Interview for private practice

[urgewrx]

I'll be interviewing for private practice pretty soon. I have been in academics so far. I'm excited because it's in a nice city but I'm hesitant because I expect to be low balled salary wise. Any ideas on how I can squeeze the most money out of them? Is it ok to haggle like buying a car? Let's say they offer 270(which is pretty much what new grads amb surg pp docs are getting working less than 40hr/week, except I'm not a new grad, I'm subspecialized, and I'll be doing sick pts most of the time and taking 5 calls/month- so, it sucks). Should I reply:
1-"how about 350?"
2-"well that's not good enough to make me move"
3-"I'll have to get back to you once I'm done shopping around"
4-"It sucks but I'll take it"
Any other ideas?

What if they say partnership is 4 years? 3, or 2? I don't really feel like waiting more than 1 year in this market. I don't even like the idea of being "married" to a program at all. Why do they need 4 years to "evaluate" you? My point of view is that if you don't get a feeling for a person in 1 year you are an idiot. Hell, people get to know each other, marry, have a kid, and get divorced in less than 1 year.
1 "sorry I won't do more than 1 year"
2 "how about a non partnership track?" What if its not an option?
3 "I might settle for 2 years if I'm guaranteed partnership at the end of the first year"
Any other ideas?

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[deleted126335]

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[urgewrx]

I just want my fair market value. They need somebody like me. In fact I was told they have been limping for months due to lack of expertise. I don't know how easy it would be for them to get someone like me, though. Sad to admit, but I'm not one of a kind. They are looking for someone for the long run (or someone to screw for a while, I don't know). I want to bring my terms to the table, but I dont want to alienate(i.e., blow it) myself by doing so.

 

[BLADEMDA]

I just want my fair market value. They need somebody like me. In fact I was told they have been limping for months due to lack of expertise. I don't know how easy it would be for them to get someone like me, though. Sad to admit, but I'm not one of a kind. They are looking for someone for the long run (or someone to screw for a while, I don't know). I want to bring my terms to the table, but I dont want to alienate(i.e., blow it) myself by doing so.

First, do you want the job? If so, show a lot of interest and enthusiasm for the job. Second, you should have a ballpark figure for the job PRIOR to the interview. What are they offering? High 200's and partnership in 24 months sounds very fair. Third, what are the partners earning? If partnership is worth $400,000 plus benefits then starting at 275-290 for 12 months followed by 325-350 for the next 12 seems pretty fair. Finally, you can ask for a formal "vote" by the Group after 12 months to determine partnership after the agreed upon track. The Group should say definite, maybe or unlikely after 12 months. 'Maybe' should be accompanied by a list of "deficiences" to be revaluated again in 6 months.

If you appear overly "cocky" or "arrogant" during the interview process the rest won't matter.

Blade

 

[usnavdoc]

First, do you want the job? If so, show a lot of interest and enthusiasm for the job. Second, you should have a ballpark figure for the job PRIOR to the interview. What are they offering? High 200's and partnership in 24 months sounds very fair. Third, what are the partners earning? If partnership is worth $400,000 plus benefits then starting at 275-290 for 12 months followed by 325-350 for the next 12 seems pretty fair. Finally, you can ask for a formal "vote" by the Group after 12 months to determine partnership after the agreed upon track. The Group should say definite, maybe or unlikely after 12 months. 'Maybe' should be accompanied by a list of "deficiences" to be revaluated again in 6 months.

If you appear overly "cocky" or "arrogant" during the interview process the rest won't matter.

Blade

So out of curiosity...This guy is not a new grad. He is(I assume) already boarded and has been in academics for a while. You still think his starting salary should be on the level with new grads? That doesnt seem right.

 

[deleted126335]

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[urgewrx]

It's all about skimming the top of the new guy. I just don't have a feeling on how strcit I should be with my negotiations.

 

[proclivity]

It's all about skimming the top of the new guy. I just don't have a feeling on how strcit I should be with my negotiations.

