Job Market - Question for Graduating Residents/Fellows

[TypicalTuesday]

I know this question has been beaten down pretty good lately, but as a 3rd-4th year medical student who is already set on pathology, I was really curious about what experience graduating residents/fellows are having with the job market.

If anyone is willing to share, I'd really appreciate hearing about:

1. # job offers (if any or even # offers of others in your program, just none of the "I have a friend who has a friend who knows a guy who got this job....")

2. general location (state/region)

3. base salary range, if willing (if not, I understand)

Again, I know this topic is touchy, but I'd really love to hear since I honestly have no concrete idea of what I'm getting myself into and since LAdoc's gloomy outlook has already brought back my long suppressed bed-wetting problem, any info would be great!

Thanks,
tt

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[Patholog]

I know this question has been beaten down pretty good lately, but as a 3rd-4th year medical student who is already set on pathology, I was really curious about what experience graduating residents/fellows are having with the job market.

If anyone is willing to share, I'd really appreciate hearing about:

1. # job offers (if any or even # offers of others in your program, just none of the "I have a friend who has a friend who knows a guy who got this job....")

2. general location (state/region)

3. base salary range, if willing (if not, I understand)

Again, I know this topic is touchy, but I'd really love to hear since I honestly have no concrete idea of what I'm getting myself into and since LAdoc's gloomy outlook has already brought back my long suppressed bed-wetting problem, any info would be great!

Thanks,
tt

1. I don't know how many job offers others received, but I can tell you this...each person from my residency program (strong program in midwest) got their #1 choice for job. No problem. All of us. Everyone from my fellowship class (finishing in 2 weeks from large general surg path fellowship different from my residency program) got their number 1 choices as well.

2. Most of us are staying in midwest...missouri, iowa, wisconsin, nebraska while two are in the plains/mountains...north dakota, colorado. One outlier is going to Oregon.

3. General starting packages seem to be around 280-350 with salaries around 200 ish + bonuses/profit sharing/insurance etc. The highest starting salary offer I know of is 300.

Partnership salaries are quite a bit higher. As I posted before, the lowest partnership salary I personally know of is 550 (and that was without owning a lab or any equipment, so salary can be higher if you buy into a group with equity. Midwest has the highest salaries overall, I think. Of course there will be anecdotal experiences that differ, but I think that statement holds up.

Out of all those people I spoke of, only 1 is subspecialty (GI) the rest (including me) are just boring old AP/CP with general surg path fellowships, so there is, at least at this point in time, still a need for general pathologists.

 

[Path or bust]

1. I don't know how many job offers others received, but I can tell you this...each person from my residency program (strong program in midwest) got their #1 choice for job. No problem. All of us. Everyone from my fellowship class (finishing in 2 weeks from large general surg path fellowship different from my residency program) got their number 1 choices as well.

2. Most of us are staying in midwest...missouri, iowa, wisconsin, nebraska while two are in the plains/mountains...north dakota, colorado. One outlier is going to Oregon.

3. General starting packages seem to be around 280-350 with salaries around 200 ish + bonuses/profit sharing/insurance etc. The highest starting salary offer I know of is 300.

Partnership salaries are quite a bit higher. As I posted before, the lowest partnership salary I personally know of is 550 (and that was without owning a lab or any equipment, so salary can be higher if you buy into a group with equity. Midwest has the highest salaries overall, I think. Of course there will be anecdotal experiences that differ, but I think that statement holds up.

Out of all those people I spoke of, only 1 is subspecialty (GI) the rest (including me) are just boring old AP/CP with general surg path fellowships, so there is, at least at this point in time, still a need for general pathologists.

Ah what a nice contrast to the negative dribble that is fed on these boards. Those are good salaries.

 

[ZZPath]

Its not drivel. I know of only one person in my residency class who got a real partnership tract job - others were either cheated, lied to, or simply went to work for a corporation. The person who has the real job now went through two other employers who were less than honest about compensation and partnership issues. By the way, the only way a job applicant would have an accurate idea of partners' comp is by studying the accounting books of the company or by having a true friend on the inside. Be careful if the group is throwing out high numbers to you but unwilling to show the actual accounting. (Why, don't you TRUST us???) Another point to consider is how much you have to pay for a share in the company (or how many multiples of revenue for a share). I know some groups that are selling their shares for wildly inflated prices (like having a very high price/earnings ratio for a stock). If the group's business is growing fast, a share might be worth a premium. The more of a premium you pay for your share, the longer you have to work to recoup your investment. Can't do much about this once you've started, but would be good to know while comparing job offers. Having some inside info on these employers will save a lot of future hurt. So, good luck and do some homework!

