Is this a good PCP offer? Tips to negotiate?

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goldsummer

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Base salary = 230,000 for first 15 months (4694 wRVU per year to keep generating that much, bonus for more)
$49 per RVU
Sign on bonus: 25,000
PTO: 22 days 1st year, 28 days years 2 and 3
CME: $3,500
Location: Southwest, good area
Medical/Dental/Vision insurance (dont know details)
AD&D insurance
Long-term disability insurance
401K plan


Any negotiating tips?? I've never done this before. Before med school, I was used to minimum wage jobs and taking whatever I could get. This is the first offer I'm serious about. Any advice would be appreciated.

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Why is the contract structured for 15 months?

Base salary is essentially $184,000 per year which seems on the lower end. (~15000 per month)

Are you taking over for someone or building a panel from scratch?

How many RVUs per month are the established people generating? The minimum wRVU you stated is 4694. This work out to ~390 wrvu per month over 12 months. If you take all of your PTO, then you can average it over 11 months so ~426 per month. This should be doable.

This is 2015 data but it lists averages wrvu by specialty

The dollars per RVU seems pretty good although I will defer to more experienced people. (I am used to the piddly medicare and medicaid rates).

What is the payback on the signing bonus? This is usually structured as a loan with a certain amount forgiven over a period of time.

Is there a non compete? If so, get rid of this or minimize as much as possible.

Who covers your tail insurance if you leave? This can cost you thousands if you are responsible and can handcuff you to a job.

What is the contract termination notice? 60 days, 90 days etc?

Depending on the employer, certain parts of the contract may not be negotiable. Never hurts to ask but just understand that.

How many days a week do you have to see patients? Would there be random Saturday clinic days?

How many rooms do you get in clinic.? How many medical assistants? If they only give you 1 to 2 rooms and you have to share an MA, then it will be tough to be efficient and generate those wrvus.

My main advice:
Be realistic

Understand your value as a physician. You bring a lot to the table although if you are fresh out, less so than someone with experience though.

Have a lawyer who specializes in employment contracts (preferably for medical professionals) review any and all contracts. This will run you around $1000 give or take but is necessary in today's world. Don't sign anything without this.

I have posted some of my employment issues etc that I ran into with my first job (different specialty but a lot of the issues are the same) . You can search for it if interested.
 
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The 184k is the amount of take home after tax I assume?

Why is the contract structured for 15 months?

The base pay 230k is guaranteed for the first 15 months, after that its productivity. The contract is 3 years and they can "re-calibrate" the amount based on productivity quarterly.



Are you taking over for someone or building a panel from scratch?
Will be starting at a new office with 3 other providers that will be relatively new as well.


Is there a non compete? If so, get rid of this or minimize as much as possible.
Yes, 5 miles from the office... Not sure if that is reasonable?


Who covers your tail insurance if you leave? This can cost you thousands if you are responsible and can handcuff you to a job.
I will have to find out more...I did ask about this, they said something a long the lines of "Theres a pot of money allocated to that in the event its needed"...What specifically do I have to ask? Should I be covered completely for at least, 5 years, for example?




How many rooms do you get in clinic.? How many medical assistants? If they only give you 1 to 2 rooms and you have to share an MA, then it will be tough to be efficient and generate those wrvus.

2 rooms, 1 dedicated MA.


Have a lawyer who specializes in employment contracts (preferably for medical professionals) review any and all contracts. This will run you around $1000 give or take but is necessary in today's world. Don't sign anything without this.

I talked to one lawyer so far who states basically what he does is read, summarize what its actually saying, then leave the negotiating up to me and them. Is that typically how its done?



Thanks for your advice. Much appreciated. I'll search for some of your older posts as well :)
 
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The 184k is the amount of take home after tax I assume?



The base pay 230k is guaranteed for the first 15 months, after that its productivity. The contract is 3 years and they can "re-calibrate" the amount based on productivity quarterly.




