Salaries

[Piebaldi]

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Hey all, so salary question.

Do pain salaries go up with time or do they stay stagnant?
I was talking to an attending in my fellowship who mentioned that they got x salary after fellowship, a guarantee for a certain number of years, and then their salary has gone down bc they are only on production.

Is this normal? isn't there a cost of living adjustment in salaries? how about bonuses? obviously there is only so much that one can produce, does that mean that salaries stagnate at some point?

 

[SommeRiver]

Salary to get you started with the expectation you're going to work hard and grow your practice so production starts later.

No reason you'd make less 2 or 3 yrs into practice. Maybe they are tired and don't want to add that extra pt or two at 345 and 400 on a Tuesday.

 

[paindoc007]

For employed positions, it’s typical to get a guaranteed salary for 1-2 years. After that when you get on production, then sure, salary could go up or down, depending on you busy you are.

I think it’s impt to calculate what you need to do to meet your base income.
for example, say your base is 350k. And your hospital is giving you $64/wrvu. That’s 5468 wrvu for the year. Assuming you work 46 weeks a year (4 week vacation plus 2 week fed holidays) that’s 119 wrvu/week. What does that look like? How many patients and procedures do you need to do? Those should be things you need to figure out and calculate when starting a job to AVOID a drop in income, which seems to be your concern.

 

[gdub25]

I will also add in that you’d have to be pretty slow to not to exceed that amount of RVU. Every pain doctor that I know personally who works in the RVU model is doing 9000+ per year.

 

[paindoc007]

I will also add in that you’d have to be pretty slow to not to exceed that amount of RVU. Every pain doctor that I know personally who works in the RVU model is doing 9000+ per year.

I think 2019 mgma avg was around 6700 wrvu/year.

 

[Piebaldi]

For employed positions, it’s typical to get a guaranteed salary for 1-2 years. After that when you get on production, then sure, salary could go up or down, depending on you busy you are.

I think it’s impt to calculate what you need to do to meet your base income.
for example, say your base is 350k. And your hospital is giving you $64/wrvu. That’s 5468 wrvu for the year. Assuming you work 46 weeks a year (4 week vacation plus 2 week fed holidays) that’s 119 wrvu/week. What does that look like? How many patients and procedures do you need to do? Those should be things you need to figure out and calculate when starting a job to AVOID a drop in income, which seems to be your concern.

I'm starting out so obviously trying to get information here. Well the attending was mentioning a salary in the upper 200's to start, and then saying they'd drop down to less than 200 bc they were mostly doing med management I guess and not that many patients getting injections which seems odd to me. I mean I was doing well over 200 doing general rehab so I don't see how that's possible. I've spent some time in their clinic and they see a ton of patients, like 25 plus daily but mostly med management I guess not that much in terms of procedures. I guess they are employed through a corporation and this person was saying that the company takes like 80% of their collections and they get 20% which seems like a poor deal to me? I was shocked but didn't seem like a typical type of situation.

But yeah let's say you get hired at 350k, and after the guarantee you work hard and are diligent, good procedurally, patients are happy and keep coming, etc. but at some point there is only so much you can produce so I ugess that the salaries/wages or whatever we call them at some point stagnate - would that be an accurate statement?

I ask bc I was thinking - a person I know for example works in a finance sector, they get x salary plus bonus so they get salary bump every year and bonus bump every year but I guess for docs at some point the bump will stop.

 

[thecentral09]

I think 2019 mgma avg was around 6700 wrvu/year.

Do I have this 2019 data? Please dm if you can share. Contract negations currently ongoing

 

[willabeast]

Hey all, so salary question.

Do pain salaries go up with time or do they stay stagnant?
I was talking to an attending in my fellowship who mentioned that they got x salary after fellowship, a guarantee for a certain number of years, and then their salary has gone down bc they are only on production.

Is this normal? isn't there a cost of living adjustment in salaries? how about bonuses? obviously there is only so much that one can produce, does that mean that salaries stagnate at some point?

At TPMG (kaiser ncal) your base salary goes up incrementally over 20 years. Also your retirement package.

 

[Piebaldi]

At TPMG (kaiser ncal) your base salary goes up incrementally over 20 years. Also your retirement package.

do they have a pension? or you mean 401k and stuff? do you think that the situation this person was mentioning is atypical? seemed like to me. they were pm&r trained but even in general pm&r it's simple to make well over 200k so I wasn't sure what to make of it.

