PP PCCM Job

[SRT 1983]

I recently interviewed for a private practise PCCM job in a small town in MA , 100 miles from Boston. Its a physician owned 8 person single speciality group. Everyone works 4 days /week ,weekends and night call(not in house ) is 1/6. Equal split ICU/consults/outpt work. Salary offered is 200,000 base plus 30% of anything over 350,000. No signing bonus/4 weeks vacation plus 1 week CME. No mention of partnership after 2 years which is the duration of the contract. Any thoughts ? I have recruited an attorney for negotiations and have a meeting with him next week.

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[gutonc]

I recently interviewed for a private practise PCCM job in a small town in MA , 100 miles from Boston. Its a physician owned 8 person single speciality group. Everyone works 4 days /week ,weekends and night call(not in house ) is 1/6. Equal split ICU/consults/outpt work. Salary offered is 200,000 base plus 30% of anything over 350,000. No signing bonus/4 weeks vacation plus 1 week CME. No mention of partnership after 2 years which is the duration of the contract. Any thoughts ? I have recruited an attorney for negotiations and have a meeting with him next week.

I'm not PCCM, or in the NE. So take the following FWIW.

I don't understand what is meant by "30% of anything over 350K". Is 350K billings? Collections? Total patients seen? It kind of doesn't matter though unless you can get an idea of what the other 5 people in the group get with respect to that number (again, whatever it is). Because, unless that number is double 350K, it doesn't seem like a particularly good deal. I mean, I work 3 days a week in a non-procedural subspecialty (in a coveted West Coast city) and share call with 12 other docs. My base salary is the same as this base + the bonus you'd get with an additional 250K over the 350K base (and I have a bonus structure on top of that too). There's probably a pretty decent upside with the bonus as described if you're busy in the ICU or the bronch suite though.

And the devil is in the details as always. Benefits? Retirement plan (match?)? Malpractice/tail? Non-compete?

 

[jdh71]

Things don't sound "equal" as there are 8 people already there and they are bringing in a 9th person and call and weekend coverage will be 1 in 6.

Base pay is low. REALLY low in fact. And if I understand the next part of the offered compensation package (and I think I do) they are basically asking you to make it to median wRVU before you get to start making any additional money. They figure the whole "working for free" thing will motivate you to work, work, work, work to make it to around "median" (though national median is closer to 380k). But even then, it's horse****. Because the second you hit median wRVU, you're still going to be getting less than 25%ile pay (0.3 * 350,000 = 105,000; add that to your base and it's $305,000 for $350,000 worth of work) (25%ile pay nationally is around 315k). And no mention of partnership??? I'm sure the partners are making that $45,000 of gravy that you are not, and are going to be taking home ALL of your work after $200,000 and UNLESS you make it to median wRVU. Definitely win/win for the guys owning the partnership.

Arguably this is "fair" (you didn't build the practice, they did) if it means you'll eventually also have a partnership opportunity and "buy in" at some reasonable time in the future (two to three years) where you can start reaping rewards of your own work and any additional monies being paid to the group as a contract for covering ICU's. Otherwise this job sounds like crap. They are looking to use and abuse some poor sucker.

 

[SRT 1983]

Thanks guys, I thought it was low too. And whether I would be able to hit that number working 4 days/week
Incentive compensation over 350,000 is based on gross receipts(based on collections)

 

[Pkboi24]

(though national median is closer to 380k)

Is that for real? I thought I was going to come out and initially only be able to make $250-300k.

Do you think it's necessary to talk to some recruiters after you graduate just to get a sense of the market and to not get screwed?

 

[Hernandez]

Is that for real? I thought I was going to come out and initially only be able to make $250-300k.

Do you think it's necessary to talk to some recruiters after you graduate just to get a sense of the market and to not get screwed?

Only? That's what they want you to think. And recruiters are the used car salesmen of medicine. Worse than drug reps.

