Starting salary?

[monkey7247]

I realize this a broad topic, but was wondering what information people have used to determine their "worth". The info I've been able to find on the internet has been highly variable.

AAO YO lecture stated ~$150-200K starting with fellowship worth ~$30K more

This link http://www.diffenbaughassociates.com/pages/PhysicianComp2007-09.xls seems to be skewed much higher than I expected.

MGMA seems to have a lot of info regarding salary by specialty, subspecialty, and region, but is not free.

How did you all determine your worth? Ideally, I'd like to find a breakdown by subspecialty and region as well.

Prior thread here: http://forums.studentdoctor.net/showthread.php?t=429449

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[speyeder]

I believe the figures from the link represent average salaries once you are established, not starting salaries. If that's the case then I think they're pretty realistic. Remember, in ophthalmology, starting salaries are notoriously low but increase substantially once you are partner.

 

[Visionary]

As speyeder correctly stated, the XLS file you linked to reflects average career salaries, not starting. There was a recent thread that covered starting salaries, among other things (http://forums.studentdoctor.net/showthread.php?t=750678). Though contentious at times, it does have some good information.

You're not going to find a good regional/specialty salary compendium; however, what it really boils down to is that associate starting salaries vary considerably by location and situation and don't necessarily reflect what you can expect to make once partner. There are many factors to consider when evaluating your "worth," but most have little to do with you, personally. Practice characteristics (e.g., size, type), population and demographics, area competition, contract structure, etc. play a much larger role in determining your starting salary and earning potential than anything you bring to the table. Fellowship training can increase base and earnings, but that's mainly for retina and plastics.

Consider the following when evaluating a potential job:
How does the base salary compare to the productivity bonus?
Are there other significant benefits in the salary and compensation package (e.g., family health insurance, moving allowance, signing bonus, CME allowance)?
How long is the associate period?
Is the expected buy-in low or high relative to the estimated practice value?
What is your predicted patient/surgical volume, once established?
Are you taking over for a retiring doc (ready-made practice) or are you a new associate in an established practice (from-scratch practice)?

Also important:
How badly do you want to be in that particular area?
Do you see yourself getting along with the other docs for the long term?
Does your practice style mesh well with the other docs?

Ophthalmology is a great specialty with a good balance of compensation and lifestyle; however, if you end up in a bad situation, it can truly suck. Get as much information as you can, when evaluating potential jobs. Be sure to get advice from those in the field (faculty mentors, etc.) whom you respect. Finally, have a good contract person evaluate before you sign.

 

[monkey7247]

Thank you both for your insight.

 

[JMK2005]

Beyond the base salary, what would be a typical and fair bonus formula?

What else do people typically include in an employment contact? CME, medical license fees, etc.

 

[Visionary]

Beyond the base salary, what would be a typical and fair bonus formula?

What else do people typically include in an employment contact? CME, medical license fees, etc.

The formula specifics vary, but most contracts will include a bonus equal to 20-30% of collections over a stated productivity goal, which is usually 2.5-3x the base salary. That's why I said it's important to have an idea of how productive you should expect to be. If your productivity goal is set too high for your expectations, you may not even qualify for a significant bonus; therefore, it's not more than window dressing. That's not necessarily a problem, because your base, being a percentage of that same high goal, will tend to be good. Just know what to expect going in. You don't want to be looking forward to a bonus and not get one, even though you worked as hard as you could. Alternatively, your base salary/productivity goal may be set too low, if you have a high expected production (e.g., replacing a retiring doc). Then, even with a healthy bonus, you will end up being shorted relative to what you bring in.

Most contracts will include license and credentialing fees, malpractice (b/c they don't want to put themselves at risk, by leaving that up to you), and a CME allowance. Extras are typically signing bonus, moving allowance, individual or family health insurance, and professional organization dues (e.g., AAO, AMA).

 

[ge0MX]

Hi Guys,

I have just been accepted at Duke and UW. I am very interested in Opthalmology.


I wanted to know which med school would be the best choice for me, and how to prepare myself in med school for becoming a competitive applicant for opthalmology?



P.S , if i go to UW it would end up cheaper for me than going to Duke,

any thoughts please?

 

[JMK2005]

Hi Guys,

I have just been accepted at Duke and UW. I am very interested in Opthalmology.


