Getting good deal for rural

[cbrons]

I am a PGY-2 currently looking for a post-residency job. I was told to look early especially if I want to practice rural (outpatient and inpatient preferably in the west/mountain states e.g. Idaho, WY, Montana, Utah) so I could get a stipend while I am a resident and a good signing bonus. I have been using websites like practicelink and careerMD but I'm not sure these are the best?

- What is the best way to find a job, particularly in rural areas?
- What is the best way to get a good signing bonus? Are places like these typically open to negotiating?
- I've seen for example 9-5pm outpatient M-F in northern wyoming town of like 10k for 200k/year, which seems low. Do places typically low-ball and are open to negotiating?
- What are good selling points that might earn you a larger contract? (e.g. procedure-wise, willing to do critical care, etc. - for example, I have an interest in addiction and have a buprenorphine waiver w/ experience in addiction clinics during residency, do places want people with such credentials?)

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[Scope guy]

3rnet.org for rural markets.
10% of annual salary can be negotiated for sign on
resident stipend may be considered based on income potential. but they may ask for 3 or 5 year term. could be 1500k/mo
outpatient in such states, you should negotiate to 225-250k base that rolls to production in two years. ALWAYS ASK HOW MUCH YOUR RVU IS and HOW MUCH CURRENT PHYSICIANS IN OUTPATIENT MAKE PER year, to give an idea of long term earning potential. see if there is need for PCP in that area, current wait time for new patients to get to see a doc.
most places have pain management doing opioid stuff. real rural clinics may let you do, provided you get such privileges at the hospital system.learn as much procedures as possible in clinic setting before graduation, after which you have to spend money to go to hands on courses.

 

[cbrons]

3rnet.org for rural markets.
10% of annual salary can be negotiated for sign on
resident stipend may be considered based on income potential. but they may ask for 3 or 5 year term. could be 1500k/mo
outpatient in such states, you should negotiate to 225-250k base that rolls to production in two years. ALWAYS ASK HOW MUCH YOUR RVU IS and HOW MUCH CURRENT PHYSICIANS IN OUTPATIENT MAKE PER year, to give an idea of long term earning potential. see if there is need for PCP in that area, current wait time for new patients to get to see a doc.
most places have pain management doing opioid stuff. real rural clinics may let you do, provided you get such privileges at the hospital system.learn as much procedures as possible in clinic setting before graduation, after which you have to spend money to go to hands on courses.

Just 10% that seems kind of low?

 

[USCguy]

Find a town you want to live in, then call the hospital there and ask for the physician recruiter or the administrative assistant for the CEO, etc. For rural, liking the town is more important, in my opinion, than how much money they are going to pay you (as all rural systems are by default going to pay you well). Don’t go somewhere you don’t really love/like for an extra whatever dollars/month then end up miserable in 2-3 years. Multiply that by 100 if you have a spouse or kids

If you are willing to do inpatient/outpatient, you are a zebra and should command a “zebra” salary.

I live in a town about 10k large doing inpatient/outpatient and life is good if you are looking for that environment. the money is great, but I stay because I like all the stuff outside of work and my family is happy

Calling the hospital directly is how I got my current job rather than going through a recruiting agency

 

[cbrons]

If you are willing to do inpatient/outpatient, you are a zebra and should command a “zebra” salary.

Thanks for reply.


Could you give me an idea of numbers? I would be extremely grateful. If you'd prefer PM I would be OK with that too.

SOme places I've talked to thus far are offering the "MGMA average" for just outpatient, which I have been thinking is low, especially for towns of 10k. I

 

[USCguy]

Thanks for reply.


Could you give me an idea of numbers? I would be extremely grateful. If you'd prefer PM I would be OK with that too.

SOme places I've talked to thus far are offering the "MGMA average" for just outpatient, which I have been thinking is low, especially for towns of 10k. I

I think it is reasonable to expect MGMA median coming out of residency, especially for an outpatient only position. For an inpatient/outpatient mixture, a little above MGMA would be reasonable to start. One way to accomplish this is to use the MGMA average for wRVU then add in a call coverage bonus, etc.

The last MGMA 50th percentile for internal medicine (that I could find) was around $45/wrvu. So let’s say you negotiate for $46/wrvu and your facility agrees; but you also want to protect yourself from doing endless nights of call so you negotiate a call bonus of say $500/night for nights over 7 per month or something like that. So then you do 9 days of call that month and get $1000 added to your paycheck, effectively increasing your dollars per wrvu above the median.

