ENT Compensation

[JieLi]

I know salary isn't the most important factor on whether to go into a specialty but I think its still important nonetheless to be educated about it beforehand so as there will be no suprises

Anybody have any information on about how much ENT can be expected to make in a big city in different settings? Private practice, academics, Kaiser?

I've seen a few of those surveys out there and they seem to have too broad a range to be useful... Also it looks like almost every other surgical subspecialty makes more (urology, ortho, ...) Why?

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[plauto]

very approximate but the younger guys doing H&N at my institution start around 300K. Several guys in private practice around here are around 800K. So, it depends on where you practice, what procedures you do, how nice you are with patients, how good you are at running your practice...oh yeah, and what Obama and company think your time is (not) worth....

 

[Pir8DeacDoc]

very approximate but the younger guys doing H&N at my institution start around 300K. Several guys in private practice around here are around 800K. So, it depends on where you practice, what procedures you do, how nice you are with patients, how good you are at running your practice...oh yeah, and what Obama and company think your time is (not) worth....

800k is in the very high end of things. My guess is they are deep into their career and have many ancillary services like allergy, in office CT scan, etc. Don't expect to make that sort of money. It will become more and more uncommon in the future.

You're not going to make what a spine surgeon makes, but you're also not going to make what a pediatrician makes. ENT is like a lot of other surgical subs. You can make roughly what you want within reason, it just depends how much time and energy you want to put into it.

 

[bronx43]

I know salary isn't the most important factor on whether to go into a specialty but I think its still important nonetheless to be educated about it beforehand so as there will be no suprises

Anybody have any information on about how much ENT can be expected to make in a big city in different settings? Private practice, academics, Kaiser?

I've seen a few of those surveys out there and they seem to have too broad a range to be useful... Also it looks like almost every other surgical subspecialty makes more (urology, ortho, ...) Why?

Why do you think? Where does your income come from as a physician? There isn't some special "compensation" fairy that flies around dropping off "total comp" packages at your doorstep. What you make is how many patients you see or how many procedures you do multiplied by what each patient/procedure pays by way of reimbursement, then you subtract your overhead. It just so happens that orthopedic procedures are well reimbursed at the moment, and they have high demand and volume. Will that remain true in the future? Probably not, but that's a different discussion altogether.

 

[OtoHNS]

very approximate but the younger guys doing H&N at my institution start around 300K. Several guys in private practice around here are around 800K. So, it depends on where you practice, what procedures you do, how nice you are with patients, how good you are at running your practice...oh yeah, and what Obama and company think your time is (not) worth....

These numbers are certainly on the (very) high end of ENT compensation but are possible. To make $800k without doing a lot of cosmetics would require business savvy, a very high volume of patients, and a lot of ancillary services (in-office CT, allergy, audio, hearing aid sales, etc).

Here are some figures I've heard through the grapevine over the years:

New hire in private practice in competitive market: $150-200K/year
New hire in rural underserved market (usually has included hospital guarantee for X number of years): $300-400k/year
Partner in private practice (2-3 years after being hired): $300-400k/year or more depending on how hard you want to work
New hire, academics: ~$200k/year
Academics, tenured: $300k
Academics, chairman: high $300s
Busy, successful facial plastics/cosmetics: $1 million and up (sky's the limit)

All these figures are only what I've heard and vary to some extent based on region, insurance reimbursements in the area, business acumen of the practice, volume of patients, etc.

 

[womp]

Why do you think? Where does your income come from as a physician? There isn't some special "compensation" fairy that flies around dropping off "total comp" packages at your doorstep. What you make is how many patients you see or how many procedures you do multiplied by what each patient/procedure pays by way of reimbursement, then you subtract your overhead. It just so happens that orthopedic procedures are well reimbursed at the moment, and they have high demand and volume. Will that remain true in the future? Probably not, but that's a different discussion altogether.

It also depends on your patient pool. Ortho sports is more immune from Medicare cuts than say Urology.

 

[resxn]

These numbers are certainly on the (very) high end of ENT compensation but are possible. To make $800k without doing a lot of cosmetics would require business savvy, a very high volume of patients, and a lot of ancillary services (in-office CT, allergy, audio, hearing aid sales, etc).

Here are some figures I've heard through the grapevine over the years:

New hire in private practice in competitive market: $150-200K/year
New hire in rural underserved market (usually has included hospital guarantee for X number of years): $300-400k/year
Partner in private practice (2-3 years after being hired): $300-400k/year or more depending on how hard you want to work
New hire, academics: ~$200k/year
Academics, tenured: $300k
Academics, chairman: high $300s
Busy, successful facial plastics/cosmetics: $1 million and up (sky's the limit)

All these figures are only what I've heard and vary to some extent based on region, insurance reimbursements in the area, business acumen of the practice, volume of patients, etc.

