How low is too low (PP buy-in/1st yr salary)

[hckyplyr]

Hi all,
Current CA-3 looking for private practice jobs to start next July. What I'm seeing is tons of jobs, mostly private equity/AMC, which I'm not interested in. Being that todays job market is on fire, most starting salaries I'm seeing (not private practice) is $450k-$550k easily. Most PP groups I've talked to say there is "no buy in", but your first salary is very low. Are they just trying to trick me? I mean I don't technically "owe" them anything, but if my first year salary is half the norm, my billable reimbursement money has to be going to someone, because its not me.

Also, call frequency is so diverse, maybe you could help me understand what's a typical "normal" amount of call, and whats considered high? I'll give an example below of the most recent PP I talked to in the South. I'll keep their location out of equation for their anonymity.

-Private practice, 2 year partnership track, small 5 physician group
- First year salary $250k, second year salary $300k (401k starts second year), As partner, I'm told they make $600k-700k year
- 6 weeks vacation non-partner, 10 weeks as partner (starts year 3)
- Mostly supervision, but MD does all regional, epidurals, spinals
- Call Q4, call person goes home around 8-9pm, home call overnight until 7am, they are called in 40% of time overnights (ex. MD has to place epidural, but CRNA manages)
- 2 weekends a month
- CRNAs employed by hospital, in house 24/7
- Great staff, atmosphere, surgeons to work with

It's a smaller town, low COL, low crime, very close to a desirable area in South (think NC/SC/TN area). I feel like 1st and 2nd year salaries are egregiously low, especially in today's hot market, high inflation, large call burden, etc. Would love some more experienced opinions and thoughts on a typical PP non-partner salary and call burden. If I'm being unreasonable, I guess I'll just have to man up though. Thanks all

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[Reveler]

If you’re not making the full salary for a period of time (unless it just represents a payment delay or is bc of decreased productivity), then that’s a buy-in.

 

[DocVapor]

Hi all,
Current CA-3 looking for private practice jobs to start next July. What I'm seeing is tons of jobs, mostly private equity/AMC, which I'm not interested in. Being that todays job market is on fire, most starting salaries I'm seeing (not private practice) is $450k-$550k easily. Most PP groups I've talked to say there is "no buy in", but your first salary is very low. Are they just trying to trick me? I mean I don't technically "owe" them anything, but if my first year salary is half the norm, my billable reimbursement money has to be going to someone, because its not me.

Also, call frequency is so diverse, maybe you could help me understand what's a typical "normal" amount of call, and whats considered high? I'll give an example below of the most recent PP I talked to in the South. I'll keep their location out of equation for their anonymity.

-Private practice, 2 year partnership track, small 5 physician group
- First year salary $250k, second year salary $300k (401k starts second year), As partner, I'm told they make $600k-700k year
- 6 weeks vacation non-partner, 10 weeks as partner (starts year 3)
- Mostly supervision, but MD does all regional, epidurals, spinals
- Call Q4, call person goes home around 8-9pm, home call overnight until 7am, they are called in 40% of time overnights (ex. MD has to place epidural, but CRNA manages)
- 2 weekends a month
- CRNAs employed by hospital, in house 24/7
- Great staff, atmosphere, surgeons to work with

It's a smaller town, low COL, low crime, very close to a desirable area in South (think NC/SC/TN area). I feel like 1st and 2nd year salaries are egregiously low, especially in today's hot market, high inflation, large call burden, etc. Would love some more experienced opinions and thoughts on a typical PP non-partner salary and call burden. If I'm being unreasonable, I guess I'll just have to man up though. Thanks all

The salaries the first two years are atrocious. You need to consider the difference as your buy-in. The partners are essentially making $650k off of you for the first two years. Final numbers, if truly accurate, reflect the very heavy call burden.

 

[Pappy Van Propofol]

The only way I’m taking $250K is if it was working 20 weeks Monday-Friday and no weekends.

 

[NICMAN]

Ask to see their W2s. Many practices include benefits in the total compensation. It makes a big difference if they are bringing in $600-$700k after also receiving $130,000 in benefits. Does that include "paid vacation", profit sharing, 401k, HSA, education fund, life and disability insurance, etc.

