D
$200k?
- Thread starter 6ft3dr2b
- Start date
- Joined
- Jun 9, 2004
- Messages
- 2,204
- Reaction score
- 0
I was offered a position in an employment model...$180-200K to start (guaranteed for 3 years), $150K in student loan repayment for a five year commitment. Granted, it's not New York, but rural midwest.
Opthalmology, and several other specialties do not start at $200 K in NY....
- Joined
- Mar 4, 2008
- Messages
- 25
- Reaction score
- 0
That is very good. Just wondering what size of community (<10,000, <20,000, etc.) and if that included doing OB or scopes?? Thanks!
- Joined
- Jun 9, 2004
- Messages
- 2,204
- Reaction score
- 0
Community ~100,000...not so rural huh? It's "medically rural" because all the surrounding areas are <10,000 and come here for medical care. I'm pretty sure you'd be very interested in the location
No scopes, no OB
- Joined
- Feb 13, 2006
- Messages
- 656
- Reaction score
- 8
Since loan repayment counts as income for tax purposes, I'd have to concede this is more than I'd expect. I'm not putting myself out as an authority on the issue. I'm just saying it's OK to be skeptical of the numbers, even if it incites name calling on the boards or invokes the "roll eyes" emoticon from Blue Dog. Overall, it's in your best interest to scrutinize the numbers hard and think through the worst case scenario.
The range $180-200K suggests there is some dependence on productivity. You will find it frustrating if come December you are quite busy but still not getting paid many times because the credentialing process is so painfully slow with most insurers. This is a problem with many new physicians in my geographic region.
I suspect credentialing processes suck everywhere, and there is no incentive for established physicians to lobby for mandating change on this. It is an effective barrier to competition for them.
- Joined
- Feb 13, 2006
- Messages
- 656
- Reaction score
- 8
Indeed, they can.
I come across many physicians in successful practices who browbeat the residents to "fight for better reimbursement" and "support your profession" by joining various political action committees (i.e. send them $$$) and then expand their practices by hiring various mid-levels every 2 or 3 years and do nothing to help open doors for new graduates.
Don't be that guy. I'm not saying you are, just don't want you to become him.
- Joined
- Feb 13, 2006
- Messages
- 656
- Reaction score
- 8
My location also states "McHospital". Try not to take it too literally Osler. If I knew how to change it to correct it I would. I spend maybe 1-2 hours per week on this site, if that...some things fall through the cracks.
D
deleted87716
You obviously haven't been paying attention.
- Joined
- Sep 18, 2003
- Messages
- 2,778
- Reaction score
- 9
Why? I've seen offers of $185 to start in a rural area, not productivity based, some of which are hospital-subsidized, and that's the guarantee. Quite a few make more than that. I've seen their bottom line, it's not hearsay. And these situations are not that uncommon in my area.
You are not an authority, except in your geographical area, and I appreciate your making that clear in your last post. But your tone is one of authority, and the sarcastic zingers directed at individuals are really not necessary.
Play nice, please.
- Joined
- Sep 18, 2003
- Messages
- 2,778
- Reaction score
- 9
1. Go to My Account
2. Under Your Control Panel, in the Your Profile section, click on Edit Your Details
3. Scroll down, and under Additional Information is a place to enter location
- Joined
- May 26, 2009
- Messages
- 14
- Reaction score
- 0
I still have a ways to go before I finish my residency but I can say this. Almost all of the 3rd year residents that I know are accepting Offers for AT LEAST 180K. Some have taken urgent care positions for 200K+. Others are planning on working in Rural communities start above 200K and with the potential to make up to 400K (Obviously after putting in a few years of work, procedure heavy clinic).
- Joined
- Jan 23, 2004
- Messages
- 417
- Reaction score
- 1
Okay, dumb question from an MS3.90
I'm seriously looking at a program in a suburban setting with some indigent care that is OB heavy. One of the attendings who has just joined is geared towards medical missions (something I'm really interested in).....
When you say procedure heavy, what sorts of things do you mean?
What should I look for in an FP program?
procedure heavy = Colposcopies, biopsies, skin procedures, Gyn procedures, vasectomies, cryotherapy, etc....
It is not very difficult to start at $180 K or more in Family Medicine. You need to read you're contract carefully -- line by line.
Geography can be a huge player also, midwest tending to pay slightly more.
Of course there are the 'recruiters', or head hunters, that tell you -- "you start at $130 K, but everyone in the group makes over $200 K"
STAY AWAY from these programs.
Family Medicine is compensated well, but not nearly well enough. FM should be making alot more.
D
deleted87716
Avoid them at your own peril, of course.
IMO, a realistic starting salary is preferable to the more typical lure of a high starting salary followed by a dose of reality when your guarantee runs out and your income goes down because you "aren't productive enough."
I've heard this before, but I don't get it. Assuming the difference between income and guarantee (the loan) will be forgiven over time, why not take as much as possible? Even if your income goes down after the guarantee, at least you have the cash from the first year.
D
deleted87716
We do a pretty good job of explaining it to potential partners.
Some of them don't get it, either.
Somebody who's looking to make a lot of money in Year One and then potentially bolt, leaving us holding the tab, isn't the sort of person we're looking for.
agreed. I once replied to a job offer for $290 K, with 'limited' Ob. Turns out, that the docs take quite a bit of both Family Medicine and Ob combined call, plus 30-40 office patients per day. That is not something that I would look forward to, day in and day out.
Lifestyle is very important also.
You can also get 'suckered' into a low paying job, that is very rigorous.
Typically, it should not be very difficult to find a job, 9-5 p.m., 1:5 weekend call, at $180 K.
OK.... I understand you wouldn't want to bring someone in who was going to "potentially bolt," but that's not what I'm asking. Assume your practice is looking for a new partner. And assume my spouse grew in the the neighborhood where your practice is located and my kids are firmly rooted in the school system there (i.e. I'm not going anywhere.) You offer an income guarantee for the first year. Why wouldn't I want to negotiate the highest income guarantee possible? If the income is set at 200K the first year and I make 150K the second year, that seems 50K better than a "reasonalbe" 150K guarantee and a 150K income. Am I missing something here?
- Joined
- Aug 4, 2003
- Messages
- 1,380
- Reaction score
- 34
My next question then would be: Why would the group offer you partnership if you can't hit target? Or, why would the hospital renew their contract with you?
I've heard of one group that adjust for this in their contracts. They let you set your salary. If you exceed your salary, the faster you can make partner (based on a formula). If your production is under your salary, the longer it takes for you to make partner. And being partner in that group is where the money's at.
But, I agree with you. Take the money. And if it's less, oh well.
Last edited:
- Joined
- Dec 14, 2001
- Messages
- 679
- Reaction score
- 16
Usually material from a recruiter. Take EVERY salary number they give you and immediately subtract 15% and you're close to what you really may earn. In some alternate galaxy, they can justify their numbers, but in general the numbers aren't based in general reality.
And yeah, that post of mine stating 200k is "2.5x" typical was supposed to be 1.5. Oops.
But yes, I suppose theoretically a 1st year grad could pull down 200k, but I'd give it at least a few years to get to that, realistically. A few years into the deal, however, and that number is pretty doable.
D
deleted87716
Yes.
When a group brings a new physician on board, they go at-risk for all of the expenses associated with doing so until the new physician has generated enough income beyond their salary to make up the deficit. The higher the salary guarantee, the longer it will take the new physician to break even. If the physician leaves the group prior to breaking even, the group loses money. If the guarantee runs out before the physician has broken even, nobody is going to be very happy, including the new physician, who will probably find themselves on the losing end of a new contract negotiation.
It's best to avoid this situation altogether by hiring people who are a good "fit," giving them a reasonable (e.g., attainable within the period of their guarantee) salary, and positioning them for success.
D
deleted87716
They probably wouldn't, unless they're stupid.
You pretty much just described what I was talking about in my previous post.
- Joined
- Oct 14, 2008
- Messages
- 19
- Reaction score
- 0
If you're willing to invest many hours and see a very high volume of patients, then you can make quite a bit. $200k is quoted as the "average" family medicine salary by executive search firms, but I think that number is quite elevated.
Obviously it's best for everyone if there is a good "fit." I asked the question as a potential new hire. I thought there may be some ugly tax consequence or something similar in this situation. Real world example: I have an offer from a hospital with an income guarantee much higher than than I could expect from collections in a new practice. The "loan" is forgiven over the next two years as long as I practice in the community full time. Are you saying this is a bad thing?
Losing end? What do you do to under-performing partners?
Do you think it's elevated for full time, established FP's? I've seen a lot of income statements in the last few months. There is so much variability that an average really doesn't mean much. However, I saw many more incomes higher than 185 than lower.
D
deleted87716
Hard to say without seeing the fine print. Hospital systems like to think that they can afford to lose money on primary care practices as long as it's offset by downstream revenue, such as hospital admissions, ancillary services, and specialty consultations within the system. The problem arises if they ever decide to make your practice a "cost center," which means that it's accountable for its own profit or loss. If their financial fortunes change, this is a realistic possibility.
They're not partners at that point, so we could do anything up to and including termination. It depends on the person and the circumstances. Trust me, it wouldn't come as a surprise.
so if FP can start at 200k and it's not too hard to go up from there with a reasonable workload, why do I hear so many PCPs (including FPs) complaining about compensation, the "death of primary care," the ridiculous number of patients they have to see etc? Are they just whining to their subspecialist colleages?
Specialists can make more but they also train additional years and go through a lot of headache with the competition. Sure, a cardiologist can start at 350k but that seems fair given the 3 more years of training and lost opportunity cost.
Why should FPs make more given whats been said on this thread?
Specialists can make more but they also train additional years and go through a lot of headache with the competition. Sure, a cardiologist can start at 350k but that seems fair given the 3 more years of training and lost opportunity cost.
Why should FPs make more given whats been said on this thread?
D
deleted87716
Because most doctors are lousy businessmen, and the money isn't going to fall into your lap like it will in most specialty fields.
Specialist incomes more than make up for any "lost opportunity cost." That's not really how these things are decided, anyway.
If every FP made $250K, I think you'd hear a lot less whining. I'll bet you'd no longer have a primary care shortage, either.
But, they don't.
It will be eat what you kill at the end of the guarantee. That seems fine to me from this side of things. I don't see why that would be a problem.
why? Because FM is not compensated nearly well enough, and not as well as the counterparts. This is extremely unfair, and action should occur.
I know.. the thought
"well gee, you should be happy seeing X amount of patients and making X amount of money"
not when the guy down the street, is making a bit more, and not working quite as hard e.g. Dermatology. It is ridiculous.
FM should make more, hands down. It is unfair, the salary discrepancy that exists.
D
deleted87716
I'm a big proponent of "eat what you kill." As long as you're comfortable with the rest of the deal, that part shouldn't be a problem.
If what you said earlier in the thread (see above) is true I don't feel bad at all for FPs in terms of compensation. In fact, I think the "unfairness" is probably just the grass is greener phenomenon cause there are plenty of specialists earning right about that. Maybe a bit more, but with 1-4 more years of training and certainly full time. Sure you'll always find a few exceptions but 200-275 for a light schedule is more than fair, and more than up-to-par with other fields given training time. Believe it or not there aren't many specialists earning 700k/yr any more.
D
deleted87716
Um...these are the exceptions. Most FPs aren't doing that.
Everybody has been asking, "It it possible?" Yes, it's possible. But it's not typical.
- Joined
- Aug 4, 2003
- Messages
- 1,380
- Reaction score
- 34
I think "eat what you kill" is a bit of a misnomer. It's more like "eat what you kill... after you've fed everyone else." I don't know for a fact, but I imagine a portion of revenue you generate goes toward the practice. If I wa a partner, I wouldn't care so much, because the money going to the practice is still "mine" (divided up into the shares I own in the partnership... if I was sole owner, it would be 100% mine).
But if I was an associate (non-partnered), there's going to be money that goes to building the practice that I may not capitalize from. That's the portion of the formula that the "eat what you kill"'s have to scrutinize (and/or accept). Because for some practices, it's the associates who are subsidizing the less-productive partners who are "skimming" from the associates.
What's worse is if you read those Medical Economics articles about practices that have absolutely NO intention of adding partners, they subsidize the young guy coming in with the guarantee. Young guy cranks hard, thinking they'd make partner. Then the partnership cuts him off when the guarantee i up and goes out and finds another young guy out of school.
Very much like law firms & investment banks.
The problem I find is that there's no way to tell what people's intentions are. Probably that explains why a lot of the young doctors I know will work for a group for a couple of years, say to themselves "this sucks, why am I making money for them, if I can do the same for myself", leave, and start their own practice.
In situations like these, I can totally see how in retrospect, you'd do what EdibleEgg said and take a big guarantee upfront, and keep your options open when the term ends.
- Joined
- Aug 4, 2003
- Messages
- 1,380
- Reaction score
- 34
Sounds like your situation is just a little bit different from the one Blue Dog is describing. You're getting your line from the Hospital, whereas in Blue Dog's practice, it sounds like the line from the Practice. I mean, I don't know your contract because it could also be coming from both sides.
2 years is not a bad deal. One of the guys who graduated with me got an offer for a 2 year guarantee but he was locked in for 5 years or else he'd have to pay back his 2 year guarantee back (either to the Hospital or Practice, I don't know). It was an opportunity to stay in the city, but I'm glad he turned it down.
I know of 3 people who got their guarantees from the Hospital to set up a practice. Hospital gives them a guarantee, which was pretty sizable, for a lock in of 2-3 years. Hospital provides the assets (computers, equipment). At the end of the 2-3 years, they meet to talk. The doctor can reevaluate at that time whether they want to leave, renegotiate another guarantee/salary, or buy out the practice the hospital help set up (for, like, $1) and become a sole proprietor. I think there's some Stark or Kick Back laws that they have to be mindful of. Sounded like a good deal to me, because the option was held by the Doctor. But I'm not very knowledgable about these kinds of things.
What's your exit strategy?
Last edited:
I agree with you, very good points. However, as pointed out, $275 is possible, but not typical. The ability to earn more is somewhat easier as a Hospitalist, at least in this part of the woods. Hospitalist is by no means easy. It is hard work, however more time off is nice. Less paperwork, overall less things to deal with.
Hospitalist is a different track, than traditional Family Medicine. Less than 3% of Family Medicine residents choose to pursue a career as a Hospitalist (anybody in Primary Care can, most just choose not to).
Now to Traditional Family Medicine.
Management of 4-5 different chronic diseases (minimum) 25-40 patients per day, and E.R. call (combined outpatient/inpatient FM), plus taking weekend call, should partially justify an increase in salary as compared to the counterparts. These are just a few things that should count, pertinent to salary matters.
Quality of work performed, does not even come close to salary received. This has been an ongoing problem in Family Medicine.
From my personal observation, the 'eat what you kill' theory is not a good way to go either.
Last edited:
My situation is more like option #2. I won't really be flying solo, as I will officially be an independent contractor, renting space in an established office. After the guarantee, if things have worked out, there may be opportunity for partnership. I do have to stay in the community to pay off the loan. There are some obvious risks in this set up, but there are risks involved any way you do things.
Why not?
D
deleted87716
Not really. The phrase is most correctly used to describe essentially a full-production (non-salaried) compensation model. In pretty much every case, this is THE most advantageous and lucrative model for physicians. However, it's also the riskiest. If you don't work, you don't get paid.
Of course, in ANY salaried position, you can rest assured that you're earning more for your employer than you're being paid. That's simply the way it works. That's the ONLY way it works. In this case, your employer is taking the risk, not you. To the victor go the spoils.
The model that suits you best is the model you should choose. You'll get what you deserve, regardless.
- Joined
- Sep 8, 2008
- Messages
- 22
- Reaction score
- 0
As someone who matched into a different specialty and have some friends in Family Med already practicing, I just want to know how come you guys are so concentrated about money and talk about it so openly it?? (its all over the FM forum more that others) I say a six figure salary is a six figure salary. I was raised by a single parent who earned close to minimum wage and raised two kids. The kids both went into medicine at top 10 unversities. So don't cry my Fam Med people making 125K is not that bad you're still in the top 15% of America. Yeah you might have to wait a little longer than your Ortho friends to buy that attachment to you jacuzzi or that 4th vehicle but you'll get it. Yes I get it we have loans we all have loans to pay back, but come on its not like we have to pay them all back at once. We became doctors to treat people in need, not to make people's diseases a business venture. If money is so improtant then go get your MBA, the economy will pick up again and you can make your legendary "200k".
- Joined
- Oct 2, 2005
- Messages
- 12,024
- Reaction score
- 9,705
I mean... - Joined
- Feb 13, 2008
- Messages
- 545
- Reaction score
- 9
First off you're acknowledgement that you chose a different specialty is pretty telling. Secondly, I think the fact that only 2 percent of american med grads are going into primary care is also pretty telling. Thirdly, it is not just in the FM forum that people are talking about the undervaluement of primary care. In addition to the work that goes into achieving the level of education and training to become a physician there is the matter of student loans and lost years putting away for retirement. Primary care is not a cult and will slowly whither away as it is now if not properly compensated. You sound very much like you know absolutely nothing or are trolling for reactions which is probably more likely.
Last edited:
- Joined
- Sep 8, 2008
- Messages
- 22
- Reaction score
- 0
I did choose a somewhat primary care field. And I did not, not choose FM for money. My type of primary care specialty pays about the same as FM. And all that I know comes from my friends and family in primary care and PC attendings (I've been talkiing to people in the KNOW). Not trying to stir reaction at all. I believe primary care is too big to whither away. Can you really imagine medicine surviving without primary care? My curiousity was for the way money has been talked about on this forum and amonst disgruntled PC students and residents. Instead of asking for more compensation, I feel that the focus should be more on decreasing the cost of healthcare. Most specialties are seeing a hit and I don't think asking for more money is the answer.
2 percent US grads going into primary care what stats are you looking at? Or are you just talking about FM. I 've learned that primary care includes specilaties: Ob/gyn, IM, Peds, and FM (>50% of my graduation class). Well thats how my school grouped us when they posted the match results. Or mabe I still know "absolutely" nothing.
whereas 30-50% of people might go to peds, IM, ob/gyn and FM the majority of US grads now specialize away with a fellowship (recent statistic I saw only 5-10% remain truly primary). And you are wrong that primary care is "too big" to go away. Like it or not we are moving more and more to specialists taking care of most things and midlevels just triaging to specialists. Is this good for patient care? No. But it's a fact and probably the compensation has something to do with it (and the quality of PCPs declining due to compensation/lifestyle declining). So go ahead and whine about people being gold diggers. It's you not them killing primary care in this country.
- Joined
- Feb 13, 2008
- Messages
- 545
- Reaction score
- 9
I am not going to bring the news to you like a dog fetches the paper especially news that is common knowledge. You can do a search just as easily as I can.
- Joined
- Sep 8, 2008
- Messages
- 22
- Reaction score
- 0
wow... I've never heard that 2% were going into primary care thats all. I don't think thats common knowleged. I'll leave you guys alone. Last post. I'm zipping it.
- Joined
- Mar 5, 2004
- Messages
- 25
- Reaction score
- 1
Whoever wrote this obviously hasnt been looking for a job in a while. I am a 3rd year resident who just saw his preceeding class of 8 residents leave with an average salary of 175k with the highest above 195k before bonuses. So yes the money is out there, btw a 170k salary was for 4day only outpatient, no call.
Whoever wrote this obviously hasnt been looking for a job in a while. I am a 3rd year resident who just saw his preceeding class of 8 residents leave with an average salary of 175k with the highest above 195k before bonuses. So yes the money is out there, btw a 170k salary was for 4day only outpatient, no call.[/QUOT
I am over $200K, almost done with my first year out in the real world.
hard intense work sometimes, and I am NOT fond of the ICU.
Last edited:
