Family Medicine Salaries Continue to Climb

[FiveRivers]

http://www.aafp.org/news/practice-professional-issues/20160617salarysurvey.html

Average $225,000; some earning $340,000.

Speaking to recruiters recently confirms this.

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[cabinbuilder]

I can confirm this. I'm in the middle of those 2 numbers.

 

[deleted87716]

I can confirm this. I'm in the middle of those 2 numbers.

Ditto, but I'm not salaried.

 

[TedStark]

Offered 225-275k plus bonuses depending on how much inpatient I was willing to do.

 

[Doctor4Life1769]

It's all regional

 

[SLC]

Got an offer yesterday for $350k base + 90% each inpatient and 100% for all procedures yesterday.

 

[medhead1990]

Got an offer yesterday for $350k base + 90% each inpatient and 100% for all procedures yesterday.

those are some pretty big numbers! what the catch?

 

[SLC]

those are some pretty big numbers! what the catch?

It's in a tiny town in the Texas Panhandle.

Saw a job advert for $450k in South Dakota too.

 

[SuckySurgeon7]

Those numbers blow my mind... did they describe the sheer amount of willpower it takes to break free of your manacles once a month and step foot outside the hospital? Seriously, though, is there a description of the actual amount of time spent in the hospital doing stuff and what kind of stuff it is?

I feel like a kindergartener being led away by a man with a big sucker... but those numbers look pretty sweet. @cabinbuilder , was it you who mentioned she was stuck in a small town in Alaska and literally couldn't go more than a couple miles out of town? I might be getting it mixed up with someone else, but that's the kind of indentured servitude I see expect with that cash.

 

[cabinbuilder]

Those numbers blow my mind... did they describe the sheer amount of willpower it takes to break free of your manacles once a month and step foot outside the hospital? Seriously, though, is there a description of the actual amount of time spent in the hospital doing stuff and what kind of stuff it is?

I feel like a kindergartener being led away by a man with a big sucker... but those numbers look pretty sweet. @cabinbuilder , was it you who mentioned she was stuck in a small town in Alaska and literally couldn't go more than a couple miles out of town? I might be getting it mixed up with someone else, but that's the kind of indentured servitude I see expect with that cash.

No that wasn't me. I'm from Alaska and have done locums there but never with restrictions.

 

[Doctor4Life1769]

those are some pretty big numbers! what the catch?

I said it's all regional...

 

[medhead1990]

It's in a tiny town in the Texas Panhandle.

Saw a job advert for $450k in South Dakota too.

WOW! those are some big #'s. As suckysurgeon said is there any indication of hours anticipated in that position in TX, Im sure its not just a 40 hr week expectation ( which is fine), however im curious if its one of those gigs where you are looking at 100 hr week consistently.

 

[medhead1990]

I said it's all regional...

Totally agree. I have a buddy or two who are thinking of doing fam in places like San Fran and NYC and it makes me cringe... because the demand is low(ish) in those places the pay is (as far as ive seen) on the lower end of the spectrum AND you are living with some of the highest costs of living in the country. ouch!

 

[Richie Truxillo]

Can confirm this is easily possible if you do some inpatient work.

 

[Merely]

Is this because payments are increasing for the work and procedures that FM does? Or just because salaries are increasing? In other words, would a solo practitioner also see his income rise?

 

[JustPlainBill]

And how many years of experience are we talking about? You couldn't pay me enough to do inpatient medicine, ever....

 

[Mjolner]

And how many years of experience are we talking about? You couldn't pay me enough to do inpatient medicine, ever....

What's so bad about inpatient medicine??


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[Merely]

What's so bad about inpatient medicine??


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As an FM doc you are the least respected in the hospital, similar to hospitalists so its not nice being in a place where you dont get much respect. It's nicer being in PP in your own office where you don't have to deal with dingus colleagues. I doubt this is the major reason but probably a secondary or tertiary reason for some.

 

[Mjolner]

As an FM doc you are the least respected in the hospital, similar to hospitalists so its not nice being in a place where you dont get much respect. It's nicer being in PP in your own office where you don't have to deal with dingus colleagues. I doubt this is the major reason but probably a secondary or tertiary reason for some.

See. Over in the anesthesia forum they say their the least respected. I feel like this is a grass is always greener thing for the most part.


