MGMA data

[mohderm]

Does anyone have access to the MGMA data for Dermatology and Mohs surgery. I am trying to negotiate a contract in private practice. I would prefer not to buy it but think it could really help me in my current situation. I'm looking for starting salary information for the Southeast region primarily for Mohs surgery. Thanks

---

Members don't see this ad.

 

[MOHS_01]

MGMA would not have that data; their data is merely a survey. While they do have one tab broken down by years in practice, they do not report for Mohs as the number of respondents are too low.

Beyond that, there is far too much variability between practice situations for these benchmarks to be applicable. PM me for specifics.

Happy hunting!


Sent from my iPhone using SDN mobile

 

[reno911]

MGMA doesn't have starting salary data per se, but it's not useless. I'm sure you and the future employer have projections about how much work you'll do. All you need to do is make a few minor assumptions and do some simple calculations to covert that work load to wRVUs. Then you can see if the salary is commensurate. That's what matters. A starting physician and an experienced physician who do the same work get paid the same by insurers. The experienced ones generally make more because they are more efficient and can do more in the same number of hours (i.e., they're doing more work).

The fact that you're just starting out doesn't really matter. What matters is how much work you anticipate doing.

As Mohs01 points out, there is too much variability among the respondents for the data to be that useful, but it's a little better than nothing.

 

[MOHS_01]

True; my two favorite metrics they report are the distribution of wRVU's by specialty and the comp /wRVU by specialty, neither of which are widely available. It is amazing the spread indicated when looking at those two metrics.


Sent from my iPad using SDN mobile

 

[doctalaughs]

True; my two favorite metrics they report are the distribution of wRVU's by specialty and the comp /wRVU by specialty, neither of which are widely available. It is amazing the spread indicated when looking at those two metrics.


Sent from my iPad using SDN mobile

Although wRVUs don't show the entire picture. The last mohs surgeon we hired wanted a pretty hefty salary and pointed out that he could produce almost double the wRVUs of a general dermatologist in our group. We pointed out that the competition/market for mohs was tighter than genderm (ie easy for us to get a lot of mohs candidates) and overhead was higher. We negotiated a salary for him higher than genderm (but not as high as he wanted based on pure wRVU calculation. I guess he could argue we are "making money" off his work but producing a steady referral stream for him in a tight market is not to be underestimated. And its true in mohs he does produce about 175% the rvu's of the general dermatologists (who do a lot of procedures /excisions) working the same number of hours but he's not paid 175% more.


Sent from my iPhone using SDN mobile app

 

[MOHS_01]

Although wRVUs don't show the entire picture. The last mohs surgeon we hired wanted a pretty hefty salary and pointed out that he could produce almost double the wRVUs of a general dermatologist in our group. We pointed out that the competition/market for mohs was tighter than genderm (ie easy for us to get a lot of mohs candidates) and overhead was higher. We negotiated a salary for him higher than genderm (but not as high as he wanted based on pure wRVU calculation. I guess he could argue we are "making money" off his work but producing a steady referral stream for him in a tight market is not to be underestimated. And its true in mohs he does produce about 175% the rvu's of the general dermatologists (who do a lot of procedures /excisions) working the same number of hours but he's not paid 175% more.


Sent from my iPhone using SDN mobile app

I know - which is why that second metric (comp/wRVU) was mentioned; one without the other is only 1/2 the story.

New guys arguing salaries (rather than production pay) is annoying to say the least. It's a red flag as far as I'm concerned... and I take care to point out that salaries should be set at the minimum level to satisfy IRS rules (which translates into a healthy salary, fwiw).

Working similar hours and comparable productivity levels should not result in 175% pay any longer thanks to the loss of the multiple procedure reduction exemption loss, btw. Our comp per wRVU is well below the gen derm as a result.

Sent from my iPhone using SDN mobile

 

[MOHS_01]

Although wRVUs don't show the entire picture. The last mohs surgeon we hired wanted a pretty hefty salary and pointed out that he could produce almost double the wRVUs of a general dermatologist in our group. We pointed out that the competition/market for mohs was tighter than genderm (ie easy for us to get a lot of mohs candidates) and overhead was higher. We negotiated a salary for him higher than genderm (but not as high as he wanted based on pure wRVU calculation. I guess he could argue we are "making money" off his work but producing a steady referral stream for him in a tight market is not to be underestimated. And its true in mohs he does produce about 175% the rvu's of the general dermatologists (who do a lot of procedures /excisions) working the same number of hours but he's not paid 175% more.


Sent from my iPhone using SDN mobile app

One last point - and I know that reality on the ground is different than the abstract - but I urge caution for everyone when discussing contract reasoning. For example, the allusion of extracting value (in dollars) for a referral stream. We all know that it is very valuable, but regs are quite clear that this is a no fly zone... so never mention it out loud or in writing... and take heed to avoid differentiating compensation formulas between MD's based on this. The fact of the matter is that treating the Mohs or path guy the same as the general dermatologist results in "disproportionate" cost sharing. The math is in the groups' favor.



Sent from my iPhone using SDN mobile

 

[doctalaughs]

One last point - and I know that reality on the ground is different than the abstract - but I urge caution for everyone when discussing contract reasoning. For example, the allusion of extracting value (in dollars) for a referral stream. We all know that it is very valuable, but regs are quite clear that this is a no fly zone... so never mention it out loud or in writing... and take heed to avoid differentiating compensation formulas between MD's based on this. The fact of the matter is that treating the Mohs or path guy the same as the general dermatologist results in "disproportionate" cost sharing. The math is in the groups' favor.



