Dermapth - Negotiation

[Dermpath2000]

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I've been following this forum for years, and am posting for the first time hoping for some input and group wisdom.

I'm currently negotiating an employment agreement with a large and expanding dermatology practice to serve as the Lab Director and head dermatopathologist. The lab's volume is over 35K specimens per year ATM. I had a few general questions:

• Compensation for the dermpath would be 50% of PC collected. I'm trying to negotiate a minimum base salary, but was wondering if 50% is within market range or if I should hold for a higher percentage? I asked for 60% with hopes that they would at least bump up a few percentage points, but it doesn't look like they will budge.
• Lab Director compensation is $75K year plus incentives for another $75K (I'm still trying to work out/understand the incentive structure but I'm assuming the bonus will not be fully realized). Curious if there is a rule of thumb for LD compensation? Also would asking for a % of TC collections be reasonable - if so is does anyone know the market range?

Any thoughts or insights would be greatly appreciated.

 

[Torsed]

I can comment on the lab directorship. I would take the 75k and the 75k bonus sounds good in this day and age. I've attempted to get my hospital lab medical directorship increased for years with no luck in this day and age. I would take that 75k for a dermatopathology lab directorship in a heartbeat. If you don't want it I would be happy to direct your lab.

As far as 50% of PC is that total PC collected? Holy crap I would also take that in a heartbeat. The benefit you have is that your derm buddies are not cutting things off of the uninsured, you probably will be top heavy with Medicare, but heck that is not too bad. You mentioned you are the head dermpath, I would ask if you have to pay the other (part/time?) dermpath out of your 50 percent or not?

Do the math for your run of the mill vanilla flavored Medicare PC charge. Someone (LADoc00?) can correct me if my simpllistic neanderthal math is wrong. Say the entire practice of 35k specimens pays 40 dollars in Medicare PC. Half = 20. 35,000 x 20 = $700,000 base guaranteed.

Add in maybe 20 percent BCBS and another 20 percent other payors not Medicare and that number goes up drastically on your contract (likely you will have a professional biller) negotiation skills. Plus add in the lovely IHC / special stain PC I would bet even at 1/2 PC you would be clearing upwards 800 to 900k a year plus medical director on top of that. I think the owners of the group are pretty generous with 1/2 PC in a situation like this. Naturally, they have to treat you well to keep their equivalent 1/2 PC flowing into their accounts.

35k is a large volume of specimens in my eyes. If only one or two of you are doing sign out I question a "safe" number of sign out per pathologist per year. This has been argued back and forth on many forums. If you are in a medicolegal perilous state I would consider this. I haven't gone over the plantiff's attorney's side yet against pathologists but as the big corporate labs squeeze out the little guys like myself, I become more and more mercenary.

I would also be interested if you would care to comment on the no compete clause. Many states do not hold them up in court, but some judges may. I would argue you get a set number of miles, say 30 or so as not to preclude you from working in the area if your family/kids are set up and a big move would upset the family dynamic.

I would advise having a special attorney read your contract, I have used McDonnell-Hopkins in the past, Jane Pine Wood moved on but there is a gentleman there named Richard Cooper who is nice to review such things. You can probably expect 600/hr in fees.

Good luck.

TORSED

 

[mario2010]

I've been following this forum for years, and am posting for the first time hoping for some input and group wisdom.

I'm currently negotiating an employment agreement with a large and expanding dermatology practice to serve as the Lab Director and head dermatopathologist. The lab's volume is over 35K specimens per year ATM. I had a few general questions:

• Compensation for the dermpath would be 50% of PC collected. I'm trying to negotiate a minimum base salary, but was wondering if 50% is within market range or if I should hold for a higher percentage? I asked for 60% with hopes that they would at least bump up a few percentage points, but it doesn't look like they will budge.
• Lab Director compensation is $75K year plus incentives for another $75K (I'm still trying to work out/understand the incentive structure but I'm assuming the bonus will not be fully realized). Curious if there is a rule of thumb for LD compensation? Also would asking for a % of TC collections be reasonable - if so is does anyone know the market range?

Any thoughts or insights would be greatly appreciated.

