Negotiating new employment contract

[DareGreatly]

Hi all,

I am roughly a year out from my first contract (a two-year contract) expiring. This is my first position after graduating residency. I think overall the position itself is good as far as employed positions go. Without going into too much detail, this is an outpatient position at a hospital-associated clinic which is part of a small hospital system. They've had a few psychiatrists leave across the system within the last year, and are having difficulty hiring psychiatrists or middle levels (big surprise!). Beyond this leverage, I bring additional value to the table in terms of teaching and leadership in the clinic. At this juncture, I think I am inclined to stay on for another 1-2 years at least, since I have a young family and will likely have another child in the coming 1-2 years. The job is not overly taxing and is pretty flexible.

With that as the backdrop, what have your experiences been like negotiating your second/subsequent contracts with employers? Is engaging in that conversation now (vs later on) a reasonable idea? Is a retention/sign-on bonus reasonable? What does the MGMA data look like for this year? Should I shop around with other employers before engaging in the conversation? I'd like to get a decent bump in compensation, as the first two years were buoyed by a sizeable sign-on bonus, but the salary was below average. Between inflation and the data I saw through medscape, it looks like salaries have increased significantly. Any tips/wisdom is appreciated. Thanks!

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[annoyedpsychiatrist]

Hi all,

I am roughly a year out from my first contract (a two-year contract) expiring. This is my first position after graduating residency. I think overall the position itself is good as far as employed positions go. Without going into too much detail, this is an outpatient position at a hospital-associated clinic which is part of a small hospital system. They've had a few psychiatrists leave across the system within the last year, and are having difficulty hiring psychiatrists or middle levels (big surprise!). Beyond this leverage, I bring additional value to the table in terms of teaching and leadership in the clinic. At this juncture, I think I am inclined to stay on for another 1-2 years at least, since I have a young family and will likely have another child in the coming 1-2 years. The job is not overly taxing and is pretty flexible.

With that as the backdrop, what have your experiences been like negotiating your second/subsequent contracts with employers? Is engaging in that conversation now (vs later on) a reasonable idea? Is a retention/sign-on bonus reasonable? What does the MGMA data look like for this year? Should I shop around with other employers before engaging in the conversation? I'd like to get a decent bump in compensation, as the first two years were buoyed by a sizeable sign-on bonus, but the salary was below average. Between inflation and the data I saw through medscape, it looks like salaries have increased significantly. Any tips/wisdom is appreciated. Thanks!

average is roughly 310k. I make 310k outpatient of a hospital system but i also have no state income tax which saves quite a bit of money. You could gently probe and see what they say/if they're receptive to increased compensation. If theyre having trouble getting providers, your value is increased, as you know. What was your compensation, just to get a comparison? Also it depends on how much you like the job/how demanding it is. If its a good job, making it work there is always ideal, because a new job can either be better or worse

 

[wolfvgang22]

I think it's reasonable to start negotiations. If you know when they are planning next years budget it is good to do it before they finish that planning. For me, I like to get other offers in hand first if I am concerned I won't be offered fair compensation. In the end your only leverage is to be able to take a different position or go into private practice. But I only mention I might leave if I'm serious. Like you noted, money isn't everything.
I earn about $300k in compensation including a bonus but not including benefits in a low cost of living area. I am myself pondering making a request for increased compensation- inflation has made it feel like I am making less. I have successfully negotiated raises and reduction in work for the same pay before. I simply ask for what I want and point out that I have been a productive employee with outstanding evaluations for years and I'm flexible to discuss it with them.

 

[Merovinge]

I think it's reasonable to start negotiations. If you know when they are planning next years budget it is good to do it before they finish that planning. For me, I like to get other offers in hand first if I am concerned I won't be offered fair compensation. In the end your only leverage is to be able to take a different position or go into private practice. But I only mention I might leave if I'm serious. Like you noted, money isn't everything.
I earn about $300k in compensation including a bonus but not including benefits in a low cost of living area. I am myself pondering making a request for increased compensation- inflation has made it feel like I am making less. I have successfully negotiated raises and reduction in work for the same pay before. I simply ask for what I want and point out that I have been a productive employee with outstanding evaluations for years and I'm flexible to discuss it with them.

Particularly keeping in mind that LoC places often pay more to MDs and HCoL areas often pay less that seems imminently reasonable to me.

