No loans?

[QueenJames]

Advertisement - Members don't see this ad

I've been seeing jobs from my preceptor averaging 230-250K+ with loan assistance figures of $50K- $100K-$200K, etc.

My question is, if you have no loans, is that "loan assistance" essentially a bonus that you are free to bank (after paying taxes of course)? or do you need to prove to these employers that you have some debt?

Just curious.

Appreciate y'all time.

 

[Stagg737]

You almost always have to prove you have debt. Typically they will not reimburse for private loans either, you have to prove that the loans were initially federal or state loans. So for individuals who have private loans these are completely pointless programs.

 

[QueenJames]

You almost always have to prove you have debt. Typically they will not reimburse for private loans either, you have to prove that the loans were initially federal or state loans. So for individuals who have private loans these are completely pointless programs.

God damn.

So then what upper hand do you have per say on these employers? Higher starting salary packages? Negotiating higher hourly wage?

 

[Stagg737]

God damn.

So then what upper hand do you have per say on these employers? Higher starting salary packages? Negotiating higher hourly wage?

If they're really desperate to hire people you negotiate to get a much better contract which includes increased salary, sign-on bonuses (instead of loan forgiveness), better benefits, CME/technology/housing reimbursements, etc. I've talked to some people who have gotten pretty ridiculous increases in salary or benefits through negotiations with desperate employers, it really just depends on how bad they need to hire someone. Something to keep in mind is that there is usually a reason such employers are so desperate to hire someone and it's usually because the job is just that bad.

 

[QueenJames]

If they're really desperate to hire people you negotiate to get a much better contract which includes increased salary, sign-on bonuses (instead of loan forgiveness), better benefits, CME/technology/housing reimbursements, etc. I've talked to some people who have gotten pretty ridiculous increases in salary or benefits through negotiations with desperate employers, it really just depends on how bad they need to hire someone. Something to keep in mind is that there is usually a reason such employers are so desperate to hire someone and it's usually because the job is just that bad.

Ahh I see. Thanks for ur input stagg.

 

[deleted87716]

If they're really desperate to hire people you negotiate to get a much better contract which includes increased salary, sign-on bonuses (instead of loan forgiveness), better benefits, CME/technology/housing reimbursements, etc. I've talked to some people who have gotten pretty ridiculous increases in salary or benefits through negotiations with desperate employers, it really just depends on how bad they need to hire someone. Something to keep in mind is that there is usually a reason such employers are so desperate to hire someone and it's usually because the job is just that bad.

Jobs generally pay what they have to (e.g., sh-tty jobs typically pay more). It's usually better to ask for a higher salary than a signing bonus, as the latter are one time only and taxed to the max, and the former are forever.

 

[QueenJames]

hmm. Question.

That leads me into... salary vs. RVU based pay?

Some jobs have impressive salaries and state you are seeing "16-18 ppd" or "22-24 ppd".

Obviously, the more patients you see the more you get paid.

What types of compensation models do you attendings prefer?

 

[deleted87716]

What types of compensation models do you attendings prefer?

Well, I can only speak for myself, but I prefer the revenue model that I've always been paid under (e.g., collections - overhead = paycheck). No smoke and mirrors (a.k.a. RVUs). You work more (and bill accurately), you make more. It's the most equitable way of doing it, IMO.

 

[QueenJames]

Well, I can only speak for myself, but I prefer the revenue model that I've always been paid under (e.g., collections - overhead = paycheck). No smoke and mirrors (a.k.a. RVUs). You work more (and bill accurately), you make more. It's the most equitable way of doing it, IMO.

If one so desires doc, what are the possibilities to make more money during the weekend? I'm assuming it's to see more patients in clinic? Or link up with an urgent care? What are your thoughts on that and do you know anybody doing such things on Saturdays/Sundays?

Appreciate your knowledge and time on this matter btw. Means a lot!

 

[deleted87716]

If one so desires doc, what are the possibilities to make more money during the weekend? I'm assuming it's to see more patients in clinic? Or link up with an urgent care? What are your thoughts on that and do you know anybody doing such things on Saturdays/Sundays?

