First job? Location vs big money vs longterm prospects

[W222]

I am looking at several jobs throughout the country and I need a little advice from some more experienced folks. The jobs I am looking at in my "home state" range from private practice making low-300s with no guarantee of or consideration for partner (flat out told me so), private practice making high-200s with partner at two years guaranteed then bump to mid-300s, to university practice with good money but max out at about 350,000 after two years.

I have expanded my search recently and looked accross the US. Have an interview at one private practice starting at 350 salaried, 50% RVU second year and then 100% RVU by third year; partnered somewhere between 4-5 years out with senior partners always above you. Plus of this job is its an extremely desireable location, downside is they want you seeing 40-60 patients a day and doing an insane number of procedures.

Last job I am considering is very rural but a nice location and low cost of living, not a desireable place to live for most though. I honestly only see myself staying in this job for 5 years max. It would be a hospital employed position starting at 350 with alot of perks, then 50% RVU at year two, and 100% RVU at year 3. They told me 3 years out will be making between 450-500.

My dilema is whether to take a job someplace where I can't see myself living longer than 5 years just to make some bank and then move to where I want to be and having to start on the bottom rung? Or do I settle where I know I want to live and work hard toward a goal of making partner and doing just ok for a while?

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[Louisville04]

I would take the rural job (pay off debts, gain experience, and build up a war chest)

 

[Ducttape]

This is my personal experience, but why essentially do a second residence by working somewhere you have no interest in staying? And the 5 year delay may mean the job market where u desire fills up...

If u listen to all the doomsayers with regards to Obama winning the next election and how they think it will ruin the economy, medicine, America, and even the known galaxy, then don't wait!!!!

 

[PMR 4 MSK]

You are concentrating too much on money. Money has a way of going away. Quickly. That $350K they promised could become $250K when they didn't tell you how they really calculated your salary. Oh, and you fell $50k short of making bonus.

CMS changes a few rules, and suddenly your collections drop 30%.

They promise $300K, but did not tell you that out of that comes your malpractice, health insurance and other business expenses. Whoops. Sorry, we shoulda told you that. But it's in the contract. Your lawyer should picked up on that.

Your salary is based on RVUs? Yeah, we calculate those a little different here. You see, that 0.054 conversion factor is actually based , in part, on assumptions of variables that were not met...

Find a group of people you want to practice with, in a place you'd like to live, and negotiate the salary from there. If you are doing the same work, you should get about the same salary. Use other offers in your negotiation. You or they might be off in your estimates of your productivity.

One thing people don't believe when I say, and I learned it from my father, is your expenses rise to meet your salary. It doesn't matter how much you make, unless you put a lot of it away, you are just going to spend it. And physician payments are going down, not up. What they offer you now, you might not be able to make in 5 years.

When you weight the pros and cons of different places, put salary last in your priority list.

Keeping your spouse, if any, happy, will be your number one priority. Like they say, "If mamma ain't happy, ain't no one happy."

 

[W222]

I am starting to think that it makes alot more sense to build contacts in an area you see yourself staying longterm and if your first job doesn't work out, then you have those contacts to fall back on. I could go to the middle of F-ing nowhere and do very well my first year with a guaranteed salary, but after that nothing is set in stone. What you said above the wife being happy is also important. If I was single then it would be a no-brainer, but I have others to think about.

 

[bedrock]

Single vs married is important. With what's on the horizon right now for medicine, if you're single I'd just try to make bank for a couple years.

PMR makes some good points, I wouldn't do that for an extra 30K a year, but if you're talking about an extra 300K then it's worth thinking about.

If married then you need an okay job without much of non-compete. Making contacts is the way to go for plan b and c. Need to keep in mind that most don't stay at their first practice for life.

 

[SSdoc33]

[QUOTE Need to keep in mind that most don't stay at their first practice for life.[/QUOTE]

....or their first wife

 

[hyperalgesia]

I don't trust big-money jobs.

