Another salary thread....oh no!!!

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FitDoc

FitDoc

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Hi all!

Before you hijack this thread, let me start by saying I've done quite a bit of research and not found the answers I'm searching for on the forums or elsewhere. I really need updated info on this.

I'm currently a Board Certified PM&R Spine Specialist, with two fellowships behind me (including Interventional Spine). I've been in practice for about 3.5 years. I see about 60 patients a week (outpatient), over a 3 day period and probably up to 35% of those get some type of office based intervention (TPI, IA joint, tendon inj). I do between 5-10 EMGs per week. We have a surgery center, where I do lots of procedures. In a given week, I will do 1-2 SCS trials (avg 5-6 per month), about 10-12 RFAs per week (most of which are either 3 level unilateral, or 2 level bilateral), and a large number of inter laminar and TFESI procedures (probably averaging about 40-45 per week). In addition, we also do PRP injections (which are all cash), averaging 1-2 per month. I also do a large number of cervical ESI/RFA/MBB, and I do cervical stims.

Now don't get me wrong, I'm paid fairly well (I think), but there's been some discussion about modifying the salary plus bonus to a more incentive based structure. Given the potential wrinkle in the original contract, I'm wondering what my skill set may be worth in the market. (purely for negotiation, mind you). I've spoken with different folks around the country with access to this kind of information. Some say for the #of procedures, the experience, and the volume (not including the reputation), I'd fall somewhere around the high $400's - $500k. Granted, I'm nowhere near that number, but would be happy to continue where I'm at with a reasonable bump.

Would like to hear feedback from those who are in the know about such things.
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Let me make sure I understand. You're seeing 60 clinic patients a week (a lot of which have a -50 modifier for in-office add on procedures) + 5-10 EMGs + 40-45 procedures per week of which 1-2 are stim trials and 10-12 are RFAs? This is just my opinion and based on my 2 years in pp but I would say you should be collecting b/w 1-1.5 million a year. Assuming 50% overhead you should be bringing in somewhere b/w $500-750k. If you're making less than 400k you're getting screwed
 
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clubdeac said:
Let me make sure I understand. You're seeing 60 clinic patients a week (a lot of which have a -50 modifier for in-office add on procedures) + 5-10 EMGs + 40-45 procedures per week of which 1-2 are stim trials and 10-12 are RFAs? This is just my opinion and based on my 2 years in pp but I would say you should be collecting b/w 1-1.5 million a year. Assuming 50% overhead you should be bringing in somewhere b/w $500-750k. If you're making less than 400k you're getting screwed
Click to expand...

Your numbers are correct. Office based collections only came in around 1.2M. That does not include ASC net collections of 650k+. You may be right.
 
FitDoc said:
Your numbers are correct. Office based collections only came in around 1.2M. That does not include ASC net collections of 650k+. You may be right.
Click to expand...

Not to mention...gaining access to the ASC profit requires at least a $1M buy in. Or more.
 
So you brought in 1.85 million and are getting paid less than 400K? That's messed up
 
FitDoc said:
Hi all!

Before you hijack this thread, let me start by saying I've done quite a bit of research and not found the answers I'm searching for on the forums or elsewhere. I really need updated info on this.

I'm currently a Board Certified PM&R Spine Specialist, with two fellowships behind me (including Interventional Spine). I've been in practice for about 3.5 years. I see about 60 patients a week (outpatient), over a 3 day period and probably up to 35% of those get some type of office based intervention (TPI, IA joint, tendon inj). I do between 5-10 EMGs per week. We have a surgery center, where I do lots of procedures. In a given week, I will do 1-2 SCS trials (avg 5-6 per month), about 10-12 RFAs per week (most of which are either 3 level unilateral, or 2 level bilateral), and a large number of inter laminar and TFESI procedures (probably averaging about 40-45 per week). In addition, we also do PRP injections (which are all cash), averaging 1-2 per month. I also do a large number of cervical ESI/RFA/MBB, and I do cervical stims.

