Questions for ALL practicing Hospitalists

[Gpan]

Hi to all practicing Hospitalists,

- When you signed your first contract after finishing residency did you do it about 6 months in advance?
- When picking a hospital do you think having a CLOSED-ICU is important? much better than OPEN-ICU?
- Is it better to be employed by a group/hospital OR be an independent contractor?
- How much did you pay to get a LAWYER to look over the contract?
- Is it easy to get privilege at a hospital ?
- What are the general requirements to keep your privilege at a hospital that you DO NOT go to daily or even monthly?

I'm a senior resident and will be full time Hospitalist summer of 2015. Thank you for any input.

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[obiwan]

Hi to all practicing Hospitalists,

- When you signed your first contract after finishing residency did you do it about 6 months in advance?
- When picking a hospital do you think having a CLOSED-ICU is important? much better than OPEN-ICU?
- Is it better to be employed by a group/hospital OR be an independent contractor?
- How much did you pay to get a LAWYER to look over the contract?
- Is it easy to get privilege at a hospital ?
- What are the general requirements to keep your privilege at a hospital that you DO NOT go to daily or even monthly?

I'm a senior resident and will be full time Hospitalist summer of 2015. Thank you for any input.

I don't remember the exact timing but it was in the latter half of PGY3 year when I was finishing up paperwork and what not. I think having a closed ICU is better from the standpoint of having too many cooks in the kitchen. I work at a place with an open ICU and it just gets annoying because I might order something and then the ICU doctor cancels that order and does something else without any communication to me so in the end I just really defer to them and see them while they're in the ICU and leave notes but nothing really managing much significant which I think is a waste of time. All the associated hospitals where I trained at had closed ICUs. Its definitely better to be employed within a group practice IMO. I didn't get a lawyer to look over contract. As for privileges, my group sees patients at a couple of places within our umbrella healthcare system and so really the only thing that I had to do was fill out the paperwork that the administrative people were telling me to sign.

 

[mrpankration]

The answers to some of your questions will depend on what type of practice you enter. I'm a hospitalist within the Kaiser system. I signed my contract in February of my PGY-3 year. The facility I'm at has a closed ICU. I agree with obiwan that a closed ICU is a better model. How important that is will depend on your preferences. I know personally that I wouldn't want a consultant canceling my orders and placing their own without communicating it to me. I have friends that work as hospitalists in places where this happens and apparently it's a regular occurrence. As far as the employment model, again, I think it depends on your personality. Kaiser Foundation Hospitals contract with The Permanente Medical Group, which is physician-owned. I will tell you that in my opinion, being employed as part of a physician-owned group is much better than being an employee of a hospital because physician-owned groups tend to have physician-friendly policies. I know mine does and it makes quality of life much better. I did not have a lawyer look over my contract, but my contract was only 7 pages and was pretty standard. I had friends that had like 45 page contracts, so if your contract appears complex or you just don't understand it, then it wouldn't be a bad idea to get a contract lawyer to look at it. Privileges were not really an issue for me, it was all just part of the routine pre-employment paperwork that I had to fill out. Hope that helps.

 

[Gpan]

Thank you so much. Anyone else wanna chime in ?

 

[FutureInternist]

Hi to all practicing Hospitalists,

- When you signed your first contract after finishing residency did you do it about 6 months in advance?
- When picking a hospital do you think having a CLOSED-ICU is important? much better than OPEN-ICU?
- Is it better to be employed by a group/hospital OR be an independent contractor?
- How much did you pay to get a LAWYER to look over the contract?
- Is it easy to get privilege at a hospital ?
- What are the general requirements to keep your privilege at a hospital that you DO NOT go to daily or even monthly?

I'm a senior resident and will be full time Hospitalist summer of 2015. Thank you for any input.

a) About that time
b) Depends on your comfort level with ICU patients. Closed means all responsibility goes to them but even in the open systems in which my friends work, once ICU is involved, you're pretty much benched
c) I would say group is better since you have more bargaining power. If it's just you, then the hospital won't care if you are threatening to quit.
d) Did not get a lawyer
e) Yes. Specially if just after Residency, it will be easy to track down your paper work etc. The hospital wants you to work so they will make it happen. The license is the big issue. I would start working on that now. Most placed I interviewed, paid for the licensing, DEA fees (after you start working)
f) If you are privileged for a procedure then you may have to do a certain amount per year but if you're doing strict IM w/o procedures then there really is no requirement that I know of (although I would check with the hospital)

 

[HospitalExec]

Not a physician, but I hire hospitalists, so I have some perspective.