 

[green mantis]

My answer may not be helpful, but it's truthful. Everyone from my graduating class (2007) is completing their 1st fellowship & will be continuing on into a 2nd. As far as I know, no one has attempted to look for a job. I think part of the reason is that we'd all like to stay in California.

If I were willing to move to the Midwest, I'd probably just do residency or 1 fellowship & start working. I'd be happy w/ a starting salary of $200K.


----- Antony

 

[ZZPath]

May you find your dream job in surfing country!

 

[Patholog]

My answer may not be helpful, but it's truthful. Everyone from my graduating class (2007) is completing their 1st fellowship & will be continuing on into a 2nd. As far as I know, no one has attempted to look for a job. I think part of the reason is that we'd all like to stay in California.

If I were willing to move to the Midwest, I'd probably just do residency or 1 fellowship & start working. I'd be happy w/ a starting salary of $200K.


----- Antony

Yeah, I don't imagine 200K would go as far as one would like in California, but in the midwest, at least where I'm moving (college town with ~100K people), it goes a long way. We bought a 4000+ sq ft, 5 bedroom home on an acre wooded lot for ~360K. Granted, we bought in when the market was not at its best. It depends where you go in the midwest. 200K in Minneapolis or Chicago is not a lot. I'm lucky that I'm from the midwest (I'm moving back to where I went to college and med school, my parents and parents-in-law are <1.5 hours away). I hear a lot of people from the coasts complaining about the job market there. I obviously have no experience with that, as I have no desire to be there.

Everything ZZTop said about investigating the books at a practice is true. Some groups will open their books to you, others are very secretive. Of course it is natural to be suspicious of a group that doesn't tell you how much they make, but part of that is to protect themselves. Reimbursement fluctuates, groups try to expand, etc and if a group promises you X dollars as a partner, but you actually make X-50K for a few years because the group is trying to expand and everyone partner's share is a little low, then that might make some people think they've been lied to or there are some silent partners lurking in the shadows, etc.

 

[Path or bust]

Its not drivel. I know of only one person in my residency class who got a real partnership tract job - others were either cheated, lied to, or simply went to work for a corporation. The person who has the real job now went through two other employers who were less than honest about compensation and partnership issues. By the way, the only way a job applicant would have an accurate idea of partners' comp is by studying the accounting books of the company or by having a true friend on the inside. Be careful if the group is throwing out high numbers to you but unwilling to show the actual accounting. (Why, don't you TRUST us???) Another point to consider is how much you have to pay for a share in the company (or how many multiples of revenue for a share). I know some groups that are selling their shares for wildly inflated prices (like having a very high price/earnings ratio for a stock). If the group's business is growing fast, a share might be worth a premium. The more of a premium you pay for your share, the longer you have to work to recoup your investment. Can't do much about this once you've started, but would be good to know while comparing job offers. Having some inside info on these employers will save a lot of future hurt. So, good luck and do some homework!

Thanks for the heads up. I think much of the reason why people get themselves into these situations is because they don't ask questions (thinking that if they ask too many questions, they might not get the job). That might be true, but I respect a person more for asking tough questions, however thorough, because it shows that the person is serious and interested.

 

[green mantis]

Yeah, I don't imagine 200K would go as far as one would like in California

Actually, $200K in California is higher than the starting salaries of some pathologists I know. They were earning somewhere between $160-$180K. Granted, they were going to practicing outside of LA/OC or the Bay Area.


----- Antony

 

[Patholog]

Actually, $200K in California is higher than the starting salaries of some pathologists I know. They were earning somewhere between $160-$180K. Granted, they were going to practicing outside of LA/OC or the Bay Area.