I could work in our after hours clinic nights and weekends if I wanted to...but I don't. I work to live, not vice versa.

 

[QueenJames]

I could work in our after hours clinic nights and weekends if I wanted to...but I don't. I work to live, not vice versa.

I see. I assume there is no "pay differential" per say is there?

BTW. I totally agree.

I'm just brainstorming. I don't want medicine to be my whole life.... but if I am blessed with the ability to possibly not have to worry about as much loans as many of my classmates, I'd like to put in the time early on in my career in order to start saving early and using extra time to find other investment ideas with family and friends who are doing major things in those areas.

But things can and always do change!

 

[deleted87716]

I see. I assume there is no "pay differential" per say is there?

Well, unlike our regular compensation model (e.g., "eat what you kill" as described above), our after hours clinic is paid based on an hourly rate. It isn't bad, but...I value my time off more. FWIW, I've been married for >30 years and have a life outside of work. YMMV.

 

[QueenJames]

Well, unlike our regular compensation model (e.g., "eat what you kill" as described above), our after hours clinic is paid based on an hourly rate. It isn't bad, but...I value my time off more. FWIW, I've been married for >30 years and have a life outside of work. YMMV.

Lookin' to mentor a youngin' by any chance?

🙂

 

[sunshinefl]

Well, unlike our regular compensation model (e.g., "eat what you kill" as described above), our after hours clinic is paid based on an hourly rate. It isn't bad, but...I value my time off more. FWIW, I've been married for >30 years and have a life outside of work. YMMV.

Can I join the evolving discussion? How possible is it to have your regular normal clinic daily hours adjusted to be a little later? In OP primary care. Like instead of 8-5, 10-7 or something. Not interested in owning my own practice (probably, and especially right away). So this would be in a group setting. I would think maybe it would help having a doctor with later appointment availability. Or would they give a hard time about “keeping the lights on” 2 extra hours, and support staff there 2 extra hours.

 

[VA Hopeful Dr]

Well, I can only speak for myself, but I prefer the revenue model that I've always been paid under (e.g., collections - overhead = paycheck). No smoke and mirrors (a.k.a. RVUs). You work more (and bill accurately), you make more. It's the most equitable way of doing it, IMO.

Smoke and mirrors? Really?

Getting paid by RVUs is the simplest possible way to be paid on production.

 

[PlutoBoy]

Can I join the evolving discussion? How possible is it to have your regular normal clinic daily hours adjusted to be a little later? In OP primary care. Like instead of 8-5, 10-7 or something. Not interested in owning my own practice (probably, and especially right away). So this would be in a group setting. I would think maybe it would help having a doctor with later appointment availability. Or would they give a hard time about “keeping the lights on” 2 extra hours, and support staff there 2 extra hours.

It’s very possible. Some clinics would stack the schedule of the staff to allow for “after hours” care.

 

[deleted87716]

Smoke and mirrors? Really?

Getting paid by RVUs is the simplest possible way to be paid on production.

No, revenue is the simplest possible way, and the most transparent. The smoke and mirrors part of RVUs has to do with how they’re calculated. As an example, there was an earlier post in another thread about an FP who was being paid less per wRVU than internists working in the same office seeing the same patients. That's pure discrimination. Also, RVUs don’t directly align with collections, so you’re always being overpaid or underpaid relative to actual revenue (typically the latter). That might fly in a health system with employed physicians, but not in private practice.

 

[VA Hopeful Dr]

No, revenue is the simplest possible way. The smoke and mirrors part of RVUs has to do with how they’re calculated. Also, RVUs don’t directly align with revenue, so you’re always being overpaid or underpaid relative to actual production (typically the latter).

How its calculated? It couldn't be more simple. Every CPT code has a set wRVU value.

Most RVU contracts have a set dollar value for each wRVU. Its literally a 2 step process. Convert CPT codes to wRVU and multiple by that value. Most EMRs can do this with the click of a button.

