This is the problem with how medicine is going in general - it’s hard to get new docs to see that joining a small independent practice is smart move.
Having been both an employee for several large systems/groups in the past as well as a partner in a small (and now largish) group I can say that it’s true - offering or promising a salary of 458k is pretty hard to justify especially for the small group.
On the other hand, large employers can often offer these salaries in exchange for less work due to a variety of factors (better contracts, market dominance, full ancillary services, self referral etc). If a practice takes off and is busy with all the ancillary revenue streams and good contracts etc then they can offer even higher than this salary; but why would they (for a new grad)?
Again, to reiterate, some insights after going through a (fairly extensive) application cycle this year as a new grad. I would say that salaries and compensation models are very specific to individual practice setting (i.e. academics, large institution, private practice) and geography (regional and urban versus rural).
- I would say that (as a new grad), most practices I've applied to in the Midwest and West Coast offered generally between 400-450k to new grads/hires.
- In the Midwest, this was generally a 4 day work week. On the West Coast, this was generally a 4.5 to 5-day work week. You could chose to take a 4-day work week on the West Coast for a reduced salary.
- The larger institutions generally used a salary-based model (i.e. academic and large multi specialty practices) so this was a long-term salary. They also had pretty sweet benefits (e.g. retirement plans with significant employer contributions, vacation, etc).
- The private practice groups usually offered a 1-2 year salary with a switch to a production-based model after this period. Some also offered a production-based model from the get go with a "safety net" guaranteed salary for the first 1-2 years.
- Many of the providers I did talk to, said it was not uncommon for your salary to decrease after 1-2 years with a switch from a salary to production-based compensation model. That is, unless you were willing to take less vacation time and/or see more patients - many chose not to for work-life balance. For some people, though, this model can lead to a higher salary if you're willing to work for it.
- Most of the private practices on the West Coast are getting sucked up into the private equity world, and I found this environment not appealing to me from a patient care perspective.
- I did apply to a few institutions in the Northeast, but didn't pursue extensively, as I found the salaries offered by larger institutions in those areas were not comparable with the salaries offered at similar-type institutions in the Midwest or West Coast. Though, it is possible this may be related to the institutions and specific city I applied to.
- Some of my friends pursued rural positions, where they'll be making between 500-600k as new grads. Not a bad option if you don't mind the location.