----- Antony

Yes, but relatively speaking, 200k in California goes less far than 200k in a small midwestern city, yes? I did a quick search on CNN money. 200k where I'm going is equivalent to anywhere b/w 240K (Bakersfield) all the way up to 374 (San Fran). The majority of cities profiled on CNN are over 300K for an equivalent salary. Insane.

I don't know how people on the coasts do it. It costs so much more to live there. Things must be so much tighter with respect to having a decent house, paying off student loans, saving for retirement and college, taking a decent vacation here and there, etc.

That being said, I would rather look out onto cliffs and the ocean any day. But I don't know if it's worth it.

 

[Matte Kudesai]

I don't know how people on the coasts do it. It costs so much more to live there. Things must be so much tighter with respect to having a decent house, paying off student loans, saving for retirement and college, taking a decent vacation here and there, etc.

That being said, I would rather look out onto cliffs and the ocean any day. But I don't know if it's worth it.

Dual income households and creative financing helps. Also investing and not relying solely on your salary.

Decent salary (200K) is a means to good credit is a means to investment capability is a means to living la vida loca........

 

[mlw03]

Yes, but relatively speaking, 200k in California goes less far than 200k in a small midwestern city, yes? I did a quick search on CNN money. 200k where I'm going is equivalent to anywhere b/w 240K (Bakersfield) all the way up to 374 (San Fran). The majority of cities profiled on CNN are over 300K for an equivalent salary. Insane.

I don't know how people on the coasts do it. It costs so much more to live there. Things must be so much tighter with respect to having a decent house, paying off student loans, saving for retirement and college, taking a decent vacation here and there, etc.

That being said, I would rather look out onto cliffs and the ocean any day. But I don't know if it's worth it.

this seems to be a frequent topic that comes up on here. i agree with you patholog. i went from FL to OH and found housing prices and overall cost of living is significantly lower. do i miss the beach? very rarely, but every day i get to live in my nice house. do i feel like i'm missing out on all the big city culture that i'd have access to in NY or Chicago? again, very rarely, and overall it's just not worth it. but that's my decision and i respect that others feel differently. but for now, there's plenty of people that want the coasts, which keeps the rents and property values much higher than they are in the middle of the country.

 

[xanthines]

True, but Columbus is a pretty nice town actually. Try moving to Cleveland or Youngstown and saying that. I'm in the CLE and pretty much can't wait to leave, but you're right about the living costs. I do think twice when I see that 3-story 6000sqft house for $260k. Of course, it's right next 5 others that are also up for sale.

-X

this seems to be a frequent topic that comes up on here. i agree with you patholog. i went from FL to OH and found housing prices and overall cost of living is significantly lower. do i miss the beach? very rarely, but every day i get to live in my nice house. do i feel like i'm missing out on all the big city culture that i'd have access to in NY or Chicago? again, very rarely, and overall it's just not worth it. but that's my decision and i respect that others feel differently. but for now, there's plenty of people that want the coasts, which keeps the rents and property values much higher than they are in the middle of the country.

 

[LADoc00]

the starting salaries I have seen in Calif range from 80K, yes ~$80,000, to around $250,000, very rare to see numbers higher than that here. Just too many people looking for jobs.

That said I just ran into a guy from the Midwest who was offering 400,000 for a person right out of fellowship.

The difference is huge.

 

[Patholog]

the starting salaries I have seen in Calif range from 80K, yes ~$80,000, to around $250,000, very rare to see numbers higher than that here. Just too many people looking for jobs.

That said I just ran into a guy from the Midwest who was offering 400,000 for a person right out of fellowship.

The difference is huge.

Absolutely unbelievable. That being said, this is economics at work. If everyone turned down 80K offers, those groups that truly need people would not be able to offer 80k.

 

[stickyshift]

Patholog,
Are these numbers really what's being offered in the Midwest? I work in NW Indiana, just outside Chicago, and I don't think these numbers are at all typical, either for new hires or partners.

 

[Patholog]

Patholog,
Are these numbers really what's being offered in the Midwest? I work in NW Indiana, just outside Chicago, and I don't think these numbers are at all typical, either for new hires or partners.

These are numbers that I know of personally. Either I interviewed with the group or one of my residency/fellowship classmates told me of their jobs. We made sure to tell each other very specific info regarding salary, although the tendency is to be more tight-lipped about it, because we wanted each other to know what is/was out there.

