Salary and FP

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I'm rotating in a clinic that has 7 full time physicians, 1 part time, 1 FNP, and 2 PA's. There is an urgent care clinic that they all share "staying late" for (open until 7 and from 8-2 Saturdays).

They have no hospital call, and from what I can tell the "call" they do is over the phone.

If it's possible to approach 200K doing what these guys do, I'd have to say it's one heck of a gig. The hours on most days are about 8-5/6 and no weekends no call.

Is it possible?

I like certain aspects of the specialty, but not sure I could handle other parts.
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JaggerPlate said:
Have these numbers been coming up in the last few years? It seems like I always hear people complaining about FP/IM guys making like 140k?
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There are different surveys out there. The MGMA survey is representative of doctors working in large multispecialty groups, which is why they tend to be on the high side.
 
Ok, so I am new grad FP, No OB. I just signed a contract with a base salary of 185K for a 5 day work week with the fourth friday/month off. I have option to work 4 day week for base of 170K. On top of the base I get 15K to cover my monthly student loan payment. The clinic has 4 other providers, 2 half time, 2 full time. I will be full time (my choice). I get full med/dental/vision/disability/401K for $125 out of pocket/month. The call is by phone only since the ER will do basic admit orders overnight and tuck them in. It is clinic plus inpatient plus nursing home. The clinic remodelled an office for me/bought the furniture I wanted/ and ordered an OMT table custom to my size. Once I do the ATLS course I am able to cover ER too for extra shifts to make $$ to pay down my debt. It is also considered underserved area so it qualifies for NHSC and the state loans repayment program. Can't complain about that.
 
cabinbuilder said:
Ok, so I am new grad FP, No OB. I just signed a contract with a base salary of 185K for a 5 day work week with the fourth friday/month off. I have option to work 4 day week for base of 170K. On top of the base I get 15K to cover my monthly student loan payment. The clinic has 4 other providers, 2 half time, 2 full time. I will be full time (my choice). I get full med/dental/vision/disability/401K for $125 out of pocket/month. The call is by phone only since the ER will do basic admit orders overnight and tuck them in. It is clinic plus inpatient plus nursing home. The clinic remodelled an office for me/bought the furniture I wanted/ and ordered an OMT table custom to my size. Once I do the ATLS course I am able to cover ER too for extra shifts to make $$ to pay down my debt. It is also considered underserved area so it qualifies for NHSC and the state loans repayment program. Can't complain about that.
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Damn ...
 
I was given an offer for $160K base WO OB, M-F 8-6, no pre-tax deduction of medical/dental/vision insurance (employer pays all insurances), paid malpractice with tail. 4 wks paid vacation excluding the 9 paid holidays, 1 week CME with $3000, call 1:24 (phone). $20K sign on bonus for $180K for first year. This is 15 min from a metro area.
 
Anyone doing ob who'd like to post recent offers (incl call schedules)? How about any FPers doing ob and/or those with c/s training? Thanks!
 
Methodnike said:
About 250 000$-300 000$ if you work in Canada. More if you are willing to work more than 40 hours a week.
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Average is closer to 250 from what I understand, minus 30% overhead though. So really about $175 before taxes, about the same as numbers given here by the U.S. docs.
 
On top of that, income taxes, in general, tend to be higher in Canada.
 
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MLT2MT2DO said:
To add onto Jagger's question: Hours a week you've been looking at?
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Mainly SE and regular hours, couple of 4 days a week in smaller areas. Just signed to do ER work in the SE, $120 an hour.
 
Direct access practice. aka boutique, concierge, cash only

400 patients x $1500 annual fee

You do the math for overhead and taxes.
 
Good Solutions said:
Direct access practice. aka boutique, concierge, cash only

400 patients x $1500 annual fee

You do the math for overhead and taxes.
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Sounds good.

The question is, do you have 400 patients, or do you want 400 patients?
 
I know a lot of r3 are out there interviewing for jobs right now. Just to get more of a vibe, if you feel comfortable enough..to describe your job offers (location, responsibilities and the salary). Thank you.
 
