Getting a job

[Hoser]

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2nd year derm resident here, starting to think about where and in what setting I would like to practice. I've talked with a few practices about jobs and their offers but really don't have a lot of things to compare the different offers to. There was a nice thread a while back about finding a private practice job and I've read all of the threads I could find about contracts and compensation, but still wondering about a few things.

I know compensation is a moving target, with salaries, incentive bonuses, benefits, etc all playing a role. It seems that salary plus something like 40-45% bonus after a certain production threshold ($500k? 700k?) has been mentioned as a good target in the past. I'm curious what kind of production bonuses are considered standard? I do realize it also depends on salary guarantee probably, which some of these jobs have. I guess I would love to hear any 3rd year residents' or attendings' experiences and thoughts about what is fair compensation.

 

[Dral]

I in no way mean to hijack this thread at all, but when answering Hoser's questions, it would be awesome if people could also give corresponding perspectives in regards to the world of academics. TIA.

 

[asmallchild]

I'm obviously fairly new to this as well but I was told that base + 40-50% bonus after 2 * base is a nice target. Base is going to depend on the type of job and the location. 50% bonus after 2 * base will probably be on the high end and 40-45% is likely more realistic. FWIW, my contract is base + 40% bonus after 2 * base. After a talk with a couple of private practice docs as well as my contract lawyer (highly recommended), I was told it was a fair deal since I was aiming for a location that is fairly saturated and my offer came with an above average base salary.

I did interview at a couple of academic institutions but my conversations never progressed to serious contract talks. Most of the institutions offered a base + bonus (I was never given any details on the bonus) + overage (if the department made money in the financial year, it seemed a percentage would often be filtered back to the faculty). As expected, base salary is lower than what you find in private practice but not as significant as I had thought (20-25% as opposed to the 50% I was always told as a resident).

 

[doc84]

I understand the base and 50% bonus. Can we talk about actual numbers of typical base and take home way of an average dermatologist?

 

[Hoser]

Thanks for the reply, asmallchild. A specific example for me was a practice offering a pretty high base (280k) with a 30% bonus after ~2.2 x base. Maybe not such a fair deal? I'm also interested, as doc84 is, in what other typical base salaries are.

A few other questions too, since I am quite naive about the whole thing: I assume that most practices will cover interview costs (flight, hotel). True? Are relocation costs typically covered as well?

 

[Hoser]

So, anyone else care to chime in? There seem to be more lively discussions on other specialty forums compared to this forum.

 

[Antynamikal]

So, anyone else care to chime in? There seem to be more lively discussions on other specialty forums compared to this forum.

I'm interested in this, also.

 

[WarEagleOne]

Could someone update this thread on earning rates for gross billings? I'm talking to several practices with no base and only an earning rate per gross billing. Thanks!

 

[asmallchild]

Could someone update this thread on earning rates for gross billings? I'm talking to several practices with no base and only an earning rate per gross billing. Thanks!

My experience with this is limited as I only interviewed at two practices that paid via % only. The same #s seem to be in play. I was told 50% is essentially partnership, 45% excellent, 40% average to good, and 35% is a bit low but this will depend on location (with more desirable areas like NYC, Miami, LA, etc usually in this range if they are doing %-only)

 

[MOHS_01]

My experience with this is limited as I only interviewed at two practices that paid via % only. The same #s seem to be in play. I was told 50% is essentially partnership, 45% excellent, 40% average to good, and 35% is a bit low but this will depend on location (with more desirable areas like NYC, Miami, LA, etc usually in this range if they are doing %-only)

....and these percentages will not be for what you bill out; they are for what you collect. Big difference between gross billing numbers and actual dollars collected. BIG.

 

[MDSlacker]

This is probably a very basic question but when you say you get base + 30-50% bonus after 2 x base does that mean you get a 30-50% bonus after you have worked for 2 years at the base salary or is that after you have billed 2x your base salary or collected 2x your base salary or what? Just a little confused on that.

Also, for the average size practice/academic institution what is an expected take home pay after bonuses and all. I don't mean in NY, Chicago, LA, Miami etc but just your average town. I know in the 2010 MGMA the median dermatologist income was listed as $385K. Is this still accurate?

 

[asmallchild]

....and these percentages will not be for what you bill out; they are for what you collect. Big difference between gross billing numbers and actual dollars collected. BIG.

