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Hi - Is there a forum for residents/dermatologists looking for jobs? I had a couple of questions. What would be considered a fair salary for a dermatologist 5 years out of residency for working 3 days a week at a private practice (northeast)? What is best for the first year at a new practice for a derm who has already been in practice - guaranteed base vs percentage? Roughly how much would malpractice and a tail cost? Thanks so much in advance!
 
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I too wonder the same thing. Ppl used to chat about this stuff on the dermboard (yuku now), so u could search old posts.... But I wonder why nobody talks about this stuff anymore. I want to know what to expect
 

DermMatch

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A lot of oldies who cut their teeth on dermboard don't know we've moved to SDN. People need to get the word out. I myself would also love more salary info.

For new grads, I understand that 1 full-day clinic = $100,000 annual take in private practice. In academics, supposedly it's $60,000 annually for 1 full-day clinic. I may be wrong -- this is all word of mouth.

I wouldn't be surprised if it doesn't hugely matter how long you've been out, because $ is going to be based on how productive you are. I know of a person who's 5 years out and is making a guaranteed base of roughly $350,000 in a metro suburb (they were a bit coy with the info but based on the data they gave me, the math works out to the mid-300s). This person works 4 days a week.

One thing I've noticed: People are VERY MUM about their job search. Yet another reflection of how incredibly cutthroat our genus is.
 

DermMatch

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About guaranteed base v percentage:

Depends on how hard you want to work.
 

jh0276

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I think the $100,000 take home for a full day of clinic is a bit optimistic. The salary for academics is about $200,000 per year for a 1.0 FTE...that does not include time off for research interests which would decrease your salary. It is probably about $50,000-$100,000 more per year for 1.0 FTE in private practice but you will work for that money. This is for medical dermatology. I believe the previous stats if you are doing atleast 1/2 your time doing cosmetics. I think that Obamacare will be hitting the subspecialties reimbursements so the salary will go down not up. Probably not a popular post, but a true one.
 

reno911

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It's kind of fun for me to read threads like these, because I remember what I used to think "reality" was when I was a med student and resident and how wrong I was.

The main problem with threads like these is that everyone wants a good general answer to the question "How much can/should/does a dermatologist make" and there is really no such answer. The correct answer, like for most things in life, is "it depends". There are too many factors to consider.

For example the $100,000 per clinic day is one that I heard myself (about 5-10 years ago). The truth is that you can find positions that will result in half as much or twice as much income...it really just depends on a lot of things.

Despite the fact that I just said that it's hard to make generalizations, here's some which you may find helpful. All of these things are true for our current health care environment. As we all know, there are going to be changes in how health care is paid for, and that may change how true some of these things are.

None of this stuff should be earth-shattering.

1. You can make as much money as you want if you're willing to do what it takes. Now I don't mean this literally, obviously. But when talking to residents about these things, one of the first questions I ask is "How much would you like to make?" No resident has ever given me a number which wasn't achievable (most are easily achievable).

This is actually true of many areas in medicine, but especially true of dermatology. There are plenty of dermatologists that make millions of dollars a year. These people work very hard and have worked for a long time to create situations in which they can be this productive. You obviously can't do this overnight. It takes years to get to this point (and some luck). But if you want to do it, you can. It's also a lot harder now than it used to be, but it's still possible.

2. There is a huge tradeoff between location and salary. You make a lot more with a lot less effort working in an small town that no dermatologist wants to live in.

3. The derm sub specialties (Mohs and Dermpath) are no longer an easy path to big bucks. If you could do Mohs or dermpath all day, every day, you would make a ton of money. However, finding such positions is increasingly difficult. Also so many dermatologists get subspecialty training, that there aren't enough general derms around to keep all of the subspecialists busy.

Just doing general dermatology with some cosmetics will give you similar income potential and a lot more flexibility. Only do a fellowship if you really enjoy the work. Doing it for the money is no longer sensible.

4. Many academic jobs and private practice jobs offer comparable salaries when you're straight out of residency (especially in larger cities). The difference is that in private practice your salary will go up a lot over time, whereas in academia it won't.

An important corollary to this is if you're looking for a permanent position, never base your decision on what they're paying you in the first year or two. Project what you'll be making once you've been there for 3-4 years and use that figure to make your decision. This is the number one mistake I see people make.