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[JustPlainBill]

What's so bad about inpatient medicine??


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I had a very abusive residency program that taught me to despise inpatient medicine --- there was no room for legitimate questions -- if you asked for help in any way, it was used against you --- for example, an intern asking about juggling the need to give a patient Lasix while at the same time trying not to impact their kidney function which was already on the edge and how to balance the two, the preferred method of dose titration, etc. was turned into a discussion of the interns medical incompetence.

As a 3rd year on nights, I had taken over a patient from day shift who was admitted for cellulitis --- already on vanc/zosyn, CPAP, morbidly obese, IVF as they were becoming tachycardic and hypotensive -- started becoming febrile and did not respond to antipyretics --- when they were stuporous and difficult to arouse, I called the attending to give them a heads up that this one may be going to the ICU --- that turned into a discussion with my residency advisor that I was a 3rd year who didn't know how to handle a fever....

No, I will NOT do inpatient medicine --

 

[needachange2017]

Did you guys choose family med because of the money, shortage, and the minimal years required to finish residency?

Just asking cause i recently made the switch i to radiology from surgery and now wondering if i shouldve gone into family instead.

Asking purely for monetary reasons.

 

[smq123]

Did you guys choose family med because of the money, shortage, and the minimal years required to finish residency?

Just asking cause i recently made the switch i to radiology from surgery and now wondering if i shouldve gone into family instead.

Asking purely for monetary reasons.

For me, the money was not as important.

The shortage of family medicine has translated into tremendous location flexibility. As family medicine, we can find a job practically anywhere. Rural, urban, suburban, NYC, Texas, California - you can get a job pretty much anywhere you want. More lucrative fields don't have that luxury, as I found out first hand when my rad onc boyfriend started looking for jobs.

Minimal years needed to finish training isn't bad either.

That being said, you do have to enjoy the work. It's not for everyone. Why did you choose radiology?

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[Ericslv]

See. Over in the anesthesia forum they say their the least respected. I feel like this is a grass is always greener thing for the most part.


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Thats because anesthesia doesn't have a home. The surgeon is the king in the OR.

 

[Ericslv]

I had a very abusive residency program that taught me to despise inpatient medicine --- there was no room for legitimate questions -- if you asked for help in any way, it was used against you --- for example, an intern asking about juggling the need to give a patient Lasix while at the same time trying not to impact their kidney function which was already on the edge and how to balance the two, the preferred method of dose titration, etc. was turned into a discussion of the interns medical incompetence.

As a 3rd year on nights, I had taken over a patient from day shift who was admitted for cellulitis --- already on vanc/zosyn, CPAP, morbidly obese, IVF as they were becoming tachycardic and hypotensive -- started becoming febrile and did not respond to antipyretics --- when they were stuporous and difficult to arouse, I called the attending to give them a heads up that this one may be going to the ICU --- that turned into a discussion with my residency advisor that I was a 3rd year who didn't know how to handle a fever....

No, I will NOT do inpatient medicine --

I agree. Let the hospitalist do it. Less call for you and less interaction with the ER doc.

 

[Ericslv]

Did you guys choose family med because of the money, shortage, and the minimal years required to finish residency?

Just asking cause i recently made the switch i to radiology from surgery and now wondering if i shouldve gone into family instead.

Asking purely for monetary reasons.

Both you choices (surgery and radiology) seem to point the the direction of least patient contact. In surgery the patients are mostly asleep and in radiology you don't have to see them at all.

The fact that you changed from surgery means that you didn't even want to interact with the patients post or pre surgery. Just my opinion but its seems you choices were to avoid patient contact as much as possible. AND, that is fine. I'm not criticizing it just point out a pattern.

If you go into FM you will be overwhelmed with patient contact and chronic complaints and nagging from patients. At least 20% of your patients will be like that. In some places even more.

On the other hand as some have pointed out in here there is flexibility in family medicine.

As far as the money goes radi0logy makes more right now but there was a time when they didn't make much and there weren't many jobs for them. Think the 90's.

 

[medhead1990]

Did you guys choose family med because of the money, shortage, and the minimal years required to finish residency?

Just asking cause i recently made the switch i to radiology from surgery and now wondering if i shouldve gone into family instead.

Asking purely for monetary reasons.