Will be starting at a new office with 3 other providers that will be relatively new as well.



Yes, 5 miles from the office... Not sure if that is reasonable?



I will have to find out more...I did ask about this, they said something a long the lines of "Theres a pot of money allocated to that in the event its needed"...What specifically do I have to ask? Should I be covered completely for at least, 5 years, for example?






2 rooms, 1 dedicated MA.




I talked to one lawyer so far who states basically what he does is read, summarize what its actually saying, then leave the negotiating up to me and them. Is that typically how its done?



Thanks for your advice. Much appreciated. I'll search for some of your older posts as well :)
No, the 184k is what you get if you take 230k (from your OP) and spread it out over 15 months. Most contracts don't do that, but make sure that's the case. For example, I'm on a 20 month salary guarantee at the moment. Its 200k annualized, meaning for the 8 months this year I get 133.3k and 200k for the 12 months of next year.

FWIW, all money numbers are pre-tax unless specifically stated otherwise.

2 rooms isn't enough long term. 1 MA is OK.

5 mile non-compete is pretty fair. I would always try to get it removed completely, but that's not a hill to die on usually.

Are all 3 of you starting at about the same time? If so, I'd be a bit worried about going on production after only 15 months. If anyone has already started, find out how busy they are to make sure the office can support 3 new doctors.

Make sure its full tail coverage. Its a one-time expense that basically covers you if you should get sued after you leave a place of employment. Malpractice Insurance: What is Tail Coverage?

That is standard contract lawyer policy for stuff like this.
 
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I think only having two rooms will make those Rvus hard to meet. If you get a patient stuck in the room while waiting on labs or X-rays you’re stuck waiting for that room to be available and your ma to turn over previous room.
Is It a 4 or 5 day work week? Does your ma help with phone calls? Does someone triage them or do they go to you? Will you have to be calling the patients with all the lab results? (Things I care a ton about now).
 
No, the 184k is what you get if you take 230k (from your OP) and spread it out over 15 months. Most contracts don't do that, but make sure that's the case. For example, I'm on a 20 month salary guarantee at the moment. Its 200k annualized, meaning for the 8 months this year I get 133.3k and 200k for the 12 months of next year

Wow...You guys are making me realize how naive I am. When I saw 0-15 at a guaranteed 230k, I assumed it was 230k for the first 12 months, and for the next 3 months they'd pay me on track for another 230. Did not even think it could be averaged over 15 months. Wow. I really got to question everything with these offers...

Is how many rooms you have something I can negotiate?? How many rooms is best for productivity? If x amount of rooms is written in my contract, how would I enforce something like that if for example I only get 2?

They prefer 5 days a week but I feel like I could negotiate 4 days a week at 10 hour days which I feel would work best for me.

No, we wont start at the office at the same time, 2 NP's are there, one new doc just started, and I would be the 4th a year from now. Right now it didnt seem crazy busy.


Thanks for the advice guys, it helps a lot. I'm gonna be talking again with them soon, if you have any other questions I should be asking, please let me know.
 
Wait people are still debating this offer after we realized it’s 184k per year? Is the job market in FM garbage? No doctor in any field should be making <200k these days...
 
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Wait people are still debating this offer after we realized it’s 184k per year? Is the job market in FM garbage? No doctor in any field should be making <200k these days...

Something around $180K is a pretty typical starting salary for new grads in most parts of the country. You can't expect to be paid as much as established docs as a newb.
 
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Wow. I'd think this would be greater incentive for the DPC / Retainer / Concierge delivery model.

-Single doc
-one waiting room with bathroom
-one large office with traditional desk, and exam table with ceiling curtain when needed
-one supply closet

Slower pace. Easily hit the same (or far greater) income potential with fraction of the patient panel. And drastically lower overhead.

Got one DPC in my area, $75/month, with all the lab/imaging/vaccine extras in office. However, has an ARNP as part of the set up, so won't switch, otherwise I would.
 
