Rural Employment Offer

[IntheClouds4ever]

So, I’m an MS4 that’s going to a rural residency in a flyover state in the south. My hometown hospital has given me an offer for employment and was wondering what you guys thought or questions I should be asking. Town is 50k and desperate for pcps, building a practice won’t be a problem

---

Members don't see this ad.

 

[VA Hopeful Dr]

What are the consequences if you leave the job after 1 year?

What are the RVU tiers?

When was the last doctor hired and did the hit 250k on production before the salary guarantee stop?

 

[IntheClouds4ever]

What are the consequences if you leave the job after 1 year?

What are the RVU tiers?

When was the last doctor hired and did the hit 250k on production before the salary guarantee stop?

-prorated repayment of residency stipend, and sign on bonus

-<25%tile-$39, 25-50%tile-$41, 50-75%tile-$44, >75%tile-$46

-locals said they were >50%tile after 1st year, with many above 75th after 2. Last pcp hired was 3.5 years ago.

 

[VA Hopeful Dr]

-prorated repayment of residency stipend, and sign on bonus

-<25%tile-$39, 25-50%tile-$41, 50-75%tile-$44, >75%tile-$46

-locals said they were >50%tile after 1st year, with many above 75th after 2. Last pcp hired was 3.5 years ago.

Prorated over how many years?

 

[IntheClouds4ever]

Prorated over how many years?

says it will be prorated if terminated prematurely, no mention of time frame for repayment of the prorated amount owed

 

[VA Hopeful Dr]

says it will be prorated if terminated prematurely, no mention of time frame for repayment of the prorated amount owed

That's very important.

If its a 10 year time frame, then even if you stay for 5 years you'll still owe them over $50,000.

 

[Piebaldi]

That's very important.

If its a 10 year time frame, then even if you stay for 5 years you'll still owe them over $50,000.

What he said - be very careful about the repayment clause. It can bite you in the butt. Make sure you understand all the fine prints. Also I never myself liked the whole "residency stipend" nonsense that you have to pay back. Clearly you still have 3+ years until you'd start so that's not a small chunk of change - obiously they are desperate as u claim. If I were u, I'd ask for a bigger sign on, and get rid of stipend if u have to repay it or for some assistance iwth relocation that u don't have to pay back.

 

[Sardonix]

Good lord M4s getting job offers now? I contacted my hometown hospital just for a rotation and got a big bowl of silence soup.

 

[VA Hopeful Dr]

Good lord M4s getting job offers now? I contacted my hometown hospital just for a rotation and got a big bowl of silence soup.

With rural hospitals its not unheard of, though usually after the match. Had one woman a year behind me who got a similar deal.

 

[Piebaldi]

Good lord M4s getting job offers now? I contacted my hometown hospital just for a rotation and got a big bowl of silence soup.

Rural desperate hospital.

 

[IntheClouds4ever]

5 pcps are retiring within the next 5 years so they are trying to fill gaps. Helps since I worked at the hospital for a few years before going to medical school, already have a wife and kid and guaranteed to be coming back to the area.. they did ask to see my scores and transcript to judge risk for matching.

 

[AMEHigh]

Yeah I’d get rid of the residency stipend if you have to pay it back. 3 years is a long time so things could change. I might have a problem with commitment because I can’t imagine commiting to something 3+ years away haha.

 

[IntheClouds4ever]

Yeah I’d get rid of the residency stipend if you have to pay it back. 3 years is a long time so things could change. I might have a problem with commitment because I can’t imagine commiting to something 3+ years away haha.

Would feel the same if I wasn’t married and didn’t have a kid. My wife and I are both from the area and have all our family here. It’s the only reason this has come about

 

[AMEHigh]

Would feel the same if I wasn’t married and didn’t have a kid. My wife and I are both from the area and have all our family here. It’s the only reason this has come about

Yes I would feel the same.
Residency is a time of growth and change. You might decide you want to do a fellowship, you might decide that you’re passionate about a particular area of family med and this job doesn’t offer it, etc.

I’ve finished residency and I’ll likely stay in the general area I’m in now for at least the next 5-10 years, but still I wouldn’t commit to a job 3 years from now, no way. I definitely wouldn’t accept a stipend that you would have to pay back, that’s too risky imo.

 

[hallowmann]

Yes I would feel the same.
Residency is a time of growth and change. You might decide you want to do a fellowship, you might decide that you’re passionate about a particular area of family med and this job doesn’t offer it, etc.

