First job

[usadoc88]

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I'm graduating from residency this year. I have interviewed in 4 clinics. I'm trying to make a decision between 2 of them. One offers a base salary of 80% in the second year whereas the other is completely based on RVU's. Hoping that others can share their experience with me. Is it common to be compensated on an RVU basis only in the 2nd year onwards?
Thanks

 

[cabinbuilder]

What is the base salary? How many patients are you expected to see in a day? Is there student loan repayment offered? They expect you to be ONLY on RVU's from day one without having any type of panel? What is the retirement compensation? What is the medical insurance benefit? How long is the contract for? Is there an out clause if you absolutely hate it? Is there a grace period in the beginning where you can "feel" out the practice and be able to get out if the fit isn't right?

I don't think you are getting responses because there are so many unanswered questions with what you have put out there, it's difficult to say whether it's a good contract or a bad one.

 

[deleted87716]

"Base salary of 80%" doesn't mean anything. 80% of what...?

And, no...it's not common to be compensated based on RVUs until your employer has dropped the mask, usually after you're already trapped.

 

[usadoc88]

Thanks for the replies.

One job offers 195 K guarantee in the first year. In the second year salary is 91% work RVUs, 3% quality, 3% collegiality, 3% service. They do not offer student loan repayment. I will have to build up my own practice. Most providers see 20-24 patients per day. Contract is for 3 years.

Second job 220 K guarantee the first year. Second year they offer 80% of the first years' guarantee and the rest depends on the number of pts seen. Most providers seeing 18-20 patients per day. Have to see NH patients once a month. No student loan repayment. 3 year contract. Will have to build up my own practice.

I'm confused. I liked the first job that I have described more but I'm concerned regarding the 91% RVU that I have to generate starting the second year. Most of my friends are getting 60-80% of the base in the second year.

 

[deleted87716]

I'd say in both cases that you should be prepared to earn less in year two than year one. These are typical bait-and-switch schemes employed by health systems to lure people in (high first-year guarantee, then change the rules). What happens after the 3-year contract is up?

 

[cabinbuilder]

To me both offers sound bad. I just couldn't do either.

 

[usadoc88]

I thought they are both reasonable offers. Please can you give me more insight as to why they are both bad offers? Do I need to look some more?

 

[cabinbuilder]

I thought they are both reasonable offers. Please can you give me more insight as to why they are both bad offers? Do I need to look some more?

They may be ok offers for you, not for me. I know right now that Family Practice is THE HOT COMMODITY. There should be sign on bonus, there should be student loan repayment, they should move you. I would NEVER do a 3 year contract - I would do 1 year with option to extend. Sound like they are trying to trap you into indentured servitude. I'm with Blue Dog, sounds like a trap. There is SOOO much better out there.

195K after taxes, etc will put you about 10K/month take home. Are you going to be able to pay all your bills with that and have a cushion?

 

[usadoc88]

You are right it may be tight. What would you say a reasonable number of interviews is?

 

[deleted87716]

 

[usadoc88]

Blue dog, I hope I am understanding you right. So this is a trap because in the 2 nd year my income will go down right considerably? Then wouldnt getting a base salary in the 2 nd year be better than RVU only? What would a good contract salary look like for 3 years? Forgive all the questions. I'm a newbie and feel so lost right now. Thank you for the input.

 

[deleted87716]

Blue dog, I hope I am understanding you right. So this is a trap because in the 2 nd year my income will go down right considerably?

Correct.

Then wouldnt getting a base salary in the 2 nd year be better than RVU only?

If you're building a practice from scratch, almost certainly.

What would a good contract salary look like for 3 years?

The actual salary amount would be dependent upon hours, location, volume, and duties (inpatient, outpatient, OB, etc.) The point is that a year isn't likely to be enough time to build up a practice, so you're virtually guaranteed to see your income drop after the first year. Personally, I think that's a crappy way to treat people. Maybe that's just me.

 

[KnuxNole]

They may be ok offers for you, not for me. I know right now that Family Practice is THE HOT COMMODITY. There should be sign on bonus, there should be student loan repayment, they should move you. I would NEVER do a 3 year contract - I would do 1 year with option to extend. Sound like they are trying to trap you into indentured servitude. I'm with Blue Dog, sounds like a trap. There is SOOO much better out there.