5. So much of your income potential is related not to the efficiency with which you see patients. More important is keeping your overhead down and getting paid for what you do. I know practitioners that keep there overhead at under 30% (exceptional) or 65% (terrible). That difference alone would double your salary.

6. Generally speaking (and this is often not true), the better a guaranteed salary you can secure, the worse your long term potential is. Actually, in most non-saturated markets the way to make the most money is to start your own practice. That has zero guarantee, and is a ton of work at the outset. But there are few ways to be making more money in the long run than starting your own practice.

I could go on, maybe I'll post some more when I have time.
 
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MOHS_01

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Reno -- good post. I take issue with #5, but otherwise a really good post. :thumbup:
 
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Thanks for the responses. Wow - 350K guarantee for 4 days a week sounds like a lot. I guess it all depends on what part of the country you're in. I am getting offered some guarantees of 50-60 K/day with incentives (40% above a certain amount) which comes out to much less. Is it typical to have to cover your own malpractice tail? Does anyone know roughly what this might cost after say 5 yrs of practice, 3 days/week? (5K ? 10K? 20K?)
 

MOHS_01

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350k/4d work week is a lot, no doubt. Again, there are too many variables to speak reliably, and it will depend upon both the payer mix, geographic location, disease mix, cost structure of the practice, etc.

Tail coverage depends upon both the state you practice in and your procedure mix. After five years, if you do a little flaps / reconstruction and no cosmetics, you will probably be looking at 20k or so -- but that's just an educated guess at best.
 

reno911

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A good rule of thumb for tail coverage is that it costs 1 to 2 times your annual premium. But as mentioned above, there are a lot of variables such as the type of practice and how long you've been practicing that can result in a deviation from this estimate.
 

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It's kind of fun for me to read threads like these, because I remember what I used to think "reality" was when I was a med student and resident and how wrong I was.

The main problem with threads like these is that everyone wants a good general answer to the question "How much can/should/does a dermatologist make" and there is really no such answer. The correct answer, like for most things in life, is "it depends". There are too many factors to consider.

For example the $100,000 per clinic day is one that I heard myself (about 5-10 years ago). The truth is that you can find positions that will result in half as much or twice as much income...it really just depends on a lot of things.

Despite the fact that I just said that it's hard to make generalizations, here's some which you may find helpful. All of these things are true for our current health care environment. As we all know, there are going to be changes in how health care is paid for, and that may change how true some of these things are.

None of this stuff should be earth-shattering.

1. You can make as much money as you want if you're willing to do what it takes. Now I don't mean this literally, obviously. But when talking to residents about these things, one of the first questions I ask is "How much would you like to make?" No resident has ever given me a number which wasn't achievable (most are easily achievable).

This is actually true of many areas in medicine, but especially true of dermatology. There are plenty of dermatologists that make millions of dollars a year. These people work very hard and have worked for a long time to create situations in which they can be this productive. You obviously can't do this overnight. It takes years to get to this point (and some luck). But if you want to do it, you can. It's also a lot harder now than it used to be, but it's still possible.

2. There is a huge tradeoff between location and salary. You make a lot more with a lot less effort working in an small town that no dermatologist wants to live in.

3. The derm sub specialties (Mohs and Dermpath) are no longer an easy path to big bucks. If you could do Mohs or dermpath all day, every day, you would make a ton of money. However, finding such positions is increasingly difficult. Also so many dermatologists get subspecialty training, that there aren't enough general derms around to keep all of the subspecialists busy.

Just doing general dermatology with some cosmetics will give you similar income potential and a lot more flexibility. Only do a fellowship if you really enjoy the work. Doing it for the money is no longer sensible.

4. Many academic jobs and private practice jobs offer comparable salaries when you're straight out of residency (especially in larger cities). The difference is that in private practice your salary will go up a lot over time, whereas in academia it won't.

An important corollary to this is if you're looking for a permanent position, never base your decision on what they're paying you in the first year or two. Project what you'll be making once you've been there for 3-4 years and use that figure to make your decision. This is the number one mistake I see people make.

