Medical director compensation

[senoranonymous]

Posting under an anonymous name... I've been asked to take over as medical director at a small ED for a colleague who stepped down to move to another state (I would keep my full time job) and wanted to get a feel for what the compensation for directors is at sites, want to get a feel for what a fair offer is, as I have absolutely no idea. The department contract is managed by a CMG I have no experience with.

If you don't want to post under your full ID you can PM me and I will post the info anonymously or I can keep it private for my own reference if you prefer. I think having some of this info out in the open may help our SDN'ers evaluate positions like this. I'll start with what I was offered. Appreciate any replies of course.

Beds: 4
Patients/day: 15
Stipend: $2250/mo
Clinical rate: $160/hr (Clinical rate at my primary site = $255/hr)
Shift requirement: 6x10hr shifts per/month (staffing is kind of short at this site however...)
Approximate admin hours required/month: 10-15
Other pertinent info: Rural site, ED docs also responsible for RRTs and floor codes, no other docs in house overnight
Acuity: Super low, one intubation/yr

---

Members don't see this ad.

 

[WilcoWorld]

It sounds like they're offering to pay you $2250 to take a $5700 pay cut (60 hours x ($255/hr-$160/hr) = $5700) .

 

[deleted109597]

So, like others are thinking, barring some extremely important reason to do this (family in the city, you're ready to semi-retire), it's a no brainer. Not worth it financially.

 

[Arcan57]

Being director is never worth it financially. The main perks are going to be control over your schedule and the ability to improve the clinical environment. If your site is constantly short than those perks are largely negated.

 

[Tenk]

If all you want to do is watch netflix all day and not do anything, sounds great!

 

[Angry Birds]

Four beds? That's a bedroom with two bunk beds, not an ER.

 

[dchristismi]

Hell, it might actually be an Emergency ROOM.

heh. couldn't help it.

FWIW, I was a medical director for awhile. When we lost the contract, the CMG apparently thought I'd be staying in an administrative position. While there were perks, the fact that we were chronically short staffed meant too many hours, and I was becoming very burned out. And I stepped away, and haven't regretted it at all.

 

[Angry Birds]

On the other hand, 160/hr for 15 pt/day is pretty good. But, you're making way more at your primary clinical site. You've made me realize I'm horribly underpaid.

 

[RustedFox]

On the other hand, 160/hr for 15 pt/day is pretty good. But, you're making way more at your primary clinical site. You've made me realize I'm horribly underpaid.

If I were unattached, I'd take that gig for awhile. Schedule 10 day blocks, take vacation every month.

 

[WilcoWorld]

If I were unattached, I'd take that gig for awhile. Schedule 10 day blocks, take vacation every month.

I might want to work in this sort of ED as soft retirement plan (in which case I definitely don't want to be the Medical Director). I probably won't be ready to stop practicing medicine right when my kids go to college, but I'll be over seeing 30 patients in a shift. And unattached enough to go work somewhere in the shadow of a mountain.

 

[EctopicFetus]

Sounds bad. Whats the commute to this rural site?

Honestly, to figure this out you have to weigh everything. It is possible and likely that this isnt a terrible deal but my looking at it makes me think this is a terrible deal. If it is really 10 hours per month you cant possibly be doing much.

 

[RustedFox]

I might want to work in this sort of ED as soft retirement plan (in which case I definitely don't want to be the Medical Director). I probably won't be ready to stop practicing medicine right when my kids go to college, but I'll be over seeing 30 patients in a shift. And unattached enough to go work somewhere in the shadow of a mountain.

I hope you get your wish, amigo. I'm four years out and I already want to "slow down". It's not the work, it's the VOLUME and the expectations....

 

[emergentmd]

Posting under an anonymous name... I've been asked to take over as medical director at a small ED for a colleague who stepped down to move to another state (I would keep my full time job) and wanted to get a feel for what the compensation for directors is at sites, want to get a feel for what a fair offer is, as I have absolutely no idea. The department contract is managed by a CMG I have no experience with.

If you don't want to post under your full ID you can PM me and I will post the info anonymously or I can keep it private for my own reference if you prefer. I think having some of this info out in the open may help our SDN'ers evaluate positions like this. I'll start with what I was offered. Appreciate any replies of course.