I will be starting with a long term care practice in a metro area with the following arrangement:

5 days/week (set my own hours-no clinic, all visits are in nursing homes), no weekends
2 weeks of paid vacation/year
1 week of CME
$500/month for health/dental insurance
401k with company matching
Call is phone back up 1week/month
Direct Call is compensated $150/night, $250 per weekend day or holiday-(I can choose how much "direct call" I take-all call is by phone only)
Signing Bonus: 20k
Base Salary: 180k
Bonuses are issued on a quarterly basis and rewarded based on production starting from first day (for the first year I collect 20% of money I earn over my base salary, 2nd year 30% of collections over base, etc.)
 
bunnymd, do you mind telling which metro area you are in?
 
JaggerPlate said:
$188?? That's not too shabby.
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OMG...188k/year...not too shabby. The average family income in the US is 50k/year. A 188k/year is pretty good salary even with 150k+ student loan.
 
demayette said:
OMG...188k/year...not too shabby. The average family income in the US is 50k/year. A 188k/year is pretty good salary even with 150k+ student loan.
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Yeah, but the average American doesn't have 200k debt and 11+ years in post high school education.

188 is good, but there are opportunity costs involved with going to med school, completing a residency etc.

Also, what I meant was that 188k was 'not to shabby' with regards to some specialties that make quite a bit more as of right now (Gas, Rads, Derm, etc).
 
Based on experience - I'll take the $188K with the debt load of $170K plus the benefits described.....

As a former engineer working 60 hour weeks with 4 years post high school education making around $80K AFTER 17 years in the business, $150K looks pretty effin' good as a starting salary.....I could maintain my comfortable 2K sq. foot home, drive a new car and put the kids through college AND be able to take a vacation now and then......

Let's do a reality check, ok.....
 
Laugh - I never thought my random adjective choice would stir up so much controversy. It's a "nice" salary. Is that better???

:smuggrin:
 
Plus, bunnymd will be making $180k with very little overhead. All visits are nursing home visits.
 
DaveinDallas said:
Based on experience - I'll take the $188K with the debt load of $170K plus the benefits described.....

As a former engineer working 60 hour weeks with 4 years post high school education making around $80K AFTER 17 years in the business, $150K looks pretty effin' good as a starting salary.....I could maintain my comfortable 2K sq. foot home, drive a new car and put the kids through college AND be able to take a vacation now and then......

Let's do a reality check, ok.....
Click to expand...
Ok, let's do a reality check....
1. unfortunate that as an engineer you got stuck. But, you got stuck in theory with far less investment then someone doing 4 additional years of university education (med school) and 3 or more years of residency.
2. you did 4 years post high school and could thus potentially be paying down those loans. You might also be saving and investing increasing net worth depending how you play it.
3. maybe you start actually living a life, having a family, etc...

Now, while you worked 17yrs with positive income, the FP fresh grad had continuous net decrease in wealth for an additional 7 or so years. They finally graduate, have a debt equal in size to some folks home mortgages.... and now they need to actually get a mortgage for a home, maybe replace the clunker they got from mom or used lot, start paying the student loans, maybe have some kids, maybe pay for kids' schools, etc, etc..... They also face the real possibility with every single patient that they might get sued and loose massively. Most engineers I know do not face that fear of malpractice suits to anything like that.

188k is not a nothing figure. But, it takes additional 7+ years of putting your life on hold for education, 7+ years accrual of increasing debt and interest, 7+ years of all the biologic hazards (to then spend a career with such hazards), full career length legal risks, etc....

The class warfare theme is very easy if you simply take dollar figures out of the context of their reality. It is nice to complain about an 80k/yr engineer job over 17 yrs and explain that you prefer the route of the physician.... but, then, why didn't you? Nobody forced us to become physicians nor did anyone force someone into engineering or 17yrs in a particular job.

The grass is always greener on the otherside until you are actually the one responsible for the lawn maintenance. The "reality check" is that a 188k starting income does not arrive to the physician cause they sat on the couch eating bon-bons for seven more years. It was and continues to be hard work. It is that work and effort the we get paid for... those that start at 188k and don't continue hard work see a dramatic drop in income usually within a year or two...

I don't think any physician need apologize for the size of income they can secure. In fact, I encourage every physician to fight for maximum payment for the level of work/services they provide. We are not monks with some poverty vow. We all need to acknowledge the sacrifices we have made by choosing the long path we chose and acknowledge that journey as having a true monetary value. It is/was an investment. We should be damn sure to collect a solid return on that investment and not leave it on the table cause someone else... made different choices.
 