5. So much of your income potential is related not to the efficiency with which you see patients. More important is keeping your overhead down and getting paid for what you do. I know practitioners that keep there overhead at under 30% (exceptional) or 65% (terrible). That difference alone would double your salary.

6. Generally speaking (and this is often not true), the better a guaranteed salary you can secure, the worse your long term potential is. Actually, in most non-saturated markets the way to make the most money is to start your own practice. That has zero guarantee, and is a ton of work at the outset. But there are few ways to be making more money in the long run than starting your own practice.

I could go on, maybe I'll post some more when I have time.
:thumbup:

Love the advice (although I still have yet to actually start training :p)

Keep it comin!
 
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6. Generally speaking (and this is often not true), the better a guaranteed salary you can secure, the worse your long term potential is.
Thank you for your post. Would you mind elaborating on this statement? Thank you!
 

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Thanks so much to the senior colleagues for jumping in. Really appreciate the feedback. I don't plan on a fellowship, but I haven't started career planning, and I'm (probably unduly) nervous. I want to avoid feeling like I'm being slaved for The Bosses at a private practice.

Please forgive the five questions below as I know I should probably Google the answers first but

(1) What is tail insurance?

(2) Is it worth hiring a lawyer/negotiator to help you with your contract? I don't want to get screwed.

(3) I've heard of places which make those who work on a percentage, PAY for their own equipment. How frequent is that?

(4) I know the range varies depending on location, but what should you typically budget to start your own practice?

(5) There were some practice management services at the AAD -- is it worth hiring one of those groups to help you launch your own business?

I've read that having to support your own EMR will be devastating to the bottom line. Private practitioners I know are dreading it -- one of them joked that they plan on retiring before they get mandated to fully implement EMR, because it's going to slow them down in clinic and cost a bundle that they'll never recoup.
 
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Thanks so much for contributing! I feel like we spend so much time amongst academics that we don't know what goes on outside of that after training. As far as what I've heard, in a major city, you can expect to get job offers of about 250k starting within the city and 350k if you go out to the burbs. My knowledge is limited however, so I have a few q's:

1) Geography - Everybody says pay varies with geography, but how so beyond the small town single derm practice. I read an article that said all areas of medicine make the most in towns of 50 to 250k ppl and less in the biggest metropolitan areas. How does income vary by geography within the country in comparably sized cities? For example, a nyc vs san fran vs chicago vs miami. Equivalent pay in nyc will go much farther in chicago.

2) If ppl are making a certain amount working 4 days per week, can u assume that if you work 5 days a week you get 20 percent more, or is there an issue with not enough work to go around?

3) Why do you say somebody who does a fellowship has less flexibility than a general dermie? Can't a mohs surgeon just do medical derm in addition? I would think a fellowship would provide MORE flexibility, just giving you another skill set.

4) Cosmetics - obviously that's a way to boost income, but how difficult is that to get into? Do you need to learn that during residency? What if your program doesn't give you that experience?

5) Geography again - how is it if you want to jump around a little bit geographically? When you leave residency and start working, does anybody move after that or is the location you choose gonna be where you stay because you don't want to restart building a practice? How about the job search out of residency from a geographical perspective, how hard is it to find a job on the other coast with no connections?

Thanks in advance for all advice!
 

reno911

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Thanks so much to the senior colleagues for jumping in. Really appreciate the feedback. I don't plan on a fellowship, but I haven't started career planning, and I'm (probably unduly) nervous. I want to avoid feeling like I'm being slaved for The Bosses at a private practice.

Please forgive the five questions below as I know I should probably Google the answers first but

(1) What is tail insurance?

(2) Is it worth hiring a lawyer/negotiator to help you with your contract? I don't want to get screwed.

(3) I've heard of places which make those who work on a percentage, PAY for their own equipment. How frequent is that?

(4) I know the range varies depending on location, but what should you typically budget to start your own practice?

(5) There were some practice management services at the AAD -- is it worth hiring one of those groups to help you launch your own business?