Beds: 4
Patients/day: 15
Stipend: $2250/mo
Clinical rate: $160/hr (Clinical rate at my primary site = $255/hr)
Shift requirement: 6x10hr shifts per/month (staffing is kind of short at this site however...)
Approximate admin hours required/month: 10-15
Other pertinent info: Rural site, ED docs also responsible for RRTs and floor codes, no other docs in house overnight
Acuity: Super low, one intubation/yr

I am going to preface this by saying that I have been director at a 50K hospital for 6 yrs in my past life. Assuming your job actually have some legit admin reponsibilities.

2250/15hr = $150/hr. So you can essentially make $2250 putting your feet up in alittle over one 12 hr shift. Realizing

1. 15 hrs of admin hrs is chopped up so you essentially have to go in for meetings and the like 4-5 times a month. That is an extra hr of getting ready/commute time on top of that. So that pushes this to about 20 hours.
2. Add on top of the complaints from doctors, admin, QA stuff, pt complaints that you have to investigate I would add another 5 hrs a month.


So you are looking at 20 hrs of your life sucked out of you for $2250 which is $112/hr. This doesn't include the time you are thinking about work, thinking how to respond to complaints, thinking b/c some line doc dislikes you, etc.

Unless you really like admin work or want to use this as a springboard to something bigger, I would definitely not take it. Just looking at the money aspect, I would not consider it unless its 5k/month and that is assuming its a very low headache position.

Now, I was paid $6500/mo when I was director and I probably put in about 8 hrs of meeting a month and probably another 4 hrs of admin stuff. So for 12 hrs of real work, I think $6500 was reasonable. The problem is you never get detached from work. There was the daily email, pt complaint, doctor complaint, work interruption with issues, etc...

Looking back, I would never do this job for $6500. If they asked me tomorrow to do the same job, I would not think about doing it for less than 10k/month.

 

[dotcb]

I share admin leadership for a much busier ED with 2 other people in my group. Together the buy-down between all of us is the equivalent of 11 ED shifts (88 hours). In other words, it is a significant job, as that is nearly a full shift load on its own. Even though 15 patients/day may not be much of an ED, it sounds like the offer may not be a fair one.

 

[The White Coat Investor]

Not enough for me to be interested in the job. I think you're in the ballpark though. I think we pay a shift and a half or two shifts worth of money a month.

 

[Janders]

1.5-2 shift buy down? That seems awful light.

I suppose it depends on how many hours of work the director has to do, and how many hours of meetings, and emails, and phone calls, and 24/7 on-call duty they have to perform, and how many helpers they have.

I'd estimate I spend and additional 50% of my clinical hours doing "chiefly" duties; this is of course ALSO variable by size of department...

 

[The White Coat Investor]

I agree with you. That's why I'm not doing it. I told them I wanted $10K for it.

 

[gutonc]

Totally unrelated field, but our "Section Head" (AKA medical director) gets a 25% clinical buy down for the job (which amounts to a full day a week...roughly the amount of time s/he puts in to it) and the RVU-based bonus structure is adjusted accordingly as well. I have been tasked as next in line for that job and there's no way I'd do it for less than that.

 

[emergentmd]

Totally unrelated field, but our "Section Head" (AKA medical director) gets a 25% clinical buy down for the job (which amounts to a full day a week...roughly the amount of time s/he puts in to it) and the RVU-based bonus structure is adjusted accordingly as well. I have been tasked as next in line for that job and there's no way I'd do it for less than that.

So if you make avg of 30k/month and at 25%, thats 7500. Seems decent but I don't think they could ever drag me into directorship again for anything under 10k at my old job and 15k/mo at my current CMG.

 

[Janders]

I agree with you. That's why I'm not doing it. I told them I wanted $10K for it.

Oh good, I like it better when we agree.

Totally unrelated field, but our "Section Head" (AKA medical director) gets a 25% clinical buy down for the job (which amounts to a full day a week...roughly the amount of time s/he puts in to it) and the RVU-based bonus structure is adjusted accordingly as well. I have been tasked as next in line for that job and there's no way I'd do it for less than that.

