Starting salaries

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Agast

Agast

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Just remembered this poll I made in the private forum where respondents are verified pain physicians. Starting salaries not including bonuses and benefits, 45 respondents. It does not include which year a person started or what region/practice type a person is in.
 

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Agast said:
Just remembered this poll I made in the private forum where respondents are verified pain physicians. Starting salaries not including bonuses and benefits, 45 respondents. It does not include which year a person started or what region/practice type a person is in.
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Such a wide range. Why is that so?
 
also based on the "model" being used.

some places will start with low base salary and low bar to increase pay from productivity (wRVU). others will start with higher base salary but have less opportunity for compensation based on productivity.
 
I've seen (and been offered) a range of salaries. Those on the high end were invariably compensating for something - incredibly high cost of living, overall terrible structure and unattractive practice type, awful location, being a pill mill/sweatshop, or as a distraction from the terrible payor mix that kicks in during your second year when your income drops precipitously (some of these even came with clawbacks, which was just swell). Those on the low end were usually a combination of desirable location, lack of self-awareness, and clever attempts at capitalizing on the COVID excuse to low-ball unsuspecting new grads. Anecdotally from my fellow-friend network across the country, the majority were offered/accepted something in the neighbourhood of 300-325 starting unless they went pretty rural or took on extra responsibilities through their primary specialty.
 
Sooshi said:
I've seen (and been offered) a range of salaries. Those on the high end were invariably compensating for something - incredibly high cost of living, overall terrible structure and unattractive practice type, awful location, being a pill mill/sweatshop, or as a distraction from the terrible payor mix that kicks in during your second year when your income drops precipitously (some of these even came with clawbacks, which was just swell). Those on the low end were usually a combination of desirable location, lack of self-awareness, and clever attempts at capitalizing on the COVID excuse to low-ball unsuspecting new grads. Anecdotally from my fellow-friend network across the country, the majority were offered/accepted something in the neighbourhood of 300-325 starting unless they went pretty rural or took on extra responsibilities through their primary specialty.
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300-325 is pretty bad. like really bad.
 
Getting out of fellowship, 300k was the magic number. Some cheapskates were offering 285/265. Now I assume some people took those, so I am seeing more along the lines of 250k now. 300k is still the bare minimum overall.
 
Yeah.. when I was interviewing down south for jobs around November/December most were starting 300-325k. There were definitely lower ones around 250k-275k.
 
chudat said:
^ lol wut? Those numbers are for total compensation including malprac, insurance, other benefits.

Starting salary in 300-350 is the norm in many places not Oklahoma.
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MGMA specifically points out that the number is not total compensation, only salary and certain benefits.
Agast said:
He’s still a resident. He has time to learn.
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This is definitely true. When I look at salary, I’m factoring in base + some production.
 
People coming out of fellowship should be prepared for low offers in the 250k range. If they consider that to be a slap in the face, it sets them up to go down a dark path (pill/procedure mills, chiro/PI operations, etc).

Coming out of fellowship, people should be thinking about how they can use and hone their skills in an environment they are comfortable with. They're not going to get super rich in medicine but they'll have a comfortable lifestyle.
 
I assume you guys are talking about private practice salaries being this low. All of the hospital employed jobs I saw were closer to $400k base starting- plus sign on bonus, production bonus, cme- I don't think it's unreasonable for a new grad to hit $500k+ in their first year in a busy hospital employed set up. And I'm not talking about rural areas either.
 
GandalfTheWhite said:
300-325 is pretty bad. like really bad.
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Welcome to being a Pain Medicine grad in 2021. This is the guaranteed base, +/- production, but it was definitely a slap in the face compared to the gas job offers I got. Difference is I wouldn't have to do traumas at 2am on a Sunday, I guess.
 