Now, obviously you had to take call to accomplish that, but if you are looking at working inpatient/outpatient mix in a rural facility; you are gonna be taking call anyway. And they will pay it to keep from hiring locums that cost twice as much

I think a guarantee of 225,000 for a year or two with wrvu of 45-46 is really good starting out...then make sure you get that call coverage bonus in there too

Once you have been there a while and prove yourself as hard working for the facility; you renegotiate for a higher wrvu amount. “I’m producing at the 90th percentile; I just think it’s fair to get paid equivalently”

 

[USCguy]

The goal is to tip toe right up to the line where you risk busting fair market value without going over

 

[cbrons]

I think it is reasonable to expect MGMA median coming out of residency, especially for an outpatient only position. For an inpatient/outpatient mixture, a little above MGMA would be reasonable to start. One way to accomplish this is to use the MGMA average for wRVU then add in a call coverage bonus, etc.

The last MGMA 50th percentile for internal medicine (that I could find) was around $45/wrvu. So let’s say you negotiate for $46/wrvu and your facility agrees; but you also want to protect yourself from doing endless nights of call so you negotiate a call bonus of say $500/night for nights over 7 per month or something like that. So then you do 9 days of call that month and get $1000 added to your paycheck, effectively increasing your dollars per wrvu above the median.

Now, obviously you had to take call to accomplish that, but if you are looking at working inpatient/outpatient mix in a rural facility; you are gonna be taking call anyway. And they will pay it to keep from hiring locums that cost twice as much

I think a guarantee of 225,000 for a year or two with wrvu of 45-46 is really good starting out...then make sure you get that call coverage bonus in there too

Once you have been there a while and prove yourself as hard working for the facility; you renegotiate for a higher wrvu amount. “I’m producing at the 90th percentile; I just think it’s fair to get paid equivalently”

How does the call coverage bonus work in that example? Does that mean if you have to come into the hospital or just if you get called overnight (e.g. clinic call overnight)?

 

[USCguy]

So you would be identified as the on call doctor for the hospital patients under your care. Whether you have to go to the hospital during the night or not is irrelevant...since you are at risk of being bothered during the night, you should get a little extra for that burden

In my situation, I would be the hospitalist for our group for a week (day and night) and then one of the other guys would come on after me in a rotation. When I joined my practice, there were 8 docs rotating a week at a time; now I’m the only one that does inpatient/outpatient in my group... all the others are either outpatient only or hospitalist only. For a while I didn’t have much locus hospitalist help so I may cover the hospital for 16, 17 days total that month. I have a bonus structure where if I work more than a defined amount of days, I get a set amount of money above and beyond my pay I get for production. So if I produced 500 wrvu and got 45/wrvu for that ($22,500) but then got $4,000 that month for excess call, my effective rate per wrvu is $53/wrvu.


You could use this example and then adjust it for your situation to get every penny you can

 

[mido114]

Can you explain how does it work for you to do both inpatient and outpatient IM ?

 

[USCguy]

Can you explain how does it work for you to do both inpatient and outpatient IM ?

It’s basically like a hospitalist gig, except I do clinic for a few hours in the middle of the day, and on the days I’m not rounding I work in the clinic all day.

 

[cbrons]

So you would be identified as the on call doctor for the hospital patients under your care. Whether you have to go to the hospital during the night or not is irrelevant...since you are at risk of being bothered during the night, you should get a little extra for that burden

In my situation, I would be the hospitalist for our group for a week (day and night) and then one of the other guys would come on after me in a rotation. When I joined my practice, there were 8 docs rotating a week at a time; now I’m the only one that does inpatient/outpatient in my group... all the others are either outpatient only or hospitalist only. For a while I didn’t have much locus hospitalist help so I may cover the hospital for 16, 17 days total that month. I have a bonus structure where if I work more than a defined amount of days, I get a set amount of money above and beyond my pay I get for production. So if I produced 500 wrvu and got 45/wrvu for that ($22,500) but then got $4,000 that month for excess call, my effective rate per wrvu is $53/wrvu.


You could use this example and then adjust it for your situation to get every penny you can

What do you think are reasonable bonuses for commencement, loan repayment etc. out of residency? And do you think places have room to negotiate on this?

 

[USCguy]

Everything is negotiable

20-30k signing
10-15k moving
25k/year loan repayment

IMO, these are good numbers

 

[cbrons]

Everything is negotiable

20-30k signing
10-15k moving
25k/year loan repayment

IMO, these are good numbers

For rural areas?