How much should I pay?

[LADoc00]

Im looking down the road for someone or a few people to cover hospital work at a location (desirable), very light averaging 20-30 cases per day. Frozen sections only rarely. No other responsibilities as I plan to do the Clin Path directorship as well some of the more in depth subspec sign out stuff. I would be a back up reference for the general surg path workload and double read new/difficult malignancies etc.

That's it, basically 9-4 cake walk. Im not going to overpay though. Would 120K/year for 1/2 time (2 weeks a month) be fairly solid? 1099 payments, all the expenses on the contractor (malpractice etc). Seems quite generous to me, given my level of support but wondering what you all think before I roll this out.

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[Freddie Mercury]

If down the road you mean 2020 when I presumably will finish residency if I choose path... this sounds like my dream job!

 

[LADoc00]

If down the road you mean 2020 when I presumably will finish residency if I choose path... this sounds like my dream job!

Well the best part is you would work directly with me, a rich man both in experience and stories. That alone is priceless.

 

[pathstudent]

If down the road you mean 2020 when I presumably will finish residency if I choose path... this sounds like my dream job!

Dream job?
Federal/California/Medicare/ss taxes at that income level 35k
Malpractice - 10k
Health deductibles/premiums for a family 10-20k
Professional expenses - licensing, credentialing, MOC, CME, SAMs - 5k
Life insurance/disability - 5k

Basically you are living off a residents salary except with less job security. Personally I would go with being a Chicago public school teacher where median salary is 80k plus benefits including a pension with close to as much time off.

 

[gbwillner]

Dude,
You get what you pay for. Can you find someone that will take that job at 120K? Yes, definitely. If you are lucky you will find a local who took time off after residency to have kids and now wants only part time work and is extremely qualified (or something of that ilk). Not sure why anyone good would ever take a job like that, especially in SoCal where cost of living and taxes are so high, as their only source of income. $120K is weak even for 50% sign-out time in academia with full benefits... you'll likely land someone who is otherwise unemployable.

 

[WEBB PINKERTON]

20-30 cases and few frozens? Will there even be places that small down the road? Most are being shut down and outsourced to larger core lab of the hospital chain.

 

[LADoc00]

Dude,
You get what you pay for. Can you find someone that will take that job at 120K? Yes, definitely. If you are lucky you will find a local who took time off after residency to have kids and now wants only part time work and is extremely qualified (or something of that ilk). Not sure why anyone good would ever take a job like that, especially in SoCal where cost of living and taxes are so high, as their only source of income. $120K is weak even for 50% sign-out time in academia with full benefits... you'll likely land someone who is otherwise unemployable.

Well you can pay some twice that and still not get what you pay for so often in Pathology $ does not equate to talent. Finding talent is an often serendipitous set of circumstances dependent more on geography and luck than any sort of package offering.

120 is what Im willing to pay for that. And you do no autopsies, did I mention that? Much more and I will probably just blaze through it myself sandwiched between a ton of other stuff Im doing down the road. I would be not taking any vacations or spending time doing my hobby stuff would be downside.

My goal is a part timer, either retired or interested in lifestyling it. Im fairly confident I can find that at this point if Im in no hurry, which Im not.

 

[LADoc00]

20-30 cases and few frozens? Will there even be places that small down the road? Most are being shut down and outsourced to larger core lab of the hospital chain.

30 cases/day is what? 6000/year? That is pretty meaty load for a solo guy. I hate to tell you but there are a TON of hospitals doing between 4000-6000 surgical accessions per year. Im fairly certain they aint all going to close shop and consolidate.

 

[coroner]

I think Webb's point is that with current trends in healthcare these are a dying breed. But there's still plenty of them around, particularly when you get out in the boonies. I actually happen to be at one of these type hospitals rolling solo dolo and we're not closing shop or merging/consolidating anytime soon. At least that's what the CFO keeps telling me...

As far as part time compensation, I have a friend doing just that at a hospital in a small town in the Midwest with a lower daily workload. He works 2 days/week for $80K and full benefits. You figure as 0.4 FTE making that, then a 0.5 FTE would be worth $100K. Although he is a hospital employee, not hired/subcontracted by a group, the caseload is slightly lower (making it even more of a cake walk), and the cost of living is definitely lower than Cali. So 120K isn't great, but do-able especially for the right segment: near/semi-retirees, stay-at-home young moms, or a kept spouse e.g. my friend whose wife is a dentist which makes it easier to take a cush gig like that...

 

[LADoc00]

Dream job?
Federal/California/Medicare/ss taxes at that income level 35k
Malpractice - 10k
Health deductibles/premiums for a family 10-20k
Professional expenses - licensing, credentialing, MOC, CME, SAMs - 5k
Life insurance/disability - 5k

Basically you are living off a residents salary except with less job security. Personally I would go with being a Chicago public school teacher where median salary is 80k plus benefits including a pension with close to as much time off.

your numbers are WAAAAY off.