Now don't get me wrong, I'm paid fairly well (I think), but there's been some discussion about modifying the salary plus bonus to a more incentive based structure. Given the potential wrinkle in the original contract, I'm wondering what my skill set may be worth in the market. (purely for negotiation, mind you). I've spoken with different folks around the country with access to this kind of information. Some say for the #of procedures, the experience, and the volume (not including the reputation), I'd fall somewhere around the high $400's - $500k. Granted, I'm nowhere near that number, but would be happy to continue where I'm at with a reasonable bump.

Would like to hear feedback from those who are in the know about such things.
Click to expand...
I'm assuming you work for a surgical practice. 60 pts/week is not nearly enough volume to be generating that many interventions. If so, you must be getting fed a lot. I can tell you that I work for an ortho group and I don't get fed hardly anything. All my procedures are essentially generated by my office visits. If you are being fed that kind of procedural volume they will probably tell you that "you wouldn't exist without us." Not in so many words but you get the drift. I'm not saying you shouldn't renegotiate but a lot of us would really have to kill ourselves in clinic just to get close to generating that kind of procedural volume. Doesn't seem like you're doing that
 
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10-12 RFs/week is pretty silly. you cant be evaluating all those patients adequately. i agree with dr. ice in that you are being sent a patient for a procedure, doing the procedure, and moving on without evaluating if they need it or if their outcomes are any good. we all know that the surgeons dont know their heads from that asses when it comes to the appropriate procedures, and PCPs / PAs are just as bad.

what you have, my friend, is a block shop.

that being said, if you can look yourself in the mirror, then you should be making >500k/year. you really need to figure out a way to get in on the ASC shares. thats fair for everyone, and the ortho guys wont be able to crap on you as much.
 
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I agree with some of the posters on here--the numbers don't add up. I'm in private practice currently and I don't see how it's possible for you to generate those procedural numbers based on the average number of clinic visits you have per week. You're multiple standard deviations beyond the norm for procedural conversion rates. Unless, of course, you're being fed procedures by surgeons, which could account for your numbers.

In any case, you're getting screwed financially. No question about it. There's a huge disconnect between the revenue you generate and what you're being paid.
 
FitDoc said:
Hi all!

Before you hijack this thread, let me start by saying I've done quite a bit of research and not found the answers I'm searching for on the forums or elsewhere. I really need updated info on this.

I'm currently a Board Certified PM&R Spine Specialist, with two fellowships behind me (including Interventional Spine). I've been in practice for about 3.5 years. I see about 60 patients a week (outpatient), over a 3 day period and probably up to 35% of those get some type of office based intervention (TPI, IA joint, tendon inj). I do between 5-10 EMGs per week. We have a surgery center, where I do lots of procedures. In a given week, I will do 1-2 SCS trials (avg 5-6 per month), about 10-12 RFAs per week (most of which are either 3 level unilateral, or 2 level bilateral), and a large number of inter laminar and TFESI procedures (probably averaging about 40-45 per week). In addition, we also do PRP injections (which are all cash), averaging 1-2 per month. I also do a large number of cervical ESI/RFA/MBB, and I do cervical stims.

Now don't get me wrong, I'm paid fairly well (I think), but there's been some discussion about modifying the salary plus bonus to a more incentive based structure. Given the potential wrinkle in the original contract, I'm wondering what my skill set may be worth in the market. (purely for negotiation, mind you). I've spoken with different folks around the country with access to this kind of information. Some say for the #of procedures, the experience, and the volume (not including the reputation), I'd fall somewhere around the high $400's - $500k. Granted, I'm nowhere near that number, but would be happy to continue where I'm at with a reasonable bump.

Would like to hear feedback from those who are in the know about such things.
Click to expand...

You appear to be as productive as 5 Kaiser Pain MD's....
 