If you are looking for least amount of time most pay do a 3 year EM residency... FM is NOT the place to go looking to make tons of money. While you may make some pretty big money in certain places as this forum is demonstrating. I am sure it is because there is a ton of work to be done at that locations, i forsee that getting a surgeons salary (ie the 350k mentioned above) comes with two things.
a). You are living somewhere that no one else wanted to consider
b). You are probably working surgeon hours/lifestyle.
When the aforementioned salary was brought up earlier in this thread i had to ask the question "so whats the catch". If the catch is simply option a, I am pretty comfortable living in the middle of no where for a bit if I can make 350k a year, that actually sounds pretty cool to mee. If the catch ends up being a)+b) or even just b), I dont think i could do that. . However long 80+ unpredictable hours, are not something I look forward too as part of my career. Thats a part of a number of things that drew me to family.

 

[Merely]

If you are looking for least amount of time most pay do a 3 year EM residency... FM is NOT the place to go looking to make tons of money. While you may make some pretty big money in certain places as this forum is demonstrating. I am sure it is because there is a ton of work to be done at that locations, i forsee that getting a surgeons salary (ie the 350k mentioned above) comes with two things.
a). You are living somewhere that no one else wanted to consider
b). You are probably working surgeon hours/lifestyle.
When the aforementioned salary was brought up earlier in this thread i had to ask the question "so whats the catch". If the catch is simply option a, I am pretty comfortable living in the middle of no where for a bit if I can make 350k a year, that actually sounds pretty cool to mee. If the catch ends up being a)+b) or even just b), I dont think i could do that. . However long 80+ unpredictable hours, are not something I look forward too as part of my career. Thats a part of a number of things that drew me to family.

It's not just that, you can also make a lot (think 500k) if you open up your own practice and run it like a businessman. Usually, to make a lot of money you can't be someones employee, at least not in FM and other low paid specialties.

 

[psychMDhopefully]

See. Over in the anesthesia forum they say their the least respected. I feel like this is a grass is always greener thing for the most part.


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The thing is, Anesthesiologist can't leave the hospital

 

[Ericslv]

It's not just that, you can also make a lot (think 500k) if you open up your own practice and run it like a businessman. Usually, to make a lot of money you can't be someones employee, at least not in FM and other low paid specialties.

I think you need to get off the 500K thing. It's very rare that an FM doc even owning their own practice is going to make that much. It may be years before they get there if they ever do. 95% of doctors don't have and won't get the skills to get there.

 

[Merely]

I think you need to get off the 500K thing. It's very rare that an FM doc even owning their own practice is going to make that much. It may be years before they get there if they ever do. 95% of doctors don't have and won't get the skills to get there.

I think you're right honestly it probably makes more sense to look at the average of a field and keep that in mind rather than expect the outliers to be the norm.

 

[NurWollen]

I think you need to get off the 500K thing. It's very rare that an FM doc even owning their own practice is going to make that much. It may be years before they get there if they ever do. 95% of doctors don't have and won't get the skills to get there.

The number of hours someone would have to work to make that kind of money sounds like misery incarnate. Not worth it.

 

[Ericslv]

The number of hours someone would have to work to make that kind of money sounds like misery incarnate. Not worth it.

You actually make my point. 95% of doctors don't understand business. Those who are making 500K are not trading time for dollars.

 

[Ericslv]

I think you're right honestly it probably makes more sense to look at the average of a field and keep that in mind rather than expect the outliers to be the norm.

But remember that it's a good thing for those doctors who are willing to do the work to get there. It can be bad as well because if a lawyer makes a million a year he is a great business man but if a doctor makes that much he must have ripped people off and is only in it for the money.

That kind of thinking makes doctors targets and creates jealousy among other doctors that can't or aren't willing to put in the time and effort. But in general the fact that they don't is an advantage to those that do. If you do put in the effort and luck is with you (anyone who makes millions has luck on their side) then you will be able to retire sooner and better assuming you don't spend everything you make.

 

[septoplasty]

I don't know if I agree w/the AAFP here, but than again, I've got zero real world experience.

But as a graduating senior, heading into fellowship in the midwest, our hospital system merged and actually is offering a LOWER base than the previous years did. Go figure. In fact, the competitor health system(s) (granted smaller) are offering a better package including base, which didn't make sense to me in the business aspect..