1.) 1/2 time malpractice cost is 3500 out the door. California has the MICRA law.

2.) Health insurance - your problem. You can get away with 8K or less with Covered California. Regardless Obamacare removed any incentive whatsoever for me to offer health insurance ever again. I never will EVER give someone healthcare again. They wanted to "disengage health insurance from your employer?" well its disengaged officially now. Go to the market.

3.) Professional expenses are also your problem. Many groups will or already have stopped covering this. Why would some old fart cover YOUR MOC? They don't have this expense, only you do. Blame ABP.

4.) Life insurance/disability LOL....NO GROUP pays for pro disability for employees, unless they idiots. And life insurance? double LOL. Go buy your own.

 

[schrute]

I'm half tempted to say I'm interested just to meet the fabled LA Doc.

 

[pathstudent]

your numbers are WAAAAY off.

1.) 1/2 time malpractice cost is 3500 out the door. California has the MICRA law.

2.) Health insurance - your problem. You can get away with 8K or less with Covered California. Regardless Obamacare removed any incentive whatsoever for me to offer health insurance ever again. I never will EVER give someone healthcare again. They wanted to "disengage health insurance from your employer?" well its disengaged officially now. Go to the market.

3.) Professional expenses are also your problem. Many groups will or already have stopped covering this. Why would some old fart cover YOUR MOC? They don't have this expense, only you do. Blame ABP.

4.) Life insurance/disability LOL....NO GROUP pays for pro disability for employees, unless they idiots. And life insurance? double LOL. Go buy your own.

Those numbers are in the ballpark for me. But I am a partner in my group so I use my part of the revenue to buy those things with pre-tax dollars (except Life Insurance) But you are correct that it would be unreasonable to assume that a path group is going to provide all of that. We only provide malpractice insurance to our hires. They get a fixed pot of money that they can use to be reimbursed for business/medical expenses. I am just pointing out that the 120k is going to get eaten up fast.

With that offer you are going to get someone who is a douche bag or a spouse of someone with a high income who just wants to keep busy. The latter would be much preferable. I see that scenario in a lot in pediatric practices. Peds is filled with a lot of women who are married to cardiologists, GIs, subspecialty surgeons, etc... and so they make it possible for the 55 year-old man who owns the practice to still make a good living by hiring young women to work 2-3 days a week for 80k a year. But either way you won't find someone who is ambitious.

Like a pulmonologist told me a number of years ago: Women have saved the field of medicine. I bet you can get it to work.

 

[yaah]

What is the case mix? Might have to pay more for certain case mix. I dunno, $120k might be reasonable but depends on what the malpractice takes out, and other expenses normally paid by a group.

 

[LADoc00]

What is the case mix? Might have to pay more for certain case mix. I dunno, $120k might be reasonable but depends on what the malpractice takes out, and other expenses normally paid by a group.

Case mix 25% cake walk GI biopsies, 10% skins, 25% trash cases (gallbladders etc), 20% breast biospies and MAYBE 20% actual real grossing cases (mastectomies, colon resections, prostatectomies, wedge lungs). And I fully intended to have a grossing PA do everything by then, read: you wont be grossing ANYTHING, yup....and no autopsies and no immediate cyto reads from radiology and no boring meetings.

Plus Im the escape valve if you get in over your head with some crazy case.

IF you are single/no kids with lots of lifestyle concerns, retired/nearing retirement with your "nut" already saved for OR the spouse of a baller/shotcaller, this would be the dream gig in my opinion. This job is made for the pikers out there, you know the gals and guys who ask how much vacation they are going to get on the first day etc. (bonus points for what movie that is from)

I want to also add that there is crazy high divorce rate among the baller/shotcaller crowd, so if you are a spouse to one it behooves you to keep your feet wet in your profession should the relationship implode....just saying.

Stay tuned, Im working on this for 2016.

 

[2121115]

This job is made for the pikers out there, you know the gals and guys who ask how much vacation they are going to get on the first day etc. (bonus points for what movie that is from)

Easy. Boiler Room.

"A piker walks at the bell. A piker asks how much vacation you get the first year. Vacation? You want vacation, go teach 3rd grade public school."

 

[turtle1966]

Case mix 25% cake walk GI biopsies, 10% skins, 25% trash cases (gallbladders etc), 20% breast biospies and MAYBE 20% actual real grossing cases (mastectomies, colon resections, prostatectomies, wedge lungs). And I fully intended to have a grossing PA do everything by then, read: you wont be grossing ANYTHING, yup....and no autopsies and no immediate cyto reads from radiology and no boring meetings.

Plus Im the escape valve if you get in over your head with some crazy case..

120k for 6k equals 20.00 per case (or ?biopsy) before business expenses.

