Reasonable salary breakdown

[lmsanscafe]

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I am asking very generally… what % breakdown is reasonable to expect and/or common, in terms of base + wRVU? Is one’s salary often 50/50; base/production? Or is it skewed a lot more towards production? If a hospital offers 300k+ production, what is the final salary one could expect on average, assuming they generate an average amount of RVU?

Of course the real answer is that it depends, but I’d appreciate any general inputs on this topic. Thanks in advance.

 

[DOctorJay]

it's all going to boil down to what $/wRVU you're able to get. there are so many ways that hospitals mess with these numbers that you really have to make sure you understand what you're being presented. most straightforward is a simple $/wRVU value above your base salary.

let's say in your first year your goal is to hit a very reasonable 7,500 wRVU and you have a $65/wRVU valuation.

the job may give you $300k base up to some threshold of say 5,000 wRVUs above which you make $65/wRVU.
so $300k for the first 5,000 wRVUs
$65/wRVU for the next 2,500 (to hit 7,500 total) = $162,500
$300,000 + $162,500 = $462,500 total

now play with the numbers for your situation understanding the single most critical factor here is your $/wRVU.
remember, a $1 increase in your $/wRVU valuation yields an additional $10,000 in your salary at 10,000 wRVUs.

 

[Ducttape]

if you are starting from scratch ie not taking over or joining an existing practice, expect that you will not make the minimum wRVU until after your first year. apparently, most employed doctor contracts are for 2 years for this reason.

most employed models are either straight $/wRVU or base salary + bonus then after reaching a minimum $wRVU. thats the model listed by DOctorJay.

 

[cowboydoc]

I am asking very generally… what % breakdown is reasonable to expect and/or common, in terms of base + wRVU? Is one’s salary often 50/50; base/production? Or is it skewed a lot more towards production? If a hospital offers 300k+ production, what is the final salary one could expect on average, assuming they generate an average amount of RVU?

Of course the real answer is that it depends, but I’d appreciate any general inputs on this topic. Thanks in advance.

This is all over the place. Generally I'd ignore your starting base/guarantee. Think of it like a loan. Of course, you need to get paid something out of the gate, but if you don't produce on par or better than what you're paid, it will end badly for everyone. A reasonable or generous production is far better than a good base, as long as you don't starve in the beginning. (You should still live like a resident early in your first job, so your base should be sufficient.)

The cost (time/effort/$/stress) of changing jobs in 2 years (or less) will far outweigh getting a decent job with reasonable opportunity to grow/produce.

My example: My base sucked, but I earned 61% of collections. I exceeded my base at month 5. Now I make about 3x my original base. I'm 100% production with rvu now. I can adjust my "base" pay based on recent production. I typically keep my monthly pay at 90% of what I expect to earn and get a check every 6 months to even things out.

I used to say "bet on yourself," and go for the job with incentives to pay you for working hard. I'd adjust that to pick a job that fits your effort level. If you want to take it easy and don't need a ton of $, take the good base and don't produce. If you want to hustle, you'll be really frustrated in a system that doesn't reward your effort, doesn't think like you and may even create disincentives for you producing more.

 

[callmeanesthesia]

if you are starting from scratch ie not taking over or joining an existing practice, expect that you will not make the minimum wRVU until after your first year. apparently, most employed doctor contracts are for 2 years for this reason.

most employed models are either straight $/wRVU or base salary + bonus then after reaching a minimum $wRVU. thats the model listed by DOctorJay.

That’s true for us as well. My starting pay was $300k. Even at that level I hadn’t made enough my first year to cover expenses, largely because being paid for your work lags 1-3 months beyond the actual service date due to insurance, so even at a modest salary plus expenses you’re $150k in the hole by the time money starts to roll in. However, as an employee that’s really just Monopoly money anyway. By 1.5 years in I was profitable and bought in (after I hired a PA). I think I still only made $350k my second full calendar year with the group, but that was 2020. Now I’m well above median for our specialty. We have ancillaries but they don’t do much, so that’s almost all my clinical earnings.
Private practice is low starting out, and it seems like if you are at a place with no partnership track, it stays that way. If you get to keep all of what you earn, there’s a pretty high potential upside.

 

[Ducttape]

cowboy makes a very important point about your effort level. very important.

id like to add to that.

do not expect to make a lot of wRVUs if you are in a HOPD that has a high percentage of Medicaid clientele. for these patients, high no shows and general lack of interventional pain procedure interest factor greatly in your wRVU volume.

in that respect, such a job is one that you will not make less in terms of bonus, so the base is important.