 

[paindoc007]

But yeah let's say you get hired at 350k, and after the guarantee you work hard and are diligent, good procedurally, patients are happy and keep coming, etc. but at some point there is only so much you can produce so I ugess that the salaries/wages or whatever we call them at some point stagnate - would that be an accurate statement?

Yes, of course your production will plateau at a certain point. Mine has already. I’m good with it. If you’re really aspiring to cont growth, can always open a practice, hire help when you hit a certain threshold, etc

 

[promethius]

I'm starting out so obviously trying to get information here. Well the attending was mentioning a salary in the upper 200's to start, and then saying they'd drop down to less than 200 bc they were mostly doing med management I guess and not that many patients getting injections which seems odd to me. I mean I was doing well over 200 doing general rehab so I don't see how that's possible. I've spent some time in their clinic and they see a ton of patients, like 25 plus daily but mostly med management I guess not that much in terms of procedures. I guess they are employed through a corporation and this person was saying that the company takes like 80% of their collections and they get 20% which seems like a poor deal to me? I was shocked but didn't seem like a typical type of situation.

But yeah let's say you get hired at 350k, and after the guarantee you work hard and are diligent, good procedurally, patients are happy and keep coming, etc. but at some point there is only so much you can produce so I ugess that the salaries/wages or whatever we call them at some point stagnate - would that be an accurate statement?

I ask bc I was thinking - a person I know for example works in a finance sector, they get x salary plus bonus so they get salary bump every year and bonus bump every year but I guess for docs at some point the bump will stop.

Yes, you are correct. Variables affecting your collections are the following: payer mix, number of patients you see (or can see), patient mix (i.e. medication management versus injections), in-house ancillaries, and overhead. You only have a finite amount of time in a day, so unless you hire extenders (i.e. midlevels, other physicians, etc.), eventually you are going to run out of time, and your collections will plateau.

Any employed position that takes 80% of your collections for overhead will be putting you in that much bigger of a hole when you eventually go on productivity. Unless the practice is being mismanaged, overhead for a pain practice should not be that high, so any practice that takes 80% of your collections is probably keeping a large chunk of it for themselves as profit. If you really want to control your overhead, consider starting your own practice or working as an independent contractor.

 

[SommeRiver]

At 3 to 4 yrs your schedule and practice should be pretty smooth. You should be making more in productions than salary at that point, and like someone else said above you are probably plateaued. That is when many people start thinking about midlevels if they want to continue in their growth.

Also LMAO at 80/20.

 

[Eilat87]

At 3 to 4 yrs your schedule and practice should be pretty smooth. You should be making more in productions than salary at that point, and like someone else said above you are probably plateaued. That is when many people start thinking about midlevels if they want to continue in their growth.

Also LMAO at 80/20.

What is a fair percentage then? 50/50 of net collections after overhead/benefits/salary?

 

[SommeRiver]

What is a fair percentage then? 50/50 of net collections after overhead/benefits/salary?

That's a big discussion because there's more to it than that, but it should be either 50/50 or 60/40 IMO. That is assuming the other benefits are reasonable. Many factors at play. How big is the overhead? What's salary?

 

[Laryngospasm]

50/50 is the goal in private practice. Sadly due to overhead and referrals etc you may do better as a hospital employee with way less headaches. It’s hard to be in private practice right now.

 

[gdub25]

We have a private practice group the tired a couple of doctors over the past couple of years, our split is roughly 60/40. We try to be as fair as possible with the new doctors that we hire and the split is purely dictated on what overhead percentages are. we did a lot of math to come up with our calculations. We ended up with a tiered structure that says they get 33% of collections for the first million collected, the second million is at 40% and the third million and above is 45%. If your structures because you’ve been private practice you’re only collecting $1 million the overhead as a percentage is going to be a lot more than if you were collecting 3 million a year. A good portion of the overhead is fixed so as the collections go up the percentage we should should keep goes down. After a couple years the doctors in our practice start to hit that plateau point where they are collecting a steady amount and that’s when they can buy into the practice if they truly want to eat what they kill. Overhead of a typical paint practice that’s ran fairly efficiently will be around 50% so the doctor may choose not to buy in for that extra 10% earnings

 

[Piebaldi]