I would try to negotiate PC% a bit more, I will agree to 50% only if I am losing the deal completely. Recently, I have been offered deals with up to 70% total PC but there was no LD fee and they were smaller volume practices 5-6 K specimens per year. 75K LD is reasonable too. With 35K specimens, for 50% PC your total compensation including stains will be around $1M with a reasonable payor mix. 35 K specimens is pretty doable solo with few years of experience. I am doing around 35K per year myself these days. You will need to arrange for the vacation coverage though if you are by yourself.

 

[Dermpath2000]

Thanks for the insightful response Torsed.

To answer some of your questions and add more clarity:
- There is another derm dermpath (I'm a path trained) and we would be splitting the volume with me reviewing 60%
- This will be a busy lab director position for a derm practice looking to quickly expand by acquisition. I am expected to attend weekly business meetings, provide financial updates, and helping with the intake of additional volume as we expand (and hire more DPs accordingly)
- There is a non-compete for 2years/15 mile radius from the lab which is in a large metropolitan area. I tried striking the clause altogether, but the practice is holding firm regarding the non-compete. The non-compete is not ideal, but ultimately does not completely rule out my metropolitan area.

Cheers,
Dermpath2000

 

[LADoc00]

75K per year for lab directorship of JUST a DP lab is pretty baller. That goes a long way to bridging the 50% of PC.

I also LOVE 50% of PC collected and not 50% of benchmark CMS rates in your region. BUT I would be very very careful to audit the records so you are not short changed. In fact, I would insist on direct access to the billing company or billers to randomly audit as you feel fit.

My guess is the other 75K per year in incentive pay will be vaporware but that isnt a dealbreaker for me.

35K of 88305s is insane. I have a chubby just picturing all that glass. Like a treasure trove of Dwarven slides under a mountain and you are Smaug swooping in to feast.

Obviously get rid of the other slide monkey as soon as possible. #Smaugdontshare

 

[LADoc00]

I would try to negotiate PC% a bit more, I will agree to 50% only if I am losing the deal completely. Recently, I have been offered deals with up to 70% total PC but there was no LD fee and they were smaller volume practices 5-6 K specimens per year. 75K LD is reasonable too. With 35K specimens, for 50% PC your total compensation including stains will be around $1M with a reasonable payor mix. 35 K specimens is pretty doable solo with few years of experience. I am doing around 35K per year myself these days. You will need to arrange for the vacation coverage though if you are by yourself.

you are putting down 35000 accession numbers SOLO? Per year? That is insane. I would assume you have a miniature giraffe, 2 girlfriends who are both models and throne made of solid gold.

 

[LADoc00]

We need to have some SDN baller event at the next CAP national meeting. Something along the lines of "if you pull down over 500K/year verified" then you get a temporary bloodhound tattoo at the meeting and entrance to a private party.

 

[WEBB PINKERTON]

We need to have some SDN baller event at the next CAP national meeting. Something along the lines of "if you pull down over 500K/year verified" then you get a temporary bloodhound tattoo at the meeting and entrance to a private party.

Does the 500K have to be solely from pushing glass?

 

[octopusprime]

lol this is why i go on SDN.

 

[mario2010]

you are putting down 35000 accession numbers SOLO? Per year? That is insane. I would assume you have a miniature giraffe, 2 girlfriends who are both models and throne made of solid gold.

35 K specimens per year. yes Solo. But they are all derms- that's the difference. There is no way I or anyone else can do any where close to 35K for routine surgicals even if they are all biopsies. That's not humanely possible. Don't know about a gold throne dude....I still drive a 13 year old Camry with 100 K plus miles and live in a small condo. Goal is to stay under the radar and exit once the F U level nest egg is ready. May be few more years....

 

[coroner]

There is no way I or anyone else can do any where close to 35K for routine surgicals even if they are all biopsies. That's not humanely possible.

I would argue it's very possible with GI. Can't claim to have done it myself. But, no inflammatory derm or atypical melanocytic lesions to slow one down. Plus, with GI over half of what's biopsied for vague ab. pain or chronic diarrhea turns out to be normal anyway.

I still drive a 13 year old Camry with 100 K plus miles and live in a small condo. Goal is to stay under the radar and exit once the F U level nest egg is ready. May be few more years....

That is sound thinking. The more successful you are, the better it is to keep a low profile...