As for being under/over paid... yeah that's a thing. But it tends to balance out given most payer mixes. For example, straight non-HMO Medicaid in my state pays $71 for a 99214. Under my current contract, I get $60 for that visit. Let's say I'm very busy and can crank out 4 of those an hour consistently. I'm pretty sure it costs more than $44/hour to cover all office expenses other than my income.

Medicare is probably closer to breaking even, though still a slight loss best I can figure.

Commercial insurance definitely shows a profit just on my work so I am being underpaid for that, but my rough guess is my patient panel is about 50% Medicare/caid and 50% commercial insurance. So I'd wager that if I went to your model of payment, at best it would be about equal to mine.

Now as I recall y'all don't take Medicaid, so an RVU system wouldn't be good for you obviously. But for those of us who do, its almost always the better deal.

 

[VA Hopeful Dr]

Well, unlike our regular compensation model (e.g., "eat what you kill" as described above), our after hours clinic is paid based on an hourly rate. It isn't bad, but...I value my time off more. FWIW, I've been married for >30 years and have a life outside of work. YMMV.

A friend of mine from residency will work in his practice groups weekend clinic from time to time. They are paid based on production there, otherwise he's flat out said he wouldn't do it but as its very busy he actually ends up making more there than his regular practice since its mostly acute, quick visits.

 

[deleted87716]

How its calculated? It couldn't be more simple...(followed by a long explanation of how simple it is)

Thanks for proving my point. 😉

 

[deleted87716]

A friend of mine from residency will work in his practice groups weekend clinic from time to time. They are paid based on production there, otherwise he's flat out said he wouldn't do it but as its very busy he actually ends up making more there than his regular practice since its mostly acute, quick visits.

I agree, production would likely pay better if you're busy. The issue with our after hours clinic has to do with covering overhead (there are typically at least three other staff working there in addition to the doc). The volume is generally pretty consistent these days, but it can fluctuate. Paying a flat hourly rate helps us keep costs predictable, and guarantees a set income for the physician regardless of volume.

 

[VA Hopeful Dr]

I agree, production would likely pay better if you're busy. The issue with our after hours clinic has to do with covering overhead (there are typically at least three other staff working there in addition to the doc). The volume is generally pretty consistent these days, but it can fluctuate. Paying a flat hourly rate helps us keep costs predictable, and guarantees a set income for the physician regardless of volume.

Yeah that place is the only one I know of that doesn't just pay hourly for after hours.

 

[VA Hopeful Dr]

Thanks for proving my point. 😉

Literally 35 words explaining how it works.

The rest was getting into the actual revenue part of it to explain why the RVU system is sometimes better than revenue minus expenses.

Edit: I am so reporting you for hurting my sensitive millennial feelings with your snark!!!

@rokshana

 

[QueenJames]

Guys guys. Stop fighting. You both can be my mentors.

 

[Ericslv]

hmm. Question.

That leads me into... salary vs. RVU based pay?

Some jobs have impressive salaries and state you are seeing "16-18 ppd" or "22-24 ppd".

Obviously, the more patients you see the more you get paid.

What types of compensation models do you attendings prefer?

I'll take the money and negotiate a bonus. But always work on the money first. Eg. I'd like to negotiate the salary. It seems low. Company: well we can use RVU. YOU: I'd rather negotiate a higher salary. This is the model I prefer.
Co: What would you like your salary to be. You: Well let me know what you are comfortable with. Company: 200 YOu: That seems a little low. How about 280. Etc. until you meet somewhere in the middle.

Then: What is the end of year bonus going to be. Salaried positions come with a bonus. I was thinking 25% of salary. Colmpany: Can't do that. You would have to do RVU. YOu: no I'm not comfortable with that. I would rather have a year end bonus. etc. Until you reach an agreement.

If the lousy MBA CEO doesn't want to negotiate, walk away. F him. Let him see the patients.