I would go where you want to go, expect a reasonable starting salary, and enjoy your life. If you go to a place that you know you wont be happy, for the promise of a big payout, after some of it evaporates due to "misunderstanding" and another 50% gets taken away by the govt, you're gonna be left with a steaming pile.

Besides, is the extra money enough to compensate for the misery you put youself in? I mean, if you gave me a mil/year, I could make some sacrifices. But if you're talking about 100k difference in salary (50k after taxes), not so much. WTF am I gonna do with 50k that will make up for a year of my life sacrificed?

The most important things I would look at (in order) are:
1) General ethical environment of the practice
2) Nice people to work with?
3) Location
4) Consequences of leaving the practice (no compete, etc)
5) Claimed salary

 

[lobelsteve]

I don't trust big-money jobs.

I would go where you want to go, expect a reasonable starting salary, and enjoy your life. If you go to a place that you know you wont be happy, for the promise of a big payout, after some of it evaporates due to "misunderstanding" and another 50% gets taken away by the govt, you're gonna be left with a steaming pile.

Besides, is the extra money enough to compensate for the misery you put youself in? I mean, if you gave me a mil/year, I could make some sacrifices. But if you're talking about 100k difference in salary (50k after taxes), not so much. WTF am I gonna do with 50k that will make up for a year of my life sacrificed?

The most important things I would look at (in order) are:
1) General ethical environment of the practice
2) Nice people to work with?
3) Location
4) Consequences of leaving the practice (no compete, etc)
5) Claimed salary

I'm doing a lot of reviews and it takes up a few extra hours per week. I buy toys for the kids and I'm paying off loans well ahead of schedule.... Sallie Mae and my mortgage company won't miss me in 2-3 years. And I won't miss them.

 

[Ducttape]

WTF am I gonna do with 50k that will make up for a year of my life sacrificed?

The most important things I would look at (in order) are:
1) General ethical environment of the practice
2) Nice people to work with?
3) Location
4) Consequences of leaving the practice (no compete, etc)
5) Claimed salary

i stayed in a profession that i loved for many years, with poor payoff. i can fairly certainly say that i made 1/3 what you all are making right now, for at least 10 years, because i loved the location and the job itself, and because i didnt want to retrain at the time. it was a good life and career.

now, i have a second job, doing something almost completely different, but i do love this new job. and i do love some of the perks (not percocet you evil thinkers!!) and it fits my current lifestyle 100 times better. it pays a lot better.

but ultimately, i have to say that it is not the pay that determines which job i have enjoyed more. its the lifestyle, the quality of work, what i am doing, how it fits in with my family, etc much more than the paycheck.


i would reiterate that your decision should be about these other factors, not how much moolah you bring in.

 

[Jcm800]

there are days i love this job, then there are the 4 days of the week...

but i would say, if i was young, married and had kids that didnt need to go to school yet, and you were aware of the need for a change in a few years, go for the big money, knowing that you will have to move, and money might be less.

but be aware that its a lot harder to leave a place a few years in, especially with a family.


If you have a place you love and want to be there, and the money is less and the job is right, go there, and stay there. you are broke now, so making 200k a year will seem like 10 million (until you go to the hospital and talk to the old timers...then you will fell like it isnt much...)

live below your means, pay off your loans, and in a few years be debt free, and its ok to make less money because you have less anchors pulling you down.

i dont think there is a right answer.

I went for the big money right out of fellowship, just for 2 years, and never left.

it happens

 

[specepic]

If there is any upside to a 'new' job, esp out of training, it is the concept of a guarantee.

Given the current climate and changes to healthcare, I would max the guarantee side of your contract.

Hospitals are usually best able to do this. The downside is hosp admin can drive you crazy

If you can squeak out a 5 year guarantee of 300+ then you should be able to kill your loans and maybe even most/all of a mortgage. Then you can chill a bit and play it by year from there.

My 0.02

 

[emd123]

I don't trust big-money jobs.

I would go where you want to go, expect a reasonable starting salary, and enjoy your life. If you go to a place that you know you wont be happy, for the promise of a big payout, after some of it evaporates due to "misunderstanding" and another 50% gets taken away by the govt, you're gonna be left with a steaming pile.

