Opportunities in Pediatrics

[Turkelton]

I had a quick question in regards to what type of jobs are available to pediatricians without fellowship training. Positions I know of are pediatric hospitalist, traditional pediatrics practice, urgent care centers, medical school faculty and residency faculty. Are there any other types of jobs one can work as a general pediatrician?

I was also wondering if it is common for pediatricians to moonlight to make extra money?

If the average pediatrician salary is roughly between 170 and 190k, would it be difficult to make between 230 and 250k if one was willing to work 60 hours a week?

As a current M1 I am looking at 430 to 500k of Med school/SMP debt when I finish residency at age 40, and I'm just trying to figure out how to go into a career I'm passionate about while also taking care of an enormous student debt. Any input is definitely appreciated.

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[michigangirl]

I don't know the most recent average pediatrician salary for private practice-- obviously varies by location. But let's say you decide to moonlight in urgent care or an ER somewhere, average salary is around these parts is 100 bucks/hour before taxes-- so you can do the math- possible, with a lot of hours.

 

[Transition Consultants]

I don't know the most recent average pediatrician salary for private practice-- obviously varies by location. But let's say you decide to moonlight in urgent care or an ER somewhere, average salary is around these parts is 100 bucks/hour before taxes-- so you can do the math- possible, with a lot of hours.

National median for general pediatrics is somewhere around 200k. The highest median by HHS region is region 9. Region 9 includes California, Arizona, Hawaii, Nevada, Guam, and American Samoa. I would imagine that more of the higher paying jobs can be found on the mainland. Private practice in California can be pretty lucractive based on the opportunities I have seen (keep in mind these are mostly private practice ownership opportunities not employed positions).

 

[oldbearprofessor]

National median for general pediatrics is somewhere around 200k. The highest median by HHS region is region 9. Region 9 includes California, Arizona, Hawaii, Nevada, Guam, and American Samoa. I would imagine that more of the higher paying jobs can be found on the mainland. Private practice in California can be pretty lucractive based on the opportunities I have seen (keep in mind these are mostly private practice ownership opportunities not employed positions).

Dang, that's a good deal. Unfortunately, that's not the STARTING salary, which according to the AAP, a rather unbiased source, is about $124,000 (2010 data, doubt it has gone up much since then). Here is the direct pdf file link. I would have considerable doubt that CURRENTLY starting med students will see the 2012 equivalent of $200,000 in their early years as attending if they ever reach that.

Moonlighting is possible, although much easier said than done, but keep in mind that the average general pediatrician works 50-55 hours/week (also AAP data, but don't have the link right now), so that's not a great long-term plan.

Working in a community or situation with pay-back options of loans is also possible, but I'm not sure if you can get those type of $$ paid back quickly.

Bottom line is that you shouldn't plan on $230,000-$250,000 in general pediatrics.

YMMV, etc.

 

[Transition Consultants]

Dang, that's a good deal. Unfortunately, that's not the STARTING salary, which according to the AAP, a rather unbiased source, is about $124,000 (2010 data, doubt it has gone up much since then). Here is the direct pdf file link. I would have considerable doubt that CURRENTLY starting med students will see the 2012 equivalent of $200,000 in their early years as attending if they ever reach that.

Moonlighting is possible, although much easier said than done, but keep in mind that the average general pediatrician works 50-55 hours/week (also AAP data, but don't have the link right now), so that's not a great long-term plan.

Working in a community or situation with pay-back options of loans is also possible, but I'm not sure if you can get those type of $$ paid back quickly.

Bottom line is that you shouldn't plan on $230,000-$250,000 in general pediatrics.

YMMV, etc.

Yes, the 200k national median is based on MGMA data for providers at least 1 year in the speciality (and it does not specify what the mean/median experience of the entire sample set is).

 

[Turkelton]

Thank you all for the responses, I do appreciate it.

Wow I was a little surprised to see the AAP salary at 124k, for those right out of residency.

This leads me to a couple of other questions.

1. How many years as a pediatric attending does it typically take, before one can start earning a median salary?

2. What is considered to be a reliable source for finding the average pediatrician salary? MGMA lists it at 211k, Merritt Hawkins lists 183k, and Cejka lists 209k as average pediatrican salaries for 2011, are any of these sources reliable, or are these numbers inflated? It seems weird that the average starting salary is 124k, yet after a couple of years one is able to average in the 180-210k range, is this really how this particular job market is?

 

[deleted109597]

From an outsider married to a pediatrician, I would say that it works as a group buy in for most.
Not many pediatricians are independent anymore. You join a group, and put in sweat equity for a few years until you make partner.
My wife starts at $140K, and this goes up 20% per year until she makes partner. When she's partner, she gets profit sharing. All in all, she tops out in the top percentile for pediatricians. Basically we lucked into this job.

 

[Transition Consultants]

From an outsider married to a pediatrician, I would say that it works as a group buy in for most.
Not many pediatricians are independent anymore. You join a group, and put in sweat equity for a few years until you make partner.
My wife starts at $140K, and this goes up 20% per year until she makes partner. When she's partner, she gets profit sharing. All in all, she tops out in the top percentile for pediatricians. Basically we lucked into this job.

Cool. Does she obtain the equity ownership based on tenure or production?