 

[QueenJames]

I'll take the money and negotiate a bonus. But always work on the money first. Eg. I'd like to negotiate the salary. It seems low. Company: well we can use RVU. YOU: I'd rather negotiate a higher salary. This is the model I prefer.
Co: What would you like your salary to be. You: Well let me know what you are comfortable with. Company: 200 YOu: That seems a little low. How about 280. Etc. until you meet somewhere in the middle.

Then: What is the end of year bonus going to be. Salaried positions come with a bonus. I was thinking 25% of salary. Colmpany: Can't do that. You would have to do RVU. YOu: no I'm not comfortable with that. I would rather have a year end bonus. etc. Until you reach an agreement.

If the lousy MBA CEO doesn't want to negotiate, walk away. F him. Let him see the patients.

I love it. When that time comes, can I take you with me on all future negotiations?!

 

[Ericslv]

I love it. When that time comes, can I take you with me on all future negotiations?!

lol. Sure. Just remember there is such a shortage of primary care that you have much negotiating power. In fact if you go rural or even a little rural (1/2 hour to 45 minutes from major city) you can do even better. Always negotiate professionally and without anger. Calm, factual, assertive negotiation no matter how much they insult you by giving you low ball numbers or by insulting your lack of experience in business etc. They may call you obtuse or short sighted. Your follow up may be "yes I can see you have a great deal of experience in the matter, However, I feel it is in my best interest to ask for the following etc." Calm, cool, collective and well thought out responses. Remember, you should always be ready and willing to walk. Just don't tell them that.

 

[deleted87716]

I'll take the money and negotiate a bonus. But always work on the money first. Eg. I'd like to negotiate the salary. It seems low. Company: well we can use RVU. YOU: I'd rather negotiate a higher salary. This is the model I prefer.
Co: What would you like your salary to be. You: Well let me know what you are comfortable with. Company: 200 YOu: That seems a little low. How about 280. Etc. until you meet somewhere in the middle.

Then: What is the end of year bonus going to be. Salaried positions come with a bonus. I was thinking 25% of salary. Colmpany: Can't do that. You would have to do RVU. YOu: no I'm not comfortable with that. I would rather have a year end bonus. etc. Until you reach an agreement.

If the lousy MBA CEO doesn't want to negotiate, walk away. F him. Let him see the patients.

I've never heard of a situation where you get to negotiate a comp plan. You might have some ability to negotiate the finer points, but if they pay all of their other docs on production (e.g. RVUs), it's unlikely that you'll be able to negotiate a salary/bonus (or vice versa).

 

[Ericslv]

I've never heard of a situation where you get to negotiate a comp plan. You might have some ability to negotiate the finer points, but if they pay all of their other docs on production (e.g. RVUs), it's unlikely that you'll be able to negotiate a salary/bonus (or vice versa).

Then you walk. There are plenty of practices that give the option. I get them in my mail everyday. They are either rvu or salary. Or, it's base plus rvu production. Or something like that. In a base rvu situation you can negotiate the base and the rvu. Most recruiters will low ball you. They make more money if the can place you for less. They usually keep the rest. For example if a locum company quotes you 100/hr and they are allowed to go to 120, if they get you at 100 then they get to keep a part of the difference.

I would also add if someone is right out of residency and can travel, they should consider doing locum for the first year or two.

If you have 100 emails for jobs I thinks it's a safe bet to be picky and name your terms as much as you can.

 

[Bully Ball]

Then you walk. There are plenty of practices that give the option. I get them in my mail everyday. They are either rvu or salary. Or, it's base plus rvu production. Or something like that. In a base rvu situation you can negotiate the base and the rvu. Most recruiters will low ball you. They make more money if the can place you for less. They usually keep the rest. For example if a locum company quotes you 100/hr and they are allowed to go to 120, if they get you at 100 then they get to keep a part of the difference.

I would also add if someone is right out of residency and can travel, they should consider doing locum for the first year or two.

If you have 100 emails for jobs I thinks it's a safe bet to be picky and name your terms as much as you can.

Thanks for your insight! Could you please elaborate on why you think fresh grads should consider locums?