I think 25-40% is reasonable, depending on size of department and number of "helpers" you get...

 

[Hercules]

I'm the medical director for our group and I get grossly underpaid. That's probably the one downside to our SDG-- we vastly undervalue admin contributions. We are a single site 50k+ community ED and I get $2500/month.

I have to admit that at this low of a rate, I delegate a good bit to my partners. Even doing so, being Director for our group is a losing financial proposition (we make >$300/hr clinically).

I just started this year, but we may need to discuss compensation at some point. The previous director was comfortable with the compensation, but I may need a little more to do the job.


Sent from my iPhone using SDN mobile

 

[goodoldalky]

I'm the medical director for our group and I get grossly underpaid. That's probably the one downside to our SDG-- we vastly undervalue admin contributions. We are a single site 50k+ community ED and I get $2500/month. I was recently offered a directorship at a CMG that paid more than 4x that rate. I had to really consider it.

I have to admit that at this low of a rate, I delegate a good bit to my partners. Even doing so, being Director for our group is a losing financial proposition (we make >$300/hr clinically).

I just started this year, but we will likely have to discuss compensation again at some point. The previous director was comfortable with the compensation, but I don't think it's a reasonable long term compensation.


Sent from my iPhone using SDN mobile

Seems like a raw deal. Why do you do that? Do you self schedule? No nights or weekends?

Seems like a 50K ED would be pretty busy admin wise.. How many hours do you spend doing stuff?

I have no idea what my medical director gets paid, I often wonder... He only works like 4 shifts a month.

 

[Vandalia]

I am going to preface this by saying that I have been director at a 50K hospital for 6 yrs in my past life. Assuming your job actually have some legit admin reponsibilities.

Looking back, I would never do this job for $6500. If they asked me tomorrow to do the same job, I would not think about doing it for less than 10k/month.

Unless you are a physician with "state minimum" GME, you are not going to come out ahead financially in an administrative position. (Someone will probably argue pointing to some VP at a large institution like the Cleveland Clinic or HCA. If you include the earnings penalty they had earlier in their career, and compound interest, they are probably still only breaking even.) Even the lower paid specialties like family medicine will probably end up making slightly more money spending that time on patient care. Even if the hourly rate is good, there are the weekend/evening calls like "X is supposed to be on at 7 but he was just here and was admitted...", "Y calling and saying if Z keeps dumping stuff on him at sign-out, Z is going to need to be admitted", having to spend 6 hours thinking about what you are going to say in the one hour meeting you are being paid for, etc., etc. And believe me, breakfast or lunch with the CEO or the board is NOT fun, it is more work than corresponding time in the ED. At the very least, I would much rather be working as an actual physician than sitting there.

The primary reason I do this stuff is because I don't want to labor under someone else mistakes. If I f*** up, then at least it was my decisions not that of someone else. For good or ill, I seem to do this stuff well, and my peers keep wanting me to do the job because I am usually able to keeping the administrators at bay and inject some level of common sense to hospital operations.

 

[Brahnold Bloodaxe]

How likely is it to parlay Medical Director experience into one of those 7-figure hospital VP gigs as you get older and seek to transition out of clinical work?

 

[Old_Mil]

How likely is it to parlay Medical Director experience into one of those 7-figure hospital VP gigs as you get older and seek to transition out of clinical work?

Probably not very likely. Medical direction is sort of like being a manager at McDonalds. There is the medical director -> chief of staff -> CMO route if you have the personality and longevity for it. There is the local site -> regional medical director payh with a CMG...

 

[deleted480308]

I'm beginning to put together why there are so many medical director jobs being advertised all the time

 

[Vandalia]

How likely is it to parlay Medical Director experience into one of those 7-figure hospital VP gigs as you get older and seek to transition out of clinical work?

About as likely as being a good high school basketball player will get you an NBA contract.

This goes back to the discussion we had a couple of weeks ago about careers outside of medicine. Corporate careers are all pyramidal. Which means for every guy at the top, there are hundreds or thousands trying to get to the top. To get those "elite" positions you have to be the best of thousands of contenders, spend all your time climbing the corporate latter and fighting off contenders. You have to have elite skills to be able to claim the job, in the same way you have to have elite skills to be on an NBA or NFL roster. (Now whether those skills are ones that benefit society or the practice of medicine is clearly open to question.)