I wanted to know which med school would be the best choice for me, and how to prepare myself in med school for becoming a competitive applicant for opthalmology?



P.S , if i go to UW it would end up cheaper for me than going to Duke,

any thoughts please?

First, learn the correct spelling of ophthalmology.

Both schools are good. Go to UW if the environment fits you.

Start a new thread if you want more advice.

 

[Visionary]

Hi Guys,

I have just been accepted at Duke and UW. I am very interested in Opthalmology.


I wanted to know which med school would be the best choice for me, and how to prepare myself in med school for becoming a competitive applicant for opthalmology?



P.S , if i go to UW it would end up cheaper for me than going to Duke,

any thoughts please?

Agree with JMK2005 that you just cannot misspell ophthalmology.

That said, I'll tell you what I wish someone had told me, when I was in your shoes. Pedigree is (perhaps too) important in medicine. A medical degree from Duke will, fair or not, open a lot more doors than one from UW. Does that mean you can't be a great doctor with great training, if you go to UW? Of course not! However, being at Duke will give you an opportunity to land stronger residency/fellowship programs than UW because of the reputation and connections. As far as ophthalmology, know that Duke Eye is a perennial top 10 eye center. Keep in mind, though, that you may change gears in med school and decide to do something else. Duke will also be the better spot, if that's the case.

Also, don't get too wrapped up in the cost of your medical training. Loan money, even in this day and age, is pretty easy to come by, and you'll accumulate a huge amount of debt, regardless of where you go. In the grand scheme of things, even $200-300k of debt is manageable. Think of it as an investment in a 25-30 year career path.

My two cents.

 

[speyeder]

Agree with JMK2005 that you just cannot misspell ophthalmology.

That said, I'll tell you what I wish someone had told me, when I was in your shoes. Pedigree is (perhaps too) important in medicine. A medical degree from Duke will, fair or not, open a lot more doors than one from UW. Does that mean you can't be a great doctor with great training, if you go to UW? Of course not! However, being at Duke will give you an opportunity to land stronger residency/fellowship programs than UW because of the reputation and connections. As far as ophthalmology, know that Duke Eye is a perennial top 10 eye center. Keep in mind, though, that you may change gears in med school and decide to do something else. Duke will also be the better spot, if that's the case.

Also, don't get too wrapped up in the cost of your medical training. Loan money, even in this day and age, is pretty easy to come by, and you'll accumulate a huge amount of debt, regardless of where you go. In the grand scheme of things, even $200-300k of debt is manageable. Think of it as an investment in a 25-30 year career path.

My two cents.

Agree with Visionary. Go to Duke. For competitive fields like ophthalmology, where you went to medical school matters a lot. This is not to say that you can't match into ophtho if you decide to go to UW. But all things being equal, you will have an easier time matching from Duke. As Visionary already mentioned Duke has a great ophtho department and name recognition counts for a lot in ophthalmology.

 

[touchadream]

Beyond the base salary, what would be a typical and fair bonus formula?

What else do people typically include in an employment contact? CME, medical license fees, etc.

I teach CME on practice and risk management and physician finances, so I have a "collection" of contracts from across the country. As a tax attorney, married to a doc, and from a family of docs, I am interested and get asked to review them a lot. Unfortunately, most of them are pretty poorly done. I don't charge young doctors for this. Although I have yet to see one which contains what it should, I'd be glad to take a look and give you some ideas. you really shouldn't sign until you have a locally licensed lawyer review it, but really if you are going to get along you will and if you won't, you don't want a fight. A good contract just tries to anticipate a number of events that are unknown unknowns, whereas most physician employment agreements start and evolve as a particular practice runs into problems. To determine if the practice is properly managed, I would like to see you have these answers :
Does the practice have a captive insurance company? (Very recent law changes, unlikely they are aware.)
When was the 401K plan last reviewed completely for costs and custom design to benefit the doctors? Does this occur regularly? (They are unlikely to understand the $$ to be saved by the practice by doing this.)
Does the 401K combine with a Defined Benefit Plan? (now permitted under the Pension Protection Act of 2006-about 5% of med practices have this, maybe less)
Is the practice a C corporation? By far the best choice. But if not...
Can you be paid as a PC, PA or PLLC under your own corporate Tax ID? Do any of the doctors or all of the doctors in the practice do this?
Will they pay your disability, long term care pre-tax? (Take it out of your salary before tax/)
Do they have excess disability available--should be able to get about 25K a month or more?
Is there an optional Section 79 Plan in place? (an executive "Roth" for the rich)
Any cross buy/sell agreements used for exiting doctors? Business interruption insurance or arrangements?
Short term disability arrangements formalized?
Are the health insurance policies high deductible so they qualify for Health Savings Accounts?
Tail insurance if they fire you? I have seen doctors owe a practice more than they were paid (practice lost hospital contract, no fault of new doctor)