I've read that having to support your own EMR will be devastating to the bottom line. Private practitioners I know are dreading it -- one of them joked that they plan on retiring before they get mandated to fully implement EMR, because it's going to slow them down in clinic and cost a bundle that they'll never recoup.
1. There are two types of malpractice insurance. Occurence and Claims-Made. Assume you work in a practice for five years and you decide to move to a different state. If you have Occurence type of malpractice insurance, you are covered if any patient you're seen in that 5 years brings a suit against you at any time (during that 5 yrs or any time in the future). If you have the claims made type of insurance, you are only covered if the suit is brought against you during the 5 years that you were working there. If someone that you saw during those 5 years sues you after you leave (and presumably no longer have the same malpractice insurance carrier), then the claims-made type of insurance will not cover you. So you need to purchase tail insurance to cover you against any lawsuits brought against you in the future by patients you saw in those 5 years.

2. Lawyer, yes. Negotiator, I'm not sure what that is, but no. You should do the negotiating yourself. You might have someone (lawyer, colleague, etc.) give you an idea about what to ask for, but you should do this part of things yourself.

3. It doesn't matter how frequent it is. What matters is if it's a good deal. That being said, I've heard of it only rarely.

4. Too many variables to possibly answer. I know someone that did it with 100K (which is almost unbelievable, but he's a good friend, so I know he's not lying) and someone else who needed 1 million.

5. This depends on how comfortable you are learning how to run your own business on the fly. Some people have a knack for it. Some don't. I will say that it's not nearly as hard as you think.
 

reno911

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Thank you for your post. Would you mind elaborating on this statement? Thank you!
Sure. But it would be more helpful if you could give me a more specific idea of what you're wondeirng about.
 
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Any thoughts on joining an established dermatology practice where one will do 2 to 3 half days of clinical dermatology and then read dermpath for the group the rest of the time? Any advice would be greatly appreciated. Thank you!
 

reno911

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Thanks so much for contributing! I feel like we spend so much time amongst academics that we don't know what goes on outside of that after training. As far as what I've heard, in a major city, you can expect to get job offers of about 250k starting within the city and 350k if you go out to the burbs. My knowledge is limited however, so I have a few q's:

1) Geography - Everybody says pay varies with geography, but how so beyond the small town single derm practice. I read an article that said all areas of medicine make the most in towns of 50 to 250k ppl and less in the biggest metropolitan areas. How does income vary by geography within the country in comparably sized cities? For example, a nyc vs san fran vs chicago vs miami. Equivalent pay in nyc will go much farther in chicago.

2) If ppl are making a certain amount working 4 days per week, can u assume that if you work 5 days a week you get 20 percent more, or is there an issue with not enough work to go around?

3) Why do you say somebody who does a fellowship has less flexibility than a general dermie? Can't a mohs surgeon just do medical derm in addition? I would think a fellowship would provide MORE flexibility, just giving you another skill set.

4) Cosmetics - obviously that's a way to boost income, but how difficult is that to get into? Do you need to learn that during residency? What if your program doesn't give you that experience?

5) Geography again - how is it if you want to jump around a little bit geographically? When you leave residency and start working, does anybody move after that or is the location you choose gonna be where you stay because you don't want to restart building a practice? How about the job search out of residency from a geographical perspective, how hard is it to find a job on the other coast with no connections?

Thanks in advance for all advice!
I'm not sure that these answers are going to be helpful, because your questions are just so general. Every one of these answer should have a bunch of qualifiers attached, which I'm not going to include in the interest of brevity.

1. For the cities that you've listed, the differences in income are likely not as large as the differences in the cost of living.

2. You've answered your own question here. It depends on the market. If you're in a saturated market, then you may not have enough demand so you won't make 20% more. On the hand, if you're in a market that is not saturated (i.e., most of them), and there's plenty of patients to go around, then you as an employee will probably make 20% more.

But if you own your own practice, you might make >20% more. The reason is because some components of your overhead, like rent, are fixed no matter how many days a week you work. For example if you pay 10K a month for your office space, it doesn't matter whether you work 4 or 5 days a week. So working 5 days vs 4 effectively reduces your overhead, meaning that once expenses are paid, you would have a >20% increase.

3. This one is an interesting one and there are really several reasons, but I'll just expound on one. If you are a subspecialist you rely on other dermatologist for referrals. That is, as a Mohs surgeon you need other dermatolgists to send you cases and as a derm path you need other dermatologists to send you biopsies. Thus the key to success in these subspecialties is that you need to find a group of dermatologists who will send cases to you. Because of the glut of Mohs and dermpath folks, this is pretty hard.