Agree with OtoHNS numbers which are very accurate compared to what Plauto said. I am continually amazed at what medical students think doctors make each year. $800k? I wish. There are those guys out there, but trust me they are few and far between. The 95th percentile for income for an ENT in the US is $400k according to the MGMA.

 

[plauto]

Agree with OtoHNS numbers which are very accurate compared to what Plauto said. I am continually amazed at what medical students think doctors make each year. $800k? I wish. There are those guys out there, but trust me they are few and far between. The 95th percentile for income for an ENT in the US is $400k according to the MGMA.

I just indicated a range of what ENTs make in the city where I live. It does actually decently line up with OtoHNS's numbers.

 

[Celcius]

Why do you think? Where does your income come from as a physician? There isn't some special "compensation" fairy that flies around dropping off "total comp" packages at your doorstep. What you make is how many patients you see or how many procedures you do multiplied by what each patient/procedure pays by way of reimbursement, then you subtract your overhead. It just so happens that orthopedic procedures are well reimbursed at the moment, and they have high demand and volume. Will that remain true in the future? Probably not, but that's a different discussion altogether.

It's obvious that the income will be based on how many procedures you do multiplied by compensation for the procedure for any field... but why is orthopedics for example compensated proportionally more for their procedures than ENT is? If compensation for ortho procedures ends up being cut in the future, it would make sense that compensation for ENT procedures would likewise be cut, would it not?...

 

[bronx43]

It's obvious that the income will be based on how many procedures you do multiplied by compensation for the procedure for any field... but why is orthopedics for example compensated proportionally more for their procedures than ENT is? If compensation for ortho procedures ends up being cut in the future, it would make sense that compensation for ENT procedures would likewise be cut, would it not?...

The reimbursement fee schedules are determined by the RUC (Relative Unit Update Committee), which is made up of different specialties. Medicare takes RUC's recommendations for reimbursement rates, and private insurances usually use Medicare as a basis for their own reimbursement rates. This whole set-up makes no sense whatsoever, as I would challenge anyone to come up with a convincing argument for how you can determine price of a service or good outside of the context of a free market. And medicine certainly isn't a free market.
If compensation for ortho procedures goes down, it would probably bode badly for all surgical specialties, save for some general surgery procedures, whose reimbursement rates are already at rock bottom. Personally, I don't foresee a bright and sunny future for most surgical specialties. In fact, I would extend those sentiments to most of medicine, except for primary care.

 

[resxn]

The reimbursement fee schedules are determined by the RUC (Relative Unit Update Committee), which is made up of different specialties. Medicare takes RUC's recommendations for reimbursement rates, and private insurances usually use Medicare as a basis for their own reimbursement rates. This whole set-up makes no sense whatsoever, as I would challenge anyone to come up with a convincing argument for how you can determine price of a service or good outside of the context of a free market. And medicine certainly isn't a free market.
If compensation for ortho procedures goes down, it would probably bode badly for all surgical specialties, save for some general surgery procedures, whose reimbursement rates are already at rock bottom. Personally, I don't foresee a bright and sunny future for most surgical specialties. In fact, I would extend those sentiments to most of medicine, except for primary care.

While I agree that the cost of medicine would be best served in a free market which we don't have and never will in this country, I have to disagree with the idea that if ortho goes down so too do other specialties.

If you look at the history of reimbursement since 1981, there are numerous examples where one field was cut dramatically and all other specialities were left unscathed. The most recent example is the 30% cut to cardiologists that took place last year. They got reamed to the tune of a 1/3 of their Medicare income, but no other specialty was affected by those cuts.

Any cut is bad for medicine as a whole and generally portends a trend to try to preserve money on the payer side, but this does not always translate to cuts across the board. I predict that the current disproportionate reimbursement for ortho will be short-lived and ultimately become more congruent with other service lines.

 

[resxn]

error

 

[resxn]

I just indicated a range of what ENTs make in the city where I live. It does actually decently line up with OtoHNS's numbers.

hmmmmm. . . . . . .yeah, not so much

 

[kilroth]

Just did interview trail for small community hospitals. Offers ranged from 280 (with full loan repayment) to 480 with partial loan repayment... guess which one I'm taking?

Employed. No purchasing office/equipment. No risk. 3 year guarantee then eat what I kill.

 

[nordr]

Just did interview trail for small community hospitals. Offers ranged from 280 (with full loan repayment) to 480 with partial loan repayment... guess which one I'm taking?

Employed. No purchasing office/equipment. No risk. 3 year guarantee then eat what I kill.

That's encouraging. Are you just finishing residency?