Besides, is the extra money enough to compensate for the misery you put youself in? I mean, if you gave me a mil/year, I could make some sacrifices. But if you're talking about 100k difference in salary (50k after taxes), not so much. WTF am I gonna do with 50k that will make up for a year of my life sacrificed?

The most important things I would look at (in order) are:
1) General ethical environment of the practice
2) Nice people to work with?
3) Location
4) Consequences of leaving the practice (no compete, etc)
5) Claimed salary

Agree, especially #1. Considering the current state of things, the last thing you want is to get stuck in a situation where you're not comfortable with the prescribing philosophy or the appropriateness of the billing. It's not worth the extra $.

 

[eljefe]

Autonomy should be high on your list. If you are someone's boy, the majority are going to be miserable no matter how much they pay you. If you have the autonomy to practice how you like, the money and satisfaction will follow.

Partnership is not always as good as it sounds and the details are usually very blurry until you are a few years into it...

 

[GMO2003]

Autonomy should be high on your list. If you are someone's boy, the majority are going to be miserable no matter how much they pay you. If you have the autonomy to practice how you like, the money and satisfaction will follow.

Partnership is not always as good as it sounds and the details are usually very blurry until you are a few years into it...

sorry to revive an old thread but I'm in a similar situation right now...I have a job all lined up in a not so great location with a pretty busy schedule the first two years and lots of vacation and twice the salary at partnership...This is in contrast to a dream location doing exactly what I want and in the ideal practice setting....The only problem is that after taxes the job is about just under 100k lower per year than the other job..what do you guys think?

 

[Ducttape]

why are you concerned about the extra money?

go to where you - and especially significant other - will be happy. extra money wont make you happy, you will be making enough as it is.

and going somewhere your spouse doesnt want to be is one way of guaranteeing that you will be hiring a moving company in 2 years.

 

[pastafan]

why are you concerned about the extra money?

go to where you - and especially significant other - will be happy. extra money wont make you happy, you will be making enough as it is.

and going somewhere your spouse doesnt want to be is one way of guaranteeing that you will be hiring a moving company in 2 years.

+1. As PMR 4 MSK pointed out most people allow their expenses to rise to rise to or exceed whatever their income level happens to be. Most here can relate. You are a med student with no money. Then you start getting paid as a resident and your wife has an income also. THings start to look pretty good. Then you get your first job as an attending and you can't believe how much larger the checks are than residency. After an adjustment period, you manage to spend that because you will be partner soon. Get your first partner's check and once again you are on easy street until you notice a few years later that those checks are soon gone.

You can control how much money you spend based on your income. You cannot control all of the practice variables that make for happiness. You absolutely cannot put a price on happiness. Choose that and then control your spending, always living below your means, because the income level can always drop.

 

[lonelobo]

When you weight the pros and cons of different places, put salary last in your priority list.

Keeping your spouse, if any, happy, will be your number one priority. ."

Don't know about your spouse, but putting salary last on a priority list could certainly effect the "happy" with my spouse

 

[Ducttape]

Not when starting out, unless one is independently wealthy. Any paycheck by an attending will be bigger than a typical resident's

 

[lobelsteve]

Don't know about your spouse, but putting salary last on a priority list could certainly effect the "happy" with my spouse

Cost of the divorce will outweigh any difference in salary.

But send her my way, I'll make her happy. Boom.

 

[pastafan]

Cost of the divorce will outweigh any difference in salary.

But send her my way, I'll make her happy. Boom.

Classic financial planning advice:

The best investment that you can make is to find yourself just one wife....

 

[lonelobo]

Cost of the divorce will outweigh any difference in salary.

But send her my way, I'll make her happy. Boom.

Sorry from your your prior posts can tell she is not your type, she is just not into Geeks

 

[lobelsteve]

Sorry from your your prior posts can tell she is not your type, she is just not into Geeks

Will you take mine anyways?