Whether this is fair or competitive, will depend on the size of your take and whether there will be a taker, in that order. I think you will find "someone."

If you paid less, but net of expenses, the offer may be more attractive to the target population.

 

[Pathwrath]

Please keep us posted on how easy/difficult it was to land a competent employee.

I strongly suspect you are right and this is in fact the new pathology "dream job" for lifestyle millennials. Sad, but I cannot argue with your logic, and I wouldn't do anything different.

 

[Over9000]

I echo everyone else's comments that this arrangement will attract either mommy-trackers/slackers or incompetent nitwits.

Both of the above demographics have one thing in common: they lack skill/experience.

Before going down this path, and I assume you've already looked into this, make sure that any clusterfxs on their part will not come back to harm you legally. Expect the worst but hope for the best.

 

[LADoc00]

Will keep this thread going for a few years to actually blog my adventures.

I would love to have a pot of money I could give to a female pathologist should she get pregnant and need to leave work but am unsure how to do it in compliant and legal manner (other than "here is some cash to tide you over for a few months, your job will be waiting for you when you decide to return").

My personal and spiritual goals include inspiring smart people to reproduce to elevate the human race so if I can do that with this position, all the better. From talking to attorneys though I cannot directly advertise in the state with this goal though...

Im fairly serious about NOT making these people employees. The employee laws in California are totally crazy, so that is a hamper on providing things like maternity leave etc.

~Hail Hydra

 

[vistaril]

120k for halftime work BEFORE malpractice/cmes/etc is just horrific. family medicine won't work for that most places.

 

[vistaril]

oh and on a 1099.....even worse. why wouldn't this person just try to get on at some corporate megalab? Do they have half time salaried gigs there?

 

[gbwillner]

oh and on a 1099.....even worse. why wouldn't this person just try to get on at some corporate megalab? Do they have half time salaried gigs there?

I hear that is what makes those jobs desirable- you are a cog in a wheel, but you can often set hours and get good benefits.

 

[LADoc00]

120k for halftime work BEFORE malpractice/cmes/etc is just horrific. family medicine won't work for that most places.

Nah. The practices in my area are paying 180K for Full Time/Q2 call for hospital based pathologists and for the more desirable areas 80K as a 1099 for 2 days per week with call (no expenses paid for this gig). Both of these have autopsy responsibilities too. But to be honest I haven't done a larger poll to be totally sure.

Primary care is getting around 90K for 1/2 with call. There would be healthcare/malprac on that too though.

Im getting excited about this little experiment. I'll take the Pepsi challenge against some crap gig at Kaiser any day of the week.

 

[vistaril]

Nah. The practices in my area are paying 180K for Full Time/Q2 call for hospital based pathologists and for the more desirable areas 80K as a 1099 for 2 days per week with call (no expenses paid for this gig). Both of these have autopsy responsibilities too. But to be honest I haven't done a larger poll to be totally sure.

Primary care is getting around 90K for 1/2 with call. There would be healthcare/malprac on that too though.

Im getting excited about this little experiment. I'll take the Pepsi challenge against some crap gig at Kaiser any day of the week.

imo, no physician(regardless of specialty) should take a job that pays those rates as an IC without any benefits or expenses anywhere.

 

[LADoc00]

imo, no physician(regardless of specialty) should take a job that pays those rates as an IC without any benefits or expenses anywhere.

I could fill a hospital staff with Surgeons getting paid 250K, Internists at 150K, Gas at 250K, Peds at 125K etc. Those are the times we live in. Of course YMMV Vistaril. I assume you are in some craphole location where you need to pay 30K upfront to just get people to drive through town. Was just chatting with a lady trying to recruit someone to a remote town and they were sweetening the deal with a free house on 5 acres.

I know those places exist for sure. I am not there.

 

[vistaril]

I could fill a hospital staff with Surgeons getting paid 250K, Internists at 150K, Gas at 250K, Peds at 125K etc. Those are the times we live in. Of course YMMV Vistaril. I assume you are in some craphole location where you need to pay 30K upfront to just get people to drive through town. Was just chatting with a lady trying to recruit someone to a remote town and they were sweetening the deal with a free house on 5 acres.

I know those places exist for sure. I am not there.

no Im in not in a remote town, but not a giant city either(metro area about a million). I'm familar with the market in several larger cities though(Atlanta, Nashville, Miami, Charlotte) and they aren't working for anything close to(in non academic settings) the money you describe above there either. But you're right- I don't know the LA area market.

 

[2121115]

I highly doubt some of the numbers being thrown around here. Highly.