I promise I am not inflating. I gave only the lowest number as a partner that I was told at interview personally because I guessed that people would not believe me if I told them the higher numbers that are truly there in other groups. Most of the "other" groups own their own reference labs. Salary range of 650-700k (again, personal knowledge) with current expansion plans. 40 hours/week with ~ 7-8 weeks off. Some have less than 5 day work week for full-time. The buy-ins can be substantial, however, and likely dwarf your student loans.

These numbers do not include perks.

Now as LADoc rightfully stated months ago, there is no gurantee that the salary that a partner makes now will be YOUR salary when it comes time. Too many things can change in the interim.

I don't know where you have looked for work, but I imagine salary and proximity to a "desirable" place to live, ie Chicago, are inversely proportional. As I stated, I am from one of the fly-over states in the midwest, and most of my classmates are too, and that is from where the numbers come. LADoc also posted his experience of someone in the midwest being offered 400k starting. Even that is higher than I have ever heard of.

FYI, the 550k job was in a town that has a total of 29,000 people. Even I found that an undesirable place to live.

 

[LADoc00]

Patholog,
Are these numbers really what's being offered in the Midwest? I work in NW Indiana, just outside Chicago, and I don't think these numbers are at all typical, either for new hires or partners.

I just literally last week met a guy who not knowing the person I was with (boarded pathologist looking for job, currently in Cali) from jack offered $400,000 so casually I spit my coffee on my shirt. Lets say that was probably double if not more than that pathologist was making in California.

Heres the kicker, that is NOT partner salary. Partner salary was some freakish number so large the guy led to me believe he lives in a mountain palace with midget servants who make him chocolate and other candies all day.

100% true story. The US coastal areas BLOW for medicine and especially path.

 

[Patholog]

I just literally last week met a guy who not knowing the person I was with (boarded pathologist looking for job, currently in Cali) from jack offered $400,000 so casually I spit my coffee on my shirt. Lets say that was probably double if not more than that pathologist was making in California.

Heres the kicker, that is NOT partner salary. Partner salary was some freakish number so large the guy led to me believe he lives in a mountain palace with midget servants who make him chocolate and other candies all day.

100% true story. The US coastal areas BLOW for medicine and especially path.

But none of you coastal types should try and come to the midwest. We can tell who you are, and we don't take kindly to your types around here.

 

[TypicalTuesday]

First of all, thanks to those who have shared. This is really helpful and I really appreciate it. Any more info from others would be nice too.

Second, does anyone have information on Arizona/Utah/Colorado/Idaho (snowboarding is more important than salary...though one without the other is meaningless).

I know this is premature for a 4th year med student and anything can change in the next five, but it's nice to try to plan ahead.

 

[Matte Kudesai]

this seems to be a frequent topic that comes up on here. i agree with you patholog. i went from FL to OH and found housing prices and overall cost of living is significantly lower. do i miss the beach? very rarely, but every day i get to live in my nice house. do i feel like i'm missing out on all the big city culture that i'd have access to in NY or Chicago? again, very rarely, and overall it's just not worth it. but that's my decision and i respect that others feel differently. but for now, there's plenty of people that want the coasts, which keeps the rents and property values much higher than they are in the middle of the country.

You've only been in the OH for a couple months. You may or may not feel the same way after a few years. 6 months of gray skies and cold weather in the flat lands can be brutal. Especially if you grew up going to the beach or the mountains.

Housing is cheap though... And there is lots of inventory out there.

 

[sweetpea7070]

When you all say that the job market is tough on the coasts, are you including the east coast, specifically around the Carolina/Virginia area? I am curious as to what the market is like in this region since this is ultimately where I would like to end up (originally from there, now in midwest for residency).

 

[Patrick O]

So, does anyone have any info on how those offers translate to a person boarded in AP/CP/DP, in the midwest?
Thanks in advance.

 

[Patholog]

So, does anyone have any info on how those offers translate to a person boarded in AP/CP/DP, in the midwest?
Thanks in advance.

As I stated, none of my colleagues, or myself, had any trouble finding (what will be) lucrative jobs, just as AP/CP (and one GI). As a DP, my guess is that you would do even better, but again, I'm not one and neither are any of my cohorts. There is a DP guy in the practice I am joining; he makes the exact same amount as the rest of them.

