Pain sallary? - Big cities

[zorro1]

I am graduating from my pain fellowship this year. I have a job lined up with a large practice in a major city (population >5 million). My offer is $225-250, with no guaranteed partnership.

I am wondering what offers people are getting out there for major cities. I have no desire to go out in the boonies of Montana to make a million, but I am thinking that my offer is pretty low. Although, being a major city, it is extreamly saturated and I am lucky to even get this offer.

Thank you

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[mid|ine]

I would say this is an average offer. If you go out a bit further into rural areas average starting offers are closer to $300k. Few offers will be over $300k.

 

[Jcm800]

I am graduating from my pain fellowship this year. I have a job lined up with a large practice in a major city (population >5 million). My offer is $225-250, with no guaranteed partnership.

I am wondering what offers people are getting out there for major cities. I have no desire to go out in the boonies of Montana to make a million, but I am thinking that my offer is pretty low. Although, being a major city, it is extreamly saturated and I am lucky to even get this offer.

Thank you

i got an offer in chicago for 250 base, with a productity bonus after 600k, with no guarantee... its "low" but standard out of the gate...

 

[drpainfree]

in southern cal, the standard offer is no base, and only percentage of your collection.

 

[PinchandBurn]

Major midwest city $350k plus productivity bonus.

Do not ever accept an offer of 300k starting. That's a slap in the face. Especially if you are anesthesia trained. You spent 1 additional year and lost that much income. Most regular anesthesiologist come out making 250-300 k starting.

Groups will say as a pain doc you take less call and the 'lifestyle' is better and that's why they cant pay you more. That's totally bologna. I've never met a pain physician taht doesnt have to work hard. Plus you have more risk and are actually bringing a patient load to the practice eventually. It's fair for the group to put you on your feet atleast for two years.

 

[Jcm800]

Major midwest city $350k plus productivity bonus.

Do not ever accept an offer of 300k starting. That's a slap in the face. Especially if you are anesthesia trained. You spent 1 additional year and lost that much income. Most regular anesthesiologist come out making 250-300 k starting.

Groups will say as a pain doc you take less call and the 'lifestyle' is better and that's why they cant pay you more. That's totally bologna. I've never met a pain physician taht doesnt have to work hard. Plus you have more risk and are actually bringing a patient load to the practice eventually. It's fair for the group to put you on your feet atleast for two years.

yes but did you get offered this right out of the gate?

 

[bedrock]

300K + fair productivity bonus, (particularly in a major city located outside of Ohio) is not a slap in the face to current grads, even those out of anesthesia. Starting salaries just aren't what they used to be 3 years ago. Simple reflection of the reality of decreased pain reimbursement.

 

[PinchandBurn]

yes but did you get offered this right out of the gate?

Yes.

Problem is new grads from outside of anesthesia 'accept' lower starting salaries, since it's higher than what their primary specialty's 'right out of the gate' salary is. This drives down the base salary. They dont look down the road..

 

[Jcm800]

Yes.

Problem is new grads from outside of anesthesia 'accept' lower starting salaries, since it's higher than what their primary specialty's 'right out of the gate' salary is. This drives down the base salary. They dont look down the road..

all private offers i recieved were under 300, usually about 250. All anesthesia based split pain/amesthesia offers were much higher. Problem was/is, to make in the 300s i took a lot of overnight call, and took all of the pain call. They took anesthesia call, but did not cover for me when consults needed to be seen...

pain and anesthesia rarely mix well these days...


Make less money, sleep in your own bed...

 

[kdlymes]

It is not a bad offer. Other questions that should be asked would be what degree of medication manaement will you be doing vs procedures. More and more pill mills are opening up.

 

[clubdeac]

I think that's a good starting offer. Plus I've heard that the base doesn't really matter. You're gonna make most of your money in productivity. Am I right? I currently don't have a productivity bonus so I don't know. Then again I go to work at 830 and am home by 3, hehe. Well not quite

 

[hyperalgesia]

The difference between 250k and 350k, after taxes is about 60k in my state. I'd MUCH rather have an honest and ethical practice and a nice lifestyle than 60k. Everyone I know that jumped on the bigger salaries straight out of the gate is miserable, jaded and burnt out. My point is you really have to look at the big picture. You only live once.