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Wait people are still debating this offer after we realized it’s 184k per year? Is the job market in FM garbage? No doctor in any field should be making <200k these days...
I just clarified with them about the 0-15 months at 230k, its not 230 spread over 15 months, its 230 per year (19,000/month) for the first 15 months.
 
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Oh ok there we go..nice!
 
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so after 15 months you switch to straight RVUs?

to all, what is a "typical" 1st contract right out of residency if any?
 
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My first contract was 187,000/year guaranteed for 3 years. Switch to production once billing consistently above that at the going rate (about 350 wRVU’s/month is my hurdle). Pension with 5year vesting requirement, very inespensive and comprehensive health benefit, 401k matching. Salary and benefits are worth $226k all told. Options for ER/Inpatient weekend coverage to augment income if desired.

While on salary guarantee, I get 6 weeks vacation/year.

Contract also includes $3500/Yr CME; all professional memberships paid, all certifications paid. Cellphone paid.

I have 3 exam rooms, 2.5 MA’s. Procedure room. In house lab and X-ray.

I work 4 days a week, 8:30-4:45; 2hr lunch break right now.

Made $130k pretax from July-Dec last year between salary and moonlighting. Not counting benefits.
 
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Sounds a great deal...Is that standard though? or did you negotiate? What region? (I am in midwest and would like to stay here)
 
Which means that it's probably a good offer. If it were too good to be true, I'd be worried.

For the benefit of the group here; what, if anything, in that setup might seem too good to be true from your POV (as someone with lots more experience than I).

The contract is solid, mainly because the company I work for is one of the better regarded, more stable, and more forward thinking groups out there. My former residency department chair told me to sign and not look back.

A year in, and the guarantees are all intact. No pressure to increase production or anything at all yet. They’re invested in my properly setting this clinic up to operate how I want it to, even if that takes some time.
 
For the benefit of the group here; what, if anything, in that setup might seem too good to be true from your POV (as someone with lots more experience than I).

An unusually high starting salary or signing bonus would be red flags that you need to read the fine print and know what you're getting into.
 
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Base salary = 230,000 for first 15 months (4694 wRVU per year to keep generating that much, bonus for more)
$49 per RVU
Sign on bonus: 25,000
PTO: 22 days 1st year, 28 days years 2 and 3
CME: $3,500
Location: Southwest, good area
Medical/Dental/Vision insurance (dont know details)
AD&D insurance
Long-term disability insurance
401K plan


Any negotiating tips?? I've never done this before. Before med school, I was used to minimum wage jobs and taking whatever I could get. This is the first offer I'm serious about. Any advice would be appreciated.
I dont think that's a good offer... This is 180k/yr, which is low for FM IMO (unless it's a Monday thru Wednesday job). I am an IM guy but I talked to a couple of FM PGY3 who signed 4 days contract for 200k+/yr + benefits.
 
I dont think that's a good offer... This is 180k/yr, which is low for FM IMO (unless it's a Monday thru Wednesday job). I am an IM guy but I talked to a couple of FM PGY3 who signed 4 days contract for 200k+/yr + benefits.

I just clarified with them about the 0-15 months at 230k, its not 230 spread over 15 months, its 230 per year (19,000/month) for the first 15 months.
 
I dont think that's a good offer... This is 180k/yr, which is low for FM IMO (unless it's a Monday thru Wednesday job). I am an IM guy but I talked to a couple of FM PGY3 who signed 4 days contract for 200k+/yr + benefits.
Non-rural in my state all start at 190k for new grads
 
That is not a bad offer... See if you can get 28+ PTO the first year and more thereafter. I would ask for 5K CME.
 
Non-rural in my state all start at 190k for new grads
If I remember correctly, you are in S. Carolina. I would not take <220k for that region regardless it is Charleston or rural areas of S. Carolina.