 

[Master Chief]

I think these numbers for the midwest are way too high. While I admit, I also know that these jobs exist, this is not - I repeat - not typical of the average job in the midwest. I would estimate 150-200K starting, and usually not more than 350K final salary would be more acurate for someone looking at the overall job prospects of an average job in the midwest. (Note: Add up to 100K for undesirable location.)

Also, the coasts do blow.... If you want to make money, look south.

 

[Matte Kudesai]

I think these numbers for the midwest are way too high. While I admit, I also know that these jobs exist, this is not - I repeat - not typical of the average job in the midwest. I would estimate 150-200K starting, and usually not more than 350K final salary would be more acurate for someone looking at the overall job prospects of an average job in the midwest. (Note: Add up to 100K for undesirable location.)

Also, the coasts do blow.... If you want to make money, look south.

This information does seem to be more accurate based on what I have heard as well.

I have heard of the 280K+ jobs but there is always a catch...

You either are the junior pion in a two man show (default coverage of all holidays etc) or some other deal that ends up not being worth it.

 

[green mantis]

That being said, I would rather look out onto cliffs and the ocean any day. But I don't know if it's worth it.

I was born & raised in California & went to medical school in Florida. I didn't live on the coast in either state. I was at least 30 min inland in both places.

If you like being close to the ocean, Florida is probably a better place to live. Florida is a peninsula, so there's quite a bit of coastline. You also have the barrier islands & the intracoastal waterway. The cost of living is lower, unless you want to live in a more exclusive area (Miami Beach, Boca Raton, West Palm Beach, etc.). Florida also doesn't have a state tax, & the sales tax is ~2% lower than most of California.

Personally, I'd take a lower salary to be able to stay in California. I'm sure a fair number of residents / fellows feel this way, as evidenced by those of us doing multiple fellowships.


----- Antony

 

[Patholog]

I think these numbers for the midwest are way too high. While I admit, I also know that these jobs exist, this is not - I repeat - not typical of the average job in the midwest. I would estimate 150-200K starting, and usually not more than 350K final salary would be more acurate for someone looking at the overall job prospects of an average job in the midwest. (Note: Add up to 100K for undesirable location.)

Also, the coasts do blow.... If you want to make money, look south.

As you stated, you estimate; I do not. These are actual numbers from groups with whom either I or my classmates have signed. These may not be typical overall for the midwest, but these are typical for all the jobs looked at and taken by my peer group, so these are all to which I can refer. But, the starting number you quoted is close. As I posted, most start ~200k salary (without perks thrown in).

You don't have to believe me. But you should. However, I and my friends have all taken these jobs, so you may not find these particular ones to compare to if you are looking in the immediate future. None of them advertised, which is a common theme for a lot of groups. Word of mouth, calls to program directors, is how these jobs get filled. I approached my group years ago (~4), before there was even a position to fill. It's a chess game.

 

[Path or bust]

As you stated, you estimate; I do not. These are actual numbers from groups with whom either I or my classmates have signed.

From what I've seen, some individuals want to only see worst in any situation.

 

[LADoc00]

As you stated, you estimate; I do not. These are actual numbers from groups with whom either I or my classmates have signed. These may not be typical overall for the midwest, but these are typical for all the jobs looked at and taken by my peer group, so these are all to which I can refer. But, the starting number you quoted is close. As I posted, most start ~200k salary (without perks thrown in).

You don't have to believe me. But you should. However, I and my friends have all taken these jobs, so you may not find these particular ones to compare to if you are looking in the immediate future. None of them advertised, which is a common theme for a lot of groups. Word of mouth, calls to program directors, is how these jobs get filled. I approached my group years ago (~4), before there was even a position to fill. It's a chess game.