 

[UscGhost]

That's an absolutely brutal buy in.

Pretty heavy call burden...my group is Q10 with 1 weekend or less per month..called back 10-20% of the time.

Key is how many units you are generating to get that income. 15000 per year? 12000? 10000? That in effect will tell you how much work you are doing to get that income. So while 650k sounds great..if you need to work 15000 units to get it, then it's a brutal grind.

Also 1099 vs W2. Your tax burden will be substantially higher in the average W2. 1099 gives you much more flexibility with a good cpa

Don't get caught up in the PP vs AMC too much..it really doesn't matter. That is just one factor in whether a group is a good opportunity or not.

There are plenty of great PP and great AMC groups, and plenty of terrible ones. It all depends on location, culture, payor mix, setup.

 

[NICMAN]

I belong to a true (non-private equity) private practice and own 1/32 share of our corporation along with 31 other anesthesiologist.

Here is our new-hire MD compensation package:

- Annual salary $425-paid at fixed monthly rate ($35,416.66)
- Assigned usual (same as any senior partner) number of calls--usually ~1 weekend a month and q10 weekdays.
- 8 weeks vacation
- Full partner after 2 years with equal distributions of surplus revenue
- Up to 2-month ($70k) salary advancement $10k signing bonus
- $15k CME
- 401k after 1 year profit sharing (retirement contribution) after 2 years
- Short-term disability follow Corp policy (5 days PDO, then Corp pays 50% 1st month, 25% 2Nd and 3rd month
- Long Term up to 5k/month paid by Corp
- Portable Disability (up to $15k premium payment yearly)
- Paid life Paid medical, vision, and dental
- HSA w/ employer contribution
- Paid malpractice

 

[kidthor]

That's an absolutely brutal buy in.

Yeah that buy in is garbage. There’s no way I’d sign up for that, also the call burden is high, and the group may not exist in 2 yrs so you’ll be left with a pat on the back. Hard no…

That group is gaslighting you by telling you working for absurdly low pay while they skim off you isn’t a buy in. There’s no other way to properly describe it. Gaslighting is weirdly common in medicine, because a lot of workers are duped or used through it.

In socal where I am most of the previously ponzi-scheme structured practices now offer near or full pay and call equity between partners and new people. The old model of exploiting the new guy by dangling an emphemeral golden carrot in front of them won’t work anymore. There are too many good options out there right now. Make hay while the sun’s shining (today).

 

[D P356]

The salaries the first two years are atrocious. You need to consider the difference as your buy-in. The partners are essentially making $650k off of you for the first two years. Final numbers, if truly accurate, reflect the very heavy call burden.

Buy in from a lower salary over two years is $650k/5 partners. They’re getting 130k (65k/year) each from you while on a partnership track.
They’ll be fronting your salary until AR starts coming in.
You can attempt to negotiate. But don’t become enamored with the partner salary at the cost of supervising hospital employed crnas.

Culture and fit shouldn’t be underestimated.

You’ll be taking less vacation, but does that mean call is still split evenly every quarter, or are you taking more call since you have less vacation.
Evenly split overnight call is the fairest, but if they’re underpaying you and having you take more call than them, that would raise red flags.

 

[aneftp]

If it’s true private practice. I would negotiate a part of any buyout the private practice will take IF YOU DO NOT become partner. Meaning if they sell out and get any profit. That is the only way to protect yourself in the two years if you are taking a low
Buy in. If they balk at it. Take another job. 250k is way too low in this market. Your buy in close to 1 million.

 

[AppTrail]

Year 1 and Year 2 salaries are very low. I would ask for 1-year partnership tract and salary of 350, especially given the q4 call. A lot of physician owned true PP may be suffering now given how CRNAs are leaving to do locums/PRN and PP groups are having to pay a lot in locums pay in the setting of hospitals chipping away on their stipends. A lot can change in 2 years and the PP may not be as profitable as advertised.

 

[linkin06]

This is bs especially in a tight labor market

 

[Maz777]

Red flag. You are going to get churned and burned while someone profits off of you. Run. Q4 call and every other weekend? Just schedule your quit date now during Year 2.