If my GP friend is getting ~200k in the southwest, FM docs should not take less than that.
 
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If I remember correctly, you are in S. Carolina. I would not take <220k for that region regardless it is Charleston or rural areas of S. Carolina.


If my GP friend is getting ~200k in the southwest, FM docs should not take less than that.
Good, more jobs for those of us that want to be there.

Besides, SC has the 5th highest income levels for family medicine in the country. I'll take a lower starting salary for that. What's 10-15k less for that first year compared to the next 30?
 
I dont think that's a good offer... This is 180k/yr, which is low for FM IMO (unless it's a Monday thru Wednesday job). I am an IM guy but I talked to a couple of FM PGY3 who signed 4 days contract for 200k+/yr + benefits.

See my previous post.
 
Yeah, people should have an attorney look at their contract...
That won't actually help with he's talking about.

Attorney's don't usually know what the actual working conditions of a place are like. They exist to tell you what the contract says and let you know of any particular problems as far as the contract goes.

They can't tell you that there are no cardiologists within 100 miles or urologists within 200. They can't tell you're in the middle of ground zero for the opioid epidemic.
 
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That won't actually help with he's talking about.

Attorney's don't usually know what the actual working conditions of a place are like. They exist to tell you what the contract says and let you know of any particular problems as far as the contract goes.

They can't tell you that there are no cardiologists within 100 miles or urologists within 200. They can't tell you're in the middle of ground zero for the opioid epidemic.

Having an attorney look over your contract is never a bad idea, but I was referring more to those other intangibles...the stuff you don't find out about until you're already there. Anybody paying significantly over the market rate is only doing so because they have to.
 
The median salary for FM nationwide is 241k/year and over 80% of FM docs work <=50 hrs/wk (according to AAMC Careers in Medicine), so getting 220k/year as a starting salary almost anywhere should not be considered outside of the norm.
 
The median salary for FM nationwide is 241k/year and over 80% of FM docs work <=50 hrs/wk (according to AAMC Careers in Medicine), so getting 220k/year as a starting salary almost anywhere should not be considered outside of the norm.
That doesn't make any sense on several levels.

First, starting salaries are almost always going to be quite a bit less than median. Why would you pay a new person anywhere close to what you pay the doc who sees 25 patients per day?

Second, there is a marked difference in pay based on location in the US. It's why people complain about low pay in NYC but can go to rural Wyoming and make easily 2x as much. Most places pay what they have to to get doctors.

Third, as @Blue Dog has posted before, a high starting salary likely means you're giving up something somewhere else (assuming a decent location). Lots of places use a high starting salary to get you there knowing that you won't be able to meet production goals to keep said salary and so will take a big salary cut after the guarantee runs out.

Fourth, most places that have a starting salary on the lower end so it for one of 2 reasons. First is really desirable location. Second is that it's a place where you will out earn the guarantee quickly so it doesn't matter. For instance, I'm 5 weeks into a new job and I'm already producing enough to cover half of my salary. Even if my growth rate gets cut by 75% (which isn't likely as summer is usually slower than fall/winter), I'll be out-earning the guarantee by the 6 month mark. Lower starting in exchange for faster growth and more long term money is a smart deal.
 
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[edit: to the OP, I would say that’s a pretty good contract and would take it if the environment/location were favorable to myself/family, and non-compete were reasonable]


IM here
My initial contract was $185k/yr with 3 year contract and stipend during residency - strictly outpt practice setting.
Hospital ended up getting bought by someone else, salary became “standardized “ and went to $210k/year, RVU requirement around the 4000s, above base RVU $45/RVU in bonus territory.
With mix of nursing homes and inpt, pre-tax with bonus > $300k.