 

[nlfru]

300K + fair productivity bonus, (particularly in a major city located outside of Ohio) is not a slap in the face to current grads, even those out of anesthesia. Starting salaries just aren't what they used to be 3 years ago. Simple reflection of the reality of decreased pain reimbursement.

What would be considered a fair productivity bonus?

 

[mid|ine]

2 years ago I was able to find a few offers for $300k. Very few for anything more and NONE of those close to a big city.

 

[zorro1]

Thank you for all the replies.
So my issue is that there is very little productivity bonus: $25K max per year. So that, coupled with no guarantee of partnership makes me a little nervous. If I could use this practice just to break into that market and get to build a little referral basis, that would be great. But then I am worried about the non-compete. Dont have the official contract yet, so don't know the terms of it. But imagine if in a couple years they say no partnership, just keep working for us at this crappy rate, plus not be able to go out on my own!

On this note, what is a reasonable non-compete that people are getting? Distance wise? Also, this practice has many locations with intent to open several more in the coming years. So would I be able to make it so that my contract says non-compete from existing locations at time of contract or do they usually do locations at the time I would leave the practice -- it would make a big difference.

Thanks again.

 

[mid|ine]

A max on the productivity bonus is crazy, its bad for you and the practice. Whats your motivation to work harder? Base is fine, production is a non-starter.

Depending on the state and how deep the practices pockets are and how much of a pain they want to be regarding the non-compete. You will probably be able to practice in the area, but it could be expensive for you to break the non-compete. I would try to negotiate 1 location to work at and make the non-compete 10m from that location. They won't go for it though.

 

[pjuer]

Major midwest city $350k plus productivity bonus.

Do not ever accept an offer of 300k starting. That's a slap in the face. Especially if you are anesthesia trained. You spent 1 additional year and lost that much income. Most regular anesthesiologist come out making 250-300 k starting.

Groups will say as a pain doc you take less call and the 'lifestyle' is better and that's why they cant pay you more. That's totally bologna. I've never met a pain physician taht doesnt have to work hard. Plus you have more risk and are actually bringing a patient load to the practice eventually. It's fair for the group to put you on your feet atleast for two years.

Hell, I have been doing this almost 20 yrs, own the practice. I never took home 300K

 

[PMR 4 MSK]

Money, money, money, money money....

What's the practice like? Good docs? Thriving practice? Everyone happy? Growth plans? How well do they get along with local hospitals? What's their competition doing?

Good location to have a family? Good nightlife/entertainment? Pro sports?

What's the weather like? Do you have to shovel snow or deal with mudslides? Do you evacuate every other year for a hurricane?

What else is included? Malpractice, health, life insurance? Loan payoff, car, cell phone - what else gets covered? Bonus structure? How do the partners share money?

What ancillaries do they have? Is that tossed in to reduce OH or do the partners get to feast on it?

In-house fluoro? If so, who gets the money for the TC? Can you put in pumps and stims in the office, or will it be at hospital or ASC?

What investment opportunities do they have? Retirement?

$200K at a really good practice with a lot thrown in beats the crap outta $350K with a bunch of greedy pigs who use you like a resident.

Salary means almost nothing. Focus on that number and they will screw you every time, just like a car dealer.

 

[lobelsteve]

Money, money, money, money money....

What's the practice like? Good docs? Thriving practice? Everyone happy? Growth plans? How well do they get along with local hospitals? What's their competition doing?

Good location to have a family? Good nightlife/entertainment? Pro sports?

What's the weather like? Do you have to shovel snow or deal with mudslides? Do you evacuate every other year for a hurricane?

What else is included? Malpractice, health, life insurance? Loan payoff, car, cell phone - what else gets covered? Bonus structure? How do the partners share money?

