Stipend for medical director?

[SLUsagar]

I'm guessing there's probably a wide range of $, but I'm interested in estimates of salaries for a medical director of either a smallish hospital and/or reference lab.

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[coroner]

By salary, I assume you are referring to the Part A contract for medical directorship excluding TC/PC/PFS. There is a range and it certainly depends on one's negotiating skills and how deep the pockets are of the hospital. No idea at reference labs, but we cover multiple hospitals all of which are smallish to medium-sized with <10K surgicals/yr and the monthly stipend is anywhere between $2-9K. This is still chump change to the "golden era"...The previous guy who was at one of the middle-sized hospitals before we took over was getting $20K/month back in the days of global fees prior to the DRG changes. Yes, you heard correctly: $224,000/yr just for having the title of medical director as a solo practioner. And that's without CPT billing.... But then he died, and our group won the contract, partly because we negotiated a lower part A. So, the hospital welcomed us with open arms because of the savings, but we're nowhere near clearing what he once used to, but that trend seems to have occurred all over nowadays...

 

[LADoc00]

Atnag, you are doing it wrong bro.

You should be a getting a net %, rough estimate, of the net revenue of the lab. Some extrapolation is of course needed because no CFO will reveal his net revenue to you on a community hospital lab.

2-9K per month is WOEFULLY inadequate.

I am 'full up', meaning I have the maximal amount of directorships a single pathologist is allowed by law to hold. There is no clinical lab operation anywhere I charge less than 10K per month to be the director of. My range is 10-25 and frankly Im worth every f'ing penny of that.

And yes in addition, I bill PC for CP if able.

If you are in a group who is dumpster diving for new contracts to feed all mouths you have, you are already locked in a downward spiral that will not cease until your group is destroyed. Beware.

 

[gbwillner]

From my experience, the range is ~$250k-$400k with a bonus structure that is 15-30%. Equity is usually available as well in industry.

 

[2121115]

From my experience, the range is ~$250k-$400k with a bonus structure that is 15-30%. Equity is usually available as well in industry.

You are talking about just medical director fees?

 

[gbwillner]

No, total compensation in industry setting. Mostly tc billing or no direct billing for a reference lab or biotech.

 

[2121115]

No, total compensation in industry setting. Mostly tc billing or no direct billing for a reference lab or biotech.

What do you see as the future of these types of companies with the ACA and accountable care organizations coming on the horizon? There is going to be so much consolidation coming in the next few years, that it would be pretty risky for a pathologist to join a situation like that, which depends on referrals. Consolidation is going to drive reference testing into local university hospitals and Quest/Lab Corps. I don't expect to see Clarient, Neogenomics, Molecular Pathology Network, etc around on the 5 year horizon.

 

[gbwillner]

What do you see as the future of these types of companies with the ACA and accountable care organizations coming on the horizon? There is going to be so much consolidation coming in the next few years, that it would be pretty risky for a pathologist to join a situation like that, which depends on referrals. Consolidation is going to drive reference testing into local university hospitals and Quest/Lab Corps. I don't expect to see Clarient, Neogenomics, Molecular Pathology Network, etc around on the 5 year horizon.

All valid points but I think the reality is heavily dependent on the specifics of the companies we are discussing. Companies with good financial worksheets and good people marketing the business will be OK. My field is molecular so I know something about it- I think it would be different in other AP subspecialties. Right now is the time for growth in this field, with really only 1 national reference lab, which honestly doesn't have such a great product. New companies are popping up left and right now, but only a few will make it- those that have the most leverage/money/experience in management and running these kinds of start-ups. There IS inherent risk, but isn't there always risk to everything? The risk is mitigated by higher salaries and especially owning equity. If consolidation occurs, and your company gets bought out, you are still rewarded with a share of the sale. And these aren't mom and pop local practices getting bought out for $3-5M- these companies will sell for hundreds of millions or billions of $. Why would these companies sell for less when they have dozens-hundreds of millions of dollars in reserves from investors? This is even before they generate any revenue as well.

The risk now is especially compounded because reimbursements haven't been solidified yet. But that's the nice thing about a reference lab vs. an academic center running these tests- the reference lab will never really eat the cost. Those with the best product and best marketing will win out. There will always be room for more competition, but as time goes on this space will get smaller and smaller.

Re: ACA- not sure how this factors into it. More like CMS deciding the relative value of these tests. If they decide to reimburse $100 for a genomic assay no one will do it ever unless the referring physicians or patients pay themselves for the service and it will be a tiny market. If reimbursements are more reasonable (relative to cost), which is where it will go (my bet), there is still a lot of room for growth here.