You certainly need to hustle a little, my contract is up this year, looking to negotiate a $20k raise on base

My location would be suburban

Red flags to offers/contracts would be very large bonus (most of the time this is a “loan” over 3-5 years), promise of $250k seeing 16 pts per day 4d/wk, strictly a percentage of gross Billings/reimbursements or strictly production after first year (insurances can vary - my area has a lot of medicaid and Medicare making reimbursement model unsustainable, but if strictly RVU it doesn’t matter).

When going in to a discussion of salary it depends on the model of reimbursement (especially with the nuisances as mentioned above). It does not hurt to ask what other physicians are doing/producing and I would ALWAYS ask to speak to two physicians over the phone/in person one on one (don’t be shy about talking numbers).

Lastly, what are your responsibilities outside of what patients you see day to day, oversight of APCs or call, if oversight of APC you should have extra compensation, if there is coverage of call can you get paid more if you take more call? What opportunities are there to moonlight, can you do nursing homes, inpt, additional hours in a clinic/urgent care?

You won’t truly know what you want and don’t want until you actually do it, if you plan to stay in the area where you are initially signing a contract, just make sure the non-compete isn’t horrible and doesn’t apply after the contract has been completed/fulfilled Incase you wished to move to a different health system/private setting.

Good luck!
 
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What is an APC? Please don’t say advanced practice anything.
 
[edit: to the OP, I would say that’s a pretty good contract and would take it if the environment/location were favorable to myself/family, and non-compete were reasonable]

Red flags to offers/contracts would be very large bonus (most of the time this is a “loan” over 3-5 years), promise of $250k seeing 16 pts per day 4d/wk, strictly a percentage of gross Billings/reimbursements or strictly production after first year (insurances can vary - my area has a lot of medicaid and Medicare making reimbursement model unsustainable, but if strictly RVU it doesn’t matter).

When people say that the sign on bonus is a “loan” that is forgiven does that mean it is not taxed? This seems too good to be true but just curious.
 
Its taxed as income. Its a loan in the sense that if you don't stay 3 yrs (or whatever the requirement is), then you have to pay it back.
Also, loan is not taxed up front, if you don’t remain for 3 years (whatever the contract length is) then you owe interest on the “loan” as well as what the principle is
A loan is really a recruitment and retention incentive
A straight sign in bonus is paid up front and usually no strings attached, tax paid on it that year.

Most state “sign on bonus” when it is a recruitment/retention loan
 
Base salary = 230,000 for first 15 months (4694 wRVU per year to keep generating that much, bonus for more)
$49 per RVU
Sign on bonus: 25,000
PTO: 22 days 1st year, 28 days years 2 and 3
CME: $3,500
Location: Southwest, good area
Medical/Dental/Vision insurance (dont know details)
AD&D insurance
Long-term disability insurance
401K plan


Any negotiating tips?? I've never done this before. Before med school, I was used to minimum wage jobs and taking whatever I could get. This is the first offer I'm serious about. Any advice would be appreciated.

A recruiter once told me, "All numbers are always negotiable". If you don't ask then you won't receive. I think your RVU number is way too high. My RVU is set at 296/month or 3600/year. Don't get caught thinking that 230K will remain a stable number if you don't reach your RVU numbers. I found out the hard way thinking I had a set base salary when I really didn't after the 15 months period. At that point you go to pure RVU's so if you don't make your numbers then you don't get paid or your pay is drastically cut. My job also projects an expected future income based upon the prior 6 months. So if I work extra that last quarter then my projected income for the next quarter with be inflated. I have to tell the payroll dept to do "balanced billing" so my base pay stays constant year round so it doesn't get cut in the slow months. Make sure they don't have that type of payroll set up. If I make over the required then I get a bonus at the end of the year.

Remember that your sign on is before taxes, so it will come out bout 17K after taxes. You should ask for 30K.

If you work 5 days a week then your PTO should be valid. My contract has PTO stated in it but since I only work 10 days a month. I don't get PTO even though its in there. We also don't get true sick leave for FMLA so make sure that PTO is a true offer. Also ask about the medical insurance. Do they take the premiums out of your base pay? or it is provided by the company? Can make a huge difference depending on what they are charging you.

