

 

[VA Hopeful Dr]

How difficult is it to hit 200k on RVU following those first few years?

Depends on your wRVU rate. National median in 2013 was $40 for outpatient FP with no OB. That would work out to 5000 wRVUs per year. If we assume a roughly even mix of level 3 and level 4 visits, that's 1.25 wRVUs per patient encounter or 4000 patient encounters per year. Assuming 20 patient visits per day, that's 200 working days. Divide by 5 days/week, that has you working only 40 weeks/year (that's 3 months off).

Take home: if you get a decent wRVU rate and code well, breaking 200k isn't all that hard to do.

 

[Dharma]

Depends on your wRVU rate. National median in 2013 was $40 for outpatient FP with no OB. That would work out to 5000 wRVUs per year. If we assume a roughly even mix of level 3 and level 4 visits, that's 1.25 wRVUs per patient encounter or 4000 patient encounters per year. Assuming 20 patient visits per day, that's 200 working days. Divide by 5 days/week, that has you working only 40 weeks/year (that's 3 months off).

Take home: if you get a decent wRVU rate and code well, breaking 200k isn't all that hard to do.

Cool. Thanks for the reply VA! At the risk of sounding like a complete idiot, what are level 3 and level 4 visits? Are RVU rates determined by insurance/medicaid/medicare? (I obviously have a lot of homework to do in this sector).

EDIT: for rookies like me, here's a link regarding coding and the type of visits: http://www.aafp.org/fpm/2007/0100/p21.html

 

[VA Hopeful Dr]

Cool. Thanks for the reply VA! At the risk of sounding like a complete idiot, what are level 3 and level 4 visits? Are RVU rates determined by insurance/medicaid/medicare? (I obviously have a lot of homework to do in this sector).

EDIT: for rookies like me, here's a link regarding coding and the type of visits: http://www.aafp.org/fpm/2007/0100/p21.html

To make it even easier (these all apply to established patients, new patients are a little bit trickier):
Level 2 visits (worth about 0.6 wRVU) - Single organ system, recommend OTC meds. This should be a pretty rare code - I mainly use it for simple skin things that OTC meds can fix, like limited poison ivy, bug bites, or single tinea outbreak.
Level 3 (worth 1 wRVU) - Single problem visit - colds, UTIs, ear infections, or single well-controlled chronic disease management. If you Rx anything from a level 2 visit, it becomes level 3
Level 4 (worth 1.5 wRVU) - Worsening chronic disease, multiple stable chronic diseases, complicated acute stuff (pneumonia, kidney stone, pyelo, stuff like that), or new problem with rx management - initial diagnosis of eczema, breast lump, weight loss with workup.

 

[Dharma]

Thanks for the at breakdown @VA Hopeful Dr !!!

 

[MedicineMan99]

I just want to add my $0.02:

Don't forget about the (often lost) opportunity to negotiate a salary and benefits. Most doctors do not do this although they should. And, I'm not talking about paying a lawyer to "review" your contract. I'm talking about telling the employer what they need to do for you for you to sign the contract. Sure, some large corporate healthcare companies will not budge, but it's worth a try. On multiple occasions, I've gotten paid more money just by saying, "You need to pay me $X more to compete with my other offer". Even if you don't ask for more money, you can always ask for your benefits to be 100% paid by them, better bonuses, more paid time off, etc.

 

[Dharma]

I just want to add my $0.02:

Don't forget about the (often lost) opportunity to negotiate a salary and benefits. Most doctors do not do this although they should. And, I'm not talking about paying a lawyer to "review" your contract. I'm talking about telling the employer what they need to do for you for you to sign the contract. Sure, some large corporate healthcare companies will not budge, but it's worth a try. On multiple occasions, I've gotten paid more money just by saying, "You need to pay me $X more to compete with my other offer". Even if you don't ask for more money, you can always ask for your benefits to be 100% paid by them, better bonuses, more paid time off, etc.

Is it pretty much standard to have a lawyer review contracts? Worth it or possibly to ride solo without taking much of a hit?

 

[MedicineMan99]

Is it pretty much standard to have a lawyer review contracts? Worth it or possibly to ride solo without taking much of a hit?

I'm not an attorney. But I have more experience with contracts, negotiations, and lawyers (for business reasons) than I care to admit.

You should always have an attorney review your contract. But, that's really just to explain to you exactly what the contract says. It's your job to actually negotiate the contract for more money. Now, in some cases attorneys will offer to do this for you- but since they charge anywhere from $250-$500/hour and the process usually takes several weeks, it's not going to save you any money. Also, the employer much prefers to deal directly with you than with your attorney. And it looks better for you.

But keep in mind it is your responsibility to read and understand every word in your contract. Contracts are not just for lawyers to understand. You really need to understand every work to which you are signing. Your lawyer is there to help you with this, but at the end you are ultimately responsible.

 

[SuckySurgeon7]

One interesting case I read about (can't find the link, unfortunately) was a surgeon operating during a case that went south pretty quickly when the CRNA messed up. Despite not being trained in anesthesiology, the surgeon shared a significant portion of the penalty burden because... wait for it... according to the hospital contract, when there is no anesthesiologist in the hospital, the supervising physician is automatically assumed to be the surgeon. This was news to the surgeon, who obviously didn't read/consider that section of the contract. I think his malpractice was out around 600,000. LPT: know your contract.

 

[DrDogMan]

What do you think of my 3 offers?
1) Hospitalist position
- Standard 7 on 7 off format
- Base pay 200k with incentives to bring salary to about 220-230 yearly
- 20k sign on and 30k loan repayment

2) Outpatient only practice for a large health system
- 5 days a week, telephone call only Q3 weekends
- Base pay 180k but must meet this in wRVUs ($40 per rvu)
- I get to keep anything over this, plus theres a quality bonus (up to 50k per year)
- 10k sign on

3) Traditional private practice - inpt + outpt
- Base pay 175k, partner opportunity after 3 yars
- 10k sign on
- Incentive pay yearly to be very significant to put yearly salary at about 280-300
- Round daily then office, weekends are Q5

 

[VA Hopeful Dr]

All 3 sound reasonable, just a matter of which job type you want.

 

[Biology101]

What is the average salary/benefits package for FM outpatient with OB (Midwest)?

How about OB Fellowship trained doctors?

 

[Tidewater]

.

 

[Malcolm X]

my family thinks that the pay for FM isn't lucrative enough to raise a family in the NYC area on 1 income + pay off loans.
But it's what I want to pursue.

Can any FM docs in the Northeast, Cali or NYC comment on compensation in those areas?

from salary.com, it says that compensation is ~190-200k.

is that false?