At a poorly run practice (unfortunately like the one I'm currently in), the difference is startling. Actual dollars collected are just barely above 50% of our gross billing numbers.

 

[asmallchild]

This is probably a very basic question but when you say you get base + 30-50% bonus after 2 x base does that mean you get a 30-50% bonus after you have worked for 2 years at the base salary or is that after you have billed 2x your base salary or collected 2x your base salary or what? Just a little confused on that.

Also, for the average size practice/academic institution what is an expected take home pay after bonuses and all. I don't mean in NY, Chicago, LA, Miami etc but just your average town. I know in the 2010 MGMA the median dermatologist income was listed as $385K. Is this still accurate?

After you've earned 2x the base, you get a %bonus on anything above that threshold. For instance, with a base of 300k, you'll get a %bonus on anything you earn above 600k (and as mentioned in a previous post, it's what you collected, not what you billed)

Hard to put an exact number out there but 385k sounds a little high in terms of a 1st year number at a private practice position. Most of the academic positions I came across had lower salaries. As you already mentioned, that number also came way down when poking around NYC and particularly LA (I didn't look around the other 2 cities you mentioned)

 

[MOHS_01]

$385 is pretty high, yes.... and I'll wager that you won't see that number in any decent sized market. Not starting out - and many will never see it.

At a poorly run practice (unfortunately like the one I'm currently in), the difference is startling. Actual dollars collected are just barely above 50% of our gross billing numbers.

Whoa - pause for just a second. You could be at the best ran practice in the country and this very well could still be the case. It's a math thing - you virtually always bill more than you are contracted to collect for if you do not you are leaving dollars on the table (poor form). Given that private carriers still pay more than govt payers (a little, for a little while at least), math dictates that you can never collect a high percentage of your billing. Many things factor into this, including payer mix, contracted rates, procedure mix, whether you provide multiple procedures on one date of service, and the big one - what you billing fee schedule is set at. If you bill at 200% MC rates or above like many if not most do, you will be mathematically guaranteed to only collect 40-60% of your billed charges depending upon your particular mix as outlined above.

 

[asmallchild]

$385 is pretty high, yes.... and I'll wager that you won't see that number in any decent sized market. Not starting out - and many will never see it.



Whoa - pause for just a second. You could be at the best ran practice in the country and this very well could still be the case. It's a math thing - you virtually always bill more than you are contracted to collect for if you do not you are leaving dollars on the table (poor form). Given that private carriers still pay more than govt payers (a little, for a little while at least), math dictates that you can never collect a high percentage of your billing. Many things factor into this, including payer mix, contracted rates, procedure mix, whether you provide multiple procedures on one date of service, and the big one - what you billing fee schedule is set at. If you bill at 200% MC rates or above like many if not most do, you will be mathematically guaranteed to only collect 40-60% of your billed charges depending upon your particular mix as outlined above.

Very true. Sadly I think our billing department is just too understaffed and beleaguered to do as thorough a job as the physicians (perhaps uninformedly and unreasonably so) expect, especially for a large multispecialty group

And that is already with a recently adjusted billing fee schedule to account for our less than favorable payor mix and contracted rates

 

[MDSlacker]

Just wanted to clarify that the 385K number I said was the median for ALL dermatologists. Not just first year salary. I'm sure first year is much lower than that.

 

[WarEagleOne]

....and these percentages will not be for what you bill out; they are for what you collect. Big difference between gross billing numbers and actual dollars collected. BIG.

Could someone quantify this "big difference"? I'm seeing words like "gross billings rate of 40% minus general dermatology and cosmetic costs". Or words like "40% of net received". Does this mean the actual in-my-pocket rate is much lower than 40%?

 

[asmallchild]

Could someone quantify this "big difference"? I'm seeing words like "gross billings rate of 40% minus general dermatology and cosmetic costs". Or words like "40% of net received". Does this mean the actual in-my-pocket rate is much lower than 40%?

If they promise gross billings rate in the contract, then you'll probably come closer to an actual in-pocket rate of 40%. In my limited experience, that is pretty rare though. Most contracts are worded to reflect 40% of net received. I don't want to go into actual numbers (feel free to PM if you'd like) on a message board but as I stated earlier, what we bill and what we collect often varies by as much as a 2:1 ratio.