Now the real question, where/how is the best way to find/negotiate with larger hospital systems for a better base/signing on bonus? My optimistic mind tells me anythings possible.. but i'd essentially be going up against people who make a living out of it.

 

[FiveRivers]

Received an offer for 280K base, with bonuses, goes to 300K.
Phone call 1:5. All outpatient.

 

[FiveRivers]

Got an offer yesterday for $350k base + 90% each inpatient and 100% for all procedures yesterday.

As a resident, I have wondered about this. How much does medicare reimburse for each day of inpatient rounding/patient? I'm sure, just as outpatient, it depends on the diagnosis code? But can anyone provide a rough estimate for the daily inpatient compensation for a patient with say CHF exacerbation? COPD exacerbation? Pneumonia?

 

[VA Hopeful Dr]

As a resident, I have wondered about this. How much does medicare reimburse for each day of inpatient rounding/patient? I'm sure, just as outpatient, it depends on the diagnosis code? But can anyone provide a rough estimate for the daily inpatient compensation for a patient with say CHF exacerbation? COPD exacerbation? Pneumonia?

The highest level initial hospital code (ignoring critical care time) was reimburse about $195. The highest level subsequent code (again, ignoring critical care time) is around $100. So generally speaking the most you're going to make is $100/patient.

 

[VA Hopeful Dr]

I don't know if I agree w/the AAFP here, but than again, I've got zero real world experience.

But as a graduating senior, heading into fellowship in the midwest, our hospital system merged and actually is offering a LOWER base than the previous years did. Go figure. In fact, the competitor health system(s) (granted smaller) are offering a better package including base, which didn't make sense to me in the business aspect..

Now the real question, where/how is the best way to find/negotiate with larger hospital systems for a better base/signing on bonus? My optimistic mind tells me anythings possible.. but i'd essentially be going up against people who make a living out of it.

Depends on how desperate the hospital system is and how badly they want you. I've been able to negotiate up from initial offer about 10-15k in salary. I might have been able to do better if I'd asked for loan repayment, but not sure. Now that being said, I've been living in what counts for the largest 2 out of 3 cities in my state. Had I gone to even #4 or 5 then I likely could've done a decent bit better based on residency classmates who did just that.

 

[HipsterLorax]

Now the real question, where/how is the best way to find/negotiate with larger hospital systems for a better base/signing on bonus? My optimistic mind tells me anythings possible.. but i'd essentially be going up against people who make a living out of it.

Just anecdotal, but a friend that recently graduated had an offer from a large system and an offer from an independent hospital and the smaller hospital was much more open to negotiating. Further, the large system made a bunch of promises in the interview that weren't actually written in the contract. When they asked for those to be written in, they refused. If they're not willing to work with you, it's probably better to look elsewhere.

 

[Ericslv]

I don't know if I agree w/the AAFP here, but than again, I've got zero real world experience.

But as a graduating senior, heading into fellowship in the midwest, our hospital system merged and actually is offering a LOWER base than the previous years did. Go figure. In fact, the competitor health system(s) (granted smaller) are offering a better package including base, which didn't make sense to me in the business aspect..

Now the real question, where/how is the best way to find/negotiate with larger hospital systems for a better base/signing on bonus? My optimistic mind tells me anythings possible.. but i'd essentially be going up against people who make a living out of it.

There are companies that can review your contract and help with negotiation. There are law firms that do this as well. medical employment law firms.

But as a general rule as for what you want and go from there. Make sure you know what that is and more importantly make sure you know what is possible. Then you will get what is probable.

If you want a new car as part of you contract and if you are going to someplace where there is not another doctor for 1000miles you might get it but you won't get that in the middle of LA.

What I always say: You won't get if you don't ask. And don't let them intimidate you. Don't be rude. Be professional and if they make a point during the negotiations that you feel trumped on (I hate using that but it fits here) then tell them you will think about it and go home talk to people and come back if you can. Look them in the eye and tell them what you want. Keep a list in your mind of what you really need to sign the deal and don't sell yourself short.

The MBA at the other end of the table deep inside knows he needs you but won't show it.

I hate the game but it exists.

 

[Brahnold Bloodaxe]

Are all these offers from hospital systems or is physician owned private practice still clinging to life in some areas?

 

[VA Hopeful Dr]

Are all these offers from hospital systems or is physician owned private practice still clinging to life in some areas?

Mostly the former, the latter tends to be more based on collections - ie. a percentage of what you bring in is what you're paid.

 

[VA Hopeful Dr]

There are companies that can review your contract and help with negotiation. There are law firms that do this as well. medical employment law firms.

But as a general rule as for what you want and go from there. Make sure you know what that is and more importantly make sure you know what is possible. Then you will get what is probable.

If you want a new car as part of you contract and if you are going to someplace where there is not another doctor for 1000miles you might get it but you won't get that in the middle of LA.

What I always say: You won't get if you don't ask. And don't let them intimidate you. Don't be rude. Be professional and if they make a point during the negotiations that you feel trumped on (I hate using that but it fits here) then tell them you will think about it and go home talk to people and come back if you can. Look them in the eye and tell them what you want. Keep a list in your mind of what you really need to sign the deal and don't sell yourself short.

The MBA at the other end of the table deep inside knows he needs you but won't show it.

I hate the game but it exists.

Great post.

The one other thing I would add is be prepared to walk away. If you have the ability to do that, you are in a much stronger position than they are. As family doctors, we can always find other jobs. They need us more than we need them.

 

[psychMDhopefully]

I thought Obama care would decrease Drs salaries? At the end of the day physicians have a monopoly on American medical care and deep down everybody knows the Nurses would kill a **** load of people if they tried to do our jobs.

 

[deleted87716]

I thought Obama care would decrease Drs salaries?

Why would you think that...?

 

[psychMDhopefully]

Why would you think that...?

That's what everybody was saying back when it first passed. I remember I almost didn't apply to med school, there was soo much" the sky is falling" crap here people saying physicians pay would be cut in half, etc. Its only after a while I realized there's almost no way that would happen in a capitalist country.

 

[Ericslv]

Great post.

The one other thing I would add is be prepared to walk away. If you have the ability to do that, you are in a much stronger position than they are. As family doctors, we can always find other jobs. They need us more than we need them.

Thank you. And yes you can walk away. Specially now with so many FM positions.

 

[Brahnold Bloodaxe]

That's what everybody was saying back when it first passed. I remember I almost didn't apply to med school, there was soo much" the sky is falling" crap here people saying physicians pay would be cut in half, etc. Its only after a while I realized there's almost no way that would happen in a capitalist country.

The thing is Obamacare hasn't fully hit yet. The two major provisions were health insurance reform and moving away from fee for service. The insurance part has already passed and its effects have probably been either neutral or slightly positive for salaries. The move away from fee for service hasn't started in earnest yet. That's the part that caused the "sky is falling" fears and frankly we don't know whether the sky will fall because it hasn't been implemented yet. But the whole rationale behind getting rid of fee for service is to contain costs ergo physician income. So it's TBD at this point. The impact will be negative, the only question is to what degree.

 

[Ericslv]

The thing is Obamacare hasn't fully hit yet. The two major provisions were health insurance reform and moving away from fee for service. The insurance part has already passed and its effects have probably been either neutral or slightly positive for salaries. The move away from fee for service hasn't started in earnest yet. That's the part that caused the "sky is falling" fears and frankly we don't know whether the sky will fall because it hasn't been implemented yet. But the whole rationale behind getting rid of fee for service is to contain costs ergo physician income. So it's TBD at this point. The impact will be negative, the only question is to what degree.

Most likely primary care salaries won't go down. Specialist salaries is another story. The biggest concern is what happens 5 to 10 years from now.
If you look at salaries of doctors in Australia, primary care does alright and specialist do better but not like they do in the US. They can but I'm talking averages. So by the time you are finished with residency things may look different.

 

[psychMDhopefully]

The thing is Obamacare hasn't fully hit yet. The two major provisions were health insurance reform and moving away from fee for service. The insurance part has already passed and its effects have probably been either neutral or slightly positive for salaries. The move away from fee for service hasn't started in earnest yet. That's the part that caused the "sky is falling" fears and frankly we don't know whether the sky will fall because it hasn't been implemented yet. But the whole rationale behind getting rid of fee for service is to contain costs ergo physician income. So it's TBD at this point. The impact will be negative, the only question is to what degree.

Fee for service isn't going anywhere, there is no other reasonable way to determine what physician should be paid what. Then again, in FM, Psych, IM you can always disconnect from the BS insurance culture and go direct primary care.