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JackADeli said:
The grass is always greener on the otherside until you are actually the one responsible for the lawn maintenance. The "reality check" is that a 188k starting income does not arrive to the physician cause they sat on the couch eating bon-bons for seven more years. It was and continues to be hard work. It is that work and effort the we get paid for... those that start at 188k and don't continue hard work see a dramatic drop in income usually within a year or two...
Click to expand...

:thumbup::thumbup: Awesome post.
 
SMQ,

You ever stop to think about how skewed perceptions can be.....
I mean, you always hear folks so easily talk about, "I would take a physicians debt for their 180k, 250k, 300k income". Then the room cheers, the crowd goes wild.... It is so clearly "fair".
Go to the next auditorium, some punk says, "I would play tennis for Venus William's millions of dollars...". Then the crowd looks at the fool and says, "you should probably be a super athlete (or at least go to the gymn for a decade) before you look for a super athletes income..."
 
JackADeli said:
SMQ,

You ever stop to think about how skewed perceptions can be.....
I mean, you always hear folks so easily talk about, "I would take a physicians debt for their 180k, 250k, 300k income". Then the room cheers, the crowd goes wild.... It is so clearly "fair".
Go to the next auditorium, some punk says, "I would play tennis for Venus William's millions of dollars...". Then the crowd looks at the fool and says, "you should probably be a super athlete (or at least go to the gymn for a decade) before you look for a super athletes income..."
Click to expand...

I completely agree. I just don't know how to "unskew" those perceptions.

For instance, there have been a series of articles recently blaming physicians for increased healthcare spending. We "order too many tests." And you surgeon types are "too anxious to cut." Even my friends, many of whom are highly educated, cannot understand the concept of CYA medicine. Nor have any of them witnessed patients who will push and push and push for the medical "Hail Mary Pass"....I mean, really. You want us to put your 97 yo grandmother with terminal cancer on CVVHD? And take her to the OR for a debulking? :confused:

How do you explain the headaches of medicine to someone whose main understanding of the medical field is by watching Gray's Anatomy every week?
 
DaveinDallas said:
Based on experience - I'll take the $188K with the debt load of $170K plus the benefits described.....

As a former engineer working 60 hour weeks with 4 years post high school education making around $80K AFTER 17 years in the business, $150K looks pretty effin' good as a starting salary.....I could maintain my comfortable 2K sq. foot home, drive a new car and put the kids through college AND be able to take a vacation now and then......

Let's do a reality check, ok.....
Click to expand...


REALITY CHECK:

4 years of "post high school" education ≠ 4 years undergrad plus 7 years more (at a minimum) at 80-90 hours per week with 36 hour shifts and then still having to work 55-60 hours per week after that. Lost time, amazingly tough, 7-8 years behind on retirement funds, 7-8 more years paying interest on loans. That, and we have to pay many thousands of dollars per year to have the privilege to work (a.k.a. malpractice insurance).
 
smq123 said:
You want us to put your 97 yo grandmother with terminal cancer on CVVHD? And take her to the OR for a debulking?
Click to expand...

Yes. And furthermore, after grandma languishes in the ICU for weeks on the vent, CVVHD, TPN and has a wound dehisence from the debulking incision, and she finally actually dies, we will be sued. And medicare won't pay for her central line infection or VAP either.

One of the problems with the American medical system is that it seems the general American public doesn't accept death as a natural outcome of life. Death is increasingly blamed on someone else.

Since the worldwide mortality from all causes is 100%, that ultimately puts American doctors in a bad situation.
 
JackADeli said:
Ok, let's do a reality check....
1. unfortunate that as an engineer you got stuck. But, you got stuck in theory with far less investment then someone doing 4 additional years of university education (med school) and 3 or more years of residency.
2. you did 4 years post high school and could thus potentially be paying down those loans. You might also be saving and investing increasing net worth depending how you play it.
3. maybe you start actually living a life, having a family, etc...

Now, while you worked 17yrs with positive income, the FP fresh grad had continuous net decrease in wealth for an additional 7 or so years. They finally graduate, have a debt equal in size to some folks home mortgages.... and now they need to actually get a mortgage for a home, maybe replace the clunker they got from mom or used lot, start paying the student loans, maybe have some kids, maybe pay for kids' schools, etc, etc..... They also face the real possibility with every single patient that they might get sued and loose massively. Most engineers I know do not face that fear of malpractice suits to anything like that.