 

[LADoc00]

35 K specimens per year. yes Solo. But they are all derms- that's the difference. There is no way I or anyone else can do any where close to 35K for routine surgicals even if they are all biopsies. That's not humanely possible. Don't know about a gold throne dude....I still drive a 13 year old Camry with 100 K plus miles and live in a small condo. Goal is to stay under the radar and exit once the F U level nest egg is ready. May be few more years....

huh...
good plan overall. I appreciate your level of self control. I oscillate between a mindfulness state where I can spend no money, fast for a week on only water and have no sex to one of total hedonism along the lines of a Russian oligarch...

keep posting, tell us when you get near the FU egg hatch time. This is the most inspirational type of tale for younger docs on this forum.

 

[AZpath]

50% of PC collected ? All PC out of 35 K cases?
Or just your cases?

50% may be crap if it is you own work load.
You may spend a lot more time then 75K for running the lab than you think.

The real question is what are you are likely to net in either scenario.

 

[AZpath]

I would argue it's very possible with GI. Can't claim to have done it myself. But, no inflammatory derm or atypical melanocytic lesions to slow one down. Plus, with GI over half of what's biopsied for vague ab. pain or chronic diarrhea turns out to be normal anyway.



That is sound thinking. The more successful you are, the better it is to keep a low profile...

You got that right. I know of a dermpath the does 25K. Word has it he is a true workaholic. Takes is his microscope on vacation etc.
Still I have got to wonder how good you can be alone working like this.

I am sure that many pathologist can maintain a good a rep and still do ****ty work. It depends on your local environment.
This is easier in the outpatient setting. Many lab commercial pathology labs would not exist if this were not true.

 

[SEpathguy]

I'm left feeling very inadequate after reading this number (granted I'm doing bone marrows, etc, in addition to general SP so volume will never compare). Did you work out a deal where they only shave off sebs, SCC, and BCC and never send any inflammatory derm or melanocytic stuff? Because if I did the math right, that's over 130 a day, assuming working 5 days a week and never taking vacation (and I'm assuming you do take at least a few weeks of vacation, despite the camry reference, so probably on average ~150/day). I know everyone has different levels of what they're comfortable with, but does it ever feel like way too much? Maybe not - honestly just wondering.

 

[AZpath]

I'm left feeling very inadequate after reading this number (granted I'm doing bone marrows, etc, in addition to general SP so volume will never compare). Did you work out a deal where they only shave off sebs, SCC, and BCC and never send any inflammatory derm or melanocytic stuff? Because if I did the math right, that's over 130 a day, assuming working 5 days a week and never taking vacation (and I'm assuming you do take at least a few weeks of vacation, despite the camry reference, so probably on average ~150/day). I know everyone has different levels of what they're comfortable with, but does it ever feel like way too much? Maybe not - honestly just wondering.

Few people can carry this kind of volume even easy sub specialty work. Most of the groups in our region do 2500-3500 with a general case mix.

My peak was around 4700 cases solo. I did all gross and FS myself.
It included plenty of breast, thorasic surgery, gyn , kidney, colons resections at a 100 bed hospital.

Did it in a 40 hour week too.
I moved right about when the CAP protos came in. I am sure it would take longer now.

If I worked for a polyp mill I doubt that I could do some of the volumes mentioned here.

My narcolepsy would take over. Zzzzzzzzzzzzzzz. Zzzzz.

 

[LADoc00]

There is no way you could anywhere near 20000+ general surgical accessions per year. No one can. Anywhere.

The most I have heard of is 12K per year and that guy literally died on the job.

35K of just derms though is still incredibly respectable IMO.

 

[icpshootyz]

I'm left feeling very inadequate after reading this number (granted I'm doing bone marrows, etc, in addition to general SP so volume will never compare). Did you work out a deal where they only shave off sebs, SCC, and BCC and never send any inflammatory derm or melanocytic stuff? Because if I did the math right, that's over 130 a day, assuming working 5 days a week and never taking vacation (and I'm assuming you do take at least a few weeks of vacation, despite the camry reference, so probably on average ~150/day). I know everyone has different levels of what they're comfortable with, but does it ever feel like way too much? Maybe not - honestly just wondering.

I'm fairly certain most of the big dermpath labs expect around 150 bottles per day per pathologist. Most of it is rapid diagnoses, often on just one slide. Sounds reasonable. GI only could probably handle the same.

 

[Nilf]

I'm left feeling very inadequate after reading this number (granted I'm doing bone marrows, etc, in addition to general SP so volume will never compare). Did you work out a deal where they only shave off sebs, SCC, and BCC and never send any inflammatory derm or melanocytic stuff? Because if I did the math right, that's over 130 a day, assuming working 5 days a week and never taking vacation (and I'm assuming you do take at least a few weeks of vacation, despite the camry reference, so probably on average ~150/day). I know everyone has different levels of what they're comfortable with, but does it ever feel like way too much? Maybe not - honestly just wondering.

Hold on. There is a disconnect here.

I consider myself fairly slow, and at my previous gig at a dermpath mill I EASILY signed out 150 CPTs daily. That's 88305s ONLY, not counting immunos and special stains. On a superbusy day I topped 250. And I've worked with guys who signed out 300+ routinely. Yes including inflammatory crap, excisions, slow mohs, direct immunofluorescence.

A lot pathology can be done if your workplace runs smoothly.

 

[AZpath]

Hold on. There is a disconnect here.

I consider myself fairly slow, and at my previous gig at a dermpath mill I EASILY signed out 150 CPTs daily. That's 88305s ONLY, not counting immunos and special stains. On a superbusy day I topped 250. And I've worked with guys who signed out 300+ routinely. Yes including inflammatory crap, excisions, slow mohs, direct immunofluorescence.

A lot pathology can be done if your workplace runs smoothly.

I was talking accessions. Most of the dermapath cases that I have seen had one biopsy. 20 % have two or more. (I am working with a small sample of providers. )

That would equal about 20K- 48K accessions. Pretty good.
Some body is getting rich.

Lab should be able get 1.8-2.5 on 30K 88305s revenue .

 

[Dave CX]

I've been following this forum for years, and am posting for the first time hoping for some input and group wisdom.

I'm currently negotiating an employment agreement with a large and expanding dermatology practice to serve as the Lab Director and head dermatopathologist. The lab's volume is over 35K specimens per year ATM. I had a few general questions:

• Compensation for the dermpath would be 50% of PC collected. I'm trying to negotiate a minimum base salary, but was wondering if 50% is within market range or if I should hold for a higher percentage? I asked for 60% with hopes that they would at least bump up a few percentage points, but it doesn't look like they will budge.
• Lab Director compensation is $75K year plus incentives for another $75K (I'm still trying to work out/understand the incentive structure but I'm assuming the bonus will not be fully realized). Curious if there is a rule of thumb for LD compensation? Also would asking for a % of TC collections be reasonable - if so is does anyone know the market range?

Any thoughts or insights would be greatly appreciated.

This deal seems excellent to me. If I had similar terms on my GI accounts I would be pushing close to a million.
I average 220 bottles per day (120 or so accessions). It takes around 5 very intensive microscope hours per day and I am wiped out at the end of it. I find that NOT eating lunch has the counterintuitive effect of keeping me alert and focused.

 

[coroner]

I average 220 bottles per day (120 or so accessions).

Yup, I figured it could be done with GI. That's over 27,000 surgicals (accessions)/yr. with 6 weeks off/yr. Dunno if the average dermpath pushing those kind of numbers would feel equally worn out.

I find that NOT eating lunch has the counterintuitive effect of keeping me alert and focused.

Just to be clear: So skipping lunch makes you more or less focused throughout the day?

 

[GlassPushingSally]

There is no way you could anywhere near 20000+ general surgical accessions per year. No one can. Anywhere.

The most I have heard of is 12K per year and that guy literally died on the job.

35K of just derms though is still incredibly respectable IMO.

That's not true. I know of a private practice where there is an OG surgical pathologist who put down 26k cases last year, all general surgery cases and cytology. He works 9am-8pm, six days a week. Just a machine. Really lovely guy. Also takes a half day off in the middle of the week and goes to the beach. You can have it all. Just never leave your desk.

 

[coroner]

I know of a private practice where there is an OG surgical pathologist who put down 26k cases last year, all general surgery cases and cytology.

 

[AZpath]

That's not true. I know of a private practice where there is an OG surgical pathologist who put down 26k cases last year, all general surgery cases and cytology. He works 9am-8pm, six days a week. Just a machine. Really lovely guy. Also takes a half day off in the middle of the week and goes to the beach. You can have it all. Just never leave your desk.

Died of a PE last week....

 

[Dave CX]

Food puts me to sleep. Hunger keeps me alert, but pissed off.