 

[WEBB PINKERTON]

Interesting article about more hospitals in California partnering with Anthem BC/BS. You just knew the hospitals would try to do something in response to these high deductible plans.

http://www.modernhealthcare.com/article/20140917/NEWS/309179965

 

[CrazyEBV]

I am well qualified for your job description, i am not female (not going to get pregnant), not retiring/retired, not a slacker, did two fellowships (HP/SP), and am flexible. I can start job in July 2015. But here is the catch - you've to sponsor my J1 waiver !!!

 

[CrazyEBV]

*bump*

Why does the world stop with the mention of the magic word "J-1"
It is indeed magical. It makes me invisible. When I say I am a "J-1" guy, people just don't see me. I cease to exist!

 

[bronx43]

Interesting article about more hospitals in California partnering with Anthem BC/BS. You just knew the hospitals would try to do something in response to these high deductible plans.

http://www.modernhealthcare.com/article/20140917/NEWS/309179965

Wow. Zero deductible plan and low premiums. They really need to be able to cut overhead the way Kaiser cuts overhead, or else they'll be in the red. The two organizations also have to work in perfect sync, or else it wouldn't work. I wouldn't be surprised if this is a big disaster and Kaiser eats them up in the next few years. (not sure what the FTC would have to say about that)

The more interesting trend is more consolidated systems outside of Cali trying to convert to the Kaiser model of being both insurer AND health care provider. Insurance companies really need to innovate to resist going extinct, since the risk pool of these systems are going to hit critical mass.

 

[Johnny Sunshine]

LA Doc, I think your plan sounds pretty good. I suspect you will get plenty of interest.

I generally abhor southern California, but one can learn to make sacrifices. Feel free to message me. I'm quite comfortable with GI, breast, and GU, and of course the more grunt stuff too. I could be stronger in inflammatory derm, but we all need an area to improve on.

 

[WEBB PINKERTON]

Wow. Zero deductible plan and low premiums. They really need to be able to cut overhead the way Kaiser cuts overhead, or else they'll be in the red. The two organizations also have to work in perfect sync, or else it wouldn't work. I wouldn't be surprised if this is a big disaster and Kaiser eats them up in the next few years. (not sure what the FTC would have to say about that)

The more interesting trend is more consolidated systems outside of Cali trying to convert to the Kaiser model of being both insurer AND health care provider. Insurance companies really need to innovate to resist going extinct, since the risk pool of these systems are going to hit critical mass.

I know. We are starting to see health systems in the insurance business where I am at. People have predicted this would happen for years.

Competition is going to be fierce to get people trapped into these ACOs. My plan has a low deductible and will pay 90 percent of my costs IF i stay within a certain ACO. Go out of it and they only pay 50%.

Have a feeling we will be seeing a lot of surgery centers go out of business as the work is taken back by the hospitals. The entrepreneurial physicians better enjoy it while they can. End of days is coming.

 

[bronx43]

I know. We are starting to see health systems in the insurance business where I am at. People have predicted this would happen for years.

Competition is going to be fierce to get people trapped into these ACOs. My plan has a low deductible and will pay 90 percent of my costs IF i stay within a certain ACO. Go out of it and they only pay 50%.

Have a feeling we will be seeing a lot of surgery centers go out of business as the work is taken back by the hospitals. The entrepreneurial physicians better enjoy it while they can. End of days is coming.

Yeah, I mean this was a perfect storm of political trends (maybe by design) for large healthcare systems. High facility reimbursement rates facilitated consolidation of systems, then ACA mandated universal coverage. The government really couldn't have done a better job setting up the field for such a hostile takeover. Now you cut out one of the middle men - insurance companies - and we'll see what that does in terms of reigning in cost. Are health care systems going to reduce costs or simply get a bigger piece of the overall pie?

 

[WEBB PINKERTON]

Possibly both. They will control the flow of patients. The savings will come from our pocket books. The specialities who actually understand supply and demand will be fine. We will be left getting whatever scraps are left since our field is clueless and has allowed it's "growth" to mostly stem from waste.

Be prepared to hear stories from old timers about the good old days when pathologists actually got their PC and weren't employees.

 

[bronx43]

Possibly both. The savings will come from our pocket books. The specialities who actually understand supply and demand will be fine.

Be prepared to hear stories from old timers about the good old days when pathologists actually got their PC and weren't employees.

It's only the few fat cats at the top that benefit from a supply and demand curve skewed towards increased supply of providers.

I honestly have zero idea how these changes in the system will translate to physician job security and income in the coming years...

 

[Torsed]

I was under the impression that everyone in the group had to be on the same malpractice plan.

I'd be careful about letting them get their own as they may not know what they are doing and if you are the medical director you can be sued too. I think it would be worth piece of mind to include the malpractice in with their salary, this is reasonable and I've rarely seen a path group that does not do this. Maybe I'm in the minority.

I think 120k for two weeks is reasonable. What if you need them for extra days, etc? So their base would be 240k? I'd be specific about it in the contract. I'd also have a good no compete clause (just to throw it out there).