 

[emergentmd]

Probably not very likely. Medical direction is sort of like being a manager at McDonalds. There is the medical director -> chief of staff -> CMO route if you have the personality and longevity for it. There is the local site -> regional medical director payh with a CMG...

I am in line for Chief of staff but I would never be CMO. That must be one of the worse job in the world. You think babysitting a group of ED docs are difficult. Try babysit a whole hospital full of docs from all different fields who think they are above everyone.

I have no clue what a CMO makes, but they would have to start pay at 500k for me even to talk.

 

[deleted480308]

I am in line for Chief of staff but I would never be CMO. That must be one of the worse job in the world. You think babysitting a group of ED docs are difficult. Try babysit a whole hospital full of docs from all different fields who think they are above everyone.

I have no clue what a CMO makes, but they would have to start pay at 500k for me even to talk.

Had a friend who was a cfo....during his last job search he turned down any call less than $500k.....and he wasn't even dealing with massive hospitals

 

[emergentmd]

Had a friend who was a cfo....during his last job search he turned down any call less than $500k.....and he wasn't even dealing with massive hospitals

Very true. I think CMO and CNO is much worse than CFO. CFO has left people that complains.

The great thing about EM now is we are highly paid. I would say that most docs I know make 350K+ working less than 35 hrs a week without bringing any Homework home.

Why would anyone (unless they love CMO stuff) want to work 50 hrs a week, Bring massive amounts of homework home and make anything less than 500K? I have no clue what a CMO makes but I hope my CMO makes atleast 500K.

 

[deleted480308]

Very true. I think CMO and CNO is much worse than CFO. CFO has left people that complains.

The great thing about EM now is we are highly paid. I would say that most docs I know make 350K+ working less than 35 hrs a week without bringing any Homework home.

Why would anyone (unless they love CMO stuff) want to work 50 hrs a week, Bring massive amounts of homework home and make anything less than 500K? I have no clue what a CMO makes but I hope my CMO makes atleast 500K.

yeah, I've thought about trying to climb that ladder from EM but quite frankly if I can amek >300 as a doc, who needs the hassle?

 

[Angry Birds]

Very true. I think CMO and CNO is much worse than CFO. CFO has left people that complains.

The great thing about EM now is we are highly paid. I would say that most docs I know make 350K+ working less than 35 hrs a week without bringing any Homework home.

Why would anyone (unless they love CMO stuff) want to work 50 hrs a week, Bring massive amounts of homework home and make anything less than 500K? I have no clue what a CMO makes but I hope my CMO makes atleast 500K.

I dunno. I can see a few good reasons:

1) As stressful as admin work must be, is it really more stressful than working in the trenches as an EM doc? I can't think of any job more stressful than ours. Responding to group emails and addressing complaints seems a lot less stressful than dealing with two or three crashing patients at the same time.

2) Longer, but more regular hours, without (or at least a lot less) nights, weekends, and holidays. Better for family life.

3) 500k is much more than 350k.

4) Job advancement.

5) Closer, more important parking space.

 

[deleted547339]

I dunno. I can see a few good reasons:

1) As stressful as admin work must be, is it really more stressful than working in the trenches as an EM doc? I can't think of any job more stressful than ours. Responding to group emails and addressing complaints seems a lot less stressful than dealing with two or three crashing patients at the same time.

2) Longer, but more regular hours, without (or at least a lot less) nights, weekends, and holidays. Better for family life.

3) 500k is much more than 350k.

4) Job advancement.

5) Closer, more important parking space.

5. Not a chance. I get a GREAT parking spot!

 

[emergentmd]

I dunno. I can see a few good reasons:

1) As stressful as admin work must be, is it really more stressful than working in the trenches as an EM doc? I can't think of any job more stressful than ours. Responding to group emails and addressing complaints seems a lot less stressful than dealing with two or three crashing patients at the same time.

2) Longer, but more regular hours, without (or at least a lot less) nights, weekends, and holidays. Better for family life.

3) 500k is much more than 350k.