 

[Hernandez]

I'm going to echo JDH's thoughts. That sounds like a crap contract unless that low base pay is accounting for your buy in. And at that base buy-in should take 1-2 years at most of its a single practice group with 1-2 offices without ownership in other outside ventures.

Few other points, do NOT accept a contract that does not include details on how to become partner and a defined equation on how they calculate the buy-in, there should be absolutely no vagueness here. 2nd, demand a copy of their business financials if you are serious about this group, if they're unwilling to share that is a huge red flag. You should know how well they're doing when you start and know about what everyone is making, and if they don't provide that ask yourself, are they looking for a scut-monkey or are they looking to recruit another partner.

 

[gutonc]

Base pay is low. REALLY low in fact. And if I understand the next part of the offered compensation package (and I think I do) they are basically asking you to make it to median wRVU before you get to start making any additional money. They figure the whole "working for free" thing will motivate you to work, work, work, work to make it to around "median" (though national median is closer to 380k). But even then, it's horse****. Because the second you hit median wRVU, you're still going to be getting less than 25%ile pay (0.3 * 350,000 = 105,000; add that to your base and it's $305,000 for $350,000 worth of work) (25%ile pay nationally is around 315k). And no mention of partnership??? I'm sure the partners are making that $45,000 of gravy that you are not, and are going to be taking home ALL of your work after $200,000 and UNLESS you make it to median wRVU. Definitely win/win for the guys owning the partnership.

I kind of figured that's what it was based on, but wasn't sure. My bonus structure is also based on MGMA median for the specialty in the region. But the bonus target starts at 40% of MGMA median for the first year and then increases by 5% every 2 years for the first 6 years, then 1-2% a year after that with a cap at 80% that rolls in somewhere around year 20 (it's been awhile since I looked at my contract). Oh...and mine is based on billings, not collections.

So yeah, starting the bonus target for a new grad at 90-100% of the MGMA median is a recipe for either failure or burnout (probably both). Especially with a low base like that.

 

[jdh71]

Is that for real? I thought I was going to come out and initially only be able to make $250-300k.

Do you think it's necessary to talk to some recruiters after you graduate just to get a sense of the market and to not get screwed?

Don't talk to recruiters. You will want to call around yourself. It's simple and easy.

 

[SRT 1983]

The contract does say that I can become a partner in 3 yrs which I had missed earlier.
Thanks a lot for all the suggestions , this is harder than I thought it would be

 

[Pkboi24]

The contract does say that I can become a partner in 3 yrs which I had missed earlier.
Thanks a lot for all the suggestions , this is harder than I thought it would be

Yeah, this sounds like it's really confusing, with young attendings ripe for getting exploited.

On a related note, is there a difference in pay for people coming out of fellowships from academic centers vs community programs?

 

[tartesos]

The contract does say that I can become a partner in 3 yrs which I had missed earlier.
Thanks a lot for all the suggestions , this is harder than I thought it would be

You can check out some job sites and see the areas you like how much they offer etc and bear in mind that usually the jobs advertised there and for too long, are the least desirable ones, but you can use it as reference.
North east pay can suck because everyone wants to be there( for some reason), but as you leave the New England area( and even there) I would not sign anything for less than 350-400.

I know of a job in ms where you can make 700k your first year if you can work it( they admit and take care for their family practice guys in house on top Pulm cs and Icu)But why would you?

Good luck!

 

[tartesos]

Yeah, this sounds like it's really confusing, with young attendings ripe for getting exploited.

On a related note, is there a difference in pay for people coming out of fellowships from academic centers vs community programs?

Not really diff in pay, but it can be a deciding factor to iv for some places( private groups ).

 

[SRT 1983]

A follow up to my original post. I ended up joining this practice mostly for it's proximity to my family. It's a 3 yr partnership track .
I work 4 days/week and 1/6 weekends. I see on an average 20 pts/day(25% ICU, 25% inpt, 50% outpt) . 1-2 EBUS or nav bronchs/week(only one in my practice who does them). My partners have always been very accommodating but I often feel underpaid as I better understand the financial aspects of medicine now. It's a "eat what you kill" model. Plus the hospital pays the practice 500k/yr for overnight coverage of which I don't see a dime. I think most of my partners make close to 400k.