Im not estimating tho, the actual numbers Ive personally witnessed from the Midwest/Central North:
400,000+401K (45)+usual benes
300,000+retirement=40k+benes+10k book fund
350+401K+benes
500, no benes
this is not partner level
partner level was 450-800
albiet there is a HUGE selection biasis in these numbers because I looked only at top groups and not scrubs, and scrubs usually outnumber them 5:1 and pay like 1/2.
If I still have the actual paperwork they gave me, like 1 page sheet with all the benefits and crap on it, I will try to scan it and block out the confidential info and post it on imageshack.

vs. LA-SF Calif/Boston
120K with benefits
200K+45K 401K+benes
180K+401K+benes
etc

huge difference in numbers.

 

[stickyshift]

LA Doc,
I'm an attending in the midwest (Northwest Indiana, just outside Chicago), and I'm just stunned by these numbers. Are you saying that the above numbers are what new attendings start at in the Midwest?
What defines a top group?
I'm a partner in my group and I barely make more than that!

 

[LADoc00]

LA Doc,
I'm an attending in the midwest (Northwest Indiana, just outside Chicago), and I'm just stunned by these numbers. Are you saying that the above numbers are what new attendings start at in the Midwest?
What defines a top group?
I'm a partner in my group and I barely make more than that!

you barely make more than what? the starting salaries I mention?

if you are pulling down less than 400 anywhere in the midwest you have serious biz issues.

**those are usually boiling down to:
-you have way too many pathologists, shoot for a minimum of 3-4K specimens/per year/per path
-you take way too much vacation, if you are gone 3-4mo a year, expect less salary
-you dont bill pro fees for CP
-you have your own histo lab and run it worse than a Tijuana taco shack, you are a source of local welfare and the mayor thanks you often.
-you outsource/in house billing and simply have no clue how do it/its getting messed up
-you contract with far too many insurance companies and they pay you nothing

Ive seen alot of laughable crap in my tours:
groups with 8 pathologists only doing 10K specimens/year..hahaha
groups with 10k specimens and 4 full time billing people in house with their own manager...LOL
groups with their own histology lab that employ 2-3 FT certified pathology assts and pay them >100K...LMAO
groups that employ a full time autopsy assistant yet get paid NOTHING for autopsies...beyond LMAO
groups that pay a non-MD with a MBA to be a "CEO" of their corporation....LMAO+spitting coffee out my nose while seizing on my office floor from laughter

 

[ZZPath]

Add groups in hardscrabble parts of the country with significant Medicaid and no pay.

 

[LADoc00]

Add groups in hardscrabble parts of the country with significant Medicaid and no pay.

where we talking?

and why is there a pathologist there to begin with?

 

[ZZPath]

No Man's Land. Grapes of Wrath country. Not California Central Valley.

There are doctors here because - well they just are.

 

[stickyshift]

LA Doc,
Very astute response. We've looked at all of these factors, and we think there might be a problem with billing, as well as our insurance reimbursement.
Are you mostly non-par? Do you balance bill?

 

[stickyshift]

Oh, and we're one of those huge groups with 20+ pathologists. But we are signing out around 90K surgicals/year!

 

[LADoc00]

Oh, and we're one of those huge groups with 20+ pathologists. But we are signing out around 90K surgicals/year!

on 30% of my patients, I collect a % of charges. Another 30% medicare, which is well medicare rates. 30% BS/BC which pay a %+medicare. And 5% private pay. Another 5% wards of the state and poor people aka MediCal (which blows atm).

I think I have a good idea of your problems, linked to having that many pathologists in 1 grp.

You would think pathologists create more collective bargaining with payors and hospitals by forming large nets of providers when in reality the opposite is often true. Why this is I could write a thesis...


Also in well established grps you have senior/founding partners and even silent retired partners who create dangerous income sieves where, and I have witnessed this, millions of dollars of profit simply vanish.

When you think about what you are getting for being in a 20 person grp, the benefits are strikingly minimal: some in house expertise and maybe vacation coverage. What you lose in autonomy and rapid decision making is HUGE.

You are only as strong as the weakest link and 20 strong link pathologists, who are likeminded and business oriented are RARE.

I was "offered" in no polite terms to merge with one of the biggest groups in Calif. Looking at it from every angle, it was a fail and I hired 2 law firms, 1 accounting group and 2 different business consulting grps to help me evaluate it.

**You will be better off taking a buddy or 2 from the grp and laying claim to one of the more healthy hospitals your grp is covering close to your home.**

 

[LADoc00]

No Man's Land. Grapes of Wrath country. Not California Central Valley.

