I am sure the salary issue has been endlessly discussed, but . . .

[Ameliacare]

. . . I have been in practice for four years and am wondering if this conforms to a "good" job relative to other's experiences.

I make around $250K base (no annual increases at this point, being here four years) with several add ons like lab directorship duties that add another $60K. Malpractice covered, insurance covered at 80% of the overall expense, 8 weeks of vacation, a half day off a week, CME money, parking/food covered by our hospital, etc.

The day to day work is not that burdensome. Maybe 25 surgicals a day. We have a PA do the grossing. Weekend call is almost a joke. Every six weeks I'm on weekend call but rarely do anything but field, at most, one call from the lab. Almost never go in on call.

Heck, even during the week, most of us leave no later than 3 pm unless we are covering frozens for the day.

So, sure I have heard about jobs paying $500K, but I am thinking, perhaps naively, that when you put it all together, my job is fairly strong. It is the only job I have had since residency, so I do not have a good point of comparison. Even my old fellow residents are a bit tight lipped when I ask.

Should I be looking for a job that pays over $400K in total compensation or does that change my lifestyle way too much? I was hired as an employee in a group that has two senior partners who will work another 20 years probably. They said there is no opportunity for partnership. Nevertheless, we all get an equal amount of cases on sign out. Maybe I am just thinking the "grass is always greener" on the other side.

Any opinions on my situation?

Amelia

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[tiredguy]

PM me when you leave your job so I can apply for it.

 

[Ameliacare]

PM me when you leave your job so I can apply for it.

So, would my current position seem to be an excellent position when all aspects are considered? I am thinking to increase my salary by any substantial degree would require more hours at work, more cases to sign out, etc.

Amelia

 

[AZpath]

Amanda,

Your pay is very competitive compared to your volume and time commitments. There are a lot groups averaging 40-50 cases daily with some complex cases and a very demanding medical directorship.
Their day is often 10 hours or more and they take six weeks or less vacation. If your group had less people and wanted to work more they would have more money per person.
If you want more at the end of the day then you will need to take in more volume . I sounds like the group choice has been family time verses pay. Nothing wrong with this if it still fits your financial goals.

 

[univlad]

. . . I have been in practice for four years and am wondering if this conforms to a "good" job relative to other's experiences.

I make around $250K base (no annual increases at this point, being here four years) with several add ons like lab directorship duties that add another $60K. Malpractice covered, insurance covered at 80% of the overall expense, 8 weeks of vacation, a half day off a week, CME money, parking/food covered by our hospital, etc.

The day to day work is not that burdensome. Maybe 25 surgicals a day. We have a PA do the grossing. Weekend call is almost a joke. Every six weeks I'm on weekend call but rarely do anything but field, at most, one call from the lab. Almost never go in on call.

Heck, even during the week, most of us leave no later than 3 pm unless we are covering frozens for the day.

So, sure I have heard about jobs paying $500K, but I am thinking, perhaps naively, that when you put it all together, my job is fairly strong. It is the only job I have had since residency, so I do not have a good point of comparison. Even my old fellow residents are a bit tight lipped when I ask.

Should I be looking for a job that pays over $400K in total compensation or does that change my lifestyle way too much? I was hired as an employee in a group that has two senior partners who will work another 20 years probably. They said there is no opportunity for partnership. Nevertheless, we all get an equal amount of cases on sign out. Maybe I am just thinking the "grass is always greener" on the other side.

Any opinions on my situation?

Amelia

So your total salary is about 310K plus additional benefits with a pretty low amount of work hours. What area of the country in general are you located? Is it a major city or rural area? It's below MGMA for the midwest, but I think you'd probably not pull in more money unless you were working more hours somewhere else and then you'd still have to work your way up to partnership at another location. Overall, I think it seems like a good deal.

 

[Ameliacare]

Amanda,

Your pay is very competitive compared to your volume and time commitments. There are a lot groups averaging 40-50 cases daily with some complex cases and a very demanding medical directorship.
Their day is often 10 hours or more and they take six weeks or less vacation. If your group had less people and wanted to work more they would have more money per person.
If you want more at the end of the day then you will need to take in more volume . I sounds like the group choice has been family time verses pay. Nothing wrong with this if it still fits your financial goals.

Thanks for your insight!

That is my basic impression as well. I am hesitant to pursue other opportunities because I do not want to adversely affect my lifestyle. It seems that I would have to work a whole lot harder to make another $100K which after taxes ends up really only another $60K in my pocket.