I’ve finished residency and I’ll likely stay in the general area I’m in now for at least the next 5-10 years, but still I wouldn’t commit to a job 3 years from now, no way. I definitely wouldn’t accept a stipend that you would have to pay back, that’s too risky imo.

I don't think this could really be overstated. I have a family and I can tell you that a lot has changed in our lives in a few years. People become ill and need to move to areas with better assisted living, healthcare, or nursing home resources. Family members die. People move elsewhere for work. And certainly, your personal interests in residency are likely to change significantly.

It's easy to think things will not change, but whenever you're relying on others (e.g. planning to stay/move back close to family), there's a lot of variables that come into play that you may not expect. I think dropping or decreasing the stipend for some freedom in case things change is worth it. OP may end up hating the job or hating the people they're working for/with. You don't want to be trapped in a bad situation because you can't afford to go break a contract.

OP, to be clear, I'm not saying you should absolutely not take this deal, simply that you should try to sacrifice maybe a little monetary gain for a little more freedom. Also, if you do end up taking the extra money during residency, I would put it immediately into savings or investments. Pretend like you don't have it and live off of your resident's salary. That will at least give you some flexibility in the future if you ever need to pay it back.

 

[Splenda88]

Good lord M4s getting job offers now? I contacted my hometown hospital just for a rotation and got a big bowl of silence soup.

Primary care is wide open with a lot of flexibility... I find it strange that people are already offering me jobs as a PGY2 when I have almost a year an half left to graduate. Being a physician is not bad

 

[Sushirolls]

GET A LAWYER TO REVIEW THE CONTRACT.

I'll say it again, pay the $200-600 dollars to GET A LAWYER TO REVIEW THE CONTRACT, and then have the lawyer be the person interacts with the hospital legal counsel for any further negotiations. Having the lawyer do your communicating with theirs will lead to results and buffer your emotional responses, and actually have the negotiations be treated seriously.

What about liability insurance? Is it occurrence or claims made? or is the hospital self insured and they set you up to be claims made, until you have worked for X amount of years and then its considered to be more of an occurrence based? If claims made, what's the tail cost? Hammer this down NOW, otherwise its a magical number that they can make up when you leave....

I second what Hallowmann posted above.

 

[IntheClouds4ever]

They are working with a state department that does loan repayment up to 200K. If they can guarantee this, I will be signing. We don't want to move back just because of family, but its home and we know its where we want to end up. I have asked questions y'all have put forth and they have been great at answering everything so nothing is hidden. Greatly appreciate everyone's input and have really tried to reflect on what's best for my family while giving myself some lateral freedom from corporate. Hopefully have some answers within the next few weeks.

 

[Piebaldi]

They are working with a state department that does loan repayment up to 200K. If they can guarantee this, I will be signing. We don't want to move back just because of family, but its home and we know its where we want to end up. I have asked questions y'all have put forth and they have been great at answering everything so nothing is hidden. Greatly appreciate everyone's input and have really tried to reflect on what's best for my family while giving myself some lateral freedom from corporate. Hopefully have some answers within the next few weeks.

Keep in mind that loan repayment frequently works in the same manner as the stipend you mentioned - you have to stay x number of years in order for you to not have to pay it back, so you should ask questions about that.
If you see yourself there long term that's good - but keep your options in a way that you are not bleeding thousands of dollars in the near future.

 

[DarkHorizon]

Would not take the job yet, would politely thank them and would tell them you need to wait at least a year or two. This job is not going anywhere with 5 physicians retiring. You’ll likely be able to negotiate a much better contract. And that’s lost money from residency stipend can easily be recouped as a sign on bonus. Once you sign and take money, you’re locked and have to pay it back with interest. Be very careful, highly recommend against this at this stage.

 

[IntheClouds4ever]

Keep in mind that loan repayment frequently works in the same manner as the stipend you mentioned - you have to stay x number of years in order for you to not have to pay it back, so you should ask questions about that.
If you see yourself there long term that's good - but keep your options in a way that you are not bleeding thousands of dollars in the near future.

Requires 4 year commitment and doesn’t interfere with contract obligations so it’s rolled in.

Would not take the job yet, would politely thank them and would tell them you need to wait at least a year or two. This job is not going anywhere with 5 physicians retiring. You’ll likely be able to negotiate a much better contract. And that’s lost money from residency stipend can easily be recouped as a sign on bonus. Once you sign and take money, you’re locked and have to pay it back with interest. Be very careful, highly recommend against this at this stage.

this does have a sign on bonus and the stipend is importantto make up for lost income due to wife not working so she can stay home with the child to avoid the scarce and less than ideal daycare scenarios In a rural area for our daughter. Plus, you still get production above base, so I’m not too worried about “getting more” other than student loan repayment.