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To answer the above questions, in actuality, there is another physiatrist in our practice doing a nearly equal number of procedures, sans PRP or SCS trials. Two neurosurgeons in the group, and everyone here monitors outcomes on MBB's, for which no one gets to RFA with less than 65% positive outcome x2. All patients we see are consulted in office before moving toward any type of procedures. Also, lots of patients may not be candidates for MBB's. We also send for PT, massage, and on occasion, discharge due to non compliance.

When I tell you we are high volume, the procedure numbers also represent blocks and RFA sent by our neurosurgeons.

We have a high volume practice, but on the basis of the work rendered, I'm now feeling underpayed. The ASC partnership has financial benefits, but imagine going into business with a boss whom you feel has been underpaying you for 3 years.
 
FitDoc said:
To answer the above questions, in actuality, there is another physiatrist in our practice doing a nearly equal number of procedures, sans PRP or SCS trials. Two neurosurgeons in the group, and everyone here monitors outcomes on MBB's, for which no one gets to RFA with less than 65% positive outcome x2. All patients we see are consulted in office before moving toward any type of procedures. Also, lots of patients may not be candidates for MBB's. We also send for PT, massage, and on occasion, discharge due to non compliance.

When I tell you we are high volume, the procedure numbers also represent blocks and RFA sent by our neurosurgeons.

We have a high volume practice, but on the basis of the work rendered, I'm now feeling underpayed. The ASC partnership has financial benefits, but imagine going into business with a boss whom you feel has been underpaying you for 3 years.
Click to expand...
You are underpaid and most likely undervalued. Doesn't change the fact that they are feeding you guys a ton of procedures based on the numbers you quoted in your first post. That's probably gonna be a tough negotiation for you but if you get the other guy on board you might have some leveraging power...some.
 
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You don’t mention anything besides salary. Are you getting other forms of remuneration?

Retirement matching, healthcare, and disability can run a business a lot, upwards of $300-500k.

You might be “under paid” at $400k, but not at $400k + everything else...
 
FitDoc said:
To answer the above questions, in actuality, there is another physiatrist in our practice doing a nearly equal number of procedures, sans PRP or SCS trials. Two neurosurgeons in the group, and everyone here monitors outcomes on MBB's, for which no one gets to RFA with less than 65% positive outcome x2. All patients we see are consulted in office before moving toward any type of procedures. Also, lots of patients may not be candidates for MBB's. We also send for PT, massage, and on occasion, discharge due to non compliance.

When I tell you we are high volume, the procedure numbers also represent blocks and RFA sent by our neurosurgeons.

We have a high volume practice, but on the basis of the work rendered, I'm now feeling underpayed. The ASC partnership has financial benefits, but imagine going into business with a boss whom you feel has been underpaying you for 3 years.
Click to expand...



if you cant beat em, joint em.

if you plan on staying a while, then buying shares is a no-brainer.
 
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Ducttape said:
You don’t mention anything besides salary. Are you getting other forms of remuneration?

Retirement matching, healthcare, and disability can run a business a lot, upwards of $300-500k.

You might be “under paid” at $400k, but not at $400k + everything else...
Click to expand...

We just convinced them to get a 401k after 2 years of discussion. We have healthcare, and disability. Most other practices I've seen have those perks as well, so apples to apples, less than $400k would just be "lean".
 
These posts are funny.

"I went to a frat party and saw a guy slip something in my drink. The next thing I remember, I wake up without pants in some strange bed. Do you think I got f**ked?"

You know the answer. The question is what you are willing to do about it.
 
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BUT... just in case you don't know. They are making more off of you than YOU are making off of you.
 
typically, apparently, benefits run 30% of your base salary. not to harp the point, but that might come out to $120,000 to $200,000. $600K is not a bad salary...

you are in a nice situation as a needle jockey, you will probably only find the kind of numbers if you stay in that sort of practice. wont be easy to find another situation like that.

before you decide to jump ship, realize that you are in a fairly uncommon situation. you dont have to fight to find work, and it doesnt sound like you worry about billing, marketing, finances, etc. with all the work they are giving you, though, they probably arent stressed out about you leaving, either.

i agree with above - getting ASC shares may be best way to improve your financial status... without a lot of the stressors of going on your own.
 