Hope this is food for thought, and maybe there is something here useful for you.

 

[Eyesore]

This post has a lot of good information. Can you explain how a section 79 works and what are the main benefits of it? Thanks.

I teach CME on practice and risk management and physician finances, so I have a "collection" of contracts from across the country. As a tax attorney, married to a doc, and from a family of docs, I am interested and get asked to review them a lot. Unfortunately, most of them are pretty poorly done. I don't charge young doctors for this. Although I have yet to see one which contains what it should, I'd be glad to take a look and give you some ideas. you really shouldn't sign until you have a locally licensed lawyer review it, but really if you are going to get along you will and if you won't, you don't want a fight. A good contract just tries to anticipate a number of events that are unknown unknowns, whereas most physician employment agreements start and evolve as a particular practice runs into problems. To determine if the practice is properly managed, I would like to see you have these answers :
Does the practice have a captive insurance company? (Very recent law changes, unlikely they are aware.)
When was the 401K plan last reviewed completely for costs and custom design to benefit the doctors? Does this occur regularly? (They are unlikely to understand the $$ to be saved by the practice by doing this.)
Does the 401K combine with a Defined Benefit Plan? (now permitted under the Pension Protection Act of 2006-about 5% of med practices have this, maybe less)
Is the practice a C corporation? By far the best choice. But if not...
Can you be paid as a PC, PA or PLLC under your own corporate Tax ID? Do any of the doctors or all of the doctors in the practice do this?
Will they pay your disability, long term care pre-tax? (Take it out of your salary before tax/)
Do they have excess disability available--should be able to get about 25K a month or more?
Is there an optional Section 79 Plan in place? (an executive "Roth" for the rich)
Any cross buy/sell agreements used for exiting doctors? Business interruption insurance or arrangements?
Short term disability arrangements formalized?
Are the health insurance policies high deductible so they qualify for Health Savings Accounts?
Tail insurance if they fire you? I have seen doctors owe a practice more than they were paid (practice lost hospital contract, no fault of new doctor)

Hope this is food for thought, and maybe there is something here useful for you.

 

[socal2014]

Not too sure about the states, but in Canada, Optho's get compensated very handsomely. It is pretty easy to net in the millions once you develop a dedicated patient base.

 

[Visionary]

Not too sure about the states, but in Canada, Optho's get compensated very handsomely. It is pretty easy to net in the millions once you develop a dedicated patient base.

Yeah, right. Why don't you provide a link for that? I know some Canadian ophthalmologists, and they definitely don't make millions. Yes, ophthalmologists are among the most highly compensated physicians in Canada (because of physician shortages), but they don't make that much. Give me a break.

 

[socal2014]

Yeah, right. Why don't you provide a link for that? I know some Canadian ophthalmologists, and they definitely don't make millions. Yes, ophthalmologists are among the most highly compensated physicians in Canada (because of physician shortages), but they don't make that much. Give me a break.

I admit, I might have overstated the amount. I would say it is easy to gross, not net millions.

As for examples/link, check out : http://www.health.gov.bc.ca/msp/legislation/pdf/bluebook2010.pdf


You would have to look up the opthos name in the PDF which allows you to see what he/she bills. Of course, they might be operating a dispensing practice and/or may be balance billing, which would drastically increase their gross income.

 

[MullerCell]

Retina docs in Canada definitely do make 7 figures. In most parts of Canada thery aren't subject to salary caps. Granted, they see 80-100 patients/day, have crummy OR access and are thus doing pneumatics on nearly every RD, but there is an endless supply of patients, and it is fee for service. General ophthalmology often has caps at ~ 400K I believe.