 

[Ericslv]

Thanks for your insight! Could you please elaborate on why you think fresh grads should consider locums?

Because of the following:

1. It's not uncommon that you make more money.
2. You can get a chance to see the country and decide where you want to live. You won't be tied into one place at the start. Setting roots too quickly can be a mistake.
3. You will see how different states and organization function. This will give you better insight and negotiating power.
4. You will have multiple state licenses. You may choose to maintain them (that will cost you some money) but you have freedom to move if when you settle down you don't like the place you settled down.
5. Networking. Both clinical and non-clinical.
6. Sometimes business and clinical opportunities are better in one place than the other OR, you may learn a business/clinical opportunity in one location and transfer it to another location that did not have it. You will be first in that location.
7. This one is a little soft. You will start with a malpractice company that is nationwide. Many doctors will start with one that only covers a few states. Then if they have to move they have to buy a tail (unless negotiated in their contract). This can be costly and timely.

 

[Keona]

Commenting on not using a recruiter. One of my former attendings found out a previous resident needed additional doctors in the clinic she is part of. It worked out much better for me than what the recruiter who later contacted me for the same area was offering. Since I’d already contacted the practice before the recruiter contacted me it ended up mutually beneficial. Especially if you think you know a rural area where you’d like to live it works much better for you to find the practice than going through the recruiters. I know the hospital system uses locums sometimes as well to make sure the physicians are a good fit in the community.

 

[cabinbuilder]

Well, I can only speak for myself, but I prefer the revenue model that I've always been paid under (e.g., collections - overhead = paycheck). No smoke and mirrors (a.k.a. RVUs). You work more (and bill accurately), you make more. It's the most equitable way of doing it, IMO.

Hey Blue Dog, I was looking at my RVU reimbursement lists today. Looks like I'm not getting reimbursed for ear lavages that irrigation only. I thought with the change to ICD-10 that changed? I'm also not getting RVU's for nebulizer treatments even though the company charges $51 per treatment. Are you having this problem? THanks.

 

[cabinbuilder]

Because of the following:

1. It's not uncommon that you make more money.
2. You can get a chance to see the country and decide where you want to live. You won't be tied into one place at the start. Setting roots too quickly can be a mistake.
3. You will see how different states and organization function. This will give you better insight and negotiating power.
4. You will have multiple state licenses. You may choose to maintain them (that will cost you some money) but you have freedom to move if when you settle down you don't like the place you settled down.
5. Networking. Both clinical and non-clinical.
6. Sometimes business and clinical opportunities are better in one place than the other OR, you may learn a business/clinical opportunity in one location and transfer it to another location that did not have it. You will be first in that location.
7. This one is a little soft. You will start with a malpractice company that is nationwide. Many doctors will start with one that only covers a few states. Then if they have to move they have to buy a tail (unless negotiated in their contract). This can be costly and timely.

Agree with all of these points.

 

[deleted87716]

Hey Blue Dog, I was looking at my RVU reimbursement lists today. Looks like I'm not getting reimbursed for ear lavages that irrigation only. I thought with the change to ICD-10 that changed? I'm also not getting RVU's for nebulizer treatments even though the company charges $51 per treatment. Are you having this problem? THanks.

AFAIK, none of our payers reimburse for ear lavage or curetting. It's bundled in the E&M. I've been told that the only way to get paid for a procedure is to use a microscope (which is what ENT does).

This link might be helpful: Cerumen Removal Coding Depends on Impaction, Method - AAPC Knowledge Center

 

[cabinbuilder]

AFAIK, none of our payers reimburse for ear lavage or curetting. It's bundled in the E&M. I've been told that the only way to get paid for a procedure is to use a microscope (which is what ENT does).

This link might be helpful: Cerumen Removal Coding Depends on Impaction, Method - AAPC Knowledge Center

OK, I did find out that I do get 0.61 RVU if I do the ear cleaning and use a curette.

 

[Ironheme]

OK, I did find out that I do get 0.61 RVU if I do the ear cleaning and use a curette.