Sent from my iPhone using SDN mobile

Yes absolutely agree - you'll see in my post we offered reasons "tight mohs market" and "overhead" but didn't mention the referral stream for the reasons you mention above (although it should be obvious to any candidate the value).

Comp/ wRVU is useful data if you can come by it. Clearly best to compare within a specialty but not the best to compare from one specialty to another (since the type of work is so different)


Sent from my iPhone using SDN mobile app

 

[doctalaughs]

You always post a lot of interesting stuff!

Out of curiosity, which market would you say is better? Dermpath or mohs?

Both are tight but my sense is dermpath is worse Many mohs people (and derm trained dermpath) fall back on doing general derm part-time, at least to start.


Sent from my iPhone using SDN mobile app

 

[MOHS_01]

You always post a lot of interesting stuff!

Out of curiosity, which market would you say is better? Dermpath or mohs?

They both suck.


Sent from my iPhone using SDN mobile

 

[MOHS_01]

Both are tight but my sense is dermpath is worse Many mohs people (and derm trained dermpath) fall back on doing general derm part-time, at least to start.


Sent from my iPhone using SDN mobile app

...piggybacking on this - agreed. I personally think derm trained dermpath is probably the most hedged training; Mohs is simply too at risk - and that process is only getting started.


Sent from my iPhone using SDN mobile

 

[reno911]

One last point - and I know that reality on the ground is different than the abstract - but I urge caution for everyone when discussing contract reasoning. For example, the allusion of extracting value (in dollars) for a referral stream. We all know that it is very valuable, but regs are quite clear that this is a no fly zone... so never mention it out loud or in writing... and take heed to avoid differentiating compensation formulas between MD's based on this. The fact of the matter is that treating the Mohs or path guy the same as the general dermatologist results in "disproportionate" cost sharing. The math is in the groups' favor.



Sent from my iPhone using SDN mobile

The funny thing is that in a couple of places I have worked, when the powers that be want to justify paying me less they always explicitly state this reason. There's no hesitation or awareness whatsoever that the argument they're making is improper. I haven't actually read the relevant regulations first hand, though. In both cases the employer was a non-profit organization, so I wonder if that changes things at all. No one that I was negotiating with would personally benefit from paying me less. It was just their job to do negotiate me down as much as possible. And I guess since we're talking about non-profit orgs, in some sense no one was profiting.

 

[reno911]

Although wRVUs don't show the entire picture. The last mohs surgeon we hired wanted a pretty hefty salary and pointed out that he could produce almost double the wRVUs of a general dermatologist in our group. We pointed out that the competition/market for mohs was tighter than genderm (ie easy for us to get a lot of mohs candidates) and overhead was higher. We negotiated a salary for him higher than genderm (but not as high as he wanted based on pure wRVU calculation. I guess he could argue we are "making money" off his work but producing a steady referral stream for him in a tight market is not to be underestimated. And its true in mohs he does produce about 175% the rvu's of the general dermatologists (who do a lot of procedures /excisions) working the same number of hours but he's not paid 175% more.


Sent from my iPhone using SDN mobile app

This interaction strikes me a little funny because it sounds like neither party here understands wRVUs very well. As Mohs o1 pointed out all you've got to do is look at the $/wRVU data. So you're on the right track that wRVUs don't show the entire picture, but the reason why is very obvious and is often reported in the same surveys as the wRVU data.

In fact, even if you don't have the data that shows Mohs has a lower $/wRVU rate, you could derive that fact fairly easily from the CMS database and some simple assumptions about a typical work day.

 

[reno911]

Does anyone have access to the MGMA data for Dermatology and Mohs surgery. I am trying to negotiate a contract in private practice. I would prefer not to buy it but think it could really help me in my current situation. I'm looking for starting salary information for the Southeast region primarily for Mohs surgery. Thanks

Along these lines does any one have the most recent Sullivan-Cotter salary survey data for Mohs. If so please, PM me. I always seem to have a hard time finding someone who has that one.

 

[MOHS_01]

The funny thing is that in a couple of places I have worked, when the powers that be want to justify paying me less they always explicitly state this reason. There's no hesitation or awareness whatsoever that the argument they're making is improper. I haven't actually read the relevant regulations first hand, though. In both cases the employer was a non-profit organization, so I wonder if that changes things at all. No one that I was negotiating with would personally benefit from paying me less. It was just their job to do negotiate me down as much as possible. And I guess since we're talking about non-profit orgs, in some sense no one was profiting.

One of the many problems with regulations is how open they are to subjective determination; look no further than the multitude of LCD's for different Medicare regions regarding Mohs. Self referral -- including financial arrangements wherein one party benefits either directly or indirectly as a result of a referral, practice pattern, etc, is similarly open to interpretation, but an open admission of skimming off the top as payment for referrals is about as blatant as it gets. Now I've never been one to be unduly shocked with ignorance or brazenness, but I have had to bite my tongue on more than one occasion when confronted with it.

I don't think the non-profits are exempt from these rules, by the way. Every entity in existence does this internal redistribution to some extent and in some fashion, but an open acknowledgment is rather rich.