 

[DrMDAware]

I’d recommend checking out MGMA to get a ball park

See how fast your staff will work. Same goes for ASC space. They could be your limiting factor now matter how hard you want to work.

Check if ASC will give you block time.

Verify what kind of patients you see (do they wanna talk a long time or are ok with a shorter visit?)

Will you be paying overhead? Is it fixed or variable?

Do you have to create connections for referrals or are they fed to you?

 

[SSdoc33]

I’d recommend checking out MGMA to get a ball park

See how fast your staff will work. Same goes for ASC space. They could be your limiting factor now matter how hard you want to work.

Check if ASC will give you block time.

Verify what kind of patients you see (do they wanna talk a long time or are ok with a shorter visit?)

Will you be paying overhead? Is it fixed or variable?

Do you have to create connections for referrals or are they fed to you?

and how the h#ll would you check on that?

ask your potential employer "you know, id really prefer not to have long conversations with my patients. can you only schedule ones that aren't blabbermouths"?

 

[runfastnow]

From a small private practice ortho setting. Posted this before.

Depends on a few things:
- What are you billing out? We do 3x Medicare rates.
- Payor mix.
- Skill of your billing department.

I see a lot of Obamacare products, Medicaid, Medicare. We bill 3x Medicare rates. Collect 38%-42% of billing and have ~50% overhead. So I expect to get paid somewhere around 20% of what I bill out.

I'm sure there are better set ups out there, but in a smaller private practice in a state with awful BCBS/commerical payment rates it is what it is.
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Question I have for the group - when you discuss comp do you include employer 401k contributions, health insurance benefits, etc. or only paycheck dollars?

 

[afob100]

From a small private practice ortho setting. Posted this before.

Depends on a few things:
- What are you billing out? We do 3x Medicare rates.
- Payor mix.
- Skill of your billing department.

I see a lot of Obamacare products, Medicaid, Medicare. We bill 3x Medicare rates. Collect 38%-42% of billing and have ~50% overhead. So I expect to get paid somewhere around 20% of what I bill out.

I'm sure there are better set ups out there, but in a smaller private practice in a state with awful BCBS/commerical payment rates it is what it is.
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Question I have for the group - when you discuss comp do you include employer 401k contributions, health insurance benefits, etc. or only paycheck dollars?

for my Hospital job, the main negotiation was base salary, signing bonus, and conversion factor in the first 2 years. the 401k + benefits were standard for all the ortho surgeons in our group (we get $10k employer match to 401k, $4k CME, and $1440/year cell phone allowance).

 

[Ronin1]

My base is 80% of my max comp. HOPD job

 

[DrMDAware]

and how the h#ll would you check on that?

ask your potential employer "you know, id really prefer not to have long conversations with my patients. can you only schedule ones that aren't blabbermouths"?

Easy. Are the new slots 45 mins or 15 mins? You get the idea.

Edit to add
- Are there double booking patients?
- Is the schedule full of follow up patients or new ones? What’s the percentage ?breakdown?
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[clubdeac]

All that matters is $/wRVU and how much block time you’ll get, how efficient your staff are and if you have a steady stream of patients. That will determine how much you make in a hospital employed model

 

[au bon pain]

Question I have for the group - when you discuss comp do you include employer 401k contributions, health insurance benefits, etc. or only paycheck dollars?

I suspect not, but most should. Especially when comparing W2 to 1099 jobs.

My experience having my own W2 employee opened my eyes to the cash costs other than just the "salary" that goes into actually employing somebody.

Putting a raw $ value on certain benefits can be challenging, but we do ourselves a disservice if we don't at least try to ballpark things when evaluating jobs options -- only way to approximate an apples to apples comparison. My base+bonus "cash" take-home is probably lower than many folks on here but I have heavy retirement contributions and other pricey benefits. When I was interviewing and negotiating for a higher salary, my now-boss suggested that their benefits were worth an additional 20% of my salary. But when I ran the numbers myself in the context of my own family situation (young kids, etc) the total value of these easily added another 30% to my salary (probably closer to 35% these days).

 

[deleted875186]

do not expect to make a lot of wRVUs if you are in a HOPD that has a high percentage of Medicaid clientele.

Unless your doing a lot of opioids in said clinic ….