You said you were sub-specialized so it sounds like you have a bit of bargaining power.

 

[BLADEMDA]

It's all about skimming the top of the new guy. I just don't have a feeling on how strcit I should be with my negotiations.

If you want my opinion then I need more information about the job. What are they offering without any haggling? How long to partnership? Expected partner level income? What UNIQUE skills are you bringing to the table? TEE Certified? Pain Fellowship?

If the opening offer is fair then you won't need to ask for much more provided the track is reasonable and the FINAL expected income is worthwhile.

Blade

 

[deleted126335]

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[johankriek]

I'll be interviewing for private practice pretty soon. I have been in academics so far. I'm excited because it's in a nice city but I'm hesitant because I expect to be low balled salary wise. Any ideas on how I can squeeze the most money out of them? Is it ok to haggle like buying a car? Let's say they offer 270(which is pretty much what new grads amb surg pp docs are getting working less than 40hr/week, except I'm not a new grad, I'm subspecialized, and I'll be doing sick pts most of the time and taking 5 calls/month- so, it sucks). Should I reply:
1-"how about 350?"
2-"well that's not good enough to make me move"
3-"I'll have to get back to you once I'm done shopping around"
4-"It sucks but I'll take it"
Any other ideas?

What if they say partnership is 4 years? 3, or 2? I don't really feel like waiting more than 1 year in this market. I don't even like the idea of being "married" to a program at all. Why do they need 4 years to "evaluate" you? My point of view is that if you don't get a feeling for a person in 1 year you are an idiot. Hell, people get to know each other, marry, have a kid, and get divorced in less than 1 year.
1 "sorry I won't do more than 1 year"
2 "how about a non partnership track?" What if its not an option?
3 "I might settle for 2 years if I'm guaranteed partnership at the end of the first year"
Any other ideas?

dude

any type of partnership track that doesnt pay you what you are worth is BS.. keep walking.. why shouldnt you get the same money if you do the same work.. forget that.. or tell them listen i will work for you for XX amount of dollars per hour as long as i am in the hospital.. period.. I dont wanna be your partner... draw up something that if they wanna fire you they have to give you 6 months notice or 4 months full time cash up front.. that way there IS security.. you will get at least 6 months notice before they fire you.. all partnership deals are BULL****. theere are a lot of places where you dont have to deal with that..

 

[deleted126335]

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[johankriek]

DUDE,

you have WAY unrealistic expectations. Show that type of attitude on an interview and you won't ever have to worry about being offered a partnership track job, except a crappy one.

Ok i am unrealistic and have an attitude and i have a crappy job. at least i sleep like a baby at night

 

[BLADEMDA]

To each his own Johan. You don't want to jump through all the "hoops" to join a Group and become partner. However, many tracks START where you are right now. Some don't mind investing time and effort provided it pays off.

After 12 months in a Group many new graduates will be making MORE money than you. After 24 months in a good Group most will be secure and making more than average income ($340,000 plus benefits). This seems like a sound financial decision.

Blade

 

[epidural man]

Urges,

why are you leaving academics anyway?

I know that 10 or so people on this forum are REALLY harsh on academics, but I don't get it. Most of us, I think, have a lot to owe to our academic institutions. I am sure most have fond memories of certain attendings that mentored them and helped them a tremendous amount.

If it weren't for academics and advancement of anesthesia was left to the 6-8 people on this forum that bash the academics, we would still be using copper kettles. (this isn't a slam on intelligence, only on resource and time...so you can stop typing). Of all the posts I have read on this site, you are the only person I can remember ever talking about publishing something.

Personally, I think academics needs great people who are committed to teaching and advancing our field through research and other efforts. Sure, they might be slower or have other things that may not fit in private practice, but whatever.

So I was just curious why you are leaving.

 

[urgewrx]

For wife reasons. Probably wil have to move. I'm applying to PP and academics. PP is an unknown to me, so I'm kind of curious. Plus, it pays more and might not have to deal with constant sabotage from residents(unless CRNA's do the same). Downside is that cases might not be that challenging and I might become bored out of my mind.