188k is not a nothing figure. But, it takes additional 7+ years of putting your life on hold for education, 7+ years accrual of increasing debt and interest, 7+ years of all the biologic hazards (to then spend a career with such hazards), full career length legal risks, etc....

The class warfare theme is very easy if you simply take dollar figures out of the context of their reality. It is nice to complain about an 80k/yr engineer job over 17 yrs and explain that you prefer the route of the physician.... but, then, why didn't you? Nobody forced us to become physicians nor did anyone force someone into engineering or 17yrs in a particular job.

The grass is always greener on the otherside until you are actually the one responsible for the lawn maintenance. The "reality check" is that a 188k starting income does not arrive to the physician cause they sat on the couch eating bon-bons for seven more years. It was and continues to be hard work. It is that work and effort the we get paid for... those that start at 188k and don't continue hard work see a dramatic drop in income usually within a year or two...

I don't think any physician need apologize for the size of income they can secure. In fact, I encourage every physician to fight for maximum payment for the level of work/services they provide. We are not monks with some poverty vow. We all need to acknowledge the sacrifices we have made by choosing the long path we chose and acknowledge that journey as having a true monetary value. It is/was an investment. We should be damn sure to collect a solid return on that investment and not leave it on the table cause someone else... made different choices.
Click to expand...

Looks like I hit a nerve.....w/o intending to....

I totally agree that a physician has no need to apologize for what they make or can secure....it's called a free market economy where you're paid what the market will bear for your skills and abilities....it's what the United States is all about.....

I'm going through the process right now WITH a mortgage, kids and family and have just matched into an FM residency. I'm staring the debt load in the face since I spent all I had while getting into school.

So, yes, I lost 8 years of earning power and am basically starting with nothing. I'm looking at 30 years of paying off loans and putting kids through college and saving for retirement that'll probably start at 75.

And from where I sit, I'll take the 188K with the debt load and be pretty doggone happy......after stocking groceries overnight at Wal-mart to keep my house while cleaning bathrooms on the weekends and taking prereqs all for a whopping $7.50 an hour....I'll take the 188K with a smile.....
 
DOtoCanada said:
REALITY CHECK:

4 years of "post high school" education ≠ 4 years undergrad plus 7 years more (at a minimum) at 80-90 hours per week with 36 hour shifts and then still having to work 55-60 hours per week after that. Lost time, amazingly tough, 7-8 years behind on retirement funds, 7-8 more years paying interest on loans. That, and we have to pay many thousands of dollars per year to have the privilege to work (a.k.a. malpractice insurance).
Click to expand...

Maybe I wasn't clear -- the 'post high school' education was an undergrad degree, thank you...just to clear that up.....

And yes, in engineering our average was 55-60 hours a week with periods of 80 hour weeks and sleeping under your desk to get the job done by the deadline....medicine has no special hold over 'whatever it takes' hours.....

As far as paying for the privilege to work....point granted.....it sucks that we're in such a litigious society and failing to see that people are human and make mistakes.....

But be that as it may....I enjoy what I do in medicine and am looking forward to starting residency in a few months..
 
DaveinDallas said:
Looks like I hit a nerve.....w/o intending to....

I totally agree that a physician has no need to apologize for what they make or can secure....it's called a free market economy where you're paid what the market will bear for your skills and abilities....it's what the United States is all about.....

I'm going through the process right now WITH a mortgage, kids and family and have just matched into an FM residency. I'm staring the debt load in the face since I spent all I had while getting into school.

So, yes, I lost 8 years of earning power and am basically starting with nothing. I'm looking at 30 years of paying off loans and putting kids through college and saving for retirement that'll probably start at 75.

And from where I sit, I'll take the 188K with the debt load and be pretty doggone happy......after stocking groceries overnight at Wal-mart to keep my house while cleaning bathrooms on the weekends and taking prereqs all for a whopping $7.50 an hour....I'll take the 188K with a smile.....
Click to expand...

don't be happy so soon, with new health care reform, the 188k debt will be accumulating more and more, let's wait and see.
 
benjee said:
don't be happy so soon, with new health care reform, the 188k debt will be accumulating more and more, let's wait and see.
Click to expand...