195K after taxes, etc will put you about 10K/month take home. Are you going to be able to pay all your bills with that and have a cushion?

Is it easy to find jobs with sign on bonuses and loan repayments?

 

[cabinbuilder]

Is it easy to find jobs with sign on bonuses and loan repayments?

The thing with jobs is that you have to understand that THEY NEED YOU, YOU DON"T NEED THEM. I learned through the first few jobs that all contract are negotiable, all numbers are negotiable, all requests are negotiable. They are only going to offer the minimum and you won't get a bonus or loan repayment UNLESS YOU ASK.

 

[VA Hopeful Dr]

The thing with jobs is that you have to understand that THEY NEED YOU, YOU DON"T NEED THEM. I learned through the first few jobs that all contract are negotiable, all numbers are negotiable, all requests are negotiable. They are only going to offer the minimum and you won't get a bonus or loan repayment UNLESS YOU ASK.

Bingo. I wish I had asked for more in my first job, but I just didn't know any better.

 

[Bacchus]

How do you guys feel about the first job being in a nonprofit health system? Where I'm at there are two major health systems (St. Luke's and Lehigh Valley). They don't really offer loan repayment. Should I feel stuck/obligated to work at one of these locations since they're nonprofit and "hopefully" I'll get PSLF? I don't think the loan repayment is negotiable from I've heard from others looking in this area.

 

[KLycos]

I'm still going to be suspect about PSLF until I hear a testimonial from a physician. I wan't to hear exactly how much debt was wiped, and when. Until then I'm personally pretending that the funding is going to be yanked or some lawyer will find a way to reneg on the deal based on vague language or some bull excuse.

 

[deleted87716]

How do you guys feel about the first job being in a nonprofit health system? Where I'm at there are two major health systems (St. Luke's and Lehigh Valley). They don't really offer loan repayment. Should I feel stuck/obligated to work at one of these locations since they're nonprofit and "hopefully" I'll get PSLF? I don't think the loan repayment is negotiable from I've heard from others looking in this area.

"Nonprofit" is a tax designation. They're likely still making plenty of profit.

That being said, loan forgiveness (even for primary care) is still uncommon outside of medically underserved areas because (let's face it) it's risky and expensive if you're the employer. If the employee quits, you're screwed. Most would rather just give you a higher salary guarantee.

 

[cabinbuilder]

"Nonprofit" is a tax designation. They're likely still making plenty of profit.

That being said, loan forgiveness (even for primary care) is still uncommon outside of medically underserved areas because (let's face it) it's risky and expensive if you're the employer. If the employee quits, you're screwed. Most would rather just give you a higher salary guarantee.

I agree, take the higher salary, figure out what your loan payment will be. Have that added into your salary they have offered and pay it automatically so you don't miss it.

 

[usadoc88]

I'm looking in a suburban area and none of them offer loan replacement.
All the jobs I've looked at have a first year guarantee ranging from 165-220. I'm concerned regarding falling for the high first year guarantee trick but this area is fairly expensive and 165 may not be enough.

 

[cabinbuilder]

I'm looking in a suburban area and none of them offer loan replacement.
All the jobs I've looked at have a first year guarantee ranging from 165-220. I'm concerned regarding falling for the high first year guarantee trick but this area is fairly expensive and 165 may not be enough.

Sounds like you are trying to start your new first job in a saturated area. In that case you will not have any pull because PCP's are not scarce. You won't get loan replacement either. The more the need, the more negotiating power you will have. $165K is extremely low and that is something you will have to weigh if you are dead set on a give area. Many new grads go work 3- years in an underserved area, make bank, pay off your loans, THEN move where the pay is low if location is more important to you.

 

[deleted87716]

$165K is extremely low and that is something you will have to weigh if you are dead set on a give area.

$150-180 is actually a pretty average starting salary for a M-F, outpatient-only job in a desirable area. Most of these jobs will have a considerable upside once you're a partner or reasonably busy on production. If an initial offer is super-high, there's going to be a reason. Be afraid.

 

[cabinbuilder]

$150-180 is actually a pretty average starting salary for a M-F, outpatient-only job in a desirable area. Most of these jobs will have a considerable upside once you're a partner or reasonably busy on production. If an initial offer is super-high, there's going to be a reason. Be afraid.