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Ducttape said:
typically, apparently, benefits run 30% of your base salary. not to harp the point, but that might come out to $120,000 to $200,000. $600K is not a bad salary...

you are in a nice situation as a needle jockey, you will probably only find the kind of numbers if you stay in that sort of practice. wont be easy to find another situation like that.

before you decide to jump ship, realize that you are in a fairly uncommon situation. you dont have to fight to find work, and it doesnt sound like you worry about billing, marketing, finances, etc. with all the work they are giving you, though, they probably arent stressed out about you leaving, either.

i agree with above - getting ASC shares may be best way to improve your financial status... without a lot of the stressors of going on your own.
Click to expand...

I think you have a good situation. You dont have to worry about anything at all. No marketing, financing, banking, staffing, nothing. Don't need to worry about your referral sources drying up because they are captive. I'd try to buy into ASC and get more vacation rather than more money. You've got a great situation there to be paid well with minimal business risk or after hours work to build the business.
 
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clubdeac said:
Let me make sure I understand. You're seeing 60 clinic patients a week (a lot of which have a -50 modifier for in-office add on procedures) + 5-10 EMGs + 40-45 procedures per week of which 1-2 are stim trials and 10-12 are RFAs? This is just my opinion and based on my 2 years in pp but I would say you should be collecting b/w 1-1.5 million a year. Assuming 50% overhead you should be bringing in somewhere b/w $500-750k. If you're making less than 400k you're getting screwed
Click to expand...
Ligament said:
I think you have a good situation. You dont have to worry about anything at all. No marketing, financing, banking, staffing, nothing. Don't need to worry about your referral sources drying up because they are captive. I'd try to buy into ASC and get more vacation rather than more money. You've got a great situation there to be paid well with minimal business risk or after hours work to build the business.
Click to expand...

They are dropping salary to $320k.
 
Ligament said:
That is definately not reasonable. I take my words back. They are ripping you off. With the volume you are seeing, you should be in the 450-600K range
Click to expand...

I'm requesting some or one of you to offer up any contracts that you've negotiated (minus personal identifiers) that would structure a realistic salary with perks in the neighborhood of "realistic compensation". I've been given the option to present to them other contractual agreements that would yield those numbers. Of course, apples to apples, the clinic must have an ASC.

Please PM if you can provide.
 
Dr. Ice said:
What's the bonus structure?
Click to expand...

That's yet to be determined, but I'm told it may allow me to get recompensation up to my current salary, if I work harder. Lol!
 
FitDoc said:
I'm requesting some or one of you to offer up any contracts that you've negotiated (minus personal identifiers) that would structure a realistic salary with perks in the neighborhood of "realistic compensation". I've been given the option to present to them other contractual agreements that would yield those numbers. Of course, apples to apples, the clinic must have an ASC.

Please PM if you can provide.
Click to expand...
Why bother? If they are actually cutting your salary, then where are you really going to get with those a$$ clowns? Check PM.
 
just tell them you want your collections - overhead. And you will take no more than 40% as overhead. If they try and negotiate then say 45%. You would still get still get 1.85 million - (0.45 x 1.85 million) = $1,017,500. Honestly that's how much you should be taking home. Other board members please correct me if I'm wrong here
 
clubdeac said:
just tell them you want your collections - overhead. And you will take no more than 40% as overhead. If they try and negotiate then say 45%. You would still get still get 1.85 million - (0.45 x 1.85 million) = $1,017,500. Honestly that's how much you should be taking home. Other board members please correct me if I'm wrong here
Click to expand...
I don't know many surgical groups that would allow you to go into an eat what you kill formula without having you pay at least 50% overhead if not more. Probably closer to 55% and the only way this formula would benefit the surgeons is if the overhead was equally distributed dispite collections which is not a great deal.
 