 

[coroner]

You should be a getting a net %, rough estimate, of the net revenue of the lab. Some extrapolation is of course needed because no CFO will reveal his net revenue to you on a community hospital lab.

He doesn't have to because those numbers have been obtained by me from the lab manager who prepares the excel spreadsheets for the CFO in the first place with monthly/annual revenue each laboratory dept is generating. You are right that a net % would be ideal, but this was already done by my colleagues before I joined.

2-9K per month is WOEFULLY inadequate.

I agree, that's why I was shocked when I learned that our predecessor was getting 20K/month. And my partners "negotiated" it down to 5K with the hospital in order to win the contract when it was up for bidding. But, this lowballing is being done more and more in a dog-eat-dog world of independent private practices and administrators are more than happy to oblige any willing docs who will peddle their services for the lowest fee...

And yes in addition, I bill PC for CP if able.

Ok, props for the extra cash flow, but doesn't semen analyses, UPEPs/SPEPs, etc. become too much of a hassle after awhile...?

If you are in a group who is dumpster diving for new contracts to feed all mouths you have, you are already locked in a downward spiral that will not cease until your group is destroyed. Beware.

That's why I rent, drive my twenty year old car I've had since undergrad to work everyday, and will now live on half my income . And of course keep looking out for better potential opportunities as one always should. But that job market, she's a ringer...

 

[LADoc00]

...hmmm I dont do semen analyses or SPEPs....

I bill for every single lab test that isnt Medicare, charging a % of the total reimbursement.

Meaning I get X dollars for the Medicare beneficiaries AND I bill a small % charge on all the routine CBCs, Chem-7s etc.

Dude if this has NOT been done in your group, flee. Flee now.

bidding a contract down to 5K per month for Medical Directorship just to get the AP work and being liable/on call for that 24-7/365 is an INSANE financial strategy. There must be more you arent telling us like they are putting 5000+ GI biopsies there or something, otherwise whoever is running your group is a *****.

 

[Substance]

...hmmm I dont do semen analyses or SPEPs....

I bill for every single lab test that isnt Medicare, charging a % of the total reimbursement.

Meaning I get X dollars for the Medicare beneficiaries AND I bill a small % charge on all the routine CBCs, Chem-7s etc.

Dude if this has NOT been done in your group, flee. Flee now.

bidding a contract down to 5K per month for Medical Directorship just to get the AP work and being liable/on call for that 24-7/365 is an INSANE financial strategy. There must be more you arent telling us like they are putting 5000+ GI biopsies there or something, otherwise whoever is running your group is a *****.

Lotsa *****s in certain medical specialties...

 

[BlondeDocteur]

...
I bill for every single lab test that isnt Medicare, charging a % of the total reimbursement.

Meaning I get X dollars for the Medicare beneficiaries AND I bill a small % charge on all the routine CBCs, Chem-7s etc.

Could you explain how this is justified, if you're not individually interpreting the tests or even QC'ing the process? Honestly curious.

 

[Path or bust]

Could you explain how this is justified, if you're not individually interpreting the tests or even QC'ing the process? Honestly curious.

That's precisely what a pathologist brings to the laboratory, quality assurance and quality control. Every time a test is validated or instrumentation is brought online it is the pathologist that is responsible for the integrity of those results.

So yes the pathologist is "even" responsible for QC'ing, monthly QC is reviewed by pathologist. That is part of CAP inspections and regulations. I encourage you to become part of CAP inspections as soon as you are able to, it will really give you incredible insight into regulations, much more than any lecture or conference you can attend.

 

[pathstudent]

Could you explain how this is justified, if you're not individually interpreting the tests or even QC'ing the process? Honestly curious.

back in the day hospitals paid pathologists salaries and it was often related to a percentage of the lab billing/ revenue. Congress put a stop to that and said pathologists had to bill for a professional component for the clan lab. This was probably one of the more lucrative for a hospital based pathologist. At some point Medicare siad they aren't paying for pccl and said it was included in the part A payment to the hospital. In the following years many of the large insurers refused to pay pccl saying they were following Medicare. Cigna is the last big insurance company that pays pccl nationally and they are in the process of trying to get out of it. There was a dust up over this just a few months ago. I think the insurance cos still have to pay for pccl in some states like Florida where legislation was passed.

For my group the revenue was low six figures per pathologist just for pccl back before united and the blues refused to pay. It was seen as a gravy train at the time.

 

[BlondeDocteur]

OK, I haven't been around long enough to know exactly what LADoc does, but it sounds like at least part of his practice is diagnostic surgical pathology. I assume he has contracts with various local hospitals and/or private groups for specimens. But unless he is also laboratory director for their clin labs, how can he bill for QC'ing?

I get that the lab director can & should bill for those things (CAP and CLIA oversight, validation, etc). Is he one, then?