Fair enough, I just know that I did this coming out of residency and barely broke even and ended up quitting because my debt to income ratio was too much.

 

[usadoc88]

Thank you for all the info. Would you say 220 is too high and I should be worried? The 220 offer is in a ' rural area' about half an hour away from a town of population 80000. It is not a highly desirable area. Providers reside in the nearby town not the area of pracitise. 2nd year onwards there is a base salary of 80%.
The other offer is in the suburbs of a big city. 190k income guarantee but the catch is that in the second year close to 90% is wRVU based. That scares me.
I want to make a good choice as I have a family and would hate to have to relocate after a year.

 

[usadoc88]

Sorry nearby town population is 45000.

 

[cabinbuilder]

Thank you for all the info. Would you say 220 is too high and I should be worried? The 220 offer is in a ' rural area' about half an hour away from a town of population 80000. It is not a highly desirable area. Providers reside in the nearby town not the area of pracitise. 2nd year onwards there is a base salary of 80%.
The other offer is in the suburbs of a big city. 190k income guarantee but the catch is that in the second year close to 90% is wRVU based. That scares me.
I want to make a good choice as I have a family and would hate to have to relocate after a year.

Why is this? What is bad about the town where they practice??

 

[cabinbuilder]

I will say, too, that a lot of getting into the first job requires a little bit of trust and a lot of luck. I took that leap 4 times in 4 years and got burned EVERY SINGLE TIME. So much of what I say comes from my own fear and known failures over the past 5 years. I'm too skittish to even think about a perm job anymore.

Blue dog and the others have has stable jobs it seems and can better advise you. But only you know what your monthly minimum bills will be so don't get caught coming up short because it's really hard to backtrack and get the contract you "need" once you are in the thick of it.

 

[usadoc88]

Rural area, 16,000 population, I guess not much to do. Schools not great. Nearby town has all the amenities, great schools, etc. Some people say drugs and gang activity. I don't know if that will affect me. They have a need for physicians. I guess drugs is a problem in all small towns now a days.

 

[deleted87716]

IMO, the biggest variable in determining your happiness is who you're working for/with and how they're treating you, not how much money you're paid. This is difficult for an applicant to assess, but any effort doing so will be time well spent. If you're being taken advantage of or treated as a commodity, run away. As in clinical medicine, don't blow off red flags, and pay attention to the hair on the back of your neck. 😉

 

[cabinbuilder]

IMO, the biggest variable in determining your happiness is who you're working for/with and how they're treating you, not how much money you're paid. This is difficult for an applicant to assess, but any effort doing so will be time well spent. If you're being taken advantage of or treated as a commodity, run away. As in clinical medicine, don't blow off red flags, and pay attention to the hair on the back of your neck. 😉

Totally agree... You may want to get a 3 month trial period clause put into your contract. I found if after 3 months you are happy with the job then you will stay happy. Usually by that time you see all the ugly (and the good) that the job offers.

 

[usadoc88]

Cabin builder and Bluedog , Thank you for your advice! It sure does help. I appreciate your time.

 

[shivasHeroLike]

here's my 2 cents:

1) salary is highly dependent location: inner city, suburb, rural, east coast vs west coast vs south vs midwest.

2) you need a guaranteed salary first year because you don't have any patient panel.. if you started RVU you wouldn't make jack. RVU is all about complexity of what you performed which is obviously dependent on if you are seeing patients. most new grads end up with a full patient panel after a year--but that is a question you need to ask your employer how long it takes for a new doc to have a full panel. Then once you are full an RVU model is not a bad idea because you control the level of service you provide which is dependent on your skillset, knowledge of what things make high RVUs (i.e. procedures, post hospital discharge follow ups), and ability to code. There are calculators out there that will calculate RVUs for various code sets (new vs old patients, level 3s, 4s, procedures) .. just input in a typical # of patients you'll see a day with mix of levels and see what you come up. You should get over 200k easy if you are seeing 18 patients/day.

3) most are offering 20k signon on bonus (or forgivable loan after 2 yr of service) and moving expenses paid for. please ask for it. the employers write this off so its no biggie for them.

 

[styphon]

Look into NHSC loan repayment program - which is independent of the employer and is based on an areas need (as measured by the NHSC)