About 6 months is right. If you're finishing up and don't have a job, I have concerns about why you're still available. 6 months out shows you know what you want and will be less likely to flake during the interview/hiring process.

N/A

Employed typically offers more stability and better working conditions. Contracted can be kicked out by the hospital if they're not performing. Leadership challenges with those groups are common. However, the pay can be higher.

Please have a lawyer review the contract. Not just any lawyer, a healthcare lawyer specializing in contracts. For residents, they should be able to do this for a flat fee of around $500 - $1000.

This is a huge deal. A normal lawyer will spend half his time substituting "may" with "shall" fifty times and waste your money. A healthcare lawyer will understand the mid-level supervision, incident to billing, and stark law.

My suggestion is to focus on deal-breakers. These should be the two or three things that would cause you not to sign the contract. You are special, but contracts are standardized. There needs to be a very good reason as to why a contract signed by X number of physicians doesn't work for you. There have been several times when I said, "I don't interpret the contract that way, but I can see your point. Let's get legal to add some clarification in the language." I've also told physicians that I can't budge on a certain section and left them to accept it or walk away.

You'll get privileges. It is a pain. Usually at least 2-3 months because of the committees you need to pass through. Don't further complicate it by not having your dea and license. Apply for those as soon as humanly possible.

See / admit patients occasionally. Pay your dues. Complete your charts. Attend certain medical staff meetings. Complete any hospital specific education.

 

[Gpan]

Great stuffs guys. Thank you so much !!! It's just a very scary/daunting process and expensive too lol

 

[gutonc]

Great stuffs guys. Thank you so much !!! It's just a very scary/daunting process and expensive too lol

Whoa, whoa, whoa. The one and only thing that you should be paying for in this situation is a license. Everything else (DEA, privileges, interview travel, etc) should be paid for by the group hiring you. If that's not the case, you know all you need to about that group and you just walk away.

 

[Gastrapathy]

And of course the hospital exec thinks being employed by a hospital is better. There are tradeoffs but that is one sided.

 

[Gpan]

So far what I have gathered from all the interviews I ve had is that being employed means 7 on 7 off and being independent contractor means working almost EVERY DAY. You need to be on call to make money. And they tend to make more than traditional hospitalist who are employed by the hospital or group with 7 on 7 off.

For those who are working with 7 on 7 off schedule, do you take on any extra shifts or locum gigs during those 7 days off? Can you make > $300K?
For those who are working as independent contractors, do you feel that your working schedule is too much for family and personal time? Is it worth it? How often are you taking call? and do you take home >300K regularly?

 

[Gpan]

so no Hospitalist out there can make $300k ?

 

[obiwan]

At least not in the Metroplex if you're working a "normal" schedule

 

[Gpan]

Would that be possible to make 300K with 7 on 7 off AND 3-6 extra shifts per month?

 

[rokshana]

At least not in the Metroplex if you're working a "normal" schedule

depends on where you are...big cities where everyone wants to be...probably not since the base salary is in the 150-180k range if you are lucky...even a few extra shifts a month not going to get you to 300k. If you work outside the major metropolitan areas the base is higher 220-250k, so a few extra shifts can get you above 300k...

and being an independent contractor doesn't mean working everyday...means more that you don't get benefits and are not considered to be employed by the hospital or group...you are self employed...thats all.

 

[chessknt]

Whoa, whoa, whoa. The one and only thing that you should be paying for in this situation is a license. Everything else (DEA, privileges, interview travel, etc) should be paid for by the group hiring you. If that's not the case, you know all you need to about that group and you just walk away.

Do you think that is true for places you cold call but arent actively recruiting? I am trying to make my way back west in to a rural/small area but I would think it would be unusual for a group I called and asked if they were hiring to then turn around and pay for my interview travel expenses.

 

[gutonc]

Do you think that is true for places you cold call but arent actively recruiting? I am trying to make my way back west in to a rural/small area but I would think it would be unusual for a group I called and asked if they were hiring to then turn around and pay for my interview travel expenses.