Sooshi said:
Welcome to being a Pain Medicine grad in 2021. This is the guaranteed base, +/- production, but it was definitely a slap in the face compared to the gas job offers I got. Difference is I wouldn't have to do traumas at 2am on a Sunday, I guess.
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That difference is definitely worth 50k less in my opinion
 
GandalfTheWhite said:
MGMA specifically points out that the number is not total compensation, only salary and certain benefits.

This is definitely true. When I look at salary, I’m factoring in base + some production.
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MGMA equals total cash compensation. Don’t let them fool you otherwise. Also MGMA means nothing to private practices as far as hiring IMO
 
manowar rules said:
Starting salary does not mean much in terms of the big picture. I made $275K in the South my first year out of fellowship. Now almost 4 years out, with the same group, I am a partner and make much more, well above MGMA average. Autonomy is king.
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Yeah agreed. Most places will just give you a starting salary as you won't have many patients in the beginning and need time to build your practice. Pain medicine compensation is much different than anesthesia. Some will give you bonuses once you reach the target WRVU and then a percentage of what you do after that. There were so many different things being thrown at me and it differed between each job. Some gave you a chance to buy in to their ASC etc.
 
Really try to picture what you want in a practice. Then I recommend interviewing/shadowing with several different groups. This will help you identify what type of practice appeals to you. Try to find a group with a mindset similar to yours. Personalities of potential partners (if partnership is possible) is very important.

And if things seem sketchy in the brief time you are interviewing, they probably are. I was offered a gig that seemed decent on the surface, but gave me weird vibes. My point-of-contact was a non-physician admin and a marketing person who promised me all sorts of things. But it was very hard to get in touch with the group’s physicians, and what I did see seemed, even to my naive eyes, completely based upon MDs supervising mid levels to write opiates. This group, Comprehensive Pain Specialists based out of Tennessee, ended up suddenly closing all of their clinics a year later and getting investigated for fraud.

Fortunately, I avoided that and signed with a group I felt more comfortable with, albeit at a lower salary. You can’t foresee everything though, and in some respects I have gotten lucky. But I think that if you find a group that practices good medicine, values what you will bring to the practice, and just gives you a good gut feeling, you will find yourself better off than if you chase the highest possible initial income.
 
Ronin1 said:
MGMA equals total cash compensation. Don’t let them fool you otherwise. Also MGMA means nothing to private practices as far as hiring IMO
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right, but most MGMA is PP since they have a filter for academic practices. Or am i mistaken on that?
 
MGMA is all self-reported information. I have never been approached to submit information or have seen it advertised asking doctors to do so. You have to wonder how that effects sampling error.
 
If mgma is self reported., those of us with higher incomes should report.. this will theoretically help raise everyone’s potential income as well as help with starting salaries. A rising tide raises all ships. The converse is it may make us more a target for reductions but when you look at the data their are plenty of specialties higher so I doubt it.
 
Laryngospasm said:
If mgma is self reported., those of us with higher incomes should report.. this will theoretically help raise everyone’s potential income as well as help with starting salaries.
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For hospital jobs, maybe. It will be harder for private practice to compete. Starting salary is based on how much I can afford to pay while someone starts net negative and incurs large up front costs before they can turn a profit. Hospitals have deeper pockets.

I tried hiring a new MA, the hospital pays her $21.50 plus benefits. My lead MA makes $18/hr. I can’t compete with the hospital.
 
Agast said:
For hospital jobs, maybe. It will be harder for private practice to compete. Starting salary is based on how much I can afford to pay while someone starts net negative and incurs large up front costs before they can turn a profit. Hospitals have deeper pockets.

I tried hiring a new MA, the hospital pays her $21.50 plus benefits. My lead MA makes $18/hr. I can’t compete with the hospital.
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as in, harder for private practice to lowball their new hires? Otherwise I dont see how it would be a negative for anyone.
To your other point about MGMA not asking you and it affecting sampling error, the higher earning docs also dont advertise their income on these surveys, so that also affects the sampling error you are referring to.
 