 

[aneftp]

North Carolina is only state I know where crna is employed by hospital with anesthesia private MD docs. That big Charlotte mednax fiasco with the lost of the contract to a fake third party company wholly owned by the hospital was the big prime example what can happen when the hospital gets smart and takes over the anesthesia billing cause they employed the crna’s.

 

[marr65]

Ummmm....run! That salary is totally cow manure in this tight labor market. Also, you will be working a lot!!!

 

[DrOwnage]

To reiterate others… that’s one of the worst buy ins I’ve seen.

 

[Hoya11]

Hi all,
Current CA-3 looking for private practice jobs to start next July. What I'm seeing is tons of jobs, mostly private equity/AMC, which I'm not interested in. Being that todays job market is on fire, most starting salaries I'm seeing (not private practice) is $450k-$550k easily. Most PP groups I've talked to say there is "no buy in", but your first salary is very low. Are they just trying to trick me? I mean I don't technically "owe" them anything, but if my first year salary is half the norm, my billable reimbursement money has to be going to someone, because its not me.

Also, call frequency is so diverse, maybe you could help me understand what's a typical "normal" amount of call, and whats considered high? I'll give an example below of the most recent PP I talked to in the South. I'll keep their location out of equation for their anonymity.

-Private practice, 2 year partnership track, small 5 physician group
- First year salary $250k, second year salary $300k (401k starts second year), As partner, I'm told they make $600k-700k year
- 6 weeks vacation non-partner, 10 weeks as partner (starts year 3)
- Mostly supervision, but MD does all regional, epidurals, spinals
- Call Q4, call person goes home around 8-9pm, home call overnight until 7am, they are called in 40% of time overnights (ex. MD has to place epidural, but CRNA manages)
- 2 weekends a month
- CRNAs employed by hospital, in house 24/7
- Great staff, atmosphere, surgeons to work with

It's a smaller town, low COL, low crime, very close to a desirable area in South (think NC/SC/TN area). I feel like 1st and 2nd year salaries are egregiously low, especially in today's hot market, high inflation, large call burden, etc. Would love some more experienced opinions and thoughts on a typical PP non-partner salary and call burden. If I'm being unreasonable, I guess I'll just have to man up though. Thanks all

agree with call burden being on the extreme end . borderline not sustainable..

my feeling is that 350-450k base salary while on partner track is reasonable along with q8-10 call at maximum...

 

[TheLoneWolf]

I belong to a true (non-private equity) private practice and own 1/32 share of our corporation along with 31 other anesthesiologist.

Here is our new-hire MD compensation package:

- Annual salary $425-paid at fixed monthly rate ($35,416.66)
- Assigned usual (same as any senior partner) number of calls--usually ~1 weekend a month and q10 weekdays.
- 8 weeks vacation
- Full partner after 2 years with equal distributions of surplus revenue
- Up to 2-month ($70k) salary advancement $10k signing bonus
- $15k CME
- 401k after 1 year profit sharing (retirement contribution) after 2 years
- Short-term disability follow Corp policy (5 days PDO, then Corp pays 50% 1st month, 25% 2Nd and 3rd month
- Long Term up to 5k/month paid by Corp
- Portable Disability (up to $15k premium payment yearly)
- Paid life Paid medical, vision, and dental
- HSA w/ employer contribution
- Paid malpractice

All md or act?

 

[Gilakend]

I belong to a true (non-private equity) private practice and own 1/32 share of our corporation along with 31 other anesthesiologist.

Here is our new-hire MD compensation package:

- Annual salary $425-paid at fixed monthly rate ($35,416.66)
- Assigned usual (same as any senior partner) number of calls--usually ~1 weekend a month and q10 weekdays.
- 8 weeks vacation
- Full partner after 2 years with equal distributions of surplus revenue
- Up to 2-month ($70k) salary advancement $10k signing bonus
- $15k CME
- 401k after 1 year profit sharing (retirement contribution) after 2 years
- Short-term disability follow Corp policy (5 days PDO, then Corp pays 50% 1st month, 25% 2Nd and 3rd month
- Long Term up to 5k/month paid by Corp
- Portable Disability (up to $15k premium payment yearly)
- Paid life Paid medical, vision, and dental
- HSA w/ employer contribution
- Paid malpractice

This is the exact practice model I'd like to be in. Are these still common? If this was a group in the midwest it sounds like my ideal job.