If they're hiring, they're hiring. If they're not, they're not. If they offer you an interview and then don't pay for your expenses, then they're just humoring you/jerking you around.

It's your call whether or not to pay your own way for a nice pat on the back.

 

[flipmd]

I had a couple of places (big city) not pay for my interview, but most did. In the end, I signed up at one of the places that DID NOT pay for my interview expenses and very happy with the decision. In retrospect, the top 2 places I was considering did not pay for the interview, but YMMV. They did pay for everything else after hiring though (license, DEA, etc).

 

[Gpan]

Has anyone worked for Sound Physician group before? Apparently it's a pretty big national group for Hospitalist. How are they treating their doctors? How is the salary? work load?

If not Sound Physician then feel free to discuss about your current group (include the name please) if you want to share. Thanks

 

[Bostonredsox]

Would that be possible to make 300K with 7 on 7 off AND 3-6 extra shifts per month?

My base 15/month gig is 230k. I moonlight nights where I cover the ICU as well for 2000/shift and generally do 5 shifts a month. I think that adds up to about 350k for 20 shifts a month. I have Friends making much more. 400k is not unobtainable for 20 shifts a month especially as an IC

 

[Cozaar33]

My base 15/month gig is 230k. I moonlight nights where I cover the ICU as well for 2000/shift and generally do 5 shifts a month. I think that adds up to about 350k for 20 shifts a month. I have Friends making much more. 400k is not unobtainable for 20 shifts a month especially as an IC

Would it be possible for a IM sub-specialist, like an Endocrinologist, to pick up these kinds of moonlighting shifts?

 

[Bostonredsox]

Sure. They generally just want board certified IM

 

[Gpan]

My base 15/month gig is 230k. I moonlight nights where I cover the ICU as well for 2000/shift and generally do 5 shifts a month. I think that adds up to about 350k for 20 shifts a month. I have Friends making much more. 400k is not unobtainable for 20 shifts a month especially as an IC

That is awesome, working 2/3 of the month and making a decent living. I am leaning toward the W2 type of work first year out of residency. Too much to handle as 1099 type for me, mostly business stuffs

 

[Gpan]

For those Hospitalist who are Independent Contractors, how do you get around the Self Employment tax? That adds up to almost %15 even in states with no state income tax. This makes being an IC in those states with no state tax less attractive, no ?

 

[michaelrack]

For those Hospitalist who are Independent Contractors, how do you get around the Self Employment tax? That adds up to almost %15 even in states with no state income tax. This makes being an IC in those states with no state tax less attractive, no ?

You could form a chapt S corp and then you would have to pay yourself a reasonable salary (which means that you would likely have to pay the full social security tax, since it caps out at about 120 k) but the rest you can pay out in dividends and not have to pay the medicare tax on that amount.

 

[Gpan]

You could form a chapt S corp and then you would have to pay yourself a reasonable salary (which means that you would likely have to pay the full social security tax, since it caps out at about 120 k) but the rest you can pay out in dividends and not have to pay the medicare tax on that amount.

Thank you

What is a reasonable salary for a Hospitalist being paid through your own S Corp? $100,000? 150,000?

I read that you can deduct half of the amount of dollars you have to pay the medicare + social security tax. Is that truth? So essentially you only lose the same amount as you would if you have W2 type of job?

And do you think $40,000 is enough to cover Malpractice+Tail coverage + HSA type health insurance+dental/vision+ CME expenses and about some for 401K ? This is what I got offered to take on an Independent Contractor type of Hospitalist gig.

 

[michaelrack]

reasonable salary for full-time hospitalist- at least 150k through s corp

I am not sure about deducting half of the medicare/ss tax, but assuming that is true and you pay federal taxes at the 35% rate, you are only getting 35% of that 1/2 of the medicare/ss tax back. A deduction is not the same thing as a tax credit.

IN my state 40k would be enough to cover malp + insurance+ cME with a little left over for 401k, probably not in states like NY

 

[Mad Jack]

reasonable salary for full-time hospitalist- at least 150k through s corp

I am not sure about deducting half of the medicare/ss tax, but assuming that is true and you pay federal taxes at the 35% rate, you are only getting 35% of that 1/2 of the medicare/ss tax back. A deduction is not the same thing as a tax credit.