 

[deleted480308]

Get a lawyer

 

[Piebaldi]

Requires 4 year commitment and doesn’t interfere with contract obligations so it’s rolled in.


this does have a sign on bonus and the stipend is importantto make up for lost income due to wife not working so she can stay home with the child to avoid the scarce and less than ideal daycare scenarios In a rural area for our daughter. Plus, you still get production above base, so I’m not too worried about “getting more” other than student loan repayment.

Many things change in 5+ years - you might have to pay back the loan repayment if something changes for whatever reason, and the stipend is not really "extra" money - it's essentially a loan - getting a bigger sign on might be much better option.

I think that while you might be excited about the job and think the position is in a good place where you and your wife want to return to long term, things change over time so I think we are all concerned that you are taking a job offer too early with what appears to be all sorts of caveats. You learn a great deal your first job and contract - so we are all suggesting you be cautious to not end up paying a bunch of money.

I interviewed for example at a job initially that gave a "guarantee" but you had to pay back any money that they paid you - while at the same time only getting 55% of whatever your collections brought in - needless to say I turned that job down, it was in a great hospital in an overall desirable city, with top of the line facilities, but to this day they are still hiring 2 years later.

So be cautious!

 

[IntheClouds4ever]

Many things change in 5+ years - you might have to pay back the loan repayment if something changes for whatever reason, and the stipend is not really "extra" money - it's essentially a loan - getting a bigger sign on might be much better option.

I think that while you might be excited about the job and think the position is in a good place where you and your wife want to return to long term, things change over time so I think we are all concerned that you are taking a job offer too early with what appears to be all sorts of caveats. You learn a great deal your first job and contract - so we are all suggesting you be cautious to not end up paying a bunch of money.

I interviewed for example at a job initially that gave a "guarantee" but you had to pay back any money that they paid you - while at the same time only getting 55% of whatever your collections brought in - needless to say I turned that job down, it was in a great hospital in an overall desirable city, with top of the line facilities, but to this day they are still hiring 2 years later.

So be cautious!

i appreciate the insight. Normally, I wouldn’t even think about it yet, but with land, other communityand Emotional ties, we know we are coming back. It’s just a matter of deciding between two different hospitals. This contract seems to be the better deal as far as tail coverage, no non compete clause, and then financial aspects. I’ve been sitting on this for a few weeks discussing it with different folks that I know, just came on here to see about any othernegotiations I should ask about if I decide to sign. This definitely hasn’t been done on a whim.

 

[FrustratedFamDoc]

To quote O Brother where Art Thou: "Do not seek the treasure! It's bushwhacked!"

I really hope it works out as it seems like you're a 99.9% yes on this offer, but I think you could be really cruising for a bruising.

So you've got a rural hospital where 5! docs are all set to 'retire' all in the same time window (that almost sounds like an entire practice). They're trying to rope you in with a 4 year commitment with devastating financial penalty if you don't live up to your end of the bargain. It took them 3 1/2 years to hire the last doc so when all 5! docs leave and stick you with their patients (rural 'older medicine' often times means quite a few patients on benzos and narcotics) and you're seeing 30+ patients a day for essentially nothing because the majority are government insurance. If you speak to any of the 'retiring' docs, expect for them all to speak glowingly about staff, patients and working for the org in general. I would never sign anything longer than a 2 year commitment under such a circumstance but they'll probably never go for it.

If this offer were for anywhere but your hometown, you would probably never give it a second thought. We can usually be happy in a few locations, but can easily find misery anywhere. Really think long and hard about this one.

 

[Piebaldi]

To quote O Brother where Art Thou: "Do not seek the treasure! It's bushwhacked!"

I really hope it works out as it seems like you're a 99.9% yes on this offer, but I think you could be really cruising for a bruising.

So you've got a rural hospital where 5! docs are all set to 'retire' all in the same time window (that almost sounds like an entire practice). They're trying to rope you in with a 4 year commitment with devastating financial penalty if you don't live up to your end of the bargain. It took them 3 1/2 years to hire the last doc so when all 5! docs leave and stick you with their patients (rural 'older medicine' often times means quite a few patients on benzos and narcotics) and you're seeing 30+ patients a day for essentially nothing because the majority are government insurance. If you speak to any of the 'retiring' docs, expect for them all to speak glowingly about staff, patients and working for the org in general. I would never sign anything longer than a 2 year commitment under such a circumstance but they'll probably never go for it.