I sometimes struggle with not being a partner. However, since cases are evenly distributed, I don't feel that I am working any harder than the senior people who are partners. Obviously, I do not have first hand knowledge, but I am guessing they make more than I do! However, since we average around 4,500 surgical cases a year per pathologist, I'm not sure they make that much more than me. The technical side is not part of our practice. I did hear them lamenting a couple years ago when our case volume was down that they might have to lower salaries. They did not and kept everybody who had been there three years at $250K.

So, do the readers think that for me to improve my situation would be nearly impossible? If I want to keep eight weeks vacation, a half day off a week, volume around 25-30 cases per day, ability to leave around 3 pm, minimal call, etc, are there jobs out there with partnership potential that I should pursue?

Amelia

P.S. I am a US grad, cytopath boards, trained at good programs

 

[WEBB PINKERTON]

4500 cases a year? We are all expected to to do 10,000 or more with very little derm. You better enjoy what you got.

 

[Ameliacare]

4500 cases a year? We are all expected to to do 10,000 or more with very little derm. You better enjoy what you got.

Just a rough calculation. I work 4 days a week in the hospital (1/2 day off and 1/2 day strictly doing lab directorship duties). One day a week, I'm on frozens and do not do surgicals. So, every week I'm at work, I do around 100 cases. 52 weeks minus my 8 vacation weeks equal 44 weeks x 100 cases per week = around 4,500 cases a year. So, yes, not wildly stressful.

Amelia

P.S. So, Webb Pinkerton, do you think financially I'm fairly set here?

 

[Ameliacare]

Just a rough calculation. I work 4 days a week in the hospital (1/2 day off and 1/2 day strictly doing lab directorship duties). One day a week, I'm on frozens and do not do surgicals. So, every week I'm at work, I do around 100 cases. 52 weeks minus my 8 vacation weeks equal 44 weeks x 100 cases per week = around 4,500 cases a year. So, yes, not wildly stressful.

Amelia

P.S. So, Webb Pinkerton, do you think financially I'm fairly set here? For the 10,000 cases you sign out a year, do you get a lot more money?

 

[yaah]

Many would consider your vacation time (which should actually be increased if you truly get a half day off a week, that's another 25 full days per year/technically 5 more weeks) as part of your compensation since it is pretty high. I am not sure what standard is but it isn't 8 weeks. Employees of big labs probably get at most 4 (but I may be wrong). Lots of private groups are somewhere between 5-8 weeks (including CME trips) but most would allow you to take more if you take less pay. So if your "full time" pay is $310k per year but you essentially have 12 weeks of vacation time your full time equivalent is quite high (because you seem to be getting paid "full time" but essentially working as a 0.8 FTE). Plus you have the extras like food and parking which is another couple thousand a year.

I am not sure why you would want to leave for a job paying 30% more - unless there is a reason you need that extra income. But a lot of it will get sucked away by the things you don't have to pay for now that you would pay for elsewhere. And if you're working less than 8 hour days for this, that's kind of priceless.

The only problem with your situation is that you are an employee, not a partner. You seem to be treated essentially like a partner in terms of your benefits though. You may not be getting paid like a partner but from the work load you describe the amount of $ you make doesn't sound like THAT much less than you would earn as a partner if everyone works like that. But not being a partner does make you more expendable and subject to the whims of the partners. I tend to question any group that has partners but employs full time people for many years without making them partner - that's selfish and frankly disrespectful - but I know it does happen. But your current situation is pretty good!

 

[Ameliacare]

Many would consider your vacation time (which should actually be increased if you truly get a half day off a week, that's another 25 full days per year/technically 5 more weeks) as part of your compensation since it is pretty high. I am not sure what standard is but it isn't 8 weeks. Employees of big labs probably get at most 4 (but I may be wrong). Lots of private groups are somewhere between 5-8 weeks (including CME trips) but most would allow you to take more if you take less pay. So if your "full time" pay is $310k per year but you essentially have 12 weeks of vacation time your full time equivalent is quite high (because you seem to be getting paid "full time" but essentially working as a 0.8 FTE). Plus you have the extras like food and parking which is another couple thousand a year.

I am not sure why you would want to leave for a job paying 30% more - unless there is a reason you need that extra income. But a lot of it will get sucked away by the things you don't have to pay for now that you would pay for elsewhere. And if you're working less than 8 hour days for this, that's kind of priceless.

The only problem with your situation is that you are an employee, not a partner. You seem to be treated essentially like a partner in terms of your benefits though. You may not be getting paid like a partner but from the work load you describe the amount of $ you make doesn't sound like THAT much less than you would earn as a partner if everyone works like that. But not being a partner does make you more expendable and subject to the whims of the partners. I tend to question any group that has partners but employs full time people for many years without making them partner - that's selfish and frankly disrespectful - but I know it does happen. But your current situation is pretty good!