 

[Visionary]

I admit, I might have overstated the amount. I would say it is easy to gross, not net millions.

As for examples/link, check out : http://www.health.gov.bc.ca/msp/legislation/pdf/bluebook2010.pdf


You would have to look up the opthos name in the PDF which allows you to see what he/she bills. Of course, they might be operating a dispensing practice and/or may be balance billing, which would drastically increase their gross income.

I can't believe I actually took the time to scan that PDF (whew!), but let me shed some light on those numbers of yours. First, the numbers reflect annual payments to individual physicians by the Medical Services Plan of British Columbia, Canada for the fiscal year ending March 31, 2010. In other words, these numbers are annual collections. What is not reflected is the overhead expenses for each of these physicians during that same period. Overhead includes lease payments, payroll, utilities, etc. I don't know about Canada, but in the US, for ophthalmologists, that can run anywhere from 50-70%. So, if you are generous and say 50%, that means you can take away 50% of each of those payments to get an idea of the actual physician income. Of the hundreds of physicians on that list (not categorized by specialty), only about 70 had 7 figure payments. Most of those were $1.3 mil or less. I counted 4 that were close to $2 mil. I doubt that all of those 7 figure docs were ophthalmologists. Even so, the best case scenario has 4 docs who could possibly have actual 7 figure incomes. Therefore, according to this report no doctors, ophthalmologists or otherwise, are making "millions" in Canada (at least British Columbia). Very few appear to even approach 1 mil.

 

[socal2014]

I can't believe I actually took the time to scan that PDF (whew!), but let me shed some light on those numbers of yours. First, the numbers reflect annual payments to individual physicians by the Medical Services Plan of British Columbia, Canada for the fiscal year ending March 31, 2010. In other words, these numbers are annual collections. What is not reflected is the overhead expenses for each of these physicians during that same period. Overhead includes lease payments, payroll, utilities, etc. I don't know about Canada, but in the US, for ophthalmologists, that can run anywhere from 50-70%. So, if you are generous and say 50%, that means you can take away 50% of each of those payments to get an idea of the actual physician income. Of the hundreds of physicians on that list (not categorized by specialty), only about 70 had 7 figure payments. Most of those were $1.3 mil or less. I counted 4 that were close to $2 mil. I doubt that all of those 7 figure docs were ophthalmologists. Even so, the best case scenario has 4 docs who could possibly have actual 7 figure incomes. Therefore, according to this report no doctors, ophthalmologists or otherwise, are making "millions" in Canada (at least British Columbia). Very few appear to even approach 1 mil.

There are several opthos making 500k+ net....overhead is very minimal in canada, as opposed to the US, because our gov. reimburses overhead etc. If you really want to know, try googling optholamologists in bc and reference the names from the search result to the msp blue book.

I would guess most opthos start at 2-300K and in 5-10 years can be in a position to net millions, if not in the high 800's. Canada is the place to be for Opthos though, however I have heard immigration is tough.


EDIT: See post #14, by Mooo of this thread: http://forums.studentdoctor.net/showthread.php?t=757659&highlight=overhead

 

[monkey7247]

As an update to the first post, I recently signed with a group in FL. Ended up right in the middle of the quoted AAO YO figures. Hope this info helps others.

BTW, what's with all the talk aboot Canada?

 

[Visionary]

There are several opthos making 500k+ net....overhead is very minimal in canada, as opposed to the US, because our gov. reimburses overhead etc. If you really want to know, try googling optholamologists in bc and reference the names from the search result to the msp blue book.

I would guess most opthos start at 2-300K and in 5-10 years can be in a position to net millions, if not in the high 800's. Canada is the place to be for Opthos though, however I have heard immigration is tough.


EDIT: See post #14, by Mooo of this thread: http://forums.studentdoctor.net/showthread.php?t=757659&highlight=overhead

Sorry for the delayed response, but I was waiting to hear back from a friend of mine who is an ophthalmologist in Montreal. I'll paraphrase what he relayed to me. Basically, each province has different billing rules and reimbursement standards, not unlike the states in the US. He is not aware of any province that reimburses for overhead expenses, other than for hospital/OR facilities. If your office/clinic is hospital-based, the government hospital funding may cover some part of that. Keep in mind that the government hospital funding must be split amongst all aspects of the hospital facility, though. The distribution to ophthalmology will likely vary from place to place. There is absolutely no overhead reimbursement for anything outside of the hospital, such as a private clinic. He said that from his personal experience and discussions with colleagues, ophthalmologists indeed do well, but not to the degree you claim. Certainly there are outliers, just as there are in the US--I know a few who likely take home 7 figures, but they absolutely work their tails off! It seems that the average ophthalmologist's income here and in Canada, however, is nowhere near 7 figures. Sorry.