 

[deleted109597]

Time served. Since it's a private group, you aren't given tenure based on publications/whatnot. Also, things to note when you have to attain partner instead of starting as one. How many people didn't make partner, and why? Does a group use young docs to make money and then hang them out to dry by not offering them partnership?

 

[Transition Consultants]

Time served. Since it's a private group, you aren't given tenure based on publications/whatnot. Also, things to note when you have to attain partner instead of starting as one. How many people didn't make partner, and why? Does a group use young docs to make money and then hang them out to dry by not offering them partnership?

Yes, these are good questions to ask before entering into this type of arrangement. The best buy-in/buy-out arrangements I've seen are those which are structured at the onset of employment. Problems arise when the purchase structure is negotiated after the associate doctor has already worked at the practice for a few years. Too often the associate feels like they are paying for the practice twice, since they have contributed to the growth of the practice during their employment and are now being asked to pay for the equity valuation they helped create.

 

[michigangirl]

So glad you guys are covering this topic- one that a subspecialty academic type like myself has no knowledge of, but is of HUGE interest to so many in pediatrics. Keep it coming-- I'm sure folks would love to hear about various practice models out there in all their forms-- nice thread!

 

[Transition Consultants]

So glad you guys are covering this topic- one that a subspecialty academic type like myself has no knowledge of, but is of HUGE interest to so many in pediatrics. Keep it coming-- I'm sure folks would love to hear about various practice models out there in all their forms-- nice thread!

There are a lot of interesting things happening in practice models these days. With health reform coming down the pike it will get even more complex (e.g. mergers, consolidations, hospital-integrations). This is especially true in medical markets where ACOs (Accountable Care Organizations) are expected to dominate the delivery model. But I’m still optimistic. Regardless of what reform actually looks like, I still think primary care providers stand to gain.

 

[wellchild]

I'm with michigangirl--the practice models and way pediatricians are paid differ greatly between academic and private practices, as do they between general pediatricians and subspecialists. Keep in mind that the time-based sweat equity type of increases in pay in private practice as discussed above are often much faster to achieve than seeing increases in pay in an academic practice, where salary is often tied to what kind of and how many different titles you hold, as well as publishing/research/etc (which ties into what types of titles you are offered). They're very different models.

In regards to the OP, spending another three years subspecializing may seem like a long time, but if you are interested in cards, PICU, or NICU it could be financially worth your time. Subspecializing beyond that hasn't shown to help the bank account much according to the paper in Pediatrics last year. (Pediatrics Vol. 127 No. 2 February 1, 2011
pp. 254 -260)

 

[michigangirl]

In pediatrics, like within most specialties, regardless of what you do, you end up getting paid by lifestyle. i.e. I have elected to stay academic and be a picu intensivist and anesthesiologist (the latter which raises my salary)-- but am I getting paid like most private practice picu intensivists and anesthesiologists? not by a long shot. Why? Because I don't work as many hours and have the flexibility when not clinical to do rigourous research while making my OWN schedule. I have colleagues that have left academics because they don't want the research pressure-- they will get paid MUCH better at these other places, but hours wise they are working more, take more call-- but when they are off, they are OFF. So lifestyle is dictated differently by everyone. I do a lot of work at home but that means I'm with my kids, which is important to me.

Just food for thought.

 

[Cuthbert]

If the average pediatrician salary is roughly between 170 and 190k, would it be difficult to make between 230 and 250k if one was willing to work 60 hours a week?

I am a general pediatrician and work around 50 hours a week on average. Some weeks more and some less. We do both clinic work and admit our own hospital patients. We also care for a level II NICU - meaning that we attend c-sections and take down to 32 weekers pending how complicated they are. Average income in our group is much more than what you are hoping to make. I would say that we make in the top 10% - but we work for it.

It all depends on how hard you want to work and the type of work that you are willing/able to do. Many of the residents from my program would not want to do or would not be comfortable with the NICU work that I do. But they will also not make the money that I do, even the ones who have specialized. I don't say that to sound superior at all; everything comes down to personal choice. More money does not equal more happiness if you are over stressed or hate what you do.

 

[deleted109597]

Agree with Cuthbert.
Another thing, is look at states with high (relative) medicaid reimbursement for children. You can do the same thing in different states, and get paid nearly twice as much in the state that actually reimburses well. Now, of course, you have to worry about declining reimbursements, but still, where you go matters.
Partner in my wife's group makes top 3% nationwide for pediatrics (probably similar to cuthbert's group). That's at the 5 year mark. They start at $140K and go up from there. There are good jobs out there, but they often aren't advertised.
Caveat, my wife's group doesn't do the NICU thing, but they do cover the multiple newborn nurseries in town, as well as the pediatric hospital patients that are theirs (and any when they're unassigned).

 

[Turkelton]

Thanks for all of the great responses to this thread. As a med student I can only speculate at the various practice models and opportunities that exist in pediatrics, so its great to hear about it from people working directly in the field and those with spouses in the field. The info posted has helped to alleviate some of the stress I have associated with the 500k tab I have to pick up at the end of residency, so seriously thanks.

 

[Turkelton]

Agree with Cuthbert.
Another thing, is look at states with high (relative) medicaid reimbursement for children. You can do the same thing in different states, and get paid nearly twice as much in the state that actually reimburses well.

Does anyone happen to know how California fares in medicaid reimbursement for children? Or how I could go about looking this up? Thanks.