 

[fakin' the funk]

I know that 10 or so people on this forum are REALLY harsh on academics, but I don't get it. Most of us, I think, have a lot to owe to our academic institutions. I am sure most have fond memories of certain attendings that mentored them and helped them a tremendous amount...

If it weren't for academics and advancement of anesthesia was left to the 6-8 people on this forum that bash the academics, we would still be using copper kettles.

Personally, I think academics needs great people who are committed to teaching and advancing our field through research and other efforts. Sure, they might be slower or have other things that may not fit in private practice, but whatever.

So seriously, how much lower is academic pay than PP? Are the hours worse/same/better? More/less collegial or fun working environment?

 

[VentdependenT]

For wife reasons. Probably wil have to move. I'm applying to PP and academics. PP is an unknown to me, so I'm kind of curious. Plus, it pays more and might not have to deal with constant sabotage from residents(unless CRNA's do the same). Downside is that cases might not be that challenging and I might become bored out of my mind.

How often do residents "sabotage" you? Why even bother to continue to teach?

 

[urgewrx]

How often do residents "sabotage" you? Why even bother to continue to teach?

Quite often. Small stuff but feels like chinese torture. Forget stuff on room set up, no suction, don't tighten stopcocks so all the drugs end up in the floor, give too much fluid, forget abx,... Teaching is entertaining other than that.

 

[pmichaelmd]

Quite often. Small stuff but feels like chinese torture. Forget stuff on room set up, no suction, don't tighten stopcocks so all the drugs end up in the floor, give too much fluid, forget abx,... Teaching is entertaining other than that.

Some of the consultants from my residency joined at a higher tier because of their previous academic experience. They started at "full" level, which was somewhere in the neighborhood of $339k + benefits.

Cheers,
PMMD

 

[Coastie]

As in, partner?

Some of the consultants from my residency joined at a higher tier because of their previous academic experience. They started at "full" level, which was somewhere in the neighborhood of $339k + benefits.

Cheers,
PMMD

 

[Noyac]

I just want my fair market value. They need somebody like me. In fact I was told they have been limping for months due to lack of expertise. I don't know how easy it would be for them to get someone like me, though. Sad to admit, but I'm not one of a kind. They are looking for someone for the long run (or someone to screw for a while, I don't know). I want to bring my terms to the table, but I dont want to alienate(i.e., blow it) myself by doing so.

I'm just responding as I read these posts so if I am repeating anything someone else has stated then ignore it.

What is special about you to them? And why can't they get someone like you? I'm asking for 2 reasons. One, it helps me to get an idea of how much bargaining room you may have. And two, for those residents and students here that may benefit from knowing what makes you special and how they may achieve this.

 

[Noyac]

dude

any type of partnership track that doesnt pay you what you are worth is BS.. keep walking.. why shouldnt you get the same money if you do the same work.. forget that.. or tell them listen i will work for you for XX amount of dollars per hour as long as i am in the hospital.. period.. I dont wanna be your partner... draw up something that if they wanna fire you they have to give you 6 months notice or 4 months full time cash up front.. that way there IS security.. you will get at least 6 months notice before they fire you.. all partnership deals are BULL****. theere are a lot of places where you dont have to deal with that..

Don't come knocking on my door with that attitude.

 

[BLADEMDA]

As in, partner?

YOu are MISSING the point. It is not what you START at but what the FINAL VALUE of partnership is worth that truly matters.

If you start at $275 and make partner in 24 months worth $500 plus then that is a better deal (sometimes) than $339 with partnership worth $375.
Understand? In other words, what is the VALUE of the partnership?

Blade

 

[Noyac]

Urges,

why are you leaving academics anyway?

I know that 10 or so people on this forum are REALLY harsh on academics, but I don't get it. Most of us, I think, have a lot to owe to our academic institutions. I am sure most have fond memories of certain attendings that mentored them and helped them a tremendous amount.