We have a private practice group the tired a couple of doctors over the past couple of years, our split is roughly 60/40. We try to be as fair as possible with the new doctors that we hire and the split is purely dictated on what overhead percentages are. we did a lot of math to come up with our calculations. We ended up with a tiered structure that says they get 33% of collections for the first million collected, the second million is at 40% and the third million and above is 45%. If your structures because you’ve been private practice you’re only collecting $1 million the overhead as a percentage is going to be a lot more than if you were collecting 3 million a year. A good portion of the overhead is fixed so as the collections go up the percentage we should should keep goes down. After a couple years the doctors in our practice start to hit that plateau point where they are collecting a steady amount and that’s when they can buy into the practice if they truly want to eat what they kill. Overhead of a typical paint practice that’s ran fairly efficiently will be around 50% so the doctor may choose not to buy in for that extra 10% earnings

I think the attending in q uestion was purely on a production type set up with no base salary, but somehow on a 20/80 basis which seems way off to me

 

[Eilat87]

We have a private practice group the tired a couple of doctors over the past couple of years, our split is roughly 60/40. We try to be as fair as possible with the new doctors that we hire and the split is purely dictated on what overhead percentages are. we did a lot of math to come up with our calculations. We ended up with a tiered structure that says they get 33% of collections for the first million collected, the second million is at 40% and the third million and above is 45%. If your structures because you’ve been private practice you’re only collecting $1 million the overhead as a percentage is going to be a lot more than if you were collecting 3 million a year. A good portion of the overhead is fixed so as the collections go up the percentage we should should keep goes down. After a couple years the doctors in our practice start to hit that plateau point where they are collecting a steady amount and that’s when they can buy into the practice if they truly want to eat what they kill. Overhead of a typical paint practice that’s ran fairly efficiently will be around 50% so the doctor may choose not to buy in for that extra 10% earnings

Pain doctors are hitting the 2-3 million target? Whaaa?

 

[Laryngospasm]

You’re looking at getting 7-800k if you bring in two million. So yes and no. You can make the hospital 3 million and still only get 400..

 

[paindoc007]

I think the attending in q uestion was purely on a production type set up with no base salary, but somehow on a 20/80 basis which seems way off to me

It is. Guy is a ***** for working there.

 

[gdub25]

Pain doctors are hitting the 2-3 million target? Whaaa?

You’re looking at getting 7-800k if you bring in two million. So yes and no. You can make the hospital 3 million and still only get 400..

Don’t mistake collections and take home. Yeah, in pain you can be busy and bring in 2-3 million in collections. To do it you have to hire a lot of support staff which is expensive. There’s that balance you have to find between how much help to get and at what cost to get that extra production. In my opinion there are two areas you want to be. Either low volume and extremely low overhead or you need to jump up to high volume where you can afford the high overhead. If you try to go for high volume and higher the staff to do sIn my opinion there are two areas you want to be. Either low volume and extremely low overhead or you need to jump up to high volume where you can afford the high overhead. I think a lot of people see the pie in the sky with guys making tons of money who are really high volume and efficient and try to get there but find themselves in and in that dead zone where they have the staff and means to do more volume but they don’t have either the referrals or expertise/speed/clinic workflow and end up with an inefficient, high overhead practice. For example, a practice it’s in a city near me had three doctors with 62 employees. They were doing about the same volume of patient visits and injections per week as my group yet my group had 27 employees for three doctors.

 

[wavygravy99]

80/20 is insane. Essentially if you collect 1 million for the practice, you only keep 200k. Unless there is a significant bonus structure that's not accounted for.

I join my practice, a small practice. Eat what I kill from day one, 50/50,I took over for a retired physician in a generalorthopedic practice, the retired physician was non interventional, but does pmr with EMG and med management. I had to build my injection practice but there was an existing patient base, and some referral. I kept 50% of my collections. I asked for a 10k a month salary. So every quarter when it's settled, 30k is deducted from my portion of 50%. I have no restriction which ASC I can go to since my practice doesn't own an ASC. I bought into an ASC 6 months into my practice so that generate extra income.

It sucked the first few months as reimbursement from insurances is behind, but after things have steadily improved

 

[Ligament]

You’re looking at getting 7-800k if you bring in two million. So yes and no. You can make the hospital 3 million and still only get 400..

Actually, you are going to make the hospital MANY millions in imaging and lab fees, for which they will pay you exactly nothing.

 

[Piebaldi]

80/20 is insane. Essentially if you collect 1 million for the practice, you only keep 200k. Unless there is a significant bonus structure that's not accounted for.

I join my practice, a small practice. Eat what I kill from day one, 50/50,I took over for a retired physician in a generalorthopedic practice, the retired physician was non interventional, but does pmr with EMG and med management. I had to build my injection practice but there was an existing patient base, and some referral. I kept 50% of my collections. I asked for a 10k a month salary. So every quarter when it's settled, 30k is deducted from my portion of 50%. I have no restriction which ASC I can go to since my practice doesn't own an ASC. I bought into an ASC 6 months into my practice so that generate extra income.