Is the surplus revenue typically a substantial increase in pay? i.e. a big jump when you get to partner?

Seems like a great gig. Congrats!

 

[DirtDocMD]

That’s not a good deal. The hospital CEO can put out some RFP’s, and that group may not even exist in a year or two (this could happen to ANY group, losing the contract). Then what have you got??

You could take a job with an AMC, paying $500k, and it’ll be 6 years before this private gig catches up, financially speaking. On top of that, q4 call and q2 weekends is ridiculous.

The private group I’m in used to do 70%\85% the first two years, on salary. NOW, we’re basically offering full salary from the get-go, with eligibility for leftover “bonus” (sometimes $50-$75k, sometimes way less) after that. Salary at $575k for everyone. The job market is way tighter than it was 5-10 years ago.

Only reason to take this job is if you’re hoping for a big $$$ buyout in 2-4 years, and if the group is offering to “pro-rate” YOUR buy-in, so you aren’t left holding the bag, if they sell-out in 18 months, before you make partner.

Look for other options.

 

[NICMAN]

All md or act?

We employ the CRNAs. All medically directed except we typically sit cases about 10-15% of the time. That is just how the schedule works.

 

[IMGASMD]

My priority is a little different than some. I’d like to know if I’m sitting in my own cases most days or directing crna. “I” would put some premium on that.

Q4 call sounds horrible with call back 40%, is about 5 days a month you’d be called back. Do you get post call off?

Q2weeknds- is that one day or both days? I was told my group used to do 72 hour calls. Yes, even “weekend calls” can be defined differently.

Like everyone already said, it’s junk. You’re making 1/2 of partners salary, and 3/5 of the time off. So you’re essentially work even more, so making even less.

I’ve been in two partnership tracks since graduate.

First one: High 300, not a lot of money. But everything was equal from day one. The “only” thing that was different was voting rights. As my very smart SO said, **** voting rights, as long as you’re making same amount of money.



Second one: ~80% then 85% partner take home. If they change any terms during the partnership track, yours will be adjusted only to your favorite. 75% then 88% vacation time.


Neither of them were “prefect” but I feel that they are “fair”.
I remember a few years ago I read a study, most people quit not because of low pay, but due to perceiving unequal treatment at work.

You definitely should renegotiate, but it sounds like the group is sooooo far away from reality, it maybe hard to get to a good place.

 

[hckyplyr]

Thank you all for the suggestions and opinions. I learned a ton about what's the going rate currently and what to watch out for with these predatory groups. There hasn't been a recent thread that I found about this specific topic, so hopefully other soon-to-be graduates can use this thread as ammunition to fuel their negotiations, I know I will. I'll keep looking for better opportunities, thanks again.

 

[IMGASMD]

Thank you all for the suggestions and opinions. I learned a ton about what's the going rate currently and what to watch out for with these predatory groups. There hasn't been a recent thread that I found about this specific topic, so hopefully other soon-to-be graduates can use this thread as ammunition to fuel their negotiations, I know I will. I'll keep looking for better opportunities, thanks again.

There are a few recent threads about what to ask on interviews…. They’re geared towards you finding out some of these answers.

It’s also good to know what the “market” rate is around you. Most folks here don’t trust mgma, but that’s probably the best guide you have, and that’s another valuable negotiation tool. I didn’t have access to it, but my lawyer did.

Go out and look. It’s never too early.

Good luck.

 

[OptionOffense]

Key is how many units you are generating to get that income. 15000 per year? 12000? 10000? That in effect will tell you how much work you are doing to get that income. So while 650k sounds great..if you need to work 15000 units to get it, then it's a brutal grind.

Do you think having by not having RVU information available is a red flag for the person offering you the job?

 

[amyl]

I think transparency is key. If they’re not going to tell you hours worked, income, etc do you really want to be their partner? I’ve sent my point sheets (hours worked), w2 and call schedules to candidates we make offers to.
I believe this is the only way to start the relationship with a future partner

 

[nimbus]

Any way you cut it, 250-300k is too low for a full time job. Many part time, no call jobs offer more. It’s a ripoff.