If it weren't for academics and advancement of anesthesia was left to the 6-8 people on this forum that bash the academics, we would still be using copper kettles. (this isn't a slam on intelligence, only on resource and time...so you can stop typing). Of all the posts I have read on this site, you are the only person I can remember ever talking about publishing something.

Personally, I think academics needs great people who are committed to teaching and advancing our field through research and other efforts. Sure, they might be slower or have other things that may not fit in private practice, but whatever.

So I was just curious why you are leaving.

No doubt, you are right. Some of us give academics a hard time b/c of the lack of flexibility and the dogma. I am sure that those of us (yes I am including myself) that bust the chops of the academic types are very fond of our training and our experiences in residency. My residency gave me the tools to be the best anesthesiologist that I can be, the rest was up to me. If you pay attention to some of the criticism here, we mostly criticize those that say things "must" be done a certain way. I may never practice the way some folks here do but I won't criticize them unless I truely feel they are dangerous or wrong. I may harass them, however. There is a difference.

 

[Noyac]

Quite often. Small stuff but feels like chinese torture. Forget stuff on room set up, no suction, don't tighten stopcocks so all the drugs end up in the floor, give too much fluid, forget abx,... Teaching is entertaining other than that.

And you never over look anything?

The only attendings that I didn't care for were the ones that acted like they were perfect.

 

[johankriek]

mind investing time and effort provided it pays off.

After 12 months in a Group many new graduates will be making MORE money than you. After 24 months in a good Group most will be secure and making more than average income ($340,000 plus benefits). This seems like a sound financial decision.
Blade

doesnt seem like a sound financial decision to me if someone will always be making more of a percentage than you and making a percentage off of your work. Sure the absolute amount is prolly nice after jumping through hoops (ie take more call, do trickier cases (potential for litigation), work with slower surgeons, do longer cases that go well into the afternoon. etc etc. which gets old very quickly. Nothing breeds hostility in an anesthesia department more than watching people who make more than you leave earlier and do easier cases. with less call however you are still kicking some of your income back and the books are generally never open for you to review. Just ask 2 questions when you interview with a group. 1) Prior to signing your contract my lawyer would like to review your contract with the hospital. 2) Will I be able to periodically review all the accounts receivable and the distribution of these.

The answer will invarably be.. no answer ......because after those questions there is no negotiation. they dont want you to see the books.. If they let you see the books it will be obvious what they are up to..
anyway, the only people skimming off of me is my standard 5 percent to my billing consultants who send out my bills and answer my calls.



I have my call obligations and minimum that i HAVE todo. But nobody is in my pocket..

 

[Noyac]

YOu are MISSING the point. It is not what you START at but what the FINAL VALUE of partnership is worth that truly matters.

If you start at $275 and make partner in 24 months worth $500 plus then that is a better deal (sometimes) than $339 with partnership worth $375.
Understand? In other words, what is the VALUE of the partnership?

Blade

Yes, exactly. And if there are a hand full of folks that have built this practice into a powerhouse of fine anesthesioligists and crna's/AA's then you can't expect to just waltz right in and reep the benefits of their sweat and tears. You must pay in one form or another.

Your partnership tract ought to reflect what you are getting in the end. If you will make greater than 500K then 2-3 yrs is expected. If you are looking at 375K then one yr. Its all relative.

If you are boarded then you may be able to negotiate something better than an incoming grad. If you are fellowship trained in something they really need than maybe more $$. But If they are hiring more than one person, they will be reluctant to give you a better contract than the other person. It ain't fair and they know it.

Also, be leary of the long partnership that guarantees big bucks. Make sure that they are in a stable area and that the competition is low. If the competition is high or the area is unstable, you may find that when you get to partnership their income has dropped substantially.