I have the second highest gross collections in my practice since I joined( per our billing consultant) but am getting 200k base plus 30% over gross receipts(based on my collections) in yr 1, 40% over gross receipts(based on collections) in yr 2 and 50% over gross receipts(based on collections) in yr 3 before I become the partner.
I was told initially I should expect 100k in bonuses but now I think it would be closer to 50k. I can't really move for another 18 months as my wife finishes her fellowship and my partners know this .

This is me venting cos my wife is sick of all the whining

 

[deleted547339]

A follow up to my original post. I ended up joining this practice mostly for it's proximity to my family. It's a 3 yr partnership track .
I work 4 days/week and 1/6 weekends. I see on an average 20 pts/day(25% ICU, 25% inpt, 50% outpt) . 1-2 EBUS or nav bronchs/week(only one in my practice who does them). My partners have always been very accommodating but I often feel underpaid as I better understand the financial aspects of medicine now. It's a "eat what you kill" model. Plus the hospital pays the practice 500k/yr for overnight coverage of which I don't see a dime. I think most of my partners make close to 400k.

I have the second highest gross collections in my practice since I joined( per our billing consultant) but am getting 200k base plus 30% over gross receipts(based on my collections) in yr 1, 40% over gross receipts(based on collections) in yr 2 and 50% over gross receipts(based on collections) in yr 3 before I become the partner.
I was told initially I should expect 100k in bonuses but now I think it would be closer to 50k. I can't really move for another 18 months as my wife finishes her fellowship and my partners know this .

This is me venting cos my wife is sick of all the whining

On the plus side, it sounds like a nice job. #CupHalfFull

 

[SRT 1983]

Another follow up , my COLLECTIONS in yr 1 were close to 600K ( not including my share of the 500k the hospital pays the group for ICU coverage).
I got 75000 bonus pre tax. I had the highest collections in my group . I become partner after 3 yrs, no buy in. There is a buy in for sleep lab though.

 

[Soccer171983]

I am waiting for the catch.....what are they actually offering you that is making you consider this offer? You could make more being a hospitalist getting paid 150/hr working half the year.

 

[Soccer171983]

life situation changed and now i need some advice! I am about to graduate this coming cycle from a pulm/cc fellowship. current boss offering about 350k. I am no longer tied to anyone or any place but I was wondering about doing some sort of locums pulm/cc gig, keeping my place in vegas and figuring out what the requisite amount of time i need to be here for me to not have to pay state tax (nv has not state income tax). I was thinking of setting up my own llc/pllc or something like that and hustling while a bit younger but still contributing to sep-ira and what not. I figured this way I could pay off debt from student loans and my vegas condo before settling for a full time type of gig where the focus is more on having a steady salary with benefits inclusive of health, vision, dental, 401k with matching. I would love to hear different options you guys can recommend. I don't mind doing a week in vegas and a week elsewhere or something like that?

 

[maverickdoc]

The “catch” is when I become a partner , I would make significantly more for doing the same amount of work . I would have a share in everything the group makes . Imo it is the way to go if you plan on staying long term otherwise as you said you lose money upfront .

 

[Soccer171983]

The “catch” is when I become a partner , I would make significantly more for doing the same amount of work . I would have a share in everything the group makes . Imo it is the way to go if you plan on staying long term otherwise as you said you lose money upfront .

how certain are you you want to stay in that region with that particular company? strong ties or incentives to stay there for a while?

 

[shaidx]

I’m sorry man. I’d be offended with that base pay and payment model and would have never accepted it

 

[tartesos]

The “catch” is when I become a partner , I would make significantly more for doing the same amount of work . I would have a share in everything the group makes . Imo it is the way to go if you plan on staying long term otherwise as you said you lose money upfront .

With that crappy pay you are buying in over 3 years.
Sorry man.



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