4) Job advancement.

5) Closer, more important parking space.

1. I don't think EM is stressful. Busy? Yes. Stressful? Nah.... After 15 yrs, nothing phases me. Now dealing with whinning doctors..... stressful
2. Longer hours, on call all the time too, take calls all night/weekends. Travels. BORING meetings.... Ill take working EM
3. I have no clue what a CMO makes, but 500K seems high. I made 450K working 35 hrs/wk last yr... No thank you
4. Job advancement? I guess it looks great to people who are not in medicine. I have seen CMO jobs filled by begging.
5. Parking space? I park right next to the CEO/CMO/CFO

 

[quicknss]

saw this yesterday http://forum.wikem.org/t/medical-directorship-15-shifts-a-month-435-000/549

You should be getting $400k at least

 

[quicknss]

I think the headaches of administrative duties would only be worth it if the compensation was high and the job was intelectually stimulating and fun. If it sucks the life out of you it doesn't matter if you make 1Mil doing it.

 

[Lostin_space]

1. I don't think EM is stressful. Busy? Yes. Stressful? Nah.... After 15 yrs, nothing phases me. Now dealing with whinning doctors..... stressful
2. Longer hours, on call all the time too, take calls all night/weekends. Travels. BORING meetings.... Ill take working EM
3. I have no clue what a CMO makes, but 500K seems high. I made 450K working 35 hrs/wk last yr... No thank you
4. Job advancement? I guess it looks great to people who are not in medicine. I have seen CMO jobs filled by begging.
5. Parking space? I park right next to the CEO/CMO/CFO

How long have you been out of residency?450k for 35 hrs? Wow! like derm rates.

 

[PhillyMed777]

How long have you been out of residency?450k for 35 hrs? Wow! like derm rates.

doesn't he live in texas or something?

 

[coachB]

doesn't he live in texas or something?

He also doesn't count his hours spend documenting as hours worked, so take it for what it is.

 

[deleted547339]

1. I don't think EM is stressful. Busy? Yes. Stressful? Nah.... After 15 yrs, nothing phases me. Now dealing with whinning doctors..... stressful
2. Longer hours, on call all the time too, take calls all night/weekends. Travels. BORING meetings.... Ill take working EM
3. I have no clue what a CMO makes, but 500K seems high. I made 450K working 35 hrs/wk last yr... No thank you
4. Job advancement? I guess it looks great to people who are not in medicine. I have seen CMO jobs filled by begging.
5. Parking space? I park right next to the CEO/CMO/CFO

You really don't feel EM is stressful anymore? I'm finishing residency and moonlight a lot. A busy moonlighting shift is very anxiety provoking. It is definitely encouraging to hear that it gets less stressful....

 

[emergentmd]

He also doesn't count his hours spend documenting as hours worked, so take it for what it is.

Live in Texas? Yes

I worked 1400 hrs last yr at my main job, and 200 hrs at my locums for 1600 hrs. That put me right at about 31hrs/wk. My locums has a scribe so I never stay back to chart. I am efficient with charting and probably avg 30 min after my shift ends. So I work about 35hr/wk with charting.

But $450,000 working 1600 hrs only puts me at $281/hr. Not bad, not great. I would say alittle better than avg. This is definitely not a unicorn job. I can find 10 jobs paying 275/hr tomorrow.

I could just do locums and hit 450k in 1000hrs or 20hrs/wk

 

[emergentmd]

You really don't feel EM is stressful anymore? I'm finishing residency and moonlight a lot. A busy moonlighting shift is very anxiety provoking. It is definitely encouraging to hear that it gets less stressful....

Nope. I think my job is quite easy. Busy? sure. Stressful? almost never. After 15 yrs, I don't think there is much that I have not seen.

 

[Angry Birds]

Nope. I think my job is quite easy. Busy? sure. Stressful? almost never. After 15 yrs, I don't think there is much that I have not seen.

Maybe that's the difference: I'm only 1 year out and find my job highly stressful. Residency was ulcer-creating stressful.

 

[emergentmd]

Maybe that's the difference: I'm only 1 year out and find my job highly stressful. Residency was ulcer-creating stressful.

