How to make the absolute most money doing FM?

[VA Hopeful Dr]

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LOL. you got me. LOL. I bet you guys love this.

I mean, who doesn't enjoy being right?

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[deleted87716]

Just like your opinion.

My comment was opinion-free.

 

[SKaminski]

Looking at job listings, it looks like there a lot more places willing to hire FM as a nocturnist than there are places willing to hire FM as EM. I'll need to keep that in mind for my training and when thinking about future career opportunities.

Also, it is hard to find reliable information telling you how much you can make performing elective D&Cs.

 

[SKaminski]

Cosmetics pay well but it's expensive to get into. It will take some time to establish yourself.

yeah maybe i can use my CME money for a couple of years to learn these things

 

[Ericslv]

My comment was opinion-free.

No, it wasn't.

 

[deleted87716]

No, it wasn't.

 

[Ericslv]

View attachment 252298

Wow. You are sooo cool. I could just s.

 

[deleted87716]

Wow. You are sooo cool. I could just s.

 

[emergentmd]

EM is slowing moving from very under supply to slightly under supply.

Places I work at would take any EM with a pulse now are well/over staffed in the past 2 yrs.

This has crept to the smaller outlying ERs that use to be staffed by non EM docs BUT now getting EM docs.

The opportunities for non EM docs are slowly dwindling and I suspect will mostly be closed with rates dropping.

 

[Relentlessrook18]

With contracts, when they offer you a base salary, how much more can you ask for without seeming like a stuck up a&@);&;? I’ve spoken to some groups that are offering 240k to 250k but they are in places people don’t want to live or have additional hospitalist duties.
Part two of this question, how long is a reasonable time to ask for that base salary cushion?
The hospital system has to be making more money than what they hired you for, or else they wouldn’t hire you. So are RVUs negotiable? Production Bonuses? How likely is it that a freshly graduated resident would make higher than the base salary?
Ton of questions, answers I haven’t exactly found online. Thanks to the original poster for this forum. (I got loans I gotta pay, I don’t need fancy toys lol)

 

[MedicineZ0Z]

EM is slowing moving from very under supply to slightly under supply.

Places I work at would take any EM with a pulse now are well/over staffed in the past 2 yrs.

This has crept to the smaller outlying ERs that use to be staffed by non EM docs BUT now getting EM docs.

The opportunities for non EM docs are slowly dwindling and I suspect will mostly be closed with rates dropping.

This is due to all the new EM residencies, right?

 

[Freezeout]

This is due to all the new EM residencies, right?

Likely also contributed to by some programs dropping to three years from four years.

 

[FrustratedFamDoc]

With contracts, when they offer you a base salary, how much more can you ask for without seeming like a stuck up a&@);&;? I’ve spoken to some groups that are offering 240k to 250k but they are in places people don’t want to live or have additional hospitalist duties.
Part two of this question, how long is a reasonable time to ask for that base salary cushion?
The hospital system has to be making more money than what they hired you for, or else they wouldn’t hire you. So are RVUs negotiable? Production Bonuses? How likely is it that a freshly graduated resident would make higher than the base salary?
Ton of questions, answers I haven’t exactly found online. Thanks to the original poster for this forum. (I got loans I gotta pay, I don’t need fancy toys lol)

Typical base salaries go 2 years. Typical places that give teaser salaries are indeed, underserved. Underserved typically means the majority of the population on government or no insurance. After your 2 year guarantee is up, you may find yourself in a situation where you're really busy, but not earning squat due to unfavorable payor mix. "Growth potential" to the recruiters means that your day will be slammed with number of visits, not necessarily salary growth.

A better situation would be in a location with a better economy, better potential payor mix, modest signing bonus and true SALARY growth potential that doesn't involve you killing yourself with stupid daily/weekly number targets.

Regardless of where you go, just starting out, your schedule will be likely be majority government payor. As word gets out about how good you are, other area docs retire, etc... things then change.

I'd never sacrifice a good first 2 years (of a likely 4-5 year contract) for years of frustration of killing myself and never seeing finances change.

 

[Keona]

With contracts, when they offer you a base salary, how much more can you ask for without seeming like a stuck up a&@);&;? I’ve spoken to some groups that are offering 240k to 250k but they are in places people don’t want to live or have additional hospitalist duties.
Part two of this question, how long is a reasonable time to ask for that base salary cushion?
The hospital system has to be making more money than what they hired you for, or else they wouldn’t hire you. So are RVUs negotiable? Production Bonuses? How likely is it that a freshly graduated resident would make higher than the base salary?
Ton of questions, answers I haven’t exactly found online. Thanks to the original poster for this forum. (I got loans I gotta pay, I don’t need fancy toys lol)

My salary guarantee lasts for 1 year. My contract is 3 years in the area but not with the same employer necessarily. I am employed by a small physician practice but the hospital paid the salary until I met the income plus expenses. Everything is negotiable but I personally didn’t want a teaser salary up front I wanted what I’d actually make and I negotiated more my sign on bonus and loan repayment. My salary will change over time with likely eventually becoming a partner. I only work 4 days a week. I took over from a retiring physician which certainly helped my patient mix and got me a panel of good patients.

 

[KeikoTanaka]

My salary guarantee lasts for 1 year. My contract is 3 years in the area but not with the same employer necessarily. I am employed by a small physician practice but the hospital paid the salary until I met the income plus expenses. Everything is negotiable but I personally didn’t want a teaser salary up front I wanted what I’d actually make and I negotiated more my sign on bonus and loan repayment. My salary will change over time with likely eventually becoming a partner. I only work 4 days a week. I took over from a retiring physician which certainly helped my patient mix and got me a panel of good patients.

