Starting Salary for Pulmonary/Critical Care

[auburnprin]

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Hey guys,

Anyone have any advice on a fair starting salary for 50/50 Pulmonary/Critical Care (where you do ICU (7 days), inpatient pulmonary, and outpatient pulmonary)? I have seen offers ranging anywhere from 300K to 550K, and have generally been advised to not accept anything less than 400K. I've seen the MGMA data from 3 years ago, mainly for total compensation, not for starting salary, and I do realize it will differ based on geography.

Any insights?

Thanks in advance!

 

[DrMetal]

Hey guys,

Anyone have any advice on a fair starting salary for 50/50 Pulmonary/Critical Care (where you do ICU (7 days),

It should be $1.5 million dollars!

 

[auburnprin]

Damn! I am definitely getting played then.

 

[HemeOncHopeful19]

Hey guys,

Anyone have any advice on a fair starting salary for 50/50 Pulmonary/Critical Care (where you do ICU (7 days), inpatient pulmonary, and outpatient pulmonary)? I have seen offers ranging anywhere from 300K to 550K, and have generally been advised to not accept anything less than 400K. I've seen the MGMA data from 3 years ago, mainly for total compensation, not for starting salary, and I do realize it will differ based on geography.

Any insights?

Thanks in advance!

I don’t know anything about Pulm/Crit but make sure you actually google what MGMA means by “total comp.”

A lot of people claim it includes all sorts of crazy things like malpractice, retirement matching etc. to justify lowering your expectations but they clearly state on their website it is purely the total of your base salary and any clinical bonuses.

 

[tartesos]

400+ should be the bare minimum you take. I know a place paying 430k plus bonus for that, 13+ weeks off a year.

I wouldn’t do it for less than 450, depending on the city. Everything is negotiable, interview well, be yourself( unless you are awkward and can’t hold a conversation and look people in the eyes ) then negotiate salary.

 

[tartesos]

Hey guys,

Anyone have any advice on a fair starting salary for 50/50 Pulmonary/Critical Care (where you do ICU (7 days), inpatient pulmonary, and outpatient pulmonary)? I have seen offers ranging anywhere from 300K to 550K, and have generally been advised to not accept anything less than 400K. I've seen the MGMA data from 3 years ago, mainly for total compensation, not for starting salary, and I do realize it will differ based on geography.

Any insights?

Thanks in advance!

Don’t talk about total compensation, discuss salary and bonuses.

If they bring in total conversation the numbers will make your eyes sparkle but they will be ripping you off.

 

[chessknt]

You won't get a clear answer because the schedules are so variable. If you work straight on/off one week ICU break it down to per shift pay to get a better idea. If they mix other stuff in to it and rvu bonuses etc it gets much harder to understand and compare.

What is your exact offer? Like region/proximity to major metro and contract details?

For reference my ICU shifts pay 2900 for ~12 hours in house with a few hundred more as a bonus for productivity per shift. My outpt work is paid differently because I intentionally separated it from my ICU work to avoid creating a mushy comp agreement.

 

[auburnprin]

400+ should be the bare minimum you take. I know a place paying 430k plus bonus for that, 13+ weeks off a year.

I wouldn’t do it for less than 450, depending on the city. Everything is negotiable, interview well, be yourself( unless you are awkward and can’t hold a conversation and look people in the eyes ) then negotiate salary.

So here is a scenario. Fairly busy practice with ICU, inpatient pulm, and outpatient pulm. About an hour from a bigger city.

Starting salary of $450K. Then once you transition from the two year guarantee, they drop you to $375K with wRVU productivity bonus and a threshold of ~6400. Afterwards, you bonus $58/wRVU above that. The docs out there are averaging 450-480K with that model.

 

[chessknt]

So here is a scenario. Fairly busy practice with ICU, inpatient pulm, and outpatient pulm. About an hour from a bigger city.

Starting salary of $450K. Then once you transition from the two year guarantee, they drop you to $375K with wRVU productivity bonus and a threshold of ~6400. Afterwards, you bonus $58/wRVU above that. The docs out there are averaging 450-480K with that model.

This is a PP job I assume if they have productivity in the icu--do they own the clinic wit a partnership track? How is ICU split up to be fair since that is where the money will be?

 

[auburnprin]

This is a PP job I assume if they have productivity in the icu--do they own the clinic wit a partnership track? How is ICU split up to be fair since that is where the money will be?

No partnership. Hospital-employed. ICU split fairly among the docs, 7 days a month. No Nights.

 

[chessknt]

No partnership. Hospital-employed. ICU split fairly among the docs, 7 days a month. No Nights.

It isn't bad but not great either... are you forced to stay in house if the unit is half empty? What about inpatient pulm--round and go? The unit rate is ok but putting you on full productivity while keeping the full PE component of the rvu is kinda bull**** imo.