You will get better. As you get older, you gain experience and shortcuts to getting stuff done. I see my partners take the more difficult path when their are easier paths. I let them flounder alittle so they can figure it out themselves.

Take care of yourself when you are working. No matter how busy it is, I always have time to grab coffee, and lunch/dinner. I never go through a shift without going to the lounge/cafeteria atleast twice and I work in a high volume/busy place. Making pts 10 minutes for yourself to get coffee/food hurts no one.

 

[dchristismi]

I dunno. I can see a few good reasons:

1) As stressful as admin work must be, is it really more stressful than working in the trenches as an EM doc? I can't think of any job more stressful than ours. Responding to group emails and addressing complaints seems a lot less stressful than dealing with two or three crashing patients at the same time.

I was to the point of palpitations (like, uncomfortable, distracting) last summer. When the body starts screaming at you like that, I listened.

And stressful is relative. Dealing with management issues is a different beast. Again, I'd have to get paid a hell of a lot to deal with that again.

 

[WilcoWorld]

At this point in my career (almost 8 years out) the medicine is almost never stressful. Patients with personality disorders aren't stressful.

On the other hand ridiculous family members, difficult nurses, and bad doctors - those things can still stress me out sometimes.

 

[Brahnold Bloodaxe]

About as likely as being a good high school basketball player will get you an NBA contract.

This goes back to the discussion we had a couple of weeks ago about careers outside of medicine. Corporate careers are all pyramidal. Which means for every guy at the top, there are hundreds or thousands trying to get to the top. To get those "elite" positions you have to be the best of thousands of contenders, spend all your time climbing the corporate latter and fighting off contenders. You have to have elite skills to be able to claim the job, in the same way you have to have elite skills to be on an NBA or NFL roster. (Now whether those skills are ones that benefit society or the practice of medicine is clearly open to question.)

These are good points. At the same time, there is a saying that goes "the best way to succeed in business is to be in business." During my brief spell in Asia after college I worked with a guy who was worth over 10m and was the CEO of his own company by his mid 30's. How did he do it? When he worked for a consulting company on a project, he randomly made friends with a manager at the client company and when that manager got a promotion he gave this guy a consulting contract for friendship's sake. That contract allowed this guy to set out on his own, hire people, and become a CEO like BAM.

Of course, for every guy like that there is a thousand nameless and soulless office drones whose greatest aspiration is to not get dumped out on the street at age 40 and be left stocking shelves. The good thing about trying to combine medicine with a part time business gig like CMO, it seems to me, is that it lets you fish for that lottery ticket while still maintaining a very nice floor that is your clinical job. The best of both worlds, in other words, the upside of business with the security of medicine.

 

[RustedFox]

At this point in my career (almost 8 years out) the medicine is almost never stressful. Patients with personality disorders aren't stressful.

On the other hand ridiculous family members, difficult nurses, and bad doctors - those things can still stress me out sometimes.

This. I'm four years out. The medicine is the easy part; the resources and staff are the hard part.

 

[BAM!]

This. I'm four years out. The medicine is the easy part; the resources and staff are the hard part.

Agreed. Medicine is the easy part. Dealing with unhappy people is the hard part. And it wouldn't be as hard if we didn't have to worry about being sued.

 

[emergentmd]

Agreed. Medicine is the easy part. Dealing with unhappy people is the hard part. And it wouldn't be as hard if we didn't have to worry about being sued.

That is why you have to find a good hospital. What makes any EM job stress free is

1. Great Hospitalists and specialists. As I have been at this hospital 15 yrs, I know everyone. I can get a sprained ankle admitted if I wanted - and I am serious about this.
2. Complete specialty coverage and availability. We have a few gaps, but almost never transfer out but for very unique cases
3. Good food - We have a great coffee shop and hot food all the time except after Midnight. But there is always the well stocked Doctors lounge, Surgeon lounge, ER doc lounge.
4. Well staffed nurses - Hit or miss but more the most part its good
5. No holds - we hold. Nothing I can do about that
6. Good EMR or scribe

My main job has the top 4. My locums has none of tha.n #6 Thus at the same volume the work is night and day different.

Medicine is definitely easy. I don't even find myself making any difficult decisions on most shifts.