Oh, just read the thread you listed. Read the whole thing. It pretty much reinforces what I just said.

 

[umsami]

Before you sign anything, PLEASE take the time to have a lawyer (employment) lawyer look over your contract. It is well worth the $300 or so you'll spend.

As for salary, you can try looking at Indeed.com in your area of the country just to get an idea of what jobs are paying.

 

[OJOJobsGuy]

I'm an Ophthalmology Recruiter, so I thought I'd throw some real world experience and numbers out there. Following applies for young ophthalmologists straight out of training.

Salary year 1: $175 plus or minus 15%

Salary year 2: Usually a 10% increase over year 1 salary

Production Bonus: Generally 25% to 30% after a threshold of 2.5 times salary is met.

Vacation: 3 or 4 weeks

CME: 1 week reimbursed at $2500

Malpractice is usually paid by the employer.

Tail coverage is hit and miss. Sometimes the employee covers this, sometimes the employer covers this and sometimes it's shared. Sorry- Wish I could be more helpful on Tail but that's what I see- kind of a mixed bag.

Partnership: Usually offered after 2 years.

Getting back to salary again for a moment. The figures I'm quoting are for new grads- fresh out of school doctors. And there are certainly exceptions to my figures just as there are exceptions to many rules. Several times a year I will hear of salaries in the mid 300's for a general ophthalmologist. When this happens- when a large figure like this is given it is usually because an older solo practice owner wants to get rid of his practice immediately. I also hear of unusually high figures thrown out there by hospitals. The one thing you'll need to keep in mind with hospital agreements, you will likely have to renegotiate your salary after the first contract term- probably 1 or 2 years in and there is no guarantee you’ll be paid at the same high rate.

If anyone would like to ask me more about this you may email me at [email protected]

Thanks

 

[Chords]

I was a bit anxious initially when hearing the starting salary for a lot of new ophthalmologists, but from reading these posts I assume there is a lot of growth the longer I practice. It's just a bit unfortunate that the potential earning potential for ophthalmologists is shrouded (AAO site often doesn't list salaries) - not quite sure why our field is so hush hush re: money.

 

[JMK2005]

[QUOTE="... not quite sure why our field is so hush hush re: money.[/QUOTE]

Competition is high in big cities/on the coast. There are many predatory practices who offer low starting salaries with the hope of partner, but really have no intention of a true partnership. They don't want to quote a low starting salary on the AAO job postings.

 

[eye love lamp]

I'm an Ophthalmology Recruiter, so I thought I'd throw some real world experience and numbers out there. Following applies for young ophthalmologists straight out of training.

Salary year 1: $175 plus or minus 15%

Salary year 2: Usually a 10% increase over year 1 salary

Production Bonus: Generally 25% to 30% after a threshold of 2.5 times salary is met.

Vacation: 3 or 4 weeks

CME: 1 week reimbursed at $2500

Malpractice is usually paid by the employer.

Tail coverage is hit and miss. Sometimes the employee covers this, sometimes the employer covers this and sometimes it's shared. Sorry- Wish I could be more helpful on Tail but that's what I see- kind of a mixed bag.

Partnership: Usually offered after 2 years.

Getting back to salary again for a moment. The figures I'm quoting are for new grads- fresh out of school doctors. And there are certainly exceptions to my figures just as there are exceptions to many rules. Several times a year I will hear of salaries in the mid 300's for a general ophthalmologist. When this happens- when a large figure like this is given it is usually because an older solo practice owner wants to get rid of his practice immediately. I also hear of unusually high figures thrown out there by hospitals. The one thing you'll need to keep in mind with hospital agreements, you will likely have to renegotiate your salary after the first contract term- probably 1 or 2 years in and there is no guarantee you’ll be paid at the same high rate.

If anyone would like to ask me more about this you may email me at [email protected]

Thanks

What region?