 

[auburnprin]

It isn't bad but not great either... are you forced to stay in house if the unit is half empty? What about inpatient pulm--round and go? The unit rate is ok but putting you on full productivity while keeping the full PE component of the rvu is kinda bull**** imo.

The docs told me it is relatively flexible, it didn't seem like I would be forced to stay if it was not busy. There's PA support. However, they are seeing 14-18 patients in the ICU, while inpatient pulm is ~20 patients, and outpatient is ~ 16-18.

What do you mean by PE?

 

[chessknt]

The docs told me it is relatively flexible, it didn't seem like I would be forced to stay if it was not busy. There's PA support. However, they are seeing 14-18 patients in the ICU, while inpatient pulm is ~20 patients, and outpatient is ~ 16-18.

What do you mean by PE?

At those numbers comp should be higher--14*4.5*58 is 3700/shift in the ICU assuming you do 0 procedures. Clinic will be 2/3 that assuming you read some pfts in the patient and input pulm somewhere between the two. 450000/3000 avg means you're only working 12 days a month or so?

PE is practice expense--ie the cost of running a practice. It is usually about 1/2-2/3 of the wrvu component designed to cover cost of staff and billing etc. If the service is always heavy that's fine but the numbers you are quoting don't add up to that comp

 

[auburnprin]

At those numbers comp should be higher--14*4.5*58 is 3700/shift in the ICU assuming you do 0 procedures. Clinic will be 2/3 that assuming you read some pfts in the patient and input pulm somewhere between the two. 450000/3000 avg means you're only working 12 days a month or so?

PE is practice expense--ie the cost of running a practice. It is usually about 1/2-2/3 of the wrvu component designed to cover cost of staff and billing etc. If the service is always heavy that's fine but the numbers you are quoting don't add up to that comp

Ah, gotcha. I just didn't know what the abbreviation stood for. Thank you.

The schedule would be 7 days in the ICU, 5 days inpatient pulmonary (rotating weekends), and 10 days in the clinic. Repeat. So definitely not working only 12 days/month. LOL.

Based on your calculations, I agree that something is off in terms of the comp. I was also expecting more. Could they just be focusing on Pulm? When I've spoken with other practices, some of them would split ICU and pulm comp agreements. I will ask them to clarify.

Also have any of you used a contract lawyer before signing with a practice to go over everything? I've had mixed reviews. Some people have recommended consulting with one, others have said no.

 

[CCM-MD]

How much time off are you getting? You're gonna be doing 12-13 weeks ICU annually which is essentially 0.5 FTE if you were working as a pure Intensivist. The last MGMA median for pure CC/Intensivist was 450k (maybe higher now). So for the ICU work alone, you should be getting 225k at the median. AND this would come with 13 weeks off. This is also assuming the median rate, and the argument can be made that you should be getting more than the median if this is a location thats >1hour from the nearest big city.

Assuming the total you are paid in cash is 450k, you're essentially getting another 225k for all the pulmonary work you are doing, which seems low to begin with. How much time off are you getting? Every ICU week on should be connected with a week off, and you should be getting some vacation time on top of that from the pulmonary portion. Seems like they are getting away with underpaying by creating a combined position and muddying the water. As suggested already, negotiating separate ICU and pulmonary contracts is a better way to go.

 

[auburnprin]

How much time off are you getting? You're gonna be doing 12-13 weeks ICU annually which is essentially 0.5 FTE if you were working as a pure Intensivist. The last MGMA median for pure CC/Intensivist was 450k (maybe higher now). So for the ICU work alone, you should be getting 225k at the median. AND this would come with 13 weeks off. This is also assuming the median rate, and the argument can be made that you should be getting more than the median if this is a location thats >1hour from the nearest big city.

Assuming the total you are paid in cash is 450k, you're essentially getting another 225k for all the pulmonary work you are doing, which seems low to begin with. How much time off are you getting? Every ICU week on should be connected with a week off, and you should be getting some vacation time on top of that from the pulmonary portion. Seems like they are getting away with underpaying by creating a combined position and muddying the water. As suggested already, negotiating separate ICU and pulmonary contracts is a better way to go.

I've noticed for a lot of the hybrid positions I have talked with they do not offer 7 days on, 7 days off. Most admin I have spoken with about this type of schedule for a Pulm/CC doc state that they do not understand or can't do this type of schedule. They do 7 days ICU, then they may give you 1-2 days off, then you're back to doing inpatient pulm and outpatient pulm.

I have asked for 7 days on/7days off, 1 week IP, 1 week OP, and have only come across a few that are either underpaid or in an undesirable location.

The best one was where they wanted me to do Nights for 1 week and then once I got off of Nights essentially pull a 36 hour shift right into seeing clinic patients.