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FitDoc said:
They are dropping salary to $320k.
Click to expand...
What was justification of Drop?
Good chance they are already recruiting someone they can pay a lower salary to if you balk
 
clubdeac said:
just tell them you want your collections - overhead. And you will take no more than 40% as overhead. If they try and negotiate then say 45%. You would still get still get 1.85 million - (0.45 x 1.85 million) = $1,017,500. Honestly that's how much you should be taking home. Other board members please correct me if I'm wrong here
Click to expand...

Do you want to be "right" or do you want to stay married?
 
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Yeah, 3.5 years is about the time they decide it's time to either pay you more or replace you, and it looks like #2. Nobody ever changes to a salary + bonus system if they think you'll make more money in bonuses than you do now.
 
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True that. He also sent me this. I don't have direct access to MGMA but I asked my group's HR manager if he could send it to me. He sent me these 2 files, only one labeled pain mgmt.
 

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You need to start looking for another job ASAP. They are going to replace you with a new grad. Rinse and repeat in 3 years. It’s not personal. They want the least cost to generate money at their asc
 
nvrsumr said:
You need to start looking for another job ASAP. They are going to replace you with a new grad. Rinse and repeat in 3 years. It’s not personal. They want the least cost to generate money at their asc
Click to expand...

Question for the OP: "Are you partnership material?" Do you do any rain-making?
 
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drusso said:
Question for the OP: "Are you partnership material?" Do you do any rain-making?
Click to expand...
This is a very important question to ask. To the op..if you did an actual analysis of your practice and were able to determine the amount of collections you were personally and independently responsible for without the surgical feeding, do you think you would be able to make enough to justify the salary they pay you? It's hard to figure out because at the end of the day you work for them and technically the argument is that the patients are "theirs." But if you can separate your evals + work up + procedures vs what they are sending you, it may help gain some perspective.
 
onewithpain said:
True that. He also sent me this. I don't have direct access to MGMA but I asked my group's HR manager if he could send it to me. He sent me these 2 files, only one labeled pain mgmt.
Click to expand...
Wow these numbers look pretty good. Do others on this board feel as though these are pretty accurate? Pain in private practice looks as good as it ever was
 
I wonder if the total compensation numbers are with or without bennies..
 
onewithpain said:
True that. He also sent me this. I don't have direct access to MGMA but I asked my group's HR manager if he could send it to me. He sent me these 2 files, only one labeled pain mgmt.
Click to expand...

Thanks for the post.

If these numbers are accurate, these are pretty much on par or even >> than ortho with regards to salaries, correct?
 
MGMA numbers always seem to skew high to me.
 
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onewithpain said:
True that. He also sent me this. I don't have direct access to MGMA but I asked my group's HR manager if he could send it to me. He sent me these 2 files, only one labeled pain mgmt.
Click to expand...

I thought avg partner salaries mid career were in the 500k range?
 
These surveys include pain docs that use the "narcs for procs" model and the "ancillaries for pts" model and the "JD-chiro-MD" model, etc, etc. Most of the high earners I know who are legit pain docs (unlike above) are rural and hospital employed. Among SDN pain docs, I think our avg is probably 350 or so before benefits. You can thank me for bringing the average down.
 
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hyperalgesia said:
These surveys include pain docs that use the "narcs for procs" model and the "ancillaries for pts" model and the "JD-chiro-MD" model, etc, etc. Most of the high earners I know who are legit pain docs (unlike above) are rural and hospital employed. Among SDN pain docs, I think our avg is probably 350 or so before benefits. You can thank me for bringing the average down.
Click to expand...

350k or so mid-career or starting? I've seen a number of starting salaries at like 350-400k +. Should those be taken as something fishy is going on?
 
MGMA is hospital based, includes benefits
 
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