 

[Noyac]

doesnt seem like a sound financial decision to me if someone will always be making more of a percentage than you and making a percentage off of your work. Sure the absolute amount is prolly nice after jumping through hoops (ie take more call, do trickier cases (potential for litigation), work with slower surgeons, do longer cases that go well into the afternoon. etc etc. which gets old very quickly. Nothing breeds hostility in an anesthesia department more than watching people who make more than you leave earlier and do easier cases. with less call however you are still kicking some of your income back and the books are generally never open for you to review. Just ask 2 questions when you interview with a group. 1) Prior to signing your contract my lawyer would like to review your contract with the hospital. 2) Will I be able to periodically review all the accounts receivable and the distribution of these.

The answer will invarably be.. no answer ......because after those questions there is no negotiation. they dont want you to see the books.. If they let you see the books it will be obvious what they are up to..
anyway, the only people skimming off of me is my standard 5 percent to my billing consultants who send out my bills and answer my calls.



I have my call obligations and minimum that i HAVE todo. But nobody is in my pocket..

Again, don't come knocking on my door.

You have too much distrust and I know that many here will agree with you but I for one am not interested in hiring someone that demands all sorts of things. I will disclose everything to you in our interview if I am interested in you and you in me. The last thing I want to do is have to look for a new partner b/c one on mine didn't work out. I hide nothing and I expect the same from my prospective group. But different people have different personalities. I want to work with people like myself.

 

[urgewrx]

And you never over look anything?

The only attendings that I didn't care for were the ones that acted like they were perfect.

The problem is not that I hate residents for it. I hate myself for not double checking on their setup. I know everybody errs and I'm a firm believer in 2nd breaks.

 

[Noyac]

The problem is not that I hate residents for it. I hate myself for not double checking on their setup. I know everybody errs and I'm a firm believer in 2nd breaks.

Fair enough.

 

[pmichaelmd]

As in, partner?

At Mayo, I guess that would be considered a "partner." The senior guys on here are right about the entire package, though. I suppose it depends on what somebody is looking for. The guys in academia, unless they are a chair, don't make much more than the guys at my former institution. They do get an annual raise and I'm thinking their top end of a 5-tier system is about $350k/year. They do have pretty good benefits, though, and lots of residents and CRNAs to do the cases for them. It would appear to be less strenuous than private practice from that standpoint, if somewhat less lucrative. They do have production pressure of a different kind, though. You know, the "publish or perish" mentality of academics. That is the one way they get job security. I would find that annoying, I think, but different strokes for different folks.

For me, I picked a group that I thought was cool and had good personalities. Money wasn't the most important thing to me, so my high end will likely be lower than some others, but that's okay with me. I'd rather be happy with less money than miserable with loads of cash. Plus, the way I figure, if I can't live off of more than $300k/year, then something is wrong with me. O course, if my group offered me a substantial raise, I wouldn't say no either

Bottom line, I'd look for a place that I "fit" and not worry too much about the $$. At this point, I doubt any of us will be starving.

Cheers,
PMMD

 

[Coastie]

Dude, he said "full". I was just checking nomenclature to see if he meant "partner". Take a chill pill!

P.S. Thanks for the reminder on checking the value of partnership versus starting

YOu are MISSING the point. It is not what you START at but what the FINAL VALUE of partnership is worth that truly matters.

If you start at $275 and make partner in 24 months worth $500 plus then that is a better deal (sometimes) than $339 with partnership worth $375.
Understand? In other words, what is the VALUE of the partnership?

Blade

 

[Khalid]

Y'all speak of "average income" like it's common knowledge ($340k plus benefits)

Really, what should mature partner income be from your perspective, including paid malpractice, paid health, and 6-8 weeks vacation???

I look forward to your responses...

 

[Coastie]

A fellow intern told me he believed the ASA reported this year that it should be 405k plus benefits on average.

I look forward to responses as well.

Y'all speak of "average income" like it's common knowledge ($340k plus benefits)

Really, what should mature partner income be from your perspective, including paid malpractice, paid health, and 6-8 weeks vacation???

I look forward to your responses...