GandalfTheWhite said:
as in, harder for private practice to lowball their new hires? Otherwise I dont see how it would be a negative for anyone.
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There’s nothing wrong with taking a hospital job that offers a big salary and signing bonuses up front. The relative freedom of private practice comes with the responsibility of running a small business on tighter margins. If and when you match into fellowship, do some research on how the sausage gets made and reimbursed, plus what goes into calculating your overhead. None of my colleagues who have hired in the past few years are moustache-twirling villains looking to make a quick buck. We’re looking at what we can risk on an unknown. It doesn’t even matter which fellowship you graduated from, the majority is personality-driven.

I give a dinner lecture each year to the local pain fellows on private practice because it’s such a different animal.
 
Agast said:
There’s nothing wrong with taking a hospital job that offers a big salary and signing bonuses up front. The relative freedom of private practice comes with the responsibility of running a small business on tighter margins. If and when you match into fellowship, do some research on how the sausage gets made and reimbursed, plus what goes into calculating your overhead. None of my colleagues who have hired in the past few years are moustache-twirling villains looking to make a quick buck. We’re looking at what we can risk on an unknown. It doesn’t even matter which fellowship you graduated from, the majority is personality-driven.

I give a dinner lecture each year to the local pain fellows on private practice because it’s such a different animal.
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I wasnt accusing you or your partners of being villains lol. But the premise is that you eventually should be making significantly more in PP than a hospital W-2. At what point does the salary ramp up then if one is expected to take a pay cut starting out?
 
manowar rules said:
Starting salary does not mean much in terms of the big picture. I made $275K in the South my first year out of fellowship. Now almost 4 years out, with the same group, I am a partner and make much more, well above MGMA average. Autonomy is king.
Click to expand...
I agreed. My starting salary was 300k in SoCal with several other offers of 225k-280k. Now 3 years out and still with same group and became partner after 2 years and now make much more. I chose this group because I had a good feeling that I will stay long with them after 2 interviews with them. I was taught by faculties not be too obsessed with high starting salary especially if you know this is the group that you want to become partner with. Your first year out of fellowship is usually a disaster. You want to make sure that you beat your starting salary in your first year to show your partners that you are worthy to be one of them. If your starting is 350k and you only bring in 300k first year (minus overhead), that makes you look terrible especially your first 3-4 months is gonna be slow and likely lose money. Just my 2 cents 🙂
 
bigyihoroi said:
I agreed. My starting salary was 300k in SoCal with several other offers of 225k-280k. Now 3 years out and still with same group and became partner after 2 years and now make much more. I chose this group because I had a good feeling that I will stay long with them after 2 interviews with them. I was taught by faculties not be too obsessed with high starting salary especially if you know this is the group that you want to become partner with. Your first year out of fellowship is usually a disaster. You want to make sure that you beat your starting salary in your first year to show your partners that you are worthy to be one of them. If your starting is 350k and you only bring in 300k first year (minus overhead), that makes you look terrible especially your first 3-4 months is gonna be slow and likely lose money. Just my 2 cents 🙂
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Do you mind sharing exactly how much you make now? What are your hours/schedule like?
 
Agast said:
There’s nothing wrong with taking a hospital job that offers a big salary and signing bonuses up front. The relative freedom of private practice comes with the responsibility of running a small business on tighter margins. If and when you match into fellowship, do some research on how the sausage gets made and reimbursed, plus what goes into calculating your overhead. None of my colleagues who have hired in the past few years are moustache-twirling villains looking to make a quick buck. We’re looking at what we can risk on an unknown. It doesn’t even matter which fellowship you graduated from, the majority is personality-driven.

I give a dinner lecture each year to the local pain fellows on private practice because it’s such a different animal.
Click to expand...

 
Agast said:
We’re looking at what we can risk on an unknown. It doesn’t even matter which fellowship you graduated from, the majority is personality-driven.
Click to expand...
It's amazing that when you're looking for a job, it seems like there's a lot of competition but when you are hiring, there are precious few good candidates that don't have some ridiculous, critical flaw...
 
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