Base salary plus productivity

[dpdoc]

Does anyone in the know (PathOne, LA doc, other) know if there are pathology positions in academic medical centers where salaries are structured as base salary plus productivity bonus?

Example: Let’s say a superstar-GU/GIsubspecialty-pathologist wants to join a university based department of pathology that has a small volume of specimens in her particular subspecialty. However, she is such a big-name that private clinicians from local/regional outpatient clinics (unaffiliated with said university) are interested in submitting material to the department to be read by her. The department chair is smart, and realizes that he can recruit her by offering, among other things, a base salary, plus X% of what she bills on material coming from these clinics.

What about consults? Let’s say Mr. or Ms. Soft Tissue Pathologist receives untold numbers of personal consults. Do these people get to keep all they bill on the consults, get just a percentage, or does it all go to the Department?

Just curious.

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[PathOne]

Medicine is a professional field, and like all other professional fields, there's basically no limit as to how cunning and/or elaborate a compensation scheme you can devise. It can be all of the examples quoted above. It can be fixed, but with a shorter workweek, heck it can even include the university/hospital/whatever setting up a brand new department, specifically to lure some über-God into their fold.

Also, a dizzying array of special side-deals are certainly not unheard-of. Do you get to keep $$$ from biotech/pharma consulting? What if you don't, but the institution promises you money for research, so you can have your personal postdoc army? The variations can be endless, IF you're the person they want.

Just remember, that you truly have to be at the top of your game, before they'll truly bend over backwards. However, even at a more junior level, there's often opportunity for making "special arrangements". In that regard, always remember, that pure raw (taxable) income isn't necessarily the only thing to go for...

 

[Potomania]

It depends on how good/reknowned the attending is and on the insitution. In general, in a system like this you are paid a base salary of say, 100K. Then anything you make on top of that is your bonus which is usually made one of two ways, although I am sure numerous veriations exist. First, you are paid according to the volume of clinical work you bring in. Alternatively, you're bonus is paid out according to the dollars you bring in from your research grants. The bonus is calculated by converting dollars brought in to a productivity point scale termed RVUs, a system that I think was started at Vanderbilt (again, I'm no expert but I think this is accurate). That decides your bonus. The technical details vary by institution, but I believe that is the general idea.

That is how the normal folks in academia get paid. Then you have your superstars who get paid even more through consulting contracts with private companies (can be as little as a couple thousand or as much as several hundred thousand), or get paid extra for the consult cases that are sent to them from all over the nation. This also varies by institution, as some institutions keep most of what you make on the consults while others allow the attending to keep a large percentage of the profits. I have heard of attendings at some institutions doubling their salaries by the consult cases alone. Then, there are also the patents for the heavy researchers. Some institutions allow you to keep a high percentage (as much as 50% in some cases) of royalties, whereas others basically take all the royalties for themselves. It is quite rare for someone to really get a ton of royalty money for any patent, but if a blockbuster test is developed or something then this would come into play. You can also collect fees for giving lectures, workshops, etc, but these usually don't amount to much other than a free trip somewhere nice.

The general rule is that academics make less than PP, but if for those zebras in the right place at the right time with the right skills, it is possible to make almost as much, as much, or even substantially more than your average Joe in PP. Not that you meant this with your post, but one should never go into academics with this this latter goal in mind because the odds of you becoming one of these people is miniscule and even those who achieve this do so by sheer dumb luck 9 times out of 10.....instead you should go into academics because you love that type of environment, you love the research, and you love educating others. Hope this helps.

 

[PathOne]

Basically true. On -- average -- private jobs pay more than academic, not infrequently double up. However, the very rare birds I know who make seven figures or high six'es are actually in academic or academic-equivalent settings. Still, these individuals are obviously, on every count, several standard deviations away from the average.

I think that most people find, that other things belong in the equation than just greenbacks - otherwise, all the smart people would end up in the private spectrum, which obviously isn't the case. During residency, and especially fellowship, some people find that they actually attach great value to opportunities like research, education and training, which obviously isn't the first priority in a billing-centric private group.

 

[dpdoc]

Many thanks, potomania and PathOne.

 

[LADoc00]

Does anyone in the know (PathOne, LA doc, other) know if there are pathology positions in academic medical centers where salaries are structured as base salary plus productivity bonus?

Example: Let's say a superstar-GU/GIsubspecialty-pathologist wants to join a university based department of pathology that has a small volume of specimens in her particular subspecialty. However, she is such a big-name that private clinicians from local/regional outpatient clinics (unaffiliated with said university) are interested in submitting material to the department to be read by her. The department chair is smart, and realizes that he can recruit her by offering, among other things, a base salary, plus X% of what she bills on material coming from these clinics.

What about consults? Let's say Mr. or Ms. Soft Tissue Pathologist receives untold numbers of personal consults. Do these people get to keep all they bill on the consults, get just a percentage, or does it all go to the Department?

Just curious.

Almost all pathology groups in academia once you get past junior attending levels are structured as base+bonus.

There are many exceptions to this tho including most positions in public/government or quasi-military/gov settings. This often includes state universities, but sometimes individual operators can eek out being a salaried biotch of the man, UCSF dermpath people are good examples.

The next step is actually negotiating what your cut of the consults/in patient/outreach actually is....that is the tricky part. The hospital/admin will claim a HUGE portion due to overhead, but of course they are gonna rob you.

They will rob you even more if you have no clue what % you should be getting. You need to do serious homework here and people will be reluctant to help. You may even need to spend some capital to hire an attorney and a biz consultant to help with this, but it is money well spent.

 

[PathOne]

Almost all pathology groups in academia once you get past junior attending levels are structured as base+bonus.

There are many exceptions to this tho including most positions in public/government or quasi-military/gov settings. This often includes state universities, but sometimes individual operators can eek out being a salaried biotch of the man, UCSF dermpath people are good examples.

The next step is actually negotiating what your cut of the consults/in patient/outreach actually is....that is the tricky part. The hospital/admin will claim a HUGE portion due to overhead, but of course they are gonna rob you.

They will rob you even more if you have no clue what % you should be getting. You need to do serious homework here and people will be reluctant to help. You may even need to spend some capital to hire an attorney and a biz consultant to help with this, but it is money well spent.

In theory, the math is fairly straight forward.
Scenario: You're at least at demi-God level, or can otherwise justify that you'll bring in your customers yourself, and you're joining a private group:

Income per biopsy/slide/case
- tech cost (cutting, staining, yada yada yada)
- Administrative costs, billing trivia etc
- Pro rata cost of overhead (office space, postage, whatever)
- Agreed contribution to the group's bottom line
= Your value added = your cut

Of course, in a real world, anybody can haggle endlessly over these numbers, although at least the first three should be fairly easy to quantify.

HOWEVER, the group will of course, usually with some justification, say, that they already have some volume in your field. How should that be computed?
Furthermore, in an academic setting, it can get really complicated. To what degree should you be compensated for time spent in research, training, education, etc etc. And/or to what degree should you give up part of your take for others, who perform said duties?

As everywhere else in medicine, a keen business sense is required, in addition to solid medical knowledge, to make seriou$ bank. Trust me, there's some people out there who're letting themselves be robbed on a daily basis, because they have supreme abilities when looking down a 'scope, but zero business sense.