How does call work for you in that small physician practice? And, if you are on call, what does a typical weekend/night look like?

 

[Keona]

We have 4 mds in our practice and we share call with a solo practitioner so I’m on call about one weekend per month and 4-5 days during the week for the month. We do not do inpatient anymore so I’m mostly dealing with nursing home patients and calls about transferring to Ed if someone falls or starting antibiotics for UTIs. I don’t get a lot of patient calls usually but some nights are worse than others.

 

[FrustratedFamDoc]

Touching more on payor mix, your government insured patients will usually be able your most medically (and socially) complicated ones you will see. They will require far more resources from you and your staff and you'll be compensated at a drastically reduced rate. In general, I can see 2 - 3 private pay patients in the time it takes me to see 1 complicated 'caid/'care patient. Extrapolate those numbers out weeks and months and see the difference it makes. Time is money and good volume is the name of the game. On my private pay heavy days, I usually still feel great at the end of the day. On my heavy caid/care days, usually not so much. In caid/care heavy environments, you work MUCH HARDER for MUCH LESS COMPENSATION and go home MUCH MORE TIRED at the end of the day.How long will you be able to keep that up and is a 2 year teaser to be locked in to that life for the next several years worth it? Places like this usually go through burned out docs pretty regularly so they need to advertise teaser rates to entice new grads and lock them in with long term contracts with a clause that states you owe the bonus back with breach of contract.

 

[Relentlessrook18]

Touching more on payor mix, your government insured patients will usually be able your most medically (and socially) complicated ones you will see. They will require far more resources from you and your staff and you'll be compensated at a drastically reduced rate. In general, I can see 2 - 3 private pay patients in the time it takes me to see 1 complicated 'caid/'care patient. Extrapolate those numbers out weeks and months and see the difference it makes. Time is money and good volume is the name of the game. On my private pay heavy days, I usually still feel great at the end of the day. On my heavy caid/care days, usually not so much. In caid/care heavy environments, you work MUCH HARDER for MUCH LESS COMPENSATION and go home MUCH MORE TIRED at the end of the day.How long will you be able to keep that up and is a 2 year teaser to be locked in to that life for the next several years worth it? Places like this usually go through burned out docs pretty regularly so they need to advertise teaser rates to entice new grads and lock them in with long term contracts with a clause that states you owe the bonus back with breach of contract.

Hearing these horror stories of owing money or time to a place just for a high salary 1-2 years or longer makes me fear signing contracts! So what’s the best way to take advantage of our training and get decent pay? Just go with production compensation pay right out of the gate after residency? Is it even worth negotiating a residency stipend/sign on bonus/loan repayment if you don’t end up making the health system enough money. Ugh I’m so confused now.

 

[FrustratedFamDoc]

I wouldn't fear a healthy sign on bonus if everything looks like adds up. I got offered a spot with our local primary care network while still in residency and have been fortunate enough after a few years that it has worked out for me. Some things could be better, but it could definitely be much worse as well.

If I were looking to move on, I would have to like the area and I'd go to where I'm most likely to encounter the kind of patients I want to see daily for the next decade or 2. This would be a growing area with a good economy. Abundant suburbs is a good sign. Go to the grocery stores and look at what your prospective patients are putting in the cart. Do you like what you see? Younger or older people? People that look like they give a damn about fitness? Do the doc offices in the area look clean and new or old and worn out? Do you see more people out walking? Smokers?

The above doesn't guarantee that you'll find a great practice, but it sure helps to round things down quite a bit. Going to see a couple patients, I'll try to answer the rest of your questions soon.

 

[FrustratedFamDoc]

If I were to try a straight production based compensation just starting out, I'd have gone broke for a while. You've still gotta live and make your student loan payments. My next contract would forego a sign on type bonus and instead structure higher yearly retention bonuses that will not be surrendered with breach of contract. I'd also have a "get the hell out of here" clause that I can walk with minimal notice for any reason in the first 6 months if I so choose.

 

[Relentlessrook18]

Do rural health clinics pay more or less than a regular health clinic? Do you have more negotiability with as a hospital employed rural health clinic physician? Trying to weigh less pay at a clinic like this with more loan repayment through NHSC. I don't know for sure if you get paid less at these clinics, but an offer I received had a range of income as a base salary "based on experience" but was significantly less that what I would have expected as it is a rural location. Any thoughts on this? I feel like NHSC is kind of a crap shoot if you don't find a location with a high enough HPSA score too.

 

[Doctorsoon2011]

Do rural health clinics pay more or less than a regular health clinic? Do you have more negotiability with as a hospital employed rural health clinic physician? Trying to weigh less pay at a clinic like this with more loan repayment through NHSC. I don't know for sure if you get paid less at these clinics, but an offer I received had a range of income as a base salary "based on experience" but was significantly less that what I would have expected as it is a rural location. Any thoughts on this? I feel like NHSC is kind of a crap shoot if you don't find a location with a high enough HPSA score too.

It should generally be more but not huge. I have found 30K or so here in Texas (but expenses are less, hell the biggest house in town in 500K, there will be exceptions clearly) The bigger the organization the less negotiating they are willing to do. Large places develop the same contract for all physicians and are resistant to change it up.

To make the most money, I would get rural desperate ER location with little volume. The small volume will allow you todo 24hour shifts and actually get some sleep (think about that, this means that you can make good money while you're sleeping). The rural location will bring you tons of shifts with a high hour rate.

 

[Keona]

I know one md who worked a day job and did ed at night a few nights of the week where he slept mostly at the hospital. I don’t think he actually needed the money but likes staying busy.