Also remember that no contract is set in stone and if things fall apart they can let you go at any time. I learned that the hard way.
 
Wait people are still debating this offer after we realized it’s 184k per year? Is the job market in FM garbage? No doctor in any field should be making <200k these days...

Exactly. $184k? You have midlevels starting at $100-$110k these days. $184k is an insult to someone with your level of training and expertise.
 
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Exactly. $184k? You have midlevels starting at $100-$100k these days. $184k is an insult to someone with your level of training and expertise.

I just clarified with them about the 0-15 months at 230k, its not 230 spread over 15 months, its 230 per year (19,000/month) for the first 15 months.
 
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So for the record it appears the offer is $230k per 12 months, not $185k (which would be a poor deal).
 
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Where in the Southwest are you applying? City or rural area? What size of town? Just asking to see how much per rvu I should be negotiating.
 
As other have said, that "salary" figure is only if you hit your production numbers, and that depends on many things. You may not get that many RVUs and you'll make less. Or, you will make that many but you'll feel like its too high of a requirement. There may be a clause that you get penalized if you won't hit your RVU production quota. Look at the fine print. Don't accept any penalties for not hitting your RVU production.

I'm not sure where people are getting 184k from. Remember at that income level, 32% is the tax rate. Once you go on production after 15 months, best case scenario you'll be taking home around 160,000 a year which is around 13,000/month, which sounds like a lot but not after you start paying a mortgage and student loans.

I wouldn't sign any contract with a non-compete clause in it, on principle. It's a completely screwed up practice that institutions use to try and maintain their monopoly in a geographic area.

It's a pretty standard contract and you aren't going to go hungry. It's probably going to be slightly below average pay once you go on production, but there are many things that can make that very acceptable. I'd happily make 160k/year if it means I have time to see my patients and have a low stress work environment, without anybody bugging me to see more patients than I was comfortable, etc. It's not all about money and whether you stay in this job, money may have little to do with it, ultimately.
 
I wouldn't sign any contract with a non-compete clause in it, on principle. It's a completely screwed up practice that institutions use to try and maintain their monopoly in a geographic area.

Good luck. Non-competes definitely serve a purpose, and it isn't as nefarious as you think.

If a group like mine hires a new physician, we go at risk. We provide them office space, staff, marketing, and everything else they need to help them build a practice in return for a guaranteed salary that they may or may not ever pay back by the end of their 3 year contract (at which point they go on full production). We can't afford to have the physician quit and open his/her own practice across the street as soon as they're busy enough. We don't have a monopoly, but we're not about to fund our competition.
 
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Good luck. Non-competes definitely serve a purpose, and it isn't as nefarious as you think.

If a group like mine hires a new physician, we go at risk. We provide them office space, staff, marketing, and everything else they need to help them build a practice in return for a guaranteed salary that they may or may not ever pay back by the end of their 3 year contract (at which point they go on full production). We can't afford to have the physician quit and open his/her own practice across the street as soon as they're busy enough. We don't have a monopoly, but we're not about to fund our competition.
The key is to find a fair balance.

One non-compete I negotiated prohibited me from working for either of the other 2 large hospital systems in the area if within 20 miles. I could work for the local FQHC, open my own practice, or pretty much anything except work for the other hospitals unless I was 20 miles away. The standard for that job was 2 years 20 miles inclusive, so not a huge change but enough that I could have stayed in town had I wanted to.
 
My non-compete states I can’t work in primary care in the county (for anyone else).

But my company is the only game in the county; and a private office could never fly here anyway. So I didn’t worry about signing it.

If I’m not working in this office; it’ll be somewhere else in the state anyway. I wouldn’t mind moving to Moab, UT; but that wouldn’t be prohibited by my current contract’s non-compete.
 
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