 

[BLADEMDA]

A fellow intern told me he believed the ASA reported this year that it should be 405k plus benefits on average.

I look forward to responses as well.

That sounds high for "average" considering last year the ASA reported around $340 plus benefits. $405 is for NO BENEFITS (1099)- at least that would be my guess.

Blade

 

[BLADEMDA]

Y'all speak of "average income" like it's common knowledge ($340k plus benefits)

Really, what should mature partner income be from your perspective, including paid malpractice, paid health, and 6-8 weeks vacation???

I look forward to your responses...

You already know the answer to your own question. Average income for 45 hours per week (includes ACTUAL WORKING CALL in those hours) with 8 weeks of vacation plus full benefit package is $340,000.

Since many work more hours per week than 45 quite a few of us earn more than "average."

Blade

 

[Khalid]

You already know the answer to your own question. Average income for 45 hours per week (includes ACTUAL WORKING CALL in those hours) with 8 weeks of vacation plus full benefit package is $340,000.

Since many work more hours per week than 45 quite a few of us earn more than "average."

Blade

What part of the country do you live BladeMDA???

Few if any full-time MDA's work 45 or fewer hours. 340k (W-2) plus full benefit package seems a bit high to me, unless, of course, one is working insane hours or your talking 1099. Then again, maybe I'm in a crappy group

 

[Noyac]

A fellow intern told me he believed the ASA reported this year that it should be 405k plus benefits on average.

I look forward to responses as well.

Very unlikely.

 

[BLADEMDA]

What part of the country do you live BladeMDA???

Few if any full-time MDA's work 45 or fewer hours. 340k (W-2) plus full benefit package seems a bit high to me, unless, of course, one is working insane hours or your talking 1099. Then again, maybe I'm in a crappy group

The local AMC (Anesthesia Management Company) is offering 1099 $340,000 per year with 8 weeks vacation. If you cut out the middle man (the AMC which takes 20% or more) a partner in a Group should do much better. The average work week for this AMC is 45 hours. The AMC includes malpractice and $5,000 extra towards health care. The other benefits are per you (retirement, better health insurance, disability, etc.).

Even the AMC's recognize AVERAGE pay and must get close to it in order to recruit/retain Anesthesiologists.

Blade

 

[me454555]

Again, don't come knocking on my door.

You have too much distrust and I know that many here will agree with you but I for one am not interested in hiring someone that demands all sorts of things. I will disclose everything to you in our interview if I am interested in you and you in me. The last thing I want to do is have to look for a new partner b/c one on mine didn't work out. I hide nothing and I expect the same from my prospective group. But different people have different personalities. I want to work with people like myself.

All he's asking for is honesty. Whats wrong with letting someone check out the contracts and the books? If everything is in order then its just a way to double check whats goin on w/the business. When you buy a stock, don't you look at the financials and cashflow? Same concept right?

 

[epidural man]

Plus, it pays more and might not have to deal with constant sabotage from residents(unless CRNA's do the same).

I take offense to this! (not really, but it sounds dramatic).

What you call "sabotage", I call learning how to be an anesthesiologist.

Actually, I asked my staff about this today while we were in the MRI scanner for 14 freaking hours. (Yes, I am still a resident because I showed up for residency in August because my boss previously wouldn't let me leave until then)

Anyway, she totally agreed with you. She said it gets really OLD dealing with the crap you mention. I could see her point. She explained it like this....she said when you get mad at your 3 year old (for swallowing something that he shouldn't, peeing on the floor, sticking a bean in his ear, etc), you really are getting mad at yourself because it is your fault REALLY, not the 3 year olds. But she also said that when your kid is 10, they should know better and it really is their fault, and she likened this to a CA-3 - and said it really sucks when they "sabatoge" you. She told me a story of where she literally choked a resident after he did something really stupid that could have killed this kid with CHD.

 

[rich1234]

How is the pay for anesthesiologist's in more desirable areas to live in? (i.e. Florida, California, New England Area.)

 

[deleted126335]

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