The problem that often arises if you are do both general derm and Mohs (for example), then you are going to find yourself competing with the very same general derms you will rely on for referrals. Since you're doing general derm also, you're competing with the general derms in the community for the general dermatology patients. But then at the same time your going to be asking them to send you their Mohs cases. That never works out well. General derms who are competing with you in one arena are unlikely to help you out in another. In fact, they may go out of their way not to send patients to you even if it would be more convenient for the patient.

4. It depends on what you mean by cosmetics. If you're just talking about botox, fillers, lasers, and chemical peels, then these are things that you can pick up in residency, going to meetings, etc. The skills are not very hard to learn. If you're talking about things like liposuction, face lifts, blepharoplasties, hair transplants, and the like, then I strongly recommend you do a fellowship.

5. Lots of people move around. The nice thing about derm is if you need to move for family or other reasons, you know that you will be able find a job wherever you need to go. And even the worst derm job is still a pretty good job compared to just about anything else. Difficulty depends on how saturated the market you're looking at is.
 

reno911

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Any thoughts on joining an established dermatology practice where one will do 2 to 3 half days of clinical dermatology and then read dermpath for the group the rest of the time? Any advice would be greatly appreciated. Thank you!
Nothing wrong with that if that's what you want to do. But they're either going to have to be a big group or you are going to have some reason to believe that others outside the group will send you biopsies if you're going to have enough dermpath to keep you busy the rest of the week.

You're going to get faster at reading slides with time and the cases you get from a private practice are not going to be as tough as what you would see in fellowship. So you probably will have a hard time filling the rest of the week just reading slides.
 
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How much (%) should one expect to be paid for supervising a PA? (ie cosigning there notes, seeing any complicated patients with them)
 
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Nothing wrong with that if that's what you want to do. But they're either going to have to be a big group or you are going to have some reason to believe that others outside the group will send you biopsies if you're going to have enough dermpath to keep you busy the rest of the week.

You're going to get faster at reading slides with time and the cases you get from a private practice are not going to be as tough as what you would see in fellowship. So you probably will have a hard time filling the rest of the week just reading slides.
Thank you! So if you are derm/dermpath, the path of least resistance, so to speak, if you want to do private practice, is to just do 100% dermpath and give up clinical dermatology altogether? Did I interpret your posts correctly?
 

reno911

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Thank you! So if you are derm/dermpath, the path of least resistance, so to speak, if you want to do private practice, is to just do 100% dermpath and give up clinical dermatology altogether? Did I interpret your posts correctly?

No, it's almost exactly the opposite. If you want to be a dermpath, it will be very difficult to find a job where you can do 100% derm path. Therefore, if you like clinical derm, and you want to do it that's great, because you can do do some of both.

So, if you want to do dermpath and you want to do private practice here are you options in order of desirability:

1. Join a large dermpath group where you can be reading only dermpath all of the time. A good job like this is hard to find these days in the private arena. But if you can find it that's great. Even if you want to do some clinical derm, you should still seek this kind of job, because you'll always be able to find a job doing 1-2 days of clinical derm somewhere if you really want to do it.

2. Join a private practice with several derms and read their path. If you do this you'll probably be doing a lot of clinical derm, but if you want to do this, there's nothing wrong with it.

3. Start your own practice. While this is the best option for someone who is a general derm, it's not a great idea for someone who wants to be primarily a dermatopathologist (especially right after fellowship).
 

eddie13231

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This is an awesome thread. It really shows that is possible in private practice when compared to academic. Thanks for all the informative responses.

So I do have one question related to this topic at hand. Is it possible to be in private practice and still do academic research? For example do 4 days in private practice and 1 day a week academic doing research.
 

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My take on this...

If you are doing basic research within a group, then not likely. If you are involved more in clinical trials within a larger group then I could see it being a maybe where one or two of those private practice days are clinics geared towards the target population of your research. Being a PI with a lab in either basic or clinical research, not likely.

50/50 is doable, from what I have seen.
 

eddie13231

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My take on this...