If this offer were for anywhere but your hometown, you would probably never give it a second thought. We can usually be happy in a few locations, but can easily find misery anywhere. Really think long and hard about this one.

This was really well said actually and I didn't even think of some of the issues you brought up! Some places do have a hard time hiring, and they will tell you all that you want to hear in order to rope you in, and once you sign, it's all "well a doctor needs to do what a doctor needs to do in order to take care of their patient" line. Ie - you are getting screwed and can't do anything about it - frequently - although I don't if that is the OP's case - there are serious financial penalties if one quits early (ie - paying part of the contract, etc). Also as you mention if 5 of the docs are retiring, that means OP will likely need to take care of all those patients - which is essentially asking OP to do the job of 5 docs. That's quite a bit! And most docs these days don't want to work in rural areas so it might be difficult to for new docs to be hired to replace the ones that left.
Not to mention that as a rural doc, OP will need to do everything! Probably not nearly as much assistance from specialists like most of us who work in a larger hospital system have access to.

 

[IntheClouds4ever]

To quote O Brother where Art Thou: "Do not seek the treasure! It's bushwhacked!"

I really hope it works out as it seems like you're a 99.9% yes on this offer, but I think you could be really cruising for a bruising.

So you've got a rural hospital where 5! docs are all set to 'retire' all in the same time window (that almost sounds like an entire practice). They're trying to rope you in with a 4 year commitment with devastating financial penalty if you don't live up to your end of the bargain. It took them 3 1/2 years to hire the last doc so when all 5! docs leave and stick you with their patients (rural 'older medicine' often times means quite a few patients on benzos and narcotics) and you're seeing 30+ patients a day for essentially nothing because the majority are government insurance. If you speak to any of the 'retiring' docs, expect for them all to speak glowingly about staff, patients and working for the org in general. I would never sign anything longer than a 2 year commitment under such a circumstance but they'll probably never go for it.

If this offer were for anywhere but your hometown, you would probably never give it a second thought. We can usually be happy in a few locations, but can easily find misery anywhere. Really think long and hard about this one.

The 5 retiring are “in the area” and work for another hospital. My point was that building a practice will be easy and I won’t be struggling after guaranteed base is gone. I’ve talked to the other hospital in the area (the that’ll have five retiring within my timeframe) and they have a similar offering with similar strings attached. So I’m just looking at which ones the lesser of two evils.

 

[BigSib]

So, I’m an MS4 that’s going to a rural residency in a flyover state in the south. My hometown hospital has given me an offer for employment and was wondering what you guys thought or questions I should be asking. Town is 50k and desperate for pcps, building a practice won’t be a problem

As others have said: have an attorney who has experience in physician contracts to review this with you. It will be well worth the money and may help you to better understand your financial situation. You can use this professional any way you please, if at least for another set of eyes on it. Also would be wise to verify the salary forecast to compare what you're getting vs what would be expected if you signed that year. Over the last 3 years here the starting salary has increased by $10k/yr and the MGMA $/RVU by a handful of dollars. Maybe you'd be getting that in stipend who knows, but you could be leaving a lot of money on the table and not know it if you're inexperienced.

 

[IntheClouds4ever]

As others have said: have an attorney who has experience in physician contracts to review this with you. It will be well worth the money and may help you to better understand your financial situation. You can use this professional any way you please, if at least for another set of eyes on it. Also would be wise to verify the salary forecast to compare what you're getting vs what would be expected if you signed that year. Over the last 3 years here the starting salary has increased by $10k/yr and the MGMA $/RVU by a handful of dollars. Maybe you'd be getting that in stipend who knows, but you could be leaving a lot of money on the table and not know it if you're inexperienced.

I did ask about the $/rvu and it will be fluid with their yearly model. After talking with some newer physicians in the area, they were hitting their base salary in the first 1-1.5 years and were eclipsing it easily by the second. So I’m not trying to let the base salary sway me too much with either hospital. Still waiting on an answer for student loan repayment from one entity. Otherwise I’ll be going with the other entity who’s contract aligns more with what’s been said on here.. fewer years, less strings attached (repayment for exiting early) with money upfront (sign-on, stipend), but I’m waiting to see if they will add tail coverage to the offer.