Thanks for your insight. Yes, I feel fortunate in my situation overall. For whatever it's worth, no employee has ever been "fired" from my group as far as I know in the past decade or so. A few have left over the years from what I have been told, basically looking for partnership slots. Hard to say if those choices were smart since I did not know them at all. I guess that is the crossroads I struggle with. I'm still young and have no geographic restrictions. However, knowing I might have to go through a 3 year employee to partnership tract, I do not want to wait too long if that's the smart move.

I wonder if I go to the trouble and then by 2020, the world of pathology is so changed financially, that I am upside down in my career? Less money than I have now, more hours, more call, etc.

So tough but I am so happy I'm not a first year resident thinking about these things and uncertainties.

Amelia

 

[cmz]

How many people are in your group? I don't know what your break down for cases is by CPT code, but I think for the 4500 cases you are signing out you're essentially covering your salary plus a whole lot more. It sounds like you have the correct set up and are efficient enough to get your cases done such that you are allowed all this extra time off. What you're getting now is actually pretty good, but I know the partners are making way more than you.

 

[stickyshift]

. . . I have been in practice for four years and am wondering if this conforms to a "good" job relative to other's experiences.

I make around $250K base (no annual increases at this point, being here four years) with several add ons like lab directorship duties that add another $60K. Malpractice covered, insurance covered at 80% of the overall expense, 8 weeks of vacation, a half day off a week, CME money, parking/food covered by our hospital, etc.

The day to day work is not that burdensome. Maybe 25 surgicals a day. We have a PA do the grossing. Weekend call is almost a joke. Every six weeks I'm on weekend call but rarely do anything but field, at most, one call from the lab. Almost never go in on call.

Heck, even during the week, most of us leave no later than 3 pm unless we are covering frozens for the day.

So, sure I have heard about jobs paying $500K, but I am thinking, perhaps naively, that when you put it all together, my job is fairly strong. It is the only job I have had since residency, so I do not have a good point of comparison. Even my old fellow residents are a bit tight lipped when I ask.

Should I be looking for a job that pays over $400K in total compensation or does that change my lifestyle way too much? I was hired as an employee in a group that has two senior partners who will work another 20 years probably. They said there is no opportunity for partnership. Nevertheless, we all get an equal amount of cases on sign out. Maybe I am just thinking the "grass is always greener" on the other side.

Any opinions on my situation?

Amelia

This is what I call a lifestyle practice. For what it is, it sounds like a great setup. Give it a few more years, and I'll bet you won't even want the higher paying job with longer hours.

 

[Ameliacare]

This is what I call a lifestyle practice. For what it is, it sounds like a great setup. Give it a few more years, and I'll bet you won't even want the higher paying job with longer hours.

That's probably a good term from the comments I have heard on this forum. I am very, very happy with my day to day job duties. Spend time with my daughter. See her even at school functions not infrequently.

I guess it just comes down to how much harder I want to work for more money and can I find a practice that pays more for that effort???

Amelia

 

[AZpath]

I will have to contradict my self. Your productivity is not too bad if you are doing 4500 with those hours. I really depends on your payer mix. This then depends on the state you live in.
Northeast and west coast pay a lot less then the south and center of the county.

I all likely hood the partners are netting 50-100K of your pay. It could be a bit more in some areas. The only way to know is look at the books.
So yes , a lateral move to another practice with similar hours may net the difference.

 

[Ameliacare]

I will have to contradict my self. Your productivity is not too bad if you are doing 4500 with those hours. I really depends on your payer mix. This then depends on the state you live in.
Northeast and west coast pay a lot less then the south and center of the county.

I all likely hood the partners are netting 50-100K of your pay. It could be a bit more in some areas. The only way to know is look at the books.
So yes , a lateral move to another practice with similar hours may net the difference.

Thanks!

Then, I guess, I would have to look at the low probability of a lateral move. If I take a new job, maybe I get $180/200/220 for a three year run to partnership. That will cost me, perhaps, around $400K total of salary during those three years that I don't earn Then, do I have to buy in? What is a buy in these days. A friend of mine said he had to pay one year of compensation as a good will buy in. Let's say my group in making $550 as a partner, it's going to cost me $400K in lost wages, $550K for a buy in, plus lost time my money would be making money being invested. So, round number, around a million in lost $$$ to make a switch to a job that pays maybe $150K more than I'm making now. So, tough since my numbers might be inaccurate.

Anybody want to chime in on that aspect?

Amelia

 

[mlw03]

Thanks!