 

[DareGreatly]

average is roughly 310k. I make 310k outpatient of a hospital system but i also have no state income tax which saves quite a bit of money. You could gently probe and see what they say/if they're receptive to increased compensation. If theyre having trouble getting providers, your value is increased, as you know. What was your compensation, just to get a comparison? Also it depends on how much you like the job/how demanding it is. If its a good job, making it work there is always ideal, because a new job can either be better or worse

Yes, I think that was around the medscape average. My total comp (sign-on, salary, loan repayment program which comes NOT through the hospital system) is ~330-360k to give you a range. My salary is only 250-270k of this though. I think at the time I signed this contract the average salary was 275k. The job is good, but I wouldn’t say ideal - not much in the way of colleagues and not a ton of professional development so far.

 

[DareGreatly]

I think it's reasonable to start negotiations. If you know when they are planning next years budget it is good to do it before they finish that planning. For me, I like to get other offers in hand first if I am concerned I won't be offered fair compensation. In the end your only leverage is to be able to take a different position or go into private practice. But I only mention I might leave if I'm serious. Like you noted, money isn't everything.
I earn about $300k in compensation including a bonus but not including benefits in a low cost of living area. I am myself pondering making a request for increased compensation- inflation has made it feel like I am making less. I have successfully negotiated raises and reduction in work for the same pay before. I simply ask for what I want and point out that I have been a productive employee with outstanding evaluations for years and I'm flexible to discuss it with them.

Good points. I agree on the inflation bit. And between continued high demand for “providers” and hospital reimbursement increases from payors, there should be some room for an increase.

 

[annoyedpsychiatrist]

Yes, I think that was around the medscape average. My total comp (sign-on, salary, loan repayment program which comes NOT through the hospital system) is ~330-360k to give you a range. My salary is only 250-270k of this though. I think at the time I signed this contract the average salary was 275k. The job is good, but I wouldn’t say ideal - not much in the way of colleagues and not a ton of professional development so far.

250k and i would even say 270k would be too low for me unless the job was incredibly chill. Also cost of living/state income tax for your region plays a huge part. Ultimately quality of life for me is number 1, but im sure theres a lot of jobs out there that pay around 300k. I would guess that most hospital systems pay around national data in the 300k range.

 

[vanfanal]

I think it's reasonable to start negotiations. If you know when they are planning next years budget it is good to do it before they finish that planning. For me, I like to get other offers in hand first if I am concerned I won't be offered fair compensation. In the end your only leverage is to be able to take a different position or go into private practice. But I only mention I might leave if I'm serious. Like you noted, money isn't everything.
I earn about $300k in compensation including a bonus but not including benefits in a low cost of living area. I am myself pondering making a request for increased compensation- inflation has made it feel like I am making less. I have successfully negotiated raises and reduction in work for the same pay before. I simply ask for what I want and point out that I have been a productive employee with outstanding evaluations for years and I'm flexible to discuss it with them.

Are you at the VA?

 

[rjs2131]

For outpatient - yearly salary is usually a smoke-and-mirrors tactic that leads people to think they are being paid fairly when in reality, they aren't. I would look at how much you are actually being paid per patient and per hour to get a sense of if things are fair or not relative to others. If you are being paid for admin time/non-clinical duties that's great but does complicate the picture a bit. Generally speaking, you should be making >$200/hr for time spent clinically (assuming 2 follow-ups/hour). Anything less than that I wouldn't find acceptable.

 

[pyrrion89]

For outpatient - yearly salary is usually a smoke-and-mirrors tactic that leads people to think they are being paid fairly when in reality, they aren't. I would look at how much you are actually being paid per patient and per hour to get a sense of if things are fair or not relative to others. If you are being paid for admin time/non-clinical duties that's great but does complicate the picture a bit. Generally speaking, you should be making >$200/hr for time spent clinically (assuming 2 follow-ups/hour). Anything less than that I wouldn't find acceptable.

Is >$200/hr for salaried clinical outpatient time the norm? I am around this mark (doing 2 follow-ups/hr) but hoping to negotiate up, especially since I generate a lot for my company (TMS makes up about 20% of my load). I am in a blue state coastal metro area with HCOL.
The local moonlighting gigs for inpatient/CL/emergency in my area are around $180-190/hr (no benefits, just pay).

 

[rjs2131]

Is >$200/hr for salaried clinical outpatient time the norm? I am around this mark (doing 2 follow-ups/hr) but hoping to negotiate up, especially since I generate a lot for my company (TMS makes up about 20% of my load). I am in a blue state coastal metro area with HCOL.
The local moonlighting gigs for inpatient/CL/emergency in my area are around $180-190/hr (no benefits, just pay).

It depends on area and setting but I would view this as the minimum acceptable rate. This is probably why I’m in PP and not working for an employer/institution, so to each their own. It isn’t too hard to figure out how much insurance companies are reimbursing for common codes (99213-15, 90833-38, etc) in your area and extrapolate this to what the employer is being paid for your work. You’re getting a cut of whatever that is, so make sure it’s worth your while.