For this particular position, PTO is 30 days and then you get 1 day off before and 1 day off after ICU week.

 

[auburnprin]

Geographical location also hasn't mattered when I've done my search. Same story.

 

[chessknt]

How much time off are you getting? You're gonna be doing 12-13 weeks ICU annually which is essentially 0.5 FTE if you were working as a pure Intensivist. The last MGMA median for pure CC/Intensivist was 450k (maybe higher now). So for the ICU work alone, you should be getting 225k at the median. AND this would come with 13 weeks off. This is also assuming the median rate, and the argument can be made that you should be getting more than the median if this is a location thats >1hour from the nearest big city.

Assuming the total you are paid in cash is 450k, you're essentially getting another 225k for all the pulmonary work you are doing, which seems low to begin with. How much time off are you getting? Every ICU week on should be connected with a week off, and you should be getting some vacation time on top of that from the pulmonary portion. Seems like they are getting away with underpaying by creating a combined position and muddying the water. As suggested already, negotiating separate ICU and pulmonary contracts is a better way to go.

You can't get vacation on a productivity model and I've never seen anything that offered vacation to a hospitalist/intensivist.

 

[chessknt]

I've noticed for a lot of the hybrid positions I have talked with they do not offer 7 days on, 7 days off. Most admin I have spoken with about this type of schedule for a Pulm/CC doc state that they do not understand or can't do this type of schedule. They do 7 days ICU, then they may give you 1-2 days off, then you're back to doing inpatient pulm and outpatient pulm.

I have asked for 7 days on/7days off, 1 week IP, 1 week OP, and have only come across a few that are either underpaid or in an undesirable location.

The best one was where they wanted me to do Nights for 1 week and then once I got off of Nights essentially pull a 36 hour shift right into seeing clinic patients.

For this particular position, PTO is 30 days and then you get 1 day off before and 1 day off after ICU week.

They exist but are harder to find. If you are going to be employed they want you working as much as possible, in PP you pay yourself to work instead of the hospital. The admins are idiots and don't know or care what your schedule looks like just what profit it brings them.

If they won't negotiate on it and you aren't restricted just move on. Even better find a PP gig that way if you want to work your butt off. Hospital based productivity for medical specialties always seems to come in terrible compared to the surgical specialties. They don't have a way to capture value in preventing hospitalization because there isn't a fixed facility fee so they give you a rubbish unit value 1/2-1/4 the other more 'productive' specialties.

 

[CCM-MD]

You can't get vacation on a productivity model and I've never seen anything that offered vacation to a hospitalist/intensivist.

Huh? I don't understand what you are trying to say. I never said anything about "vacation" being offered to Intensivists. No one on productivity gets vacation is obviously not true. Even the poster here said he is being offered 30 days PTO.

 

[chessknt]

Huh? I don't understand what you are trying to say. I never said anything about "vacation" being offered to Intensivists. No one on productivity gets vacation is obviously not true. Even the poster here said he is being offered 30 days PTO.

If you're on a productivity model that is 30 days of no productivity, how is it paid? Even reducing the rvu target by a % is tricky because isn't done based on % of working days or just callebdar days? And pure productivity isn't going to pay you **** on your 'pto'--how would they come up with a unit number?

I've seen the exact contract setup OP is referencing--it mentions PTO but doesn't mention how that is paid on productivity. When you ask them (because on the guarantee they tell you it doesn't matter of course ignoring the target rvu number) what happens on productivity there is a lot of dancing around just to reveal you just don't get paid and that actually a lot of their doctors only take 1-2 weeks off so they can make more etc etc so this all bull****. They say it's just the opportunity to take that time off like they do you a solid to let you have time off work in exchange for not getting paid (i.e. the weekend everywhere else).

 

[auburnprin]

If you're on a productivity model that is 30 days of no productivity, how is it paid? Even reducing the rvu target by a % is tricky because isn't done based on % of working days or just callebdar days? And pure productivity isn't going to pay you **** on your 'pto'--how would they come up with a unit number?

I've seen the exact contract setup OP is referencing--it mentions PTO but doesn't mention how that is paid on productivity. When you ask them (because on the guarantee they tell you it doesn't matter of course ignoring the target rvu number) what happens on productivity there is a lot of dancing around just to reveal you just don't get paid and that actually a lot of their doctors only take 1-2 weeks off so they can make more etc etc so this all bull****. They say it's just the opportunity to take that time off like they do you a solid to let you have time off work in exchange for not getting paid (i.e. the weekend everywhere else).

I actually had a similar conservation with a hospital-employed practice in the Northeast, where the initial offer sounded great and they told me I would have 6 weeks PTO. I was impressed, but then when we delved further into the conversation, I found out that their docs are only really taking 2-3 weeks of vacation in order to maintain their base salaries and desired productivity.