Then, I guess, I would have to look at the low probability of a lateral move. If I take a new job, maybe I get $180/200/220 for a three year run to partnership. That will cost me, perhaps, around $400K total of salary during those three years that I don't earn Then, do I have to buy in? What is a buy in these days. A friend of mine said he had to pay one year of compensation as a good will buy in. Let's say my group in making $550 as a partner, it's going to cost me $400K in lost wages, $550K for a buy in, plus lost time my money would be making money being invested. So, round number, around a million in lost $$$ to make a switch to a job that pays maybe $150K more than I'm making now. So, tough since my numbers might be inaccurate.

Anybody want to chime in on that aspect?

Amelia

I'm not a surgical pathologist, but I like economics and I think your argument above is reasonable. And if accurate, I wouldn't bother even trying for the lateral move. You have a pretty good to excellent situation - you make enough money to live very comfortably, lots of vacation, and pretty chill work hours. It sounds like your admin duties are minimal, and thus relatively low stress. So why try to go elsewhere to make a bit more money that probably won't drastically change your daily life (financially) but would change your work life, probably in a net negative. If you salary goes up 150K per year and you work 20 more years, you make another 3 mil in salary, but it costs you 1 mil in cost to get there. So a gross different of 2 mil, minus taxes and lost investment income on the first million. You probably come out ahead from the move, but not that much.

 

[stickyshift]

I'm not a surgical pathologist, but I like economics and I think your argument above is reasonable. And if accurate, I wouldn't bother even trying for the lateral move. You have a pretty good to excellent situation - you make enough money to live very comfortably, lots of vacation, and pretty chill work hours. It sounds like your admin duties are minimal, and thus relatively low stress. So why try to go elsewhere to make a bit more money that probably won't drastically change your daily life (financially) but would change your work life, probably in a net negative. If you salary goes up 150K per year and you work 20 more years, you make another 3 mil in salary, but it costs you 1 mil in cost to get there. So a gross different of 2 mil, minus taxes and lost investment income on the first million. You probably come out ahead from the move, but not that much.

On the other hand, it could really be worth it to move, because that net $2 million is above and beyond whatever she's saving now. She will have to work harder at the higher-paying job, but hopefully not longer (in years). She might even be able to retire early.

An example of what I'm talking about: if she is able to $50,000/year at her current job, for example, that additional $2 million from a higher paying job is essentially 40 years of additional savings (without having to put in the additional 40 years of work!)

 

[stickyshift]

On the other hand, it could really be worth it to move, because that net $2 million is above and beyond whatever she's saving now. She will have to work harder at the higher-paying job, but hopefully not longer (in years). She might even be able to retire early.

An example of what I'm talking about: if she is able to save $50,000/year at her current job, for example, that additional $2 million from a higher paying job is essentially 40 years of additional savings (without having to put in the additional 40 years of work!)

 

[stickyshift]

On the other hand, it could really be worth it to move, because that net $2 million is above and beyond whatever she's saving now. She will have to work harder at the higher-paying job, but hopefully not longer (in years). She might even be able to retire early.

An example of what I'm talking about: if she is able to $50,000/year at her current job, for example, that additional $2 million from a higher paying job is essentially 40 years of additional savings (without having to put in the additional 40 years of work!)

"If she is able to SAVE $50,000/year" Sorry about leaving out that word.

 

[AZpath]

True.
If you are good fit for the next group you might be able to get two years. Also, perhaps 250-300 K while you wait.

My last buy in was paid out of the current salary but the increased bonus still netted 50k more a year.
It was paid off in two years.

Our buy in was based on accounts receivables. When I left the group I got paid the about the same amount back.
It might be high if they own a lab with a lot of assets.
You have to ask before you accept the position what the buy in will entail. Also, ask to have provisions in the contract that make this automatic so your not being played

Also, could push for partnership in 4-5 years in your current group.

Also, don't assume that your current salary is stable. You have no real say right now.
CMS could cut fees next year and your bonus will likely drop a l0t more than the partners.

As partner the risks are shared.

I think you have to ask yourself what does a long term fit look like and what are your goals.

 

[stickyshift]

"If she is able to SAVE $50,000/year" Sorry about leaving out that word.

I, of course, am not taking into account the taxes on that extra $2 million (actually, more like $3 million) earned, which would, of course, cut into those savings. But you get my point.

 

[Ameliacare]

I, of course, am not taking into account the taxes on that extra $2 million (actually, more like $3 million) earned, which would, of course, cut into those savings. But you get my point.

The entire discussion reminds me of the old adage, "a bird in the hand . . .". I know there are no easy answers, but I just don't want to do anything that negatively impacts my career. Maybe staying is the worse decision. Maybe leaving is the worse decision. Oh well. I guess the future is uncertain. If I'm happy here and reconcile my "employee" status in my head, maybe my best move is to sit tight.