There are doctors here because - well they just are.

No because in Central Cali, where 40% of the pop are migrant farm workers, the pathologists make over 550K a year.

Dont blame crappy locations on your financial incompetence. Sorry to be that blunt, but its true.

 

[stickyshift]

Your payer mix looks a lot like ours: 30% Medicare, 30%BC/BS, a little self pay(no pay), more Medicaid than we'd like, and the rest commercial payers (that pay around 130-135% Medicare).
We are essentially the pathology group for a large hospital system, and as a result we are more or less dependent on its marketing efforts to get new business. Also, the system has veto power over who we can or cannot work with. So yes, there are a lot of constraints.
On the other hand, we are so entrenched (for better or worse), I think that we have more security than a group that might be dependent on its contract with on only one or two hospitals.
P.S. Do you know what the practice climate is like in Walnut Creek? Pretty affluent community . . .

 

[LADoc00]

Your payer mix looks a lot like ours: 30% Medicare, 30%BC/BS, a little self pay(no pay), more Medicaid than we'd like, and the rest commercial payers (that pay around 130-135% Medicare).
We are essentially the pathology group for a large hospital system, and as a result we are more or less dependent on its marketing efforts to get new business. Also, the system has veto power over who we can or cannot work with. So yes, there are a lot of constraints.
On the other hand, we are so entrenched (for better or worse), I think that we have more security than a group that might be dependent on its contract with on only one or two hospitals.
P.S. Do you know what the practice climate is like in Walnut Creek? Pretty affluent community . . .

Walnut Creek, California? or somewhere in Indiana?

and I usually roll my eyes when someone says entrenched group, that says to me zero innovation, the fat cats who started the practice have already made their millions and simply want to coast to retirment/death. Never good imo.

When I go out, I already have an agreement to blow my group up, no legacy, no entrenching. The next crew will start from scratch and learn the business side of this world, for their own good.

 

[stickyshift]

Walnut Creek, CA. I was once invited to apply for a job there, but my wife's family is all in the Midwest.
Entrenched . . . I see your point. But the practice has had a complete sea change in leadership, so I'm guardedly hopeful: we've outsourced our billing (in house group was in over its head, as even a cursory audit--me eyeballing our monthly reports--revealed).
This NPI business is killing us here in Indiana--how about you?

 

[LADoc00]

Walnut Creek, CA. I was once invited to apply for a job there, but my wife's family is all in the Midwest.
Entrenched . . . I see your point. But the practice has had a complete sea change in leadership, so I'm guardedly hopeful: we've outsourced our billing (in house group was in over its head, as even a cursory audit--me eyeballing our monthly reports--revealed).
This NPI business is killing us here in Indiana--how about you?

Walnut Creek California as in John Muir-Mount Diablo? or Kaiser?

Expensive place to live, coming from your world. But I rarely hear about partners in one group applying for a junior slot in a different grp...how do you get out of your partnership arrangement? sell your shares? Do you have equity stake/account rec. you can sell off?


What is NPI? not familiar with it by that name here. National provider identification?? I havent a problem with it all personally, what is happening?

 

[stickyshift]

Walnut Creek, CA, John Muir. Very profitable hospital, very affluent community.
I've heard of partners leaving their practice to join another one. In my group, I would have to sell my share (worth very little, as there was essentially no buy-in).
NPI is National Provider Identifier. Medicare mandated that all claims to Medicare (and essentially to your third-party payers using electronic submission, as well) be submitted with your NPI, as of May 23. My viewpoint is that it has been a disaster for many of us in particular states, since Medicare carriers are denying claims that are not submitted perfectly. Some carriers report that the rate of denials has quadrupled since May 23 (24%). So we're in a cash flow crunch right now, since we haven't seen a Medicare payment in awhile.