It sucked the first few months as reimbursement from insurances is behind, but after things have steadily improved

Right I thought it was crazy too. No bonus apparently.

 

[Laryngospasm]

Actually, you are going to make the hospital MANY millions in imaging and lab fees, for which they will pay you exactly nothing.

That’s the point I was trying to make..

 

[drusso]

Actually, you are going to make the hospital MANY millions in imaging and lab fees, for which they will pay you exactly nothing.

A new formula to track the ROI of your employed physicians - Becker's Hospital Review | Healthcare News & Analysis

When thinking about the financial performance of the employed physician enterprise for your health system, is your first instinct to focus on the operating loss of the medical group as a standalone business? While this is certainly an important part of the equation, it's by no means the whole story.

www.beckershospitalreview.com

What makes this possible? $O$...

 

[Ferrismonk]

A primarily med management "pain doc" is going to be reimbursed primarily by E/M visits, much like a PCP. So they'll get PCP salaries. $200-300K is reasonable.

To answer your original question, yes in an eat-what-you-kill model, your income is at the mercy of trading time for money, and time is a limited resource. This is nothing like your friends who work for a big corporation that get a salary and bonus structure that is independent on what they actually do. If you're a cog in the assembly line at Ford, what you get paid (and whether you have a job really) has little to do with what you are actually doing day to day.

Also, as a physician you are paid largely by insurance companies and the government. These entities are always looking to cut costs so there will be downward pressure on your wages over time. Some things gets a boost, some things get paid less every year. Red tape goes up and staff time being spent getting authorization (overhead) goes up. It is what it is.

 

[Piebaldi]

A primarily med management "pain doc" is going to be reimbursed primarily by E/M visits, much like a PCP. So they'll get PCP salaries. $200-300K is reasonable.

To answer your original question, yes in an eat-what-you-kill model, your income is at the mercy of trading time for money, and time is a limited resource. This is nothing like your friends who work for a big corporation that get a salary and bonus structure that is independent on what they actually do. If you're a cog in the assembly line at Ford, what you get paid (and whether you have a job really) has little to do with what you are actually doing day to day.

Also, as a physician you are paid largely by insurance companies and the government. These entities are always looking to cut costs so there will be downward pressure on your wages over time. Some things gets a boost, some things get paid less every year. Red tape goes up and staff time being spent getting authorization (overhead) goes up. It is what it is.

Yep I guess you said it well - nice to know that after all these years of work, the person with a bachelor's might make more than us. Sigh. anyways it also seems that pain jobs are becoming difficult to come by?

I have received emails from recruiters advertising candidates!

 

[DoYouEvenLiftBro]

Yep I guess you said it well - nice to know that after all these years of work, the person with a bachelor's might make more than us. Sigh. anyways it also seems that pain jobs are becoming difficult to come by?

I have received emails from recruiters advertising candidates!

What happened to your multi million whistleblower suit?

 

[SommeRiver]

Yep I guess you said it well - nice to know that after all these years of work, the person with a bachelor's might make more than us. Sigh.

There are many, many people in the world that are only high school graduates that are not only smarter than you, but far more successful.

Just bc you agreed to keep going to school doesn't mean you're smarter or more deserving than other people.

A doctor has a great income but until you invent a device or start a franchise you'll be just another member of the upper middle class and that's a great place to be.

Grow up chick...

 

[Piebaldi]

What happened to your multi million whistleblower suit?

Still in place and going strong. Why do you ask?

 

[deleted993114]

Yep I guess you said it well - nice to know that after all these years of work, the person with a bachelor's might make more than us. Sigh. anyways it also seems that pain jobs are becoming difficult to come by?

I have received emails from recruiters advertising candidates!

The most you can ask for in life is to be able to go to work and find your job interesting, be able to take some nice trips, and have a good family.

The pursuit of cash is pointless and never ending, as it is never "enough". The best blessing I have had is to contract two different cancers (both with not the best prognoses); it changed my life for the better and woke me up. I only wish it would have happened sooner.

Medicine is not the best area to be in if one's goals are purely economic. However, it is a pretty interesting gig and can maintain one's interest and satisfaction for a career. Think about the reasons you wanted to be a doctor in the first place.

 

[Laryngospasm]

That ladies and gentlemen is the voice of a wise man.