What ancillaries do they have? Is that tossed in to reduce OH or do the partners get to feast on it?

In-house fluoro? If so, who gets the money for the TC? Can you put in pumps and stims in the office, or will it be at hospital or ASC?

What investment opportunities do they have? Retirement?

$200K at a really good practice with a lot thrown in beats the crap outta $350K with a bunch of greedy pigs who use you like a resident.

Salary means almost nothing. Focus on that number and they will screw you every time, just like a car dealer.

How about $225k and free oil changes for life?

 

[hyperalgesia]

How about $225k and free oil changes for life?

Not bad for doing what you like and getting to keep your soul. My biggest concern with the high salaries was not how much work you have to do but how unethical the practices were. Jesus, if you're gonna do repeat local NBs for chronic pain mgmt and a series of 3 for every procedure, why not just open a pill mill and make some real money?

 

[Jcm800]

i agree, but how much does the job pay!!! hehee.

Money, money, money, money money....

What's the practice like? Good docs? Thriving practice? Everyone happy? Growth plans? How well do they get along with local hospitals? What's their competition doing?

Good location to have a family? Good nightlife/entertainment? Pro sports?

What's the weather like? Do you have to shovel snow or deal with mudslides? Do you evacuate every other year for a hurricane?

What else is included? Malpractice, health, life insurance? Loan payoff, car, cell phone - what else gets covered? Bonus structure? How do the partners share money?

What ancillaries do they have? Is that tossed in to reduce OH or do the partners get to feast on it?

In-house fluoro? If so, who gets the money for the TC? Can you put in pumps and stims in the office, or will it be at hospital or ASC?

What investment opportunities do they have? Retirement?

$200K at a really good practice with a lot thrown in beats the crap outta $350K with a bunch of greedy pigs who use you like a resident.

Salary means almost nothing. Focus on that number and they will screw you every time, just like a car dealer.

 

[PMR 4 MSK]

I would never work with a productivity cap. Makes no sense.

 

[nctxil]

I've never heard of a capped productivity bonus. Sounds shady. The productivity bonus is where you should be making your money.
It's hard coming out of fellowship, but I would try not to focus on starting base salary. It is really irrelevent in the long-term.

 

[PinchandBurn]

.... How's the commute (remember it takes an additional $40k/yr to make an hour commute worth it)? How are the schools? Etc, etc, etc. I'll gladly make a little less and be happier, than make a ton of money, but be miserable with work.

Just wondering how you come up wiht this extra 40k number. I'd say on avg people drive 30 min to work. So let's say you add an extra 30 min both ways to that. Are you really going to spend that much more on gas/wear and tear of your vehicle. What if you would get paid an extra 150k? would you do it then?

Extra 30 min both ways (keep in mind this is just 5 days a week). You can also listen to lectures/news/radio/phone friends,etc. Also if the weather is bad maybe you can spend a night at a hotel for $50. Again, for an extra 150k you wouldnt do that? (i know thats not part of this thread, but jus wondering).

 

[hyperalgesia]

Just wondering how you come up wiht this extra 40k number. I'd say on avg people drive 30 min to work. So let's say you add an extra 30 min both ways to that. Are you really going to spend that much more on gas/wear and tear of your vehicle. What if you would get paid an extra 150k? would you do it then?

Extra 30 min both ways (keep in mind this is just 5 days a week). You can also listen to lectures/news/radio/phone friends,etc. Also if the weather is bad maybe you can spend a night at a hotel for $50. Again, for an extra 150k you wouldnt do that? (i know thats not part of this thread, but jus wondering).

It also depends on the kind of commute. If you're stuck in bumper to bumper traffic doing stop-and-go, that's a lot different than a peaceful drive through the countryside. But 150k is a lot of money. All other things being equal, I'd consider it.

 

[PinchandBurn]

It also depends on the kind of commute. If you're stuck in bumper to bumper traffic doing stop-and-go, that's a lot different than a peaceful drive through the countryside. But 150k is a lot of money. All other things being equal, I'd consider it.

completely agree.