PS AP-only, me.

 

[pathstudent]

OK, I haven't been around long enough to know exactly what LADoc does, but it sounds like at least part of his practice is diagnostic surgical pathology. I assume he has contracts with various local hospitals and/or private groups for specimens. But unless he is also laboratory director for their clin labs, how can he bill for QC'ing?

I get that the lab director can & should bill for those things (CAP and CLIA oversight, validation, etc). Is he one, then?

PS AP-only, me.

Well I can't say how it works everywhere, but for us the practice bills pccl for every lab test performed on admitted patients with the medical director listed as the performing physician. There are cpt codes for all lab tests even bedside glucose testing and stuff like that. We have had AP only partners and they share equally in the pccl revenue based on the structure of the practice.

But as I said we only collect a small fraction of out pccl billing as the major insurance companies simply don't pay it under the bs claim that they are following Medicare. Only Cigna pays it and a bunch of small minor companies pay it but they don't amount to much compared to if united health still paid it.

 

[WEBB PINKERTON]

That's precisely what a pathologist brings to the laboratory, quality assurance and quality control. Every time a test is validated or instrumentation is brought online it is the pathologist that is responsible for the integrity of those results.

So yes the pathologist is "even" responsible for QC'ing, monthly QC is reviewed by pathologist. That is part of CAP inspections and regulations. I encourage you to become part of CAP inspections as soon as you are able to, it will really give you incredible insight into regulations, much more than any lecture or conference you can attend.

CAP inspections suck. A bunch of catty women arguing over whether or not their lab section has deficiencies. I seriously have seen it almost come to blows at the summation. One time I felt like we were being held hostage until a deficiency was removed. It can be scary at times.

Just download the checklists and save yourself a wasted trip.

I hate being on the border of 3 states. We end up all over the freaking place. Appalachia to Columbus, Ohio to Northern Indiana.

 

[LADoc00]

OK, I haven't been around long enough to know exactly what LADoc does, but it sounds like at least part of his practice is diagnostic surgical pathology.

I perform Wizardry. Like a medical Gandalf.

“Courage will now be your best defence against the storm that is at hand-—that and such hope as I bring.”

 

[Tissue issue]

I perform Wizardry. Like a medical Gandalf.

“Courage will now be your best defence against the storm that is at hand-—that and such hope as I bring.”

Hey Gandalf- can you make some residency slots disappear?

 

[BlondeDocteur]

Wizardry like... Reaganomics?

 

[coroner]

More like Kenny Powers makin' it rain...

 

[Ziehl-Neelsen]

Atnag, you are doing it wrong bro.

2-9K per month is WOEFULLY inadequate.

I am 'full up', meaning I have the maximal amount of directorships a single pathologist is allowed by law to hold. There is no clinical lab operation anywhere I charge less than 10K per month to be the director of. My range is 10-25 and frankly Im worth every f'ing penny of that.

Heh. Try being in the military where medical directorship of off-site clinic and community hospital laboratories falls under "duties as assigned". I'm currently directing 3 off-site laboratories (and they're trying to give me more) and don't see an extra dime.

OK, I haven't been around long enough to know exactly what LADoc does, but it sounds like at least part of his practice is diagnostic surgical pathology. I assume he has contracts with various local hospitals and/or private groups for specimens. But unless he is also laboratory director for their clin labs, how can he bill for QC'ing?

I get that the lab director can & should bill for those things (CAP and CLIA oversight, validation, etc). Is he one, then?

PS AP-only, me.

Ehh. This is why its probably best for AP only and CP only pathologists to remain ensconced within the ivory tower. And on the rare occasion that I see an AP or CP only pathologist venturing beyond the confines of the university, I view them like the morlocks viewed the eloi.

Every hospital laboratory requires a medical director (a pathologist or PhD that meets certain requirements) and laboratory medical directors are limited by law to 5 laboratories. In the military pathology residents are required to complete a combined AP/CP residency, and I often feel as though CP certification is more important to the military than AP certification as there is significant need for medical directors of various and assorted laboratories in places like Okinawa, Korea, and Germany. I have known occasional pathologists who failed to pass their CP boards and could not take call or serve as medical directors--useless as tits on a boar.

I perform Wizardry. Like a medical Gandalf.
“Courage will now be your best defence against the storm that is at hand-—that and such hope as I bring.”

I always had you pegged as more of a Saruman type than Gandalf.

 

[LADoc00]

If you are in the military you are employee, plain and simple. Same with Kaiser. Same with the VA or a University.

Be lucky you arent counting limbs at an IED crossroad outside FOB: Falcon in Khadahar bro.

Getting a few extra bucks for a remote base lab should be least of your concerns...