 

[bronx43]

Just did interview trail for small community hospitals. Offers ranged from 280 (with full loan repayment) to 480 with partial loan repayment... guess which one I'm taking?

Employed. No purchasing office/equipment. No risk. 3 year guarantee then eat what I kill.

Is there a Walmart within 50 miles of the hospital paying you 480k starting out?

 

[kilroth]

Yeah it's not too rural. Some were... but they were around my home town so I would have family there. In the end, the "least rural" one paid the most because I hit it off with them. They weren't even looking for an ENT... I cold called them.

 

[DrBodacious]

I've heard from one guy coming out and joining a hospital based practice that his "guarantee" for the first 3 years has strings attached. For his set up, he still has to meet some production quotas, i.e. he can't flounder for 3 years, otherwise he owes them money back after the three years.

It sounds like it is more of a "line of credit" so you can plan on a lifestyle while you are starting out, and that assuming you become busy, you will be fine.

It would seem if you are moving in to a market with reasonable demand, and you have reasonable ability to attract patients, you shouldn't have any problems.

Is this consistent with what you all have heard about these deals?

 

[kilroth]

Yea some are like that. In fact, my #2 choice was. I got hints of "well you'll have to decide if you want to scale back your vacation" if you want to meet the guarantee. Didn't seem like a guarantee to me.. only extra stress.

My job is definitely not going to be like that. Made it very clear. In fact, VP said he'd be happy if I made 20% the first year. My guarantee is for 3 years with no pay backs if I leave. I really have no risk except staying there for 3 years. I really like the location though so may stay for my career.

 

[resxn]

A word of caution on guarantees.

If you are given a guarantee, it will, by necessity come with some sort of string. The most common string is one that is benign in terms of contract but will kick you in the arse later. This is the forgiveness period. Most guarantees come with a requirement to stay in the primary service area of the facility providing the guarantee for a period of time--typically 3 years for a 1 year guarantee. Where you get reamed on this is that a guarantee with forgiveness over 3 years is considered by the IRS to be a loan. So let's take some easy math and say your guarantee is for $500k with $250k set aside for salary and $250k for overhead expenses (rent, payroll, insurance, equipment, etc). The forgiveness period (time you're required to stick around after the guarantee) is exactly that. Take $500k and divide it by the 3 years--$167k. This will be what your hospital reports to the IRS as your 1099-MISC income for each of those years as your forgiveness. The longer the forgiveness the lower the 1099-MISC.

Why this hurts is because even if you are making $250k at the end of the guarantee (which many 2nd year ENT's won't be able to do depending on location), you will be reporting that amount plus the $167k plus any additional income to the IRS. In other words, you will be paying about 35% on $167k that you never actually made. Therefore, not only will you owe $87.5k in taxes on the $250k income (minus deductions this is more reaslistically to be about $60k with a good accountant) you will also owe $58.4k on the $167 from the 1099-MISC which would be a grand total of $118.4k in taxes on a total of only $250k in income. That's quite a pinch. And I would certainly call that a string.

There are often other strings too. Non-competes come to mind, not only in terms of geographic vicinity, but also to employees.

If a contract looks too good to be true, I'd be very leery that you weren't seeing the big picture. Remember, these health care systems have enough depth to their pockets to hire the right attorneys to make sure their needs come first. The 1099-MISC is not a malicious thing on their part, but it certainly is a component of contracts that many incoming attendings overlook.

 

[blz]

Just did interview trail for small community hospitals. Offers ranged from 280 (with full loan repayment) to 480 with partial loan repayment... guess which one I'm taking?

Employed. No purchasing office/equipment. No risk. 3 year guarantee then eat what I kill.

Can someone elaborate more on these job opportunities that offer loan repayments? Considering that I will be in a crapload of debt when I finish residency, I would be interested in this option, howeveer, it seems way too good to be true.

 

[HEENT]

Agree with OtoHNS numbers which are very accurate compared to what Plauto said. I am continually amazed at what medical students think doctors make each year. $800k? I wish. There are those guys out there, but trust me they are few and far between. The 95th percentile for income for an ENT in the US is $400k according to the MGMA.

Are you sure about that? I agree that $800k is absurd to expect as a reasonable amount. But MGMA 2010 says 90th percentile is $725k (quite a lot more than $400k)

 

[Rollo]

Are you sure about that? I agree that $800k is absurd to expect as a reasonable amount. But MGMA 2010 says 90th percentile is $725k (quite a lot more than $400k)

Yeah the median, according to 2010 MGMA, is around 370K.

Link: http://forums.studentdoctor.net/showthread.php?t=817247

 

[resxn]

Are you sure about that? I agree that $800k is absurd to expect as a reasonable amount. But MGMA 2010 says 90th percentile is $725k (quite a lot more than $400k)

Agree, and quite a difference from the $413k quoted in 2007 MGMA that I had. Apologize for that. One thing to keep in mind is that the MGMA themselves have suggested the survey over-reports compensation by 10-11% so the $700k is probably more realistically $630--still a nice sum.

Also, regional variances can be as great as 18% between the highest and lowest--again at least in 2007.

 

[kilroth]

resxn,

I'm going to be salary for 3 years but there is no forgiveness time mentioned in contract. I will also get 30k a year for loans every year that I stay up to 5 years, and that is taxed (so not quite as sexy).

I need a good accountant I see!

 

[kilroth]

oh and for MGMA, you will see drastic numbers because the average salaries are broken down in so many different ways.. and it depends what the hospital shows you. I found this out because they would show me the charts in the survey (which is very expensive to buy so only hospitals can afford it)... and I saw very different numbers.

From what I gathered in my region, 75% is around 450k and 90th % is around 600ish.

 

[resxn]

resxn,

I'm going to be salary for 3 years but there is no forgiveness time mentioned in contract. I will also get 30k a year for loans every year that I stay up to 5 years, and that is taxed (so not quite as sexy).

I need a good accountant I see!

That's great that there is no forgiveness, but that just means that you'll pay the taxes the same year and won't get reamed during the forgiveness, so I think your getting a better deal than most on guarantees. The taxes on the $30k isn't so bad but when it's on the entire package is when you get nailed.

Sounds like you got a sweet deal. Good luck!

 

[JieLi]

New MGMA was released this week. Urology took a 5% hit. Interestingly the limited media version they released doesn't include ENT.

I wonder whether ENT went up or down.

 

[Silent Cool]

Why do you think? Where does your income come from as a physician? There isn't some special "compensation" fairy that flies around dropping off "total comp" packages at your doorstep. What you make is how many patients you see or how many procedures you do multiplied by what each patient/procedure pays by way of reimbursement, then you subtract your overhead. It just so happens that orthopedic procedures are well reimbursed at the moment, and they have high demand and volume. Will that remain true in the future? Probably not, but that's a different discussion altogether.

Bronx,

Are saying that...the compensation fairy isn't....isn't real?? Say it ain't so...

 

[Pir8DeacDoc]

Raise an eyebrow with large guarantees for a lot of years. I'm in PP but the last two ENTs at the hospital got way overpaid for 3 years and when that time was up they either took a huge pay cut or left. Both left. No one wants to cut their take home in half.

 

[nacholibre]

grades, research, shadowing, volunteer, extracurricular during undergrad (stress)
Do well on MCAT (stress)
Apply / Get into med school (stress)
Research in Med school (stress)
Get higher than average Step 1 Score (stress)
Apply to Residency (stress)
Step 2 (kind of stress)
Match (most stress of my life)
Residency (chronic stress + no sleep)

AND THE PRIZE: Lots of potential money + all of the above mentioned stress ya'll are talking about here.

WHEN WILL IT END??

Take home point here: should have just taken over the family plumbing business. :smile:

 

[Pir8DeacDoc]

You forgot yearly in service exams and then that big written and oral test for board certification. Stress and testing are just part of the territory. I'm glad to be done with the testing part for awhile.

 

[neutropeniaboy]

grades, research, shadowing, volunteer, extracurricular during undergrad (stress)
Do well on MCAT (stress)
Apply / Get into med school (stress)
Research in Med school (stress)
Get higher than average Step 1 Score (stress)
Apply to Residency (stress)
Step 2 (kind of stress)
Match (most stress of my life)
Residency (chronic stress + no sleep)

AND THE PRIZE: Lots of potential money + all of the above mentioned stress ya'll are talking about here.

WHEN WILL IT END??

Take home point here: should have just taken over the family plumbing business. :smile:

The job isn't for everybody.

Sent via Tapatalk.

 

[nacholibre]

Honestly, I feel really lucky to be in a position where these are the stresses in my life, I'm sure there are plenty of people out there who would call these extremely "first world" problems, but man it really adds up. Not at any point along this path to a career do you fully comprehend the difficulty/stress that lies ahead. But I have a feeling that getting to stand in the OR a few times a week for 30 years while people let me cut them open and fix miscellany of problems makes all the "hassle" worth it.

Agree? Disagree?

 

[JekyllandHyde]

Agree and Disagree.

I definitely agree in that it is a huge privilege to be able to do what doctors do everyday.

I disagree in that I don't think I should just be "okay" with declining reimbursement given how much time and money I've sacrificed and continue to sacrifice to get to the point where I could practice independently.

Not to mention how the recent maintenance on my car costs more than some lifesaving surgeries.

But thats my two cents...