It wasn't the debt that was $188K...it was the salary....;)
 
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benjee said:
don't be happy so soon, with new health care reform, the 188k debt will be accumulating more and more, let's wait and see.
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DaveinDallas said:
It was the debt that was $188K...it was the salary....;)
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There's nothing in the bill that would directly affect debt one way or another.

There are several things in the bill that increase payments to primary care physicians.
 
Blue Dog said:
There's nothing in the bill that would directly affect debt one way or another.

There are several things in the bill that increase payments to primary care physicians.
Click to expand...

They did pass some student loan fixes in the bill. They lowered the max percentage of income for IBR (I forget the exact percentage), and decreased the time to total forgiveness of remaining debt (from 25 to 20 years). Also gave a slight increase to the funding the the NHSC programs...but not enough to matter.
 
Nobody cares if there are a small percentage of future doctors who think they would be happy making half of what most specialists make and less than a nurse anesthetist even with a much greater debt load. The point is our field is not sustainable at those kinds of disparities as evidenced by the primary care shortage. There are a few people who think placing coke bottles in their rectums is Saturday night entertainment and even more who would tell you that on an internet forum just to get a rise out of you. So spare us we don't care and it's irrelevant anyway.
 
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MedicineDoc said:
There are a few people who think placing coke bottles in their rectums is Saturday night entertainment....
Click to expand...

Read their stories in the "things I learn from my patients" thread in the emergency medicine forum!
 
JackADeli said:
SMQ,

You ever stop to think about how skewed perceptions can be.....
I mean, you always hear folks so easily talk about, "I would take a physicians debt for their 180k, 250k, 300k income". Then the room cheers, the crowd goes wild.... It is so clearly "fair".
Go to the next auditorium, some punk says, "I would play tennis for Venus William's millions of dollars...". Then the crowd looks at the fool and says, "you should probably be a super athlete (or at least go to the gymn for a decade) before you look for a super athletes income..."
Click to expand...

cold hard truth. it takes a special kind of person to go through what it takes to become a physician. just like being a pro athlete, not everyone has what it takes be a doctor. people seem to lose sight of that when they start talking about income.
 
First contract: $165K guarantee x 2 yrs, 75K bonus. Group gave me list of prior years gross income by provider. Only 1 of the 10 made less. More junior partners were seeing around 25 pts/day, but also generally more acute stuff. More senior docs were avg about 18-20/ day, but more chronic/geriatric/complicated pts. I expect, once in "real world" practice, I will quickly determine where desires for compensation and lifestyle equilibrate. There is still a lot of potential for individualization and creativity in FP.
 
johnhobbes said:
First contract: $165K guarantee x 2 yrs, 75K bonus...
Doctor Grim said:
75K bonus? Wow!!
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digitlnoize said:
Agreed! Where is this...roughly?
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Click to expand...
I'm not saying it's a bad deal. But, isn't $165k on the lower end of the scales??? I would defer to someone like BD to comment further.

My thoughts are as such... I guess you have to decide if you want less salary base and more bonus upfront. Also, keep in mind, the bonus is often more in the form of a forgiveable loan... the salary isn't. I think it's all a matter of what the balance is. With a lower base and higher bonus, not sure such a wow factor.
 
JackADeli said:
I'm not saying it's a bad deal. But, isn't $165k on the lower end of the scales??? I would defer to someone like BD to comment further...Also, keep in mind, the bonus is often more in the form of a forgiveable loan.
Click to expand...

The guarantee sounds about right, depending on what part of the country he's in. I'd be curious if the job includes hospital work, and what kind of hours and call schedule is involved.

The bonus is somewhat atypical, and makes me wonder (as you did) if it's actually more of a loan, requiring that he stay with the group for a period of time (probably 2 years) or be forced to pay it back. If so, this suggests that perhaps they've had some difficulty with retention in the past, or are located in a somewhat less-than-desirable location.

This isn't necessarily a bad thing, of course, assuming he likes the job and the location enough to stay there at least two years.
 
reedman said:
cold hard truth. it takes a special kind of person to go through what it takes to become a physician. just like being a pro athlete, not everyone has what it takes be a doctor. people seem to lose sight of that when they start talking about income.
Click to expand...

Our Western population tends to value athletic prowess, which adds very little if anything to society, over intelligence. I have no idea why.

This is one reason why the general individual takes issue with a doctor making a lot of money, yet is ok with A-Rod raking in millions to catch a ball.
 
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