I was told by our biller that the MD can bill for it if we do the curette part. If the nurse/MA does the ear wash, then it's a no go on getting any of it.

 

[cabinbuilder]

I was told by our biller that the MD can bill for it if we do the curette part. If the nurse/MA does the ear wash, then it's a no go on getting any of it.

Yes, that is what I found out too

 

[VA Hopeful Dr]

AFAIK, none of our payers reimburse for ear lavage or curetting. It's bundled in the E&M. I've been told that the only way to get paid for a procedure is to use a microscope (which is what ENT does).

This link might be helpful: Cerumen Removal Coding Depends on Impaction, Method - AAPC Knowledge Center

That is my understanding as well

 

[QueenJames]

Just an update:

Finished my first FM rotation and I LOVED IT. Shelf is after this weekend soooo hopefully I can kill it!

Preceptor stated that "240-250K is a joke. I make way more than that and am here four days of the week."

I think I'm frickin' sold.

 

[Ericslv]

Just an update:

Finished my first FM rotation and I LOVED IT. Shelf is after this weekend soooo hopefully I can kill it!

Preceptor stated that "240-250K is a joke. I make way more than that and am here four days of the week."

I think I'm frickin' sold.

That's interesting. What part of country. How many patients per day? etc.

 

[QueenJames]

That's interesting. What part of country. How many patients per day? etc.

This is southwest. Seeing ~ 20ish ppd.

Also showed me a job offer near by with 100K sign on bonus and starting salaries in 230-240 range.

Ridiculous.

 

[Sardonix]

This is southwest. Seeing ~ 20ish ppd.

Also showed me a job offer near by with 100K sign on bonus and starting salaries in 230-240 range.

Ridiculous.

Similar stats here in the Midwest, from what my preceptors were showing me. An alumnus from my school just moved to Minneapolis and is making $250,000 2yrs post residency.

 

[Postictal Raiden]

A close friend got a job offer at a hospital in the heart of Los Angeles County. 3.5 days per week outpatient. 240k. Kaiser offers same salary with much better benefits for 4 days/week.

 

[QueenJames]

A close friend got a job offer at a hospital in the heart of Los Angeles County. 3.5 days per week outpatient. 240k. Kaiser offers same salary with much better benefits for 4 days/week.

I read somewhere of the Kaiser "golden handcuffs" conundrum... What's up with that?

 

[Postictal Raiden]

I read somewhere of the Kaiser "golden handcuffs" conundrum... What's up with that?

Yeah I read that too.

Their retirement package is very tempting. You get to retire after working 20 years and collect nearly half of your highest salary for life. You and your dependents half health coverage for life. And more.

In return, you give up the potential to make more money and be your own boss. You’ll have to play by the rules and succumb to the scheme.

 

[W19]

I am gonna have to move to some rural place so I can make a ton of $$$ and semi retire in 10 yrs...

 

[Ericslv]

This is southwest. Seeing ~ 20ish ppd.

Also showed me a job offer near by with 100K sign on bonus and starting salaries in 230-240 range.

Ridiculous.

That's a great start. Pay off those loans faster.

 

[Ericslv]

I am gonna have to move to some rural place so I can make a ton of $$$ and semi retire in 10 yrs...

Not a bad idea. 275K will leave you with around 190K after taxes. Live on 70K save the rest. That's 120K x 10 plus compounding interest. Lets say around 6%. That would put you at around 1.6 million. Then if you want you can keep living on 70k working part time and let that 1.6million grow till you are fully retired. That's not a bad retirement plan.

 

[QueenJames]

Not a bad idea. 275K will leave you with around 190K after taxes. Live on 70K save the rest. That's 120K x 10 plus compounding interest. Lets say around 6%. That would put you at around 1.6 million. Then if you want you can keep living on 70k working part time and let that 1.6million grow till you are fully retired. That's not a bad retirement plan.

1.6 million is a good down payment for a real estate project that you could pass onto a management company and let them run it while you sit and collect them checks.