If you are doing basic research within a group, then not likely. If you are involved more in clinical trials within a larger group then I could see it being a maybe where one or two of those private practice days are clinics geared towards the target population of your research. Being a PI with a lab in either basic or clinical research, not likely.

50/50 is doable, from what I have seen.
Definitely not basic science more like running pharma clinical trials or just testing general clinical ideas.
 

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Reno911 - thanks for contributing to the great discussion. A few more questions:

1. What's a reasonable number for "percent of collections" if that is all that your compensation is based on as an employee (excluding benefits, which are all fully covered)?

2. Are there any numbers out there for how many work RVUs and total collections are generated by a medical dermatologist, on average, for every hour of patient contact time?

3. I am curious about why you think the compensation guarantee tends to correlate negatively with the ultimate earning potential. Is it all a big bait-and-switch?

4. I'll restate derm1234's question: How much, % or flat fee (i.e. 25k/yr), should one expect to be paid for supervising a PA? (ie cosigning there notes, seeing any complicated patients with them)

5. How appropriate is it for new grads to negotiate compensation? Or are most offers "take-it-or-leave-it"?
 

reno911

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Reno911 - thanks for contributing to the great discussion. A few more questions:

1. What's a reasonable number for "percent of collections" if that is all that your compensation is based on as an employee (excluding benefits, which are all fully covered)?

2. Are there any numbers out there for how many work RVUs and total collections are generated by a medical dermatologist, on average, for every hour of patient contact time?

3. I am curious about why you think the compensation guarantee tends to correlate negatively with the ultimate earning potential. Is it all a big bait-and-switch?

4. I'll restate derm1234's question: How much, % or flat fee (i.e. 25k/yr), should one expect to be paid for supervising a PA? (ie cosigning there notes, seeing any complicated patients with them)

5. How appropriate is it for new grads to negotiate compensation? Or are most offers "take-it-or-leave-it"?
The answer to all of these is that it depends (i.e., my standard disclaimer), but here's some general answers

1. If they are offering you anything less than 40%, I would probably look elsewhere. Low 40s is reasonable, high 40s is good and anything above 50 is outstanding. Of course this depends on a lot of things, so I could imagine situations where below 40 or above 50 is reasonable.

I personally would never accept 40% if it was going to be a long term situation. 40% is fine initially, but if that's is the way things are expected to be forever, then I'd probably look elsewhere. Standard disclaimer applies.

2. Yes. But there is so much variation in practice among dermatologists that "average" numbers don't tell you much.

3. That's just the way it happens to work out. I don't think that there is any malicious intent. And there are plenty of exceptions.

4. If you're asking about a flat fee, then that depends entirely on how busy and capable the PA is. Impossible to answer that intelligently in a vacuum. I can't even begin to speculate on this one.

If you're asking about percentage, assuming you're supervising the PA 100% of the time, then the answer is that you should probably get most of what is left over after the overhead and the PA are paid.

5. Completely appropriate. Your negotiating power depends on the market you're in. In certain markets you have tremendous power, in others you have less, but you've always got some. You should always assume that you can negotiate yourself something better that what you've been initially offered (and maybe not better in terms of salary, but there's a million things you can negotiate). You may not be successfull all of the time, but you should always try.

Generally speaking, because of the relative shortage of dermatologists in most areas, you are in an excellent position, and you should take advantage of that.


Good luck
 
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MOHS_01

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Reno911 - thanks for contributing to the great discussion. A few more questions:

1. What's a reasonable number for "percent of collections" if that is all that your compensation is based on as an employee (excluding benefits, which are all fully covered)?

2. Are there any numbers out there for how many work RVUs and total collections are generated by a medical dermatologist, on average, for every hour of patient contact time?

3. I am curious about why you think the compensation guarantee tends to correlate negatively with the ultimate earning potential. Is it all a big bait-and-switch?

4. I'll restate derm1234's question: How much, % or flat fee (i.e. 25k/yr), should one expect to be paid for supervising a PA? (ie cosigning there notes, seeing any complicated patients with them)

5. How appropriate is it for new grads to negotiate compensation? Or are most offers "take-it-or-leave-it"?
You also have to consider that "not all revenues are created equal"; it really depends upon your practice mix (payers, procedures, etc) -- so it is very difficult to give solid generalities.