I just wonder if it's more likely than not that if I take another position, I am more likely to work a lot more hours and only make nominally more over the long haul. Who knows? I guess nobody really could!

Amelia

 

[jp123ok]

. . . I have been in practice for four years and am wondering if this conforms to a "good" job relative to other's experiences.

I make around $250K base (no annual increases at this point, being here four years) with several add ons like lab directorship duties that add another $60K. Malpractice covered, insurance covered at 80% of the overall expense, 8 weeks of vacation, a half day off a week, CME money, parking/food covered by our hospital, etc.

The day to day work is not that burdensome. Maybe 25 surgicals a day. We have a PA do the grossing. Weekend call is almost a joke. Every six weeks I'm on weekend call but rarely do anything but field, at most, one call from the lab. Almost never go in on call.

Heck, even during the week, most of us leave no later than 3 pm unless we are covering frozens for the day.

So, sure I have heard about jobs paying $500K, but I am thinking, perhaps naively, that when you put it all together, my job is fairly strong. It is the only job I have had since residency, so I do not have a good point of comparison. Even my old fellow residents are a bit tight lipped when I ask.

Should I be looking for a job that pays over $400K in total compensation or does that change my lifestyle way too much? I was hired as an employee in a group that has two senior partners who will work another 20 years probably. They said there is no opportunity for partnership. Nevertheless, we all get an equal amount of cases on sign out. Maybe I am just thinking the "grass is always greener" on the other side.

Any opinions on my situation?

Amelia

The balance of salary and lifestyle that you describe is highly desirable. I recommend that you stay where you are; don't try and find greener pastures.

 

[gbwillner]

Sounds like you have a sweet gig. Being partner may be no small picnic either- you may be expected to go out and get business, and have a lot more responsibility.

 

[stickyshift]

The entire discussion reminds me of the old adage, "a bird in the hand . . .". I know there are no easy answers, but I just don't want to do anything that negatively impacts my career. Maybe staying is the worse decision. Maybe leaving is the worse decision. Oh well. I guess the future is uncertain. If I'm happy here and reconcile my "employee" status in my head, maybe my best move is to sit tight.

I just wonder if it's more likely than not that if I take another position, I am more likely to work a lot more hours and only make nominally more over the long haul. Who knows? I guess nobody really could!

Amelia

When I take into account the extra hours you would probably work at another gig (at least 10 hours more/week) for the next 20 years, you probably wouldn't make much more/hour than you do now. Your current position actually sounds pretty good (assuming you don't need $500K/year!).

 

[octopusprime]

Guess it depends on what your comfort level is and what you're used to. If you've never made 700, 350 sounds great. Most orthos (et al high paying specialties) make at least 4-500, but some--many--make double that pretty easy--they don't necessarily work harder or have double the volume, just better billing, better reimbursement, better business deals, better geographic locations...
Path is similar just hard to find those better paying jobs...you don't hear about them because people making that much don't come on these forums for several reasons...or they do, they just watch from the sidelines.
It does sound like a good job, but only relatively speaking because the market is saturated and national labs (and groups selling out to them) have ruined the landscape. I'd say if you're happy and content, and aren't bothered by the fact your colleagues are making money off of you, stay.

 

[Ameliacare]

Guess it depends on what your comfort level is and what you're used to. If you've never made 700, 350 sounds great. Most orthos (et al high paying specialties) make at least 4-500, but some--many--make double that pretty easy--they don't necessarily work harder or have double the volume, just better billing, better reimbursement, better business deals, better geographic locations...
Path is similar just hard to find those better paying jobs...you don't hear about them because people making that much don't come on these forums for several reasons...or they do, they just watch from the sidelines.
It does sound like a good job, but only relatively speaking because the market is saturated and national labs (and groups selling out to them) have ruined the landscape. I'd say if you're happy and content, and aren't bothered by the fact your colleagues are making money off of you, stay.

Appreciate your thoughts. I think I might just take the advice to enjoy my situation for what it is, a compromise of salary and lifestyle choices.

Amelia

 

[yaah]

Also may depend where you're living and what life is like. All the salary increases may not mean much if it's in a place with a higher cost of living, or more time spent having to do things like travel to work, drive around, whatever.

The ideal situation is probably a low cost of living area with great public schools. It's almost like you get "extra income" that way.

Personally, I also tend to think that high-end salary estimates are probably an overestimation for the future. Our reimbursement has declined fairly significantly for various reasons most of which are played out nation-wide in some fashion.