IN my state 40k would be enough to cover malp + insurance+ cME with a little left over for 401k, probably not in states like NY

150k? Ouch... Employed hospitalists here start around 200k with full benefits and malpractice, why would it ever make sense to work for so little? Or is that just the salary draw while the S-corp retains the rest of earnings?

 

[michaelrack]

150k? Ouch... Employed hospitalists here start around 200k with full benefits and malpractice, why would it ever make sense to work for so little? Or is that just the salary draw while the S-corp retains the rest of earnings?

I meant that 150k was the least I would feel comfortable reporting to the IRS as a salary draw from an S corp, with the rest paid out as dividends (or retained).

 

[gutonc]

I am not sure about deducting half of the medicare/ss tax, but assuming that is true and you pay federal taxes at the 35% rate, you are only getting 35% of that 1/2 of the medicare/ss tax back. A deduction is not the same thing as a tax credit.

Thanks for bringing this up, you beat me to the punch. This is yet another sign of how poorly physicians are educated on business/financial matters (myself included, but I'm working on it). A tax deduction means that, up to a certain level, you can deduct the amount of a particular expense from your taxable income, not that you're going to get all that money back from Uncle Sam in April.

150k? Ouch... Employed hospitalists here start around 200k with full benefits and malpractice, why would it ever make sense to work for so little? Or is that just the salary draw while the S-corp retains the rest of earnings?

The point of an S Corp is to minimize both your tax exposure AND the likelihood of getting audited. So if you're looking at $350-400K in gross income and reporting $150-200K salary from your S Corp (while plowing the rest back into your S Corp which is, of course, you), the IRS is unlikely to bother with you. Report a salary of $75K on the other hand and expect an IRS inspector at your doorstep a couple of times a year.

This is one of those times when a good tax attorney or CPA familiar with S Corps will be worth his (no doubt corpulent) weight in gold.

 

[Gpan]

Thanks for bringing this up, you beat me to the punch. This is yet another sign of how poorly physicians are educated on business/financial matters (myself included, but I'm working on it). A tax deduction means that, up to a certain level, you can deduct the amount of a particular expense from your taxable income, not that you're going to get all that money back from Uncle Sam in April.


The point of an S Corp is to minimize both your tax exposure AND the likelihood of getting audited. So if you're looking at $350-400K in gross income and reporting $150-200K salary from your S Corp (while plowing the rest back into your S Corp which is, of course, you), the IRS is unlikely to bother with you. Report a salary of $75K on the other hand and expect an IRS inspector at your doorstep a couple of times a year.

This is one of those times when a good tax attorney or CPA familiar with S Corps will be worth his (no doubt corpulent) weight in gold.

Of course the tax deduction is the amount you use to bring your taxable income down , NOT the amount you will get to keep from the IRS. I hope I didn't make it sound like I thought otherwise. Anyways anything helps. That's why we all scramble to find little things to deduct, even the drop in the bucket like student loan interest $2500 per year.

I will be in CA if I take that gig, so I assume $40,000 is NOT enough for Malpractice+Tail coverage + HSA type health insurance+dental/vision+ CME expenses and about some for 401K?

So If I pay myself $150K and the rest goes into the S-Corp I would get to benefit a lower tax bracket for that portion of money belongs to the S-Corp, correct?

What about if AFTER paying myself $150K, I deduct another say, $40K from buying my own benefit to make it total $110 taxable income for me? Is that ok ? I assuming the money I use to buy my own benefit is before tax. Correct me if I'm wrong

 

[gutonc]

You've clearly chosen to ignore the last sentence in the post of mind that you quoted, which is far and away the most important.

 

[Gpan]

You've clearly chosen to ignore the last sentence in the post of mind that you quoted, which is far and away the most important.

Absolutely not. I plan on hiring an excellent CPA lol. I just thought this is a forum for us to exchange ideas or for us rookies to ask you veterans these rookie questions. Thanks for the input so far !

 

[michaelrack]

What about if AFTER paying myself $150K, I deduct another say, $40K from buying my own benefit to make it total $110 taxable income for me? Is that ok ? I assuming the money I use to buy my own benefit is before tax. Correct me if I'm wrong

Talk this over with an accountant, but I believe the benefits/expenses should be paid by the S corp, not you personally.