 

[LADoc00]

Walnut Creek, CA, John Muir. Very profitable hospital, very affluent community.
I've heard of partners leaving their practice to join another one. In my group, I would have to sell my share (worth very little, as there was essentially no buy-in).
NPI is National Provider Identifier. Medicare mandated that all claims to Medicare (and essentially to your third-party payers using electronic submission, as well) be submitted with your NPI, as of May 23. My viewpoint is that it has been a disaster for many of us in particular states, since Medicare carriers are denying claims that are not submitted perfectly. Some carriers report that the rate of denials has quadrupled since May 23 (24%). So we're in a cash flow crunch right now, since we haven't seen a Medicare payment in awhile.

ouch. No, I havent experienced the NPI denials. I had my stuff ready with the billing company about 6 months ago. And our hospital forced all the docs to show proof of having a NPI last year I believe.

I know John Muir, there are other more profitable hospitals in the area, but it aint bad. Walnut Creek is somewhat affluent, but nothing like a Mill Valley/Stinson Beach, Tiburon, St Helena, Hillsborough, Woodside. Still not bad tho.

 

[stickyshift]

on 30% of my patients, I collect a % of charges. Another 30% medicare, which is well medicare rates. 30% BS/BC which pay a %+medicare. And 5% private pay. Another 5% wards of the state and poor people aka MediCal (which blows atm).

I think I have a good idea of your problems, linked to having that many pathologists in 1 grp.

You would think pathologists create more collective bargaining with payors and hospitals by forming large nets of providers when in reality the opposite is often true. Why this is I could write a thesis...


Also in well established grps you have senior/founding partners and even silent retired partners who create dangerous income sieves where, and I have witnessed this, millions of dollars of profit simply vanish.

When you think about what you are getting for being in a 20 person grp, the benefits are strikingly minimal: some in house expertise and maybe vacation coverage. What you lose in autonomy and rapid decision making is HUGE.

You are only as strong as the weakest link and 20 strong link pathologists, who are likeminded and business oriented are RARE.

I was "offered" in no polite terms to merge with one of the biggest groups in Calif. Looking at it from every angle, it was a fail and I hired 2 law firms, 1 accounting group and 2 different business consulting grps to help me evaluate it.

**You will be better off taking a buddy or 2 from the grp and laying claim to one of the more healthy hospitals your grp is covering close to your home.**

LA Doc,
I'm really intrigued in this business with the silent partners. Our founding members more or less all retired at the same time, and more than one of us has wondered if they are drawing from the practice trough. How would this be hidden from the practice? Would it necessitate complicity with our business manager?
Dave

 

[LADoc00]

LA Doc,
I'm really intrigued in this business with the silent partners. Our founding members more or less all retired at the same time, and more than one of us has wondered if they are drawing from the practice trough. How would this be hidden from the practice? Would it necessitate complicity with our business manager?
Dave

Yeah it would, if the biz manager is also the book keeper.

I would consider hiring a forensic accountant to audit the books if you are concerned.

One thing I have seen is this:
Group of guys start a prac and all retire, they sell their shares of the practice with list price of millions$ (often with no true market value analysis), the new people cant raise that capital so they are issued a note, which is basically a personal loan for the amount. It is arranged at whatever borrowing rate the founders want, usually 10%+. Then each year the group has to set aside a chunk of their income to service this debt. This amount can actually be negatively amortized too, meaning by the terms of loan, the prinicipal continues to rise because the interest isnt paid quick enough (aka the nut vise scam).

I was so keenly aware of this, I went a totally different angle, jettisoned the all prior affliations, bidded the RFPs on my own and built my group literally from the ground up. There was simply no way that I could see a large group which owned property and had tens of millions in revenue not falling victim to either an unsavory partner OR even worse a surviving heir or spouse.

I built numerous doomsday clauses into my operation for death, divorce, dissolution etc to create my own sort of private practice "poison pill" should someone attempt shenanigans.

I also have accountants that audit billing that are in turn audited by other accountants and looked over by attorneys. Then I go drinking with my attorneys to ensure they are on the level. But Im a very paranoid guy.

 

[djmd]

I built numerous doomsday clauses into my operation for death, divorce, dissolution etc to create my own sort of private practice "poison pill" should someone attempt shenanigans.

I know you are serious, and it is serious business, but the phrases "doomsday clauses" and "poison pill" made my day...

I picture a switch like this on your desk.

 

[TypicalTuesday]

Anyone else graduating from any other programs with first-hand experience regarding job market?

 

[fajacko]

Anyone else